liver

Background: Delaying or slowing functional loss is a valuable goal of Multiple Sclerosis (MS) rehabilitation. The mHealth app-based exercise rehabilitation intervention is expected to overcome barriers related to routine care of MS. Due to the ubiquitous presence of smartphones, they offer an excellent opportunity for remote monitoring, scheduled interaction with experts, and instruction for exercise in a home environment. Challenges in MS routine care include forgotten rehabilitation steps, limited access to local MS experts, and internal barriers such as low health literacy, mobility limitations, and fatigue, alongside external obstacles like service availability and transport costs.Objectives: To develop a mHealth app that is user-centered and context-specific for rehabilitation of MS symptoms, and to evaluate its clinical and cost effectiveness in individuals with RRMS.Methods: The proposed research will be conducted in two phases; the first phase (Phase 1a) will be focused on the development of mHealth app content (ReMiT-MS app trial I). The pilot phase (Phase 1b), where a prototype of the application will be designed, and its usability will be evaluated. Finally, in the second phase (Phase 2), the clinical and cost-effectiveness of the ReMiT-MS app for the rehabilitation of individuals with RRMS will be evaluated (ReMiT-MS app trial II).Conclusion: The findings of this proposed trial may provide a telerehabilitation platform for individuals with RRMS in a resource-limited setting and establish a low-cost healthcare delivery model. In addition, the results of this research work might open a new window in healthcare delivery in India and similar settings.Trial registration:  CTRI/2022/09/045266 [Registered on 06/09/2022]

Severe alcoholic hepatitis is an ethical and clinical conundrum, wherein a liver transplant is often recommended. The adequacy of medical treatment versus the risk of recidivism after transplant is often debated. Complete recovery in 26 of 27 patients with severe alcoholic hepatitis was observed, and hence the data was retrospectively analysed.Methods: 27 patients, with severe alcoholic hepatitis, with Maddrey's discriminant function between 59.7 to 165.2 (mean 107.53), from June 2017 to May 2022, were followed up for between 11 months to 6 years. INR ranged from 1.99 to 3.7 (mean 2.709), and bilirubin was between 7.6 to 37.01, (mean 20.859). 8 patients had pre-existing liver cirrhosis. All patients received probiotics, nutritional support, physical rehabilitation, saturated fat (clarified butter/ desi ghee) supplementation, and anti-oxidant support. At 90 days, total bilirubin improved to between 1.0 to 6.8 (mean 2.625). ALT (Alanine Transaminase/ SGPT) ranged from 65 to 550 (mean ALT – 197); and AST (Aspartate Transaminase / SGOT) ranged from 58 to 810 (mean AST – 271.51). Both the AST and ALT were near normal after 90 days. One patient died due to bacterial pneumonia and sepsis; the remaining 26 patients made a complete recovery. All patients including those with diagnosed liver cirrhosis, had complete resolution of their ascites, and near-normal liver function. At the last outpatient visit, none had ascites, edema, or encephalopathy, and had normal albumin levels and INR values. Conclusion: Probiotics, nutrition, a saturated fat diet, and exercise; all have shown benefits in patients with severe alcoholic hepatitis when tested individually. Concomitant use of all the above has not been reported in the treatment of alcoholic hepatitis. The role of nutrition alone versus the contribution of nutritional deficiencies and the role of gut-derived endotoxemia need to be studied in detail. How to identify patients who need a transplant, if it is needed at all, remains a challenge.

The spleen plays a pivotal role in our immune system by facilitating the proliferation and differentiation of lymphocytes and monocytes. Typically located in the left upper quadrant retroperitoneally, splenic tissue found outside of its usual position is termed ectopic spleen. When the tissue maintains its histological architecture and encapsulation and receives blood supply from splanchnic vessels, it is called an accessory spleen. Although it commonly presents near the splenic hilum or pancreatic tail, rare instances have been reported in the gastric, liver, gastrosplenic/lienorenal ligaments, as well as thoracic and gonadal regions. However, the case of an accessory spleen, mimicking a hepatic lesion in the right diaphragm represents a novel observation.

Objective: To study the therapeutic effect of B-ultrasound-guided intrahepatic infusion of autologous bone marrow nucleated cells on decompensated cirrhosis. Methods: To observe the clinical treatment of 75 cases of decompensated cirrhosis. Among them, 30 cases received routine liver protection and diuretic treatment. 45 cases were treated by percutaneous transhepatic infusion of autologous bone marrow nucleated cells under the guidance of B ultrasound. There were no significant differences in liver function and blood routine indexes between the two groups before treatment (p > 0.05). Results: The indexes of liver function and blood routine at different time periods of 1 month, 3 months, 6 months, and 12 months in the conventional treatment group did not change significantly. 6 cases died of liver failure within 1 year, the fatality rate was 20%. The indexes of liver function and blood routine of percutaneous liver transhepatic infusion of autologous bone marrow nucleated cells at 1 month, 3 months, 6 months, and 12 months under the guidance of B-ultrasound were significantly better than those of the conventional treatment group (p < 0.05). One case died of gastrointestinal bleeding in the group of percutaneous transhepatic infusion of autologous bone marrow nucleated cells guided by B ultrasound, with a fatality rate of 2.5%. Compared with the conventional treatment group, there were significant differences (p < 0.05). Conclusion: Conventional drug therapy has no obvious effect on decompensated cirrhosis. Intrahepatic infusion of bone marrow nucleated cells can significantly promote liver function reconstruction in decompensated cirrhosis.

Mesenchymal stem cell (MSC) transplantation may be an alternative to liver transplantation for patients with end-stage liver disease. A 24-year-old patient with Hepatic Encephalopathy due to alcoholic liver cirrhosis underwent UCMSC transplantation because there were no donors available for liver transplants involving adult deceased and living individuals. The patient was given allogeneic Umbilical cord-derived MSCs, which were then cultured following accepted practices. Subsequently, the UCMSCs were infused through the intravenous route 3 times at the interval of 30 days. Serum bilirubin, globulin, and ammonia levels were improved after the infusion and the morphology of the liver and spleen had also improved.

Evening and weekend imaging services at outpatient radiology centers offer extended access to diagnostic imaging, potentially increasing patient satisfaction and accessibility, especially for underserved populations. This review explores the benefits and challenges associated with these after-hours operations, focusing on health equity, patient satisfaction, economic considerations, energy and cost savings, and the impact on healthcare professionals. Findings indicate that while after-hours operations can enhance patient satisfaction and access, they also pose challenges such as increased operational costs and staff fatigue. Strategies for improvement include optimizing shift schedules, leveraging technology for better scheduling and communication, and enhancing patient-centered care. Collaborative efforts among imaging centers can further improve service delivery and efficiency.

The World Drug Report highlights that the prevalence of hepatitis C virus (HCV) is one of the leading causes of cirrhosis and hepatocellular carcinoma globally. This report estimates that HCV is responsible for the annual death of around 700,000 people due to liver disease and is associated with high levels of morbidity and mortality with high health and socio-economic costs. This exploratory study aims to evaluate the socio-economic return provided by HCV treatment of individuals integrated into the MOP developed by the NGO Ares do Pinhal in Portugal. Using the SROI (Social Return on Investment) methodology is estimated that for every euro invested in this program, the return for society is 3,75€. This is a significantly positive SROI value, highlighting the importance of this investment in the creation of monetized value for society, as well as to provide greater well-being to those who need it and to society as a whole.

Probiotic gummy candy is an innovative food that can be used as a carrier to deliver probiotics. This study aimed to manufacture healthy gummy candy (HGC) as a carrier for probiotic capsules. The ingredients' effect on the viability of probiotic capsules and free cells was evaluated for 48 days under refrigerated conditions. Also, the textural properties, overall acceptability of products, and physicochemical properties were tested. The encapsulation probiotics in sodium alginate and chitosan provided a high efficiency of 88.16%. At the same time, the encapsulated cells-based HGC (HGC-C) had higher counts of probiotics than free cells-based HGC, and it remained above the 3 log CFU/g at the end of the 48-day storage period in HGC-C, while the free cells reached zero at 30 days. The HGC product showed a low hardness value and high antioxidant capacity as well as, and the colour coordinates for the product showed more yellow, with an intense red colour. Using mango pulp and probiotics in gummy candies is an innovative and viable alternative to the confectionery industry; therefore, combining fruits as a source of prebiotics and probiotic bacteria could be a promising formula for probiotics gummy supplement preparation.

According to a 2022 systematic review on the prevalence of psychiatric disorders in general hospitals, it was estimated that approximately one-third of medical inpatients present with a coinciding psychiatric condition. However, other studies have reported that a low rate of patients actually obtain an inpatient psychiatric consult; and even fewer patients receive a consultation when it would not be traditionally indicated. Therefore, we have seen an emergence of the use of Proactive Consultation-Liaison (C-L) Psychiatry across many hospital settings. This model of care utilizes systematic screening for active mental health concerns, proactive interventions tailored to individual patients, team-based delivery, and care integration with primary services to provide psychiatric consultation earlier. This study conducted a focused PubMed search to review the research to date on proactive C-L psychiatry and its impact on hospital length of stay (LOS) in patients over 18 years old. Results show a consequential reduction in average hospital LOS when proactive C-L psychiatry services are used compared to reactive, on-request consultation services. A shortened LOS is seen with this practice when there is a quicker time for consultation or referral. Thus, there is evidence of proactive C-L psychiatry’s success in decreasing average hospital LOS and improving patient care. Additional studies are necessary to determine its significance, as little research to date has been completed on the topic. It is recommended to expand the scope of investigation to different patient populations, including but not limited to pediatrics and patients without an underlying mental health illness.

Introduction: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) was first reported in 2003. In 2014, it was revealed that not only bisphosphonates but also other antiresorptive and antiangiogenic drugs can cause osteonecrosis (Medication-related osteonecrosis of the jaw: MRONJ). The aim of this study is to compare awareness and knowledge about BRONJ and MRONJ among specialists/trainers (ST), general dental practitioners (GDP); and dentists who graduated before and after the year 2014. Materials and methods: A survey regarding demographic information and knowledge about BRONJ and MRONJ was prepared and delivered to dentists via social media.Results: A total of 422 dentists participated in our study. It was observed that the awareness and knowledge about BRONJ and MRONJ were statistically higher in ST and in dentists who graduated in 2014 or later. In addition, when their specialties were compared to each other, it was seen that the awareness and knowledge of Oral and Maxillofacial Radiologists (OMR) and Oral and Maxillofacial Surgeons (OMS) were higher than others.Discussion: According to the results of this study, it was seen that the awareness and knowledge of the ST group were higher than GDP, maybe because they may encounter these cases more. In addition, dentists who graduated in 2014 or later had higher awareness, maybe because MRONJ was coined and entered the dentistry education curriculum in 2014. Awareness and knowledge of OMR and OMS were found higher may be because they encounter these patients more frequently. Planning educational strategies for all dentists, especially GDP and dentists who graduated before 2014 is very important for post-graduate dentistry education.

In many sectors, ranging from sports and military operations to professional settings (notably cognitive enhancement); human performance augmentation has been an enduring ambition. The idea behind this movement, known as human enhancement, has evolved over time from simple means of training to the improvement or augmentation of physical ability through recent developments in fields such as pharmaceuticals and implantable devices that can enhance natural abilities. They span from pharmaceutical agents to wearable technologies used for sophisticated self-experimentation, which offer promise but also present ethical, health, and societal risks Performance-Enhancing Drugs are used to enhance the performance of humans in one way or another as a basic idea. The categories of Performance Enhancing Drugs (PEDs) included are Stimulants: Stimulant drugs, including amphetamines and caffeine (in the form of coffee) have been used for thousands of endeavours and physical stamina for decades. There have been many sources of controversy in the sporting world due to use or misuse and side-effectual restrictions. The release of neurotransmitters such as dopamine and allowing muscles to grow big, and fast. Nevertheless, the consumption of anabolic steroids is strictly controlled because it has side effects and complications such as liver damage, hormonal imbalances, and greater aggression. Erythropoietin EPO is a hormone that produces red blood cells, and increased oxygen delivery to muscle. EPO Athletes and even more notably endurance athletes (such as cyclists) have a storied history of abusing this performance-enhancing agent to build stamina. However, the misuse of this drug can be very hazardous, as it causes complications such as blood clotting and heart issues.

Aim and objective: The current study aims to explore the effectiveness of food dyes as potential agents for the formation of latent fingerprints on non-porous substrates. Introduction: The development of fingerprints is a long-established forensic technique crucial for identifying perpetrators. Traditional methods often use various powders to reveal latent fingerprints on different surfaces, but these methods can be costly and pose health risks when exposed to humans. Consequently, there is an increasing demand for alternative techniques that are cost-effective while still providing high-resolution fingerprint visibility. Materials and methods: In this study, Colormist Super whip food powder red, blue, orange, turquoise, and pink was used for the Development of Latent fingerprints on different non-porous surfaces (CD, Mobile screen, Glass bottle, Mirror, Steel bottle). Results: The ColorMist Super Whip edible powders proved successful in developing high-quality finger marks with visible level 1 and level 2 fingerprint details across all substrates, showcasing its effectiveness in latent fingerprint enhancement. Conclusion: Food dyes provide a simple, cost-effective, and eco-friendly method for developing latent fingerprints on nonporous surfaces. Red and black dyes consistently deliver clear ridge detail, while turquoise performs well on glass. Surface type plays a crucial role in dye effectiveness; making food dyes a practical, non-invasive alternative for on-site forensic use.

Shoulder dystocia is a rare but severe complication of vaginal delivery with possibly serious consequences. Certain risk factors are associated with shoulder dystocia, but a general forecasting model is lacking. We present a Case report using a newly modified Posterior Axilla Maneuver technique that saved a 5.140 g (11 lbs. 5 oz.) newborn from shoulder dystocia. The child was born with Apgar 7/9, pH 7.17. Currently, there are no signs of any long-term sequelae.Our procedure comprised the following steps: 1. First, we pulled the posterior shoulder downwards - in the direction and to the outer surface of the perineum. 2. Then we pulled the posterior shoulder backward - toward the maternal spine - when it was already outside the perineum and finished extracting the posterior shoulder. 3. By completing the first two steps, a Tilt of the shoulder girdle was reached in the midsagittal plane, resulting in a backward slope for the shoulder girdle so that the anterior shoulder touched the symphysis slightly from the back in a skewed manner, freeing it from the initial impacted position. 4. We applied the Kristeller procedure only after dislodging the anterior shoulder from its initial impacted position. 5. We also applied the McRoberts Maneuver at the end of the process to increase the diameter of the birth canal.

Epithelioid angiomyolipomas (AML) are uncommon mesenchymal neoplasms, belonging to the group of perivascular epithelioid cell neoplasms (PECOMA). Hepatic PECOMA is even rarer. It’s difficult to diagnose in preoperative by imaging, especially when the fatty component is scant or absent. The gold standard for the diagnosis is histologic examination coupled with an immunohistochemical study. Positive HMB45 immunostaining of the myoid cells is a major diagnostic feature. Herein, we report a particular case of hepatic angiomyolipoma in a middle-aged woman with no significant medical past history. The preoperative diagnosis was difficult given the absence of specific clinical manifestations, even the radiologists considered high suspicion of hepatocellular carcinoma. The final diagnosis has been made by post-operative histology coupled with an immunohistochemistry study.

Background: Preterm Birth (PTB) is the largest direct cause of neonatal mortality and the second leading cause of under-five mortality following pneumonia. Although there are studies conducted before, the magnitude of PTB remains a major issue in most developing countries including Yemen. Therefore, this study aims to assess the prevalence and associated factors of premature birth among newborns delivered in Jiblah University Hospital in Ibb governorate, Yemen.Objectives: No studies have previously been conducted about preterm labour in Jiblah University Hospital in Ibb governorate, Yemen.Methods: This retrospective observational study was conducted in the Department of Obstetrics & Gynecology, Jiblah University Hospital in Ibb Governorate, from 1 December 2023 to 29 February 2024.Results: A total of 1350 pregnancies, 252 (18.67%) were preterm deliveries and 1089 (80.66%) were full-term deliveries at Jiblah University Hospital, Ibb. Our study shows the distribution of participants based on socio-demographic factors. The data that out of the total 252 female participants, with ages mean ± std = 27.43 ± 6.34 roughly 18.67% experienced preterm deliveries. Our study demonstrates that several factors are significantly linked to preterm birth, including the number of siblings, blood pressure, gravida, and abortion number, where the Chi-square p - value was < 0.05. On the other hand, the results from the logistic regression analysis indicated the predictive potential of certain socio-demographic factors in relation to preterm birth. Conclusion: In this study, the number of siblings, blood pressure, gravida, and abortion number are the risk factors for premature delivery. Recognizing the most common risk factors for PTB will help to increase awareness about high-risk pregnancy, improve the preventive measures of preterm risk factors, and modify preterm care protocol in nurseries. 

Introduction: Research provides a framework for Anesthesia residents who are critical thinkers who approach clinical practice with an open mind. The goal of this study was to determine current attitudes regarding performing research during residency as well as perceived obstacles to doing so. A resident physician should be ready to face the challenges of the growing technology, tons of journals published in different portals, and increasing sophistication of the health care delivery system. Practice-based learning, systems-based practices, and medical knowledge are the vital core directly affected by strong research skill set. Methods: The study was done through a survey of all 15 current residents in Vicente Sotto Memorial Medical Center Anesthesia Resident. They answered a 13 self-administered survey, which was adopted from previous similar research. Data was collected for 1 week to give time to the busy schedule of the resident. Results: Respondents cited that the lack of time in balancing clinical and research responsibilities is the most common obstacle encountered by 86.7% of respondents. Researchers feel they have inadequate research skills and a lack of time in balancing responsibilities between family and work was among the most common answers by the respondents. 2nd prevalent barrier to research during residency was a lack of mentoring. Conclusion: The top barriers to research are lack of time and inadequate access to research mentors. These barriers can be addressed to optimize the current research environment for residents. Anesthesia residents identified several critical aspects that they believe are obstacles to research. These findings can be used by programs to overcome hurdles and increase the inclusion of research into residency training.

Background: The health professional appears to be concerned given the number of questions surrounding the patient’s post-transplant survival, patient selection method, and the continuous search for scores that reflect their reality and reconcile the results they desire with the patient’s expectations. It is from these considerations that the present work was born with the purpose of understanding the reality of patients hospitalized for hepatocellular carcinoma and what adherence to the Model For End-Stage Liver Disease (MELD) criteria meant in Brazil. Methods: This study is a discrete, univariate time series on emergency hospitalizations that occurred between 2000 and 2018, in the city of São Paulo, Brazil. Python version 3.11 was the software used for statistical treatment and analysis of the time series. Results: There were 6887 hospitalizations for malignant neoplasm of liver and intrahepatic bile ducts, in the period 2000-2006, of which 2898 were elective and 3915 (56.85%) were urgent in the period. There was an increase of 63.97% in the number of emergency hospitalizations in relation to the period 2000-2006 and 2007-2013. To highlight, in 2013 there were 1270 emergency admissions, which represented an increase of 109.22% in relation to the number of emergency admissions in 2006. The contingency correlation analysis demonstrated a significant association between the variables in which the chi-square value was 82.18, the p-value was 1.24 x 10-19, and the critical value was 3.84 with one degree of freedom. There was a 123.65% increase in the number of hospitalizations for chronic hepatitis, not elsewhere classified, between the periods 2000-2006 and 2007-2013. The chi-square value of the contingency association was 221.22, with a p-value of 4.90 x 10-50, a critical value of 9.488, with a significance level of 5% and one degree of freedom. The study showed an increase in hospitalizations of 21.88% for alcoholic liver disease between the periods 2000-2006 and 2007-2013. In the period 2000-2006, there were 21330 hospitalizations, 19224 of which were urgent (90.13%). In the period 2007-2013, there were 25997 hospitalizations, of which 22,802 (87.71%) occurred urgently. The chi-square value was 68.95, the p-value was 1 x 10-16, and the critical value was 3.84, with one degree of freedom. Conclusion: The MELD score, as it is sensitive to the patient’s severity, selects those who are at an advanced stage of the disease for liver transplantation. In this scenario, patients do not necessarily have access to outpatient services and begin to attend them regularly when MELD identifies the advanced stage of the disease, opening a gap between prevention, treatment, and rehabilitation.

Introduction: The rise in cesarean section rates globally has led to a growing population of women with uterine scars, necessitating more targeted obstetric care in subsequent pregnancies. These women are faced with the decision of attempting vaginal delivery after cesarean section (VBAC) or opting for an elective repeat cesarean section. The likelihood of a VBAC depends on various factors both maternal and fetal, gathered in two known scores Grobman and Zhang, utilizing them could make VBAC successful and more widely attempted.  This study aims to validate the prognostic of these scores in a Moroccan population.Objectives:•    Validate the international predictive scores (Grobman and Zhang) for the probability of a successful VBAC in the Moroccan population.•    Explore additional criteria specific to the Moroccan population and develop a simplified VBAC score.  Results:•    Out of 2,973 women with a cesarean history, 313 attempted  TOLAC, 79% of these attempts were successful VBAC.•    The characteristics of successful VBAC included lower BMI, previous vaginal birth, lower estimated fetal weight, younger maternal age, and more favorable cervical conditions at admission.•    The Grobman and Zhang scores showed good predictive accuracy, with both models achieving 82.2% accuracy.•    When dividing women into groups based on predicted success (using both Grobman and Zhang scores), significant differences were found in success rates across different probability categories.Conclusion: Both Grobman and Zhang’s models were effective in predicting VBAC success in the Moroccan population, with a slight preference for the Zhang model. However, further research is needed to validate these models in clinical practice. It could involve developing a more population-specific model.

Gilbert’s Syndrome (GS) is a hereditary disease that can cause hyperbilirubinemia due to a mutation in the promoter of the UGT1A1 gene, which causes a decrease in uridine diphosphate glucuronyltransferase enzyme activity. Polymorphisms in the UGT1A1 gene are associated with induced hyperbilirubinemia by Tyrosine Kinase Inhibitors (TKI) in Chronic Myeloid Leukemia (CML). We report a case of patient who developed hepatotoxicity when treated on Imatinib and subsequently diagnosed with Gilbert’s syndrome. Eight months after initiating Imatinib, the patient developed conjunctival jaundice and signs of hepatotoxicity with increase in liver enzymes and hyperbilirubinemia with elevated level of unconjugated bilirubin. Gilbert’s syndrome was suspected in the presence of predominantly unconjugated hyperbilirubinemia and a prior history of transient episodes of jaundice. Genetic testing revealed homozygosity for the UGT1A1 TA7 (*28) polymorphism. Imatinib was stopped due to continuous increase of aminotransferases and hyperbilirubinemia and restarted after improvement of Liver Function Tests (LFTs) with a reduced dose of 200 mg/day but LFTs worsted again, and the patient was switched to Dasatinib 100 mg/day, without hepatic cytolysis and a mild persistent hyperbilirubinemia after a follow up of 20 months.Patients with an unexplained rise in serum bilirubin levels on Imatinib therapy should be screened for the genetic UGT1A1 polymorphisms.

This study explores the dynamics of social exclusion in healthcare settings within the rural Ganderbal district of Kashmir, focusing on the availability of health facilities and the health-seeking behaviors of socially disadvantaged populations. Through a mixed-methods approach, combining quantitative data from interviews and qualitative insights from observation, the research reveals significant disparities in healthcare access between rural and urban areas. Key findings indicate that rural residents face exclusion due to a scarcity of hospitals, unavailability of 24-hour medical staff, inadequate infrastructure, staffing shortages, and systemic biases, compounded by environmental and occupational challenges. Communicable diseases predominate, with majority of respondents affected, and traditional healers and medical shops serve as primary care sources over formal institutions like government hospitals. Socio-economic factors, including low literacy, reliance on agriculture, and poverty, exacerbate these issues. The study highlights higher infant mortality and malnutrition rates in rural areas compared to urban centers, underscoring the need for attitudinal shifts among healthcare providers and systemic improvements in infrastructure and policy to enhance health equity. By addressing an underexplored gap in rural health research in India, this work aims to inform strategies for inclusive healthcare delivery, potentially yielding broader societal benefits through improved well-being and demographic dividends.