Detection of Serum Biomarkers In Hepatocellular Carcinoma Patients

Scientific background: HCC has increased significantly in the last decade, as the major risk factors are chronic infections withhepatitis B and C viruses (HBV & HCV), other risk factors involve aflatoxin B1 exposure, pesticides, alcohol consumption, andgenetic defects. New serum tumor markers are required for the diagnosis of HCC instead of alpha-fetoprotein (the most widelyused marker) as it's diagnostic accuracy is poor. Aim: To assess the diagnostic accuracy of serum AFP, AFP-L3, soluble Fas (sFas) and soluble Fas Ligand (sFasL) levels as biomarkers for the diagnosis of HCC. Subjects and Methods: 100 adult patients were selected for this study. Fifty (50) healthysubjects, age and sex-matched, were considered as controls. Routine tests for liver cirrhosis & HCC were done. Serum sFas andsFasL levels were measured using enzyme-linked immunosorbent assay. Results: Serum AFP, AFPL3, sFas, and sFasL levels were significantly elevated in HCC group when compared with other 2 groups. At a cut off level AFP ≥ 20 pg/ml, the sensitivity and specificity were 70 and 77 respectively. Serum sFas had sensitivity and specificity much better than AFPL3 in the diagnosis of HCC. Regarding serum sFasL level for diagnosis of HCC, it had 87% sensitivity, 84% specificity at a cut off level ≥ 17.5pg/ml.Conclusions: The results of this present study clearly demonstrate that serum sFas and sFasL had a better sensitivity and specificity than AFP in differentiating patients with HCC from those with cirrhosis. s FasL could be used as the best reliable biomarkers in HCC resulting from chronic hepatitis C

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially