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Sunday, July 20, 2014

Non-Alcoholic Fatty Liver Disease (NAFLD) and steatohepatitis (NASH) may lead to serious Liver Diseases.

Posted by Prahallad Panda on 11:23 AM Comments


Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are are most common liver disease in western countries; now, the incidence is increasing in the Middle East, Far East, Africa, the Caribbean, and Latin America.
NAFLD and NASH represent a major global public health problem, which is pandemic and affects rich and poor countries alike.
NAFLD is a condition, where there is excessive accumulation of fat in the form of triglycerides (steatosis) in the liver.

Micrograph demonstrating marked (macrovesicula...
Micrograph demonstrating marked (macrovesicular) steatosis in non-alcoholic fatty liver disease. Masson's trichrome stain. (Photo credit: Wikipedia)
It has been found in a study that the prevalence of NAFLD has doubled during last 20 years, whereas the prevalence of other chronic liver diseases has remained stable or even decreased.
NAFLD may progress to NASH, where there occurs liver cell injury and inflammation in addition to the excessive fat accumulation.
Progression of NAFLD to NASH dramatically increases the risks of cirrhosis, liver failure, and hepatocellular carcinoma.
The exact cause of NASH has not been elucidated, however it is most closely related to insulin resistance, obesity, and the metabolic syndrome. But, it not at all a rule that all patients with these conditions will lead to NAFLD/NASH, and vice-versa.
NAFLD and NASH are the diseases diagnosed by method of exclusion of other conditions. Not every person with fatty liver needs aggressive therapy.
Diet and exercise should be instituted for all patients. Patients with NASH or risk factors for NASH may additionally be treated with high dosages of Vitamin E or pentoxifylline, experimental therapy. These should only be tried in patients who fail to achieve a 5% to 10% weight reduction over 6 months to 1 year of successful lifestyle changes.
Bariatric surgery may be considered in patients in whom the above approaches fail, and it should be performed before the patient becomes cirrhotic.
Liver transplantation is successful in patients who meet the criteria for liver failure; however, NASH may recur after transplantation and is likely to be denied to patients with morbid obesity.
As a Clinician may not be able to diagnose NASH on the basis of clinical data alone, in a similar way the pathologist may not be able to document the histological lesions of steatohepatitis and reliably distinguish those of non-alcoholic origin from those of alcoholic origin.

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Saturday, July 12, 2014

Sandalwood Scent Activate Olfactory Receptors in Skin to hasten wound healing

Posted by Prahallad Panda on 9:58 PM Comments



Skin can smell!
Skin cells can get excited by the fragrance from sandal wood and kick start wound healing; the researchers from Ruhr-Universität Bochum, Germany have discovered.

English: Glass vial containing Sandalwood (San...
English: Glass vial containing Sandalwood (Santalum album) Essential Oil (Photo credit: Wikipedia)

Not only nose is the site for Olfactory Receptors (OR) as popularly known, but also these receptors are housed in many other cells; spermatozoa, melanocytes and dendritic cells etc..
They have found several ORs in the skin cells called keratinocytes viz. OR6M1, OR11A1, OR6V1, OR5V1 and OR2AT4 using microarray and RT-PCR analyses.
Out of the host of olfactory receptors, OR2AT4 is of special interest for wound healing because activated OR2AT4 triggers the proliferation and migration of keratinocytes, which are the essential steps for re-epithelialization of the wounds.
Possibly this happens via calcium-dependant signalling pathway in primary keratinocytes induced by Sandalore and Brahmanol found in sandal wood oil.
Further down stream, the signaling cascade possibly activates the cAMP/PKA pathway or multiple pathways including EGFR to the phosphorylation of the MAP kinases Erk1/2 and p38, resulting the increased proliferation and migration of cells.
All the synthetic sandalwood molecules may not have the desired molecules to have the effect.


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Saturday, June 28, 2014

Updated Recommendation for Testing of HIV 1 & 2 Infection

Posted by Prahallad Panda on 10:05 PM Comments

According to a press release in 2012, the total number of people living with HIV/AIDS in India is estimated at 21 lakhs in 2011. Children (<15 yrs) account for 7% of all infections, while 86% are in the age group of 15-49 years. Of all HIV infections, 39% (8.16 lakh) are among women.
An estimated 1.1 million persons in United States were living with human immunodeficiency virus (HIV) infection as of 2010, of whom an estimated 181,000 were unaware of their infection.

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HIV F
Approximately 49,000 new HIV diagnoses are reported to Centers for Disease Control (CDC) each year.As of 2009, an estimated 83 million adults aged 18 to 64 years reported they had been tested for HIV.
Accurate laboratory diagnosis of HIV is essential to identify persons who could benefit from treatment, to reassure persons who are uninfected, and to reduce HIV transmission.
HIV immunoassays based on different design principles are generally grouped into “generations”:  
  • 1st generation—All antigens used to bind HIV antibodies are from a lysate of HIV-1 viruses grown in cell culture. An indirect immunoassay format employs labeled antihuman IgG for detection of IgG antibodies. Significant specimen dilution is required to overcome cross-reactivity with cellular protein contaminants. Examples commercially available in the United States as of May 2014 include the HIV-1 Western blot and the HIV-1 IFA.  
  • 2nd generation—Synthetic peptide or recombinant protein antigens alone or combined with viral lysates are used to bind HIV antibodies. An indirect immunoassay format employs labeled antihuman IgG or protein A (which binds to IgG with high affinity for detection of IgG antibodies. Design of the specific antigenic epitopes improves sensitivity for HIV-1 group O and HIV-2; eliminating cellular antigens that contaminate viral lysates improves specificity by eliminating cross-reactivity with cellular proteins. Examples commercially available in the United States as of May 2014 include one HIV-1 enzyme immunoassay and six rapid HIV antibody tests.
  • 3rd generation—Synthetic peptide or recombinant protein antigens are used to bind HIV antibodies in an immunometric antigen sandwich format (HIV antibodies in the specimen bind to HIV antigens on the assay substrate and to antigens conjugated to indicator molecules). This allows detection of IgM and IgG antibodies. Lower sample dilutions and the ability to detect IgM antibodies (which are expressed before IgG antibodies) increase sensitivity during early seroconversion. Examples commercially available in the United States as of May 2014 include one HIV-1/HIV-2 enzyme immunoassay and two HIV-1/HIV-2 chemiluminescent immunoassays.
  • 4th generation—Synthetic peptide or recombinant protein antigens are used in the same antigen sandwich format as 3rd generation assays to detect IgM and IgG antibodies, and monoclonal antibodies are also included to detect p24 antigen. Inclusion of p24 antigen capture allows detection of HIV-1 infection before seroconversion. These assays (termed “combo” assays”) usually do not distinguish antibody reactivity from antigen reactivity. Examples commercially available in the United States as of May 2014 include one HIV-1/HIV-2 enzyme immunoassay, one HIV-1/HIV-2 chemiluminescent immunoassay, and one HIV-1/HIV-2 rapid test that uses separate indicators for antigen and antibody reactivity.
Immediately after HIV infection, low levels of HIV-1 RNA (ribonucleic acid) might be present
intermittently, but no viral markers are consistently detectable in plasma. Approximately 10
days after infection, HIV-1 RNA becomes detectable by Nucleic Acid Test (NAT) in plasma and quantities increase to very high levels.
Next, HIV-1 p24 antigen is expressed and quantities rise to levels that can be detected by 4th generation immunoassays within 4 to 10 days after the initial detection of HIV-1 RNA. However, p24 antigen detection is transient because, as antibodies begin to develop, they bind to the p24 antigen and form immune complexes that interfere with p24 assay detection unless the assay includes steps to disrupt the antigen-antibody complexes.immunoglobulin (Ig)M antibodies are expressed which can be detected by 3rd and 4th generation immunoassays 3 to 5 days after p24 antigen is first detectable, 10 to 13 days after the appearance of viral RNA.
Finally, IgG antibodies emerge and persist throughout the course of HIV infection. First and second generation immunoassays designed to detect only IgG antibodies exhibit considerable variability in their sensitivity during early infection, becoming reactive 18 to 38 days or more after the initial detection of viral RNA.

Recommended Laboratory HIV Testing Algorithm for Serum or Plasma Specimens 

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 FDA approved Tests

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Source: Centers for Disease Control and Prevention (CDC); Read more
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Thursday, June 19, 2014

Washing Raw Chicken may land you in a Hospital

Posted by Prahallad Panda on 7:28 PM Comments

Many, including myself are unaware of the fact that washing raw chicken may land us in a hospital and may make us chronically ill.

English: Chicken in public market, Mazatlan, S...
English: Chicken in public market, Mazatlan, Sinaloa, Mexico. Français : Des poulets dans un marché. Mazatlán, État de Sinaloa, Mexique. Türkçe: Açıkta satılan tavuklar, Mazatlán, Sinaloa, Meksika Español: Pollos en un mercado en Mazatlán, Sinaloa, México. (Photo credit: Wikipedia)
In some cases of gastroenteritis, it is being seen that there was a history of washing raw chicken some days back. A notorious bacterium called campylobacter is being increasingly incriminated for this.
The chicken are carrier of campylobacter, which may contaminate hands, work surfaces, sinks, clothing, cooking equipment such as chopping boards, sponges and cloths etc.; spreading through the droplets of water slashing, while washing it. Droplets from washing chicken under a kitchen tap can travel up to a metres.
A few campylobacter are needed to cause disease and food poisoning. This does not occur as soon as contaminated food is taken, in contrast to some other bacteria causing food poisoning, viz. Staphylococcus and E. Coli etc.
It may take between one and five days. In about half of the cases, the illness starts with 24-hour with flu-like symptoms. It progresses to profuse diarrhoea that can contain blood; vomiting, abdominal pains and cramps may accompany it. Typically, it lasts around a week.
The main problem is that someone can recover from this acute episode, but in about a quarter of patients, the bacteria can trigger a number of conditions, such as irritable bowel syndrome (IBS). This is due to an irreversible change in the lining of the gut that can last for years in some cases. One possible cause is a toxin produced by the bacteria that disrupts bowel function.
The infection may also damage nerves lining the gut, responsible for gut motility leading to altered bowel movements and increased awareness of pain in the gastrointestinal tract.
Around 1 per cent of cases of campylobacter infection may lead to 'reactive' arthritis, which is usually short term, but can sometimes become chronic. Here, inflammation - redness and swelling - are triggered in response to an infection. This most commonly affects the joints (leading to pain and stiffness), the eyes (causing conjunctivitis) and the urethra (leading to pain when urinating). The classic triad of arthritis, urethritis and conjunctivitis is termed as Reiter's Syndrome.
Another more alarming condition, Guillain-Barre Syndrome, is strongly linked to campylobacter. Although rare, it usually occurs after a viral or bacterial infection, which may trigger the immune system to attack nerve roots and peripheral nerves, causing partial paralysis and sometimes even death. Around 1,200 people a year suffer from it.
While anyone can get campylobacter food poisoning or the serious complications, the under-fives and over-60s are at a slightly increased risk because their immune systems tend to be weaker.
C. jejuni and C. coli are most frequently reported in human diseases.
Take home message:
  • The bacteria normally inhabit the intestinal tract of warm-blooded animals such as poultry and cattle, and are frequently detected in foods derived from these animals.
  • Campylobacter species can be killed by heat and thoroughly cooking food.
  • To prevent Campylobacter infections, make sure to follow basic food hygiene practices when preparing food.
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Tuesday, June 10, 2014

Managing Overactive Bladder (OAB)

Posted by Prahallad Panda on 7:21 PM Comments

Fail to postpone the need to urinate, need to urinate more than 8 times per day, Leakage of urine with urge to urinate and need to get up at least twice at night to urinate?
You might be suffering from “Overactive Bladder (OAB)” that comprises urinary urgency, frequency, urge incontinence and nocturia (described above). An overactive bladder is not an illness per say, but rather a term used to describe the above 4 of urinary symptoms.

The first sensation of bladder filling is experienced at a volume of 100 to 150 mL in an adult, and the first desire to void is elicited when the bladder becomes distended with 150 to 250 mL of urine. A person becomes uncomfortably aware of a full bladder when the volume is 350 to 400 ml. An increase in volume to 700 mL creates pain and, often, loss of control.
Overactive bladder is a fairly common condition, which affects about 33 million Americans. This equates to about 30 percent of all men and 40 percent of all women in the United States living with symptoms of an overactive bladder.
It may be a neurological problem or may be that the bladder muscles are overactive to give rise to premature contraction of bladder.
Sometimes people with OAB also have "urgency incontinence." This means that urine leaks after they feel the sudden urge to go. This isn’t the same as "stress urinary incontinence" or "SUI.” Women with SUI leak urine while sneezing, laughing or doing other physical activity.
Common conditions that give rise to frequency, urgency, urge incontinence or nocturia are;
For Women:

• UTI – urinary tract infection

• Fibroids (Myomas) – non-cancerous growths of the uterus

• Cystitis – inflammation of the bladder

• Childbirth – pelvic muscles can become out of sync after childbirth and contract when they shouldn’t

• Idiopathic – cause is unknown

For Men:

• UTI

• Enlarged prostate

• Bladder Stones

• Bladder Cancer

Therefore, all these serious conditions are to be rules out by your doctor, who may like to order tests like;
  • Post-void residual urine
  • ultrasound scan of your bladder
  • Measuring urine flow rate by uroflowmetry.
  • Testing bladder pressure by Cystometry etc.
After investigations to rule out a definite causes, diagnosis of OAB (Idiopathic) can be made, so to say by method of exclusion.

Medications that relax the bladder can be effective for relieving symptoms of overactive bladder (Idiopathic) and reducing episodes of urge incontinence. These drugs include:

Tolterodine
Oxybutynin
Oxybutynin as a skin patch
Solifenacin
Darifenacin
Mirebegron

Common side effects of most of these drugs include dry eyes and dry mouth, but drinking water to quench thirst can aggravate symptoms of overactive bladder. Constipation — another potential side effect — can decrease bladder capacity, also aggravating symptoms. Extended-release forms of these medications, including the skin patch or gel, may cause fewer side effects.
Other treatment options like surgery, injection of Botox and sacral nerve stimulation are being talked about.
But, in most of the cases reassurance, less intake of coffee & alcohol, avoiding drinking of a lot of fluid after evening and some sedative for good night's sleep may work without having to take the medications.




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