Autoimmune hepatitis in India: profile of an uncommon disease

BACKGROUND: Autoimmune hepatitis (AIH) has been reported to show considerable geographical variation in frequency and clinical manifestations. It is considered a rare cause of liver disease in India. The present study was undertaken to determine the incidence, clinical, biochemical and histological profile of AIH in this part of the world. METHODS: Patients presenting with acute or chronic liver disease between January 1999 and June 2002 were evaluated prospectively. AIH was diagnosed using the international autoimmune hepatitis group criteria. Workup included clinical, biochemical, USG, viral markers, UGI endoscopy, AI markers (ANA, SMA, Anti-LKM, AMA, RF, p-ANCA) using indirect immunofluorescence and liver biopsy if possible. RESULTS: Forty-one of 2401 (1.70%) patients were diagnosed to have autoimmune liver disease. Out of these, 38 had autoimmune hepatitis and the rest 3 had primary biliary cirrhosis. The mean age of the patients of autoimmune hepatitis was 36.2 (15.9) years, 34 (89.4%) were females, and the duration of symptoms was 20.3 (20.5) months. Nineteen (50%) of them presented with chronic hepatitis, 13 (34.2%) as cirrhosis, 5 (13.1%) with acute hepatitis and 1 (2.6%) with cholestatic hepatitis. The presentations were jaundice in 21 (55.2%), pedal edema and hepatomegaly in 17 (44.7%), splenomegaly in 13 (34.2%), encephalopathy, abdominal pain in 9 (23.6%) and fever in 8 (21%). Twelve had esophageal varices and 3 had bled. Biochemical parameters were ALT 187 (360) U/L, AST 157 (193) U/L, ALP 246 (254) U/L, globulin 4.1 (1.6) g/dL, albumin 2.8 (0.9) g/dL, bilirubin 5.2 (7.4) mg/dL, prothrombin time 17 (7) sec and ESR 47 (17) sec. The autoimmune markers were SMA (24), ANA (15), both SMA and ANA (4), AMA (1), rheumatoid factor (2), pANCA (1), and Anti-LKM in none. Thirty (79%) patients had definite AIH and eight (21%) had probable AI hepatitis. Associated autoimmune diseases was seen in 15/38 (39.4%), diabetes 4, hypothyroidism 3, vitiligo 2, thrombocytopenia 2, rheumatoid arthritis 2, Sjogren's syndrome 1 and autoimmune polyglandular syndrome III in 1. Viral markers were positive in two patients, one presenting as acute hepatitis and HEV-IgM positive and another anti-HCV positive. CONCLUSION: In India, autoimmune hepatitis is uncommon and usually presents with chronic hepatitis or cirrhosis, acute hepatitis being less common. Age at presentation was earlier but clinical parameters and associated autoimmune diseases were similar to that reported from the west. Primary biliary cirrhosis is rare. Type II AIH was not observed

Tip-surface forces, amplitude, and energy dissipation in amplitude-modulation (tapping mode) force microscopy

Amplitude-modulation (tapping mode) atomic force microscopy is a technique for high resolution imaging of a wide variety of surfaces in air and liquid environments. Here by using the virial theorem and energy conservation principles we have derived analytical relationships between the oscillation amplitude, phase shift, and average tip-surface forces. We find that the average value of the interaction force and oscillation and the average power dissipated by the tip-surface interaction are the quantities that control the amplitude reduction. The agreement obtained between analytical and numerical results supports the analytical method.This work has been supported by the Dirección General de Investigación Científica y Técnica (PB98-0471) and the European Union (BICEPS, BIO4-CT-2112). A. S. P. acknowledges financial support from the Comunidad Autónoma de Madrid.Peer reviewe

The ecological diversity of vegetation within Urban Parks in the Dabrowski Basin (southern Poland)

The aim of this work is to present the diversity of flora in terms of ecological requirements. The research was conducted in the area of two urban parks in the area of two cities in southern Poland: Bedzin and Czeladz. These parks were established in different historical periods, and were planned (and are managed) differently. The results of the investigation have shown that the occurrence of 192 vascular species has been observed in the Gora Zamkowa (Castle Hill) Park, while in the Grabek park, 334 such species are known to exist. Such disparity is the result of the occurrence of micro-habitats and of the differences between the ways the two parks are managed. It is also due to these parks’ different functions. In the first case, the park area is protected by law. In the latter case, human activity has created a new ecological niche for organisms with a high degree of ecological tolerance. Based on the ecological values, the following groups of plants were distinguished: saxifrages grasslands, xerothermic grasslands, beech forests, alder forests and artificial planted trees. Analysis has shown that urban parks are potential places for growth various type of vegetation and also for increasing biodiversity, and can constitute particularly important hotspots for biodiversity in the cityscape, even if their primary role is recreational. As the study shows, the environment of a highly urbanized and industrialized region can also have a positive influence on ecological and floristic diversity

City refuse compost and sodium dodecyl sulphate as modifiers of diazinon leaching in soil

Spanish "Comisi6n Interminterial de Ciencia y Tecnologia" (Projet AMB94-0688). Consejo Superior de Investigaciones Científicas (CSIC.Peer reviewe

Low incidence of positive smooth muscle antibody and high incidence of isolated IgM elevation in Chinese patients with autoimmune hepatitis and primary biliary cirrhosis overlap syndrome: a retrospective study

<p/> <p>Background</p> <p>Up to now, few data are available regarding the clinical characteristics of autoimmune hepatitis and primary biliary cirrhosis overlap syndrome. The study was to investigate and analyze the prevalent and clinical features of Chinese patients with this disease.</p> <p>Methods</p> <p>Clinical data on patients diagnosed as autoimmune hepatitis and primary biliary cirrhosis overlap syndrome in our hospital from January 2001 to December 2006 were collected and analyzed.</p> <p>Results</p> <p>Overlap syndrome of autoimmune hepatitis and primary biliary cirrhosis accounted for 10.33% of patients with autoimmune liver diseases during the past six years. For these patients with overlap syndrome, xanthochromia, lethargy and anorexia were the predominant complaints; a low incidence (14/146) of smooth muscle antibody positivity and a high incidence (37/89) of isolated IgM elevation were the main serological characteristics.</p> <p>Conclusions</p> <p>Overlap syndrome of autoimmune hepatitis and primary biliary cirrhosis was not rare in Chinese patients with clinical manifests of autoimmune liver diseases. Overlap of the diseases should not be disregarded when isolated IgM elevation was exhibited, and smooth muscle antibody might have little diagnostic significance in the overlap syndrome. If it was difficult to make a definite diagnosis, liver biopsy was necessary.</p

A striking correspondence between the dynamics generated by the vector fields and by the scalar parabolic equations

The purpose of this paper is to enhance a correspondence between the dynamics of the differential equations $\dot y(t)=g(y(t))$ on $\mathbb{R}^d$ and those of the parabolic equations $\dot u=\Delta u +f(x,u,\nabla u)$ on a bounded domain $\Omega$. We give details on the similarities of these dynamics in the cases $d=1$, $d=2$ and $d\geq 3$ and in the corresponding cases $\Omega=(0,1)$, $\Omega=\mathbb{T}^1$ and dim($\Omega$)$\geq 2$ respectively. In addition to the beauty of such a correspondence, this could serve as a guideline for future research on the dynamics of parabolic equations

Recreating living experiences from past memories through virtual worlds for people with dementia

This paper describes a study aimed to understand the use of 3D virtual world (VW) technology to support life engagement for people with dementia in long-term care. Three versions of VW prototypes (reminiscence room, virtual tour and gardening) utilising gestured-base interaction were developed iteratively. These prototypes were tested with older residents (80+) with dementia in care homes and their caregivers. Data collection was based on observations of how the residents and care staff interacted collaboratively with the VW. We discussed in depth the use of VWs in stimulating past memories and how this technology could help enhance their sense of self through various means. We also highlighted key approaches in designing VWs to sustain attention, create ludic experiences and facilitate interaction for older people with dementia

Recording therapy sessions: What do clients and therapists really think?

Aims: Recording therapy sessions has become part of routine practice amongst trainee psychotherapists. To date most research has focused on the benefits of recording sessions to support clinical supervision. There are few data about the benefits or risks for clients. This study aimed to explore the views of clients who had had their therapy sessions recorded and therapists who had recorded sessions. Design: Five clients and 25 therapists completed a qualitative survey, the results of which were analysed using thematic analysis. Findings: All clients and several therapists reported that the recording devices are soon forgotten. Both therapists and clients reported the benefits of recording as being purely for the therapist with none identified for clients. Conclusions: It was observed that clients perhaps did not always understand how recordings were used, suggesting the need for clearer practice guidance. © 2013 British Association for Counselling and Psychotherapy