New developments in the treatment of primary biliary cholangitis - role of obeticholic acid.

Primary biliary cholangitis (PBC) is a chronic autoimmune cholestatic liver disease that predominantly affects women in early to middle age. It is typically associated with autoantibodies to mitochondrial antigens and results in immune-mediated destruction of small and medium-sized intrahepatic bile ducts leading to cholestasis, hepatic fibrosis and may progress to cirrhosis or hepatic failure and, in some cases, hepatocellular carcinoma. The clinical presentation and the natural history of PBC have improved over the years due to recognition of earlier widespread use of ursodeoxycholic acid (UDCA); about one-third of patients show suboptimal biochemical response to UDCA with poor prognosis. Until recently, UDCA was the only US Food and Drug Administration approved agent for this disease for more than two decades; obeticholic acid was approved in 2016 for treatment of patients with PBC with a suboptimal response or intolerance to UDCA. Currently, liver transplantation is the most effective treatment modality for PBC patients with end-stage liver disease. This review will focus on the recent advances in therapy of primary biliary cholangitis, with emphasis on obeticholic acid

Chronic Hepatitis C in Elderly Patients: Current Evidence with Direct-Acting Antivirals.

Since the introduction of direct-acting antivirals (DAAs), the outcomes of hepatitis C (HCV) treatment have shown an improvement in cure rates with minimal side effects. However, to date, the safety and efficacy of DAAs have not been specifically examined in elderly patients. The treatment of HCV in the era of pegylated interferon and ribavirin was more challenging among elderly patients due to the increased prevalence of multiple comorbid conditions associated with an increased risk of side effects, including anemia, and high rates of discontinuation, likely as a result of poor tolerability, resulting in lower rates of sustained virologic response (SVR). The advent of highly efficacious all-oral DAA agents with minimal adverse events has provided more data on the outcomes of treatment in the elderly population. The current evidence shows that DAA agents have been effective and safe in the elderly population, with comparable rates of SVR. The aim of this article was to review the safety and efficacy of commonly prescribed DAA agents in the management of chronic HCV in the elderly population

An Update on the Treatment and Follow-up of Patients with Primary Biliary Cholangitis.

Primary biliary cholangitis (PBC) is an autoimmune liver disease characterized by chronic granulomatous lymphocytic cholangitis of the small bile ducts. PBC was a leading indication for liver transplant in the United States; with early diagnosis and treatment, the majority of patients with PBC have a normal life expectancy. Pathogenesis involves inflammatory damage of bile duct epithelium secondary to innate and adaptive immune responses, and toxicity from accumulated bile acids. Cholestasis and disease progression can lead to cirrhosis. Extrahepatic complications include dyslipidemia, metabolic bone disease, and fat-soluble vitamin deficiency. Ursodeoxycholic acid is a well-established therapy. Novel targeted therapeutics are being developed

The effect of mold sensitization and humidity upon allergic asthma

Introduction:  Humidity is commonly associated with increased airway hyperresponsiveness in asthma. Objective:  To examine mold sensitization in patients with allergic asthma or allergic rhinitis and self-reports of humidity as exacerbating factors of clinical symptoms. Methods:  A retrospective, cross-sectional study at a University hospital outpatient allergy and asthma clinic was performed. A total of 106 patients with either allergic asthma or allergic rhinitis completed standard prick-puncture skin testing with 17 allergens and controls and completed standardized forms addressing trigger factors for clinical symptoms. Results:  Allergic asthmatics sensitized to Cladosporium were more likely to have a more severe asthma severity class (odds ratio = 4.26, confidence interval = 1.30-16.93). Sensitization to Alternaria, Cladosporium, Helminthosporium, Aspergillus and Dermatophagoides pteronyssinus in asthma was associated with higher likelihood for previous hospitalization, while sensitization to Cladosporium, Helminthosporium, Aspergillus, Dermatophagoides pteronyssinus and cockroach in asthma was associated with higher likelihood of having reduced pulmonary function based on forced expiratory volume in 1 s. Furthermore, allergic asthmatics more commonly reported humidity as an exacerbating factor of symptoms than did patients only with allergic rhinitis (68.42% vs 42.86%, respectively; P \u3c 0.05). Conclusion:  Mold sensitization is highly associated with more severe asthma, while humidity is more of an exacerbating factor in patients with allergic asthma as compared with allergic rhinitis alone. Further delineation between mold sensitization and humidity is needed to determine whether these are independent factors in asthma

Apartemen Di Kota Malang

Penduduk yang berdatangan ke Kota Malang banyak dijumpai tinggal dalam kurun waktu yang panjang, bahkan tak jarang yang menetap dengan berbagai alasan, seperti tinggal di Kota Malang untuk mempermudah dalam menjangkau tempat bekerja. Sebagai akibatnyaadalah lahan yang ada di Kota Malang banyak difungsikan sebagai tempat hunian yang berakhir pada tingkat kepadatan bangunan yang tak terkendali. Untuk menyikapi permasalahan diatas, maka dibutuhkan sebuah solusi yang tetap dapat merespon jumlah penduduk yang berdatangan ke Kota Malang dengan sesedikit mungkin (optimal) penggunaan lahan dalam pembangunannya. Untuk itulah, kehadiran apartemen saya anggap dapat menjawab permasalah ini. Terlebih metode pembangunan yang dilakukan secara vertikal, dapat menampung banyak unit hunian dan dapat meminimalisir penggunaan lahan. Untuk menghadirkan bangunan apartemen yang memiliki sentuhan arsitektural, dibutuhkan tema yang akan menjadi acuan dalam proses perancangan. Dalam hal ini, saya menggunakan tema Arsitektur High Tech. Dengan penerapan tema ini kedalam rancangan apartemen, diharapkan mampu menghadirkan bangunan apartemen yang elegan dan modern. Terkait dengan mata kuliah Konsep Skripsi, inilah yang mendasari pemikiran Saya secara pribadi untuk mempertimbangkan judul “Apartemen di Kota Malang dengan tema Arsitektur High Tech”