Acute-on-chronic Liver Failure: MELD Score 30-day Mortality Predictability and Etiology in a Pakistani Population

Background: Cirrhosis is a pathological condition that ultimately leads to liver failure. Acute on chronic liver failure (ACLF) has a high short term mortality rate. Viral hepatitis is the most common cause of liver failure in our local population. We carried out this study to identity the 30-day mortality and etiology of patients presenting with ACLF using Model for End-Stage Liver Disease (MELD) score predictability. Methodology: This was a descriptive case series, conducted at Sheikh Zayed Hospital, Lahore, Pakistan from January 31, 2018 to July 30, 2018. One hundred and eighty five patients who met the inclusion criteria were enrolled using 95% confidence level and 4% margin of error. Data was entered and analyzed with SPSS version 23.0. Numerical variables including age was presented by Mean ± S.D. Categorical variables i.e. gender, etiology of acute-on-chronic liver failure and 30-day mortality were presented by frequency and percentage. Data was stratified for age, gender, duration of chronic liver disease and MELD grade to address the effect modifiers. Post-stratification chi-square test was calculated using 95% significance (p≤0.05). Results: Majority of the enrolled patients were male (74.6%) while only 25.4% of the patients were female. One hundred and thirty patients (70.3%) had underlying viral hepatitis while twelve patients (6.5%) and forty three patients (23.2%) presented with alcoholic liver disease and drug-induced ACLF, respectively. Eighty patients (43.2%) died within 30 days of admission.The 30-day mortality with respect to MELD grade was statistically significant (p<0.001) with the highest mortality noted in grade-IV and thirty five patients (43.8%) dying within 30 days of admission (p<0.001). Grade-II and III MELD scores also contributed to the 30-day mortality with twenty three patients (28.8%) and nineteen patients (23.8%) dying within 30 days of admission (p<0.001). Conclusion: MELD scores are able to accurately predict the short-term mortality in patients with ACLF and viral hepatitis was the most common etiology in our population. Early detection and use of appropriate prognostic models may alleviate mortality and morbidity in paitents with ACLF

Influence of Radar Frequency on the Relationship Between Bare Surface Soil Moisture Vertical Profile and Radar Backscatter

International audienceThe aim of this letter is to discuss the influence of radar frequency on the relationship between surface soil moisture and the nature of radar backscatter over bare soils. In an attempt to address this issue, the advanced integral equation model was used to simulate backscatter from soil surfaces with various moisture vertical profiles, for three frequency bands, namely, L, C, and X. In these computations, we investigated the influence of the vertical heterogeneity of soil moisture on the characteristics of the backscattered signals. The influence of radar frequency is clearly demonstrated. A database produced from Envisat ASAR and TerraSAR-X data, which was acquired over bare soils with in situ measurements of moisture content and ground surface roughness, was used to validate the utility of taking the soil moisture heterogeneity into account in the backscatter model

Bare soil moisture retrieval from multi-temporal X-band TerraSAR-X SAR images

IGARSS 2015, Milan, ITA, 26-/07/2015 - 31/07/2015International audienceThe aim of the present study is to analyze the sensitivity of X-band SAR (TerraSAR-X) signals as a function of different physical bare soil parameters (soil moisture, soil roughness), and to evaluate the accuracy of change detection approach proposed for soil moisture estimation. Firstly, we presented a brief description of our ground and satellite database. Secondly, we considered the main results of our statistical analysis of the relationships between radar and soil parameters: soil moisture and different roughness parameters (the rms height, Zs parameter, and a new roughness parameter Zg. Finally, we proposed an algorithm combing multi-temporal X-band SAR images (TerraSAR-X) with different continuous thetaprobe measurements for the retrieval of surface soil moisture at a high spatial resolution

Prevalence of Muscle Dysmorphia and Associated Health Activities in Male Medical Students in Karachi, Pakistan

Background: Muscle Dysmorphia (MD) is a subtype of body dysmorphic disorder (BDD) and is currently classified under anxiety disorders (subheading: Obsessive-compulsive disorder) in DSM 5. MD is hypothesized to affect the self-esteem and social outlook of the younger generation. MD shows a higher rate in males and may influence their self-confidence rendering them more prone towards using steroids, supplementary proteins and other drugs to alter their physical outlooks as shown in previous studies. This problem has been on the rise lately due to revolutionary advancement in the media and film industry and the abrupt changes about the standards of physical good looks and body shapes. With the lack of studies done in our population, our study will be helpful to consider the prevalence of the disease in our setting and increase awareness in the general public and clinicians. We hope to help clinicians/ therapists find better options in managing the disease. Materials: We performed a cross-sectional study with a sample size of 246 medical school students in Karachi to collect data through self-administered questionnaires. We used the DSM 5 criteria for the diagnosis of BDD and additional questions on the presence of MD. Nutritional habits, exercise routines, use of supplements and drugs were also obtained for exploratory analysis. Results: Our study predicted the prevalence of MD to be 25%. Other main findings included statistical significant associations between MD and the thoughts and practice of steroid use for muscularity. Conclusion: MD is an underdiagnosed and often unrecognized disease that we believe has significant consequences for the young male population. Further work is needed on this in our part of the world. Our research, we believe, can be a stepping stone for further studies that would incorporate wider populations

A cost effectiveness analysis of salt reduction policies to reduce coronary heart disease in four Eastern Mediterranean countries.

BACKGROUND: Coronary Heart Disease (CHD) is rising in middle income countries. Population based strategies to reduce specific CHD risk factors have an important role to play in reducing overall CHD mortality. Reducing dietary salt consumption is a potentially cost-effective way to reduce CHD events. This paper presents an economic evaluation of population based salt reduction policies in Tunisia, Syria, Palestine and Turkey. METHODS AND FINDINGS: Three policies to reduce dietary salt intake were evaluated: a health promotion campaign, labelling of food packaging and mandatory reformulation of salt content in processed food. These were evaluated separately and in combination. Estimates of the effectiveness of salt reduction on blood pressure were based on a literature review. The reduction in mortality was estimated using the IMPACT CHD model specific to that country. Cumulative population health effects were quantified as life years gained (LYG) over a 10 year time frame. The costs of each policy were estimated using evidence from comparable policies and expert opinion including public sector costs and costs to the food industry. Health care costs associated with CHDs were estimated using standardized unit costs. The total cost of implementing each policy was compared against the current baseline (no policy). All costs were calculated using 2010 PPP exchange rates. In all four countries most policies were cost saving compared with the baseline. The combination of all three policies (reducing salt consumption by 30%) resulted in estimated cost savings of $235,000,000 and 6455 LYG in Tunisia;$39,000,000 and 31674 LYG in Syria; $6,000,000 and 2682 LYG in Palestine and$1,3000,000,000 and 378439 LYG in Turkey. CONCLUSION: Decreasing dietary salt intake will reduce coronary heart disease deaths in the four countries. A comprehensive strategy of health education and food industry actions to label and reduce salt content would save both money and lives

Exchange flow between open water and floating vegetation

This study describes the exchange flow between a region with open water and a region with a partial-depth porous obstruction, which represents the thermally-driven exchange that occurs between open water and floating vegetation. The partial-depth porous obstruction represents the root layer, which does not penetrate to the bed. Initially, a vertical wall separates the two regions, with fluid of higher density in the obstructed region and fluid of lower density in the open region. This density difference represents the influence of differential solar heating due to shading by the vegetation. For a range of root density and root depths, the velocity distribution is measured in the lab using PIV. When the vertical wall is removed, the less dense water flows into the obstructed region at the surface. This surface flow bifurcates into two layers, one flowing directly through the root layer and one flowing beneath the root layer. A flow directed out of the vegetated region occurs at the bed. A model is developed that predicts the flow rates within each layer based on energy considerations. The experiments and model together suggest that at time- and length-scales relevant to the field, the flow structure for any root layer porosity approaches that of a fully blocked layer, for which the exchange flow occurs only beneath the root layer.National Science Foundation (U.S.) (grant EAR0509658

UPAYA MENINGKATKAN KEMAMPUAN KERJASAMA PESERTA DIDIK MELALUI PEMBELAJARAN KOOPERATIF TEKNIK MAKE A MATCH DENGAN TEMA MEKANISME PENDENGARAN DI SMP N 2 PIYUNGAN

Penelitian ini merupakan Penelitian Tindakan Kelas yang bertujuan untuk meningkatkan kemampuan kerjasama peserta didik belajar IPA dengan penerapan pembelajaran kooperatif teknik make a match. Subjek penelitian ini adalah peserta didik kelas VIII E SMP N 2 Piyungan dengan jumlah 30 peserta didik. Setiap siklus penelitian terdiri atas perencanaan, pelaksanaan dan observasi, dan refleksi. Penelitian dilaksanakan dalam II siklus. Data yang diperoleh untuk melihat kemampuan kerjasama peserta didik melalui observasi, pengisian lembar penilaian antar teman, dan pendokumentasian. Analisis data yang digunakan adalah analisis data lembar observasi dan penilaian antar teman. Keberhasilan tindakan dapat diukur dari total skor lembar observasi kerjasama. Data yang telah diperoleh kemudian dihitung dan dipersentase. Analisis data penilaian antar teman dilakukan dengan cara menjumlahkan skor keseluruhan yang diperoleh setiap siswa pada setiap pernyataan dan mencari persentasenya. Hasil penelitian ini menunjukkan bahwa penerapan model kooperatif teknik make a match dapat meningkatkan kemampuan kerjasama peserta didik kelas VIII E SMP N 2 Piyungan. Penilaian kemampuan kerjasama dengan penilaian antar teman dalam belajar IPA antar peserta didik mengalami peningkatan dari siklus I ke siklus II, yaitu siklus I ketercapaian tingkat kerjasama peserta didik persentase terbesarnya berada dalam kategori sedang berjumlah 18 peserta didik mencapai 60% dan peserta didik yang mencapai katagori rendah berjumlah 12 peserta didik yaitu sebesar 40%. Kriteria keberhasilan tindakan yang telah ditetapkan sebelumnya yakni 75% dari jumlah peserta didik adalah 22 peserta didik dan 75% kemampuan kerjasama yang berada dalam katagori tinggi belum dapat tercapai dalam siklus ini. Pada siklus II kemampuan kerjasama peserta didik mengalami peningkatan dibandingkan dengan siklus I. Pada siklus II persentase terbesar berada pada katagori tinggi mencapai 23 peserta didik (77%). Peserta didik yang berkatagori sedang sebanyak 7 peserta didik sebesar (23%), sedangkan tidak terdapat peserta didik yang berkatagori rendah. Berdasarkan hasil dari penilaian antar teman siklus I sebesar 73%, sedangkan siklus II sebesar 93% sehingga sudah mencapai kriteria keberhasilan. Jadi hasil lembar penilaian antar teman dengan hasil lembar observasi saling mendukung. Kata kunci: pembelajaran kooperatif, teknik make a match, meningkatkan kemampuan kerjasama antar peserta didik

Immunohistochemical Study of Stellate Cells in Patients with Chronic Viral Heptitis C Histopathological study

Background: Chronic hepatitis is defined as liver inflammation that lasts for at least 6 months. The Hepatitis C virus is responsible for 60 to 70% of chronic hepatitis cases; the virus causes continued inflammation that slowly damages the liver, eventually leading to cirrhosis, liver failure, and, in rare cases, liver cancer. Aim of the work: To evaluate the changes in distribution and percentage of alpha-smooth muscle actin-positive hepatic stellate cells and the correlation with the degree of the fibrosis in cirrhotic livers, in patients with HCV chronic hepatitis. Material and methods: 50 hepatic core biopsies selected randomly were received from Histopathology Department at National Hepatology and Tropical Medicine Research Institute and examined for histopathological features using (hematoxylin and eosin), stage of hepatic fibrosis using stellate cell Masson s' trichrome stain, and examined for stellate cell activity using alpha smooth muscle actin (ASMA) immunostaining. Results: The relation between degree of ASMA expression by stellate cells and stage of fibrosis was highly significant with a p value <0.001, also the relation between degree of necroinflammation and degree of ASMA expression by stellate cells was highly significant with a p value <0.001. The relation between degree of necroinflammation and stage of fibrosis was highly significant with a p value <0.001. The relation between age of patient and stage of fibrosis also was statistically significant with a p value =0.012. The relation between age of patient and degree of necroinflammation was statistically significant with a p value =0.017. Conclusion: To summarize from hepatic core biopsies of patients suffering from chronic HCV, the number of active stellate cells was found to be positively associated with stage of hepatic fibrosis