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

Design of a robotic hand with a biologically-inspired parallel actuation system for prosthetic applications

Trabajo presentado al 34th Annual Mechanisms and Robotics Conference celebrado en Quebec del 15 al 18 de agosto de 2010.This paper presents the design of a robotic hand for prosthetic applications. The main characteristic of this robotic hand is its biologically-inspired parallel actuation system, which is based on the behavior/strength space of the Flexor Digitorum Profundus (FDP) and the Flexor Digitorum Superficialis (FDS) muscles. The design separates the strength space of the FDS and FDP muscles into a lighter strength region where finer manipulation and general approach tasks are executed, and a higher strength region where the more robust grasps are achieved. Two parallel actuator types and kinematic structures are designed to complement the requirements of both strength space regions.This research was performed under an award/contract from Telemedicine Advanced Technology Research Center (TATRC), of the U.S. Army Medical Research and Materiel Command (USAMRMC) of the U.S. Department of Defense.Peer Reviewe

Deconstructing Weight Management Interventions for Young Adults: Looking Inside the Black Box of the EARLY Consortium Trials.

ObjectiveThe goal of the present study was to deconstruct the 17 treatment arms used in the Early Adult Reduction of weight through LifestYle (EARLY) weight management trials.MethodsIntervention materials were coded to reflect behavioral domains and behavior change techniques (BCTs) within those domains planned for each treatment arm. The analytical hierarchy process was employed to determine an emphasis profile of domains in each intervention.ResultsThe intervention arms used BCTs from all of the 16 domains, with an average of 29.3 BCTs per intervention arm. All 12 of the interventions included BCTs from the six domains of Goals and Planning, Feedback and Monitoring, Social Support, Shaping Knowledge, Natural Consequences, and Comparison of Outcomes; 11 of the 12 interventions shared 15 BCTs in common across those six domains.ConclusionsWeight management interventions are complex. The shared set of BCTs used in the EARLY trials may represent a core intervention that could be studied to determine the required emphases of BCTs and whether additional BCTs add to or detract from efficacy. Deconstructing interventions will aid in reproducibility and understanding of active ingredients

Stakeholder perceptions of the benefits and barriers of implementing environmental management systems in the Nigerian construction industry

© 2016 Vilnius Gediminas Technical University (VGTU) Press. This study investigates stakeholder opinions of the major benefits and barriers of Environmental Management Systems (EMS) to the Nigerian construction industry, and the perceived issues to EMS adoption among organisations in the industry. The study highlights the environment as an important stakeholder in the industry because it affects and is affected by construction activities on a regular basis. It identifies the importance of ISO 14001 in ensuring adequate consideration for the environment is maintained on construction projects. The research adopts a quantitative approach by analysing responses from an online survey among construction industry professionals in Nigeria. The questions on the survey were drawn from a similar study carried out in Asia and the results were analysed using the Weighted Average and Standard Deviation statistical approach. Results reveal that the major benefits of EMS to the Nigerian construction industry were improved efficiency in waste management and environmental protection, as well as an overall increase in employee motivation due to better opportunities for training and development. Lack of technological support in organisations and the high cost of implementing EMS were viewed as the major barriers towards its uptake in construction companies. The findings also indicate that a feasible EMS implementation strategy must not ignore the unique nature of the Nigerian construction industry, which comprises mostly small and medium enterprises. The study concludes by recommending the use of a waste management plan based on the Reuse-Reduce-Recycle-Recover model and an employee training plan to ensure continuous improvement in the organisation’s environmental management strategy

Dilatonic ghost condensate as dark energy

We explore a dark energy model with a ghost scalar field in the context of the runaway dilaton scenario in low-energy effective string theory. We address the problem of vacuum stability by implementing higher-order derivative terms and show that a cosmologically viable model of ``phantomized'' dark energy can be constructed without violating the stability of quantum fluctuations. We also analytically derive the condition under which cosmological scaling solutions exist starting from a general Lagrangian including the phantom type scalar field. We apply this method to the case where the dilaton is coupled to non-relativistic dark matter and find that the system tends to become quantum mechanically unstable when a constant coupling is always present. Nevertheless, it is possible to obtain a viable cosmological solution in which the energy density of the dilaton eventually approaches the present value of dark energy provided that the coupling rapidly grows during the transition to the scalar field dominated era.Comment: 26 pages, 6 figure