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Non Invasive Evaluation of Liver Fibrosis in Patients With Chronic Hepatitis B and C

Thesis Info

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Author

Shahzad Ashraf

Program

PhD

Institute

Baqai Medical University

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2006

Thesis Completion Status

Completed

Subject

Applied Sciences

Language

English

Link

http://prr.hec.gov.pk/jspui/bitstream/123456789/2082/1/33S.pdf

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676726759353

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Chronic viral hepatitis is an important cause of morbidity and mortality in the present day world [Goldstein et al, 2005; Baldo et al, 2008] 1,2 . The situation is particularly precarious in the developing countries [Jafri et al, 2006] 3 . It is estimated that by the year 2020-5, there will be three fold rise in cirrhosis, and hepatocellular carcinoma from HBV and HCV [Nguyen et al, 2008; Law et al, 2003] 4,5 . In chronic viral hepatitis the prognosis and management are highly dependent on the extent of liver fibrosis [Sebastiani et al, 2006] 6 . Though classically considered the “gold standard”; the liver biopsy is far from perfect, and has significant limitations [Poynard et al, 2004] 7 . This has led researchers to look for other methods to assess the stage of liver fibrosis [Afdhal et al, 2004] 8 .The noninvasive markers are the most widely used alternative to liver biopsy [ Manning et al, 2008; Castera et al, 2007; Morra et al, 2007] 9,10,11 . In the study presented, the association between serum markers, platelet parameters and liver fibrosis was investigated taking liver biopsy as the reference standard. A set of 5 serum markers, Fibroscore, consisting of: bilirubin, gamma glutamyl transferase (GGT), hyaluronic acid (HA), alpha 2 macroglobulin (A2M), and platelets; has shown very high diagnostic accuracy for the near absence of fibrosis, and cirrhosis. The area under the ROC for F2 (stage 2) fibrosis was 0.808, for F3 the ROC was 0.938, and for F4 the ROC was 0.959. A central cut off point of > 0.5, in the model, predicted clinically significant fibrosis, (F2, F3 and F4) with a sensitivity of 82%, specificity of 92%, and overall diagnostic accuracy of 89%. By increasing the cut off to 0.65, for stages F2-F4, the PPV was 95%. Lowering the cut off to < 0.08 for the exclusion of stages F2-F4 provided 98% NPV, thus almost certainly ruling out stages F2-F4. The PDW index consists of platelet distribution width (PDW), mean platelet volume (MPV), and platelet count. The area under the ROC for advanced fibrosis (F3-F4) for PDW index was 0.840, compares with the well known AST to Platelet Ratio Index (APRI) with area under ROC of 0.888. It is concluded that, Fibroscore has a high diagnostic accuracy for stages F2-F4, and PDW Index reliably predicts advanced fibrosis. The noninvasive markers will be helpful in the screening and management of fibrotic liver disease [Morra et al, 2007] 11 , and will replace liver biopsy in most patients with chronic liver disease from viral related causes [Castera et al, 2007; Morra et al, 2007] 10,11 .
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۔غزل

غزل ---فرحت شکور(پاکپتن)

مت پوچھ کہ ہم کیسی بلاؤں میں گھرے ہیں
بے یارو مدد گار تیرے چاہنے والے
جینے کا ہمیں حق ہے نہ مرنے کی اجازت
آنکھوں میں کوئی خواب نہ دل میں کوئی خواہش
سینچا ہے لہو دے کے سدا لالہ و گل کو
حسرت ، کبھی نفرت ، کبھی غربت ہمیں بخشی
افلاس و فلاکت کی چلی آندھیاں ہر سو
اے میرے خدا کیوں یہ میرے دیس کے باسی
سچ ، سوچ ، قدم اور قلم محدود ہیں اپنے
ہوتے ہی نہیں پست کبھی حوصلے میرے
لوٹے نہ میرے صاحب اس شہرِ فسوں جا کر
آیا نہ خیال ان کو میری صحرا گری کا
یکسر نہیں میرا ، تو رقیبوں کو مبارک
کیا پوچھتے ہو حالِ دلِ زار ہمارا
کس موڑ پہ لے آیا یہ عشق ہمیں فرحتؔ

 

خوابوں سے جو نکلے تو صداؤں میں گھرے ہیں
صحراؤں کی جاں سوز ہواؤں میں گھرے ہیں
ہم اہلِ وفا کیسی سزاؤں میں گھرے ہیں
ہم زیست کی بے رنگ خلاؤں میں گھرے ہیں
کیوں اہلِ چمن پھر بھی خزاؤں میں گھرے ہیں
ہم لوگ مقدر کی عطاؤں میں گھرے ہیں
کیوں اہلِ وطن اتنی وباؤں میں گھرے ہیں
ڈر خوف کی محبوس فضاؤں میں گھرے ہیں
ہم اہلِ سخن ایسے خداؤں میں گھرے ہیں
شاید کسی اپنے کی دُعاؤں میں گھرے ہیں
کسی دلرُبا کی دلکش اداؤں میں گھرے ہیں
کس زُلفِ گرہ گیر کی چھاؤں میں گھرے ہیں
ہم اہلِ طلب اب کہ اناؤں میں گھرے ہیں
اک یار بے وفا کی جفاؤں میں گھرے ہیں
دُکھ درد کی گھنگھور گھٹاؤں میں گھرے ہیں

Orientalists on the Style of Quran: A Critical Study

The literary grandeur of the Quranic style is simply inimitable. It treats diverse subjects in such a unique and exalted manner as is nowhere to be found in any genre of Arabic literature. But in spite of its astounding sublimity, some orientalists have bitterly criticized the literary style of the Holy Quran. The following paper is an academic attempt to prove their fallacy and failure to appreciate the incomparable style of the Holy Quran. It includes the representative views of those orientalists who made a scathing criticism as well the ideas of those orientalists who generously acknowledged the exceptional eloquence of the Holy Quran.

An Analysis of Indian, Russian & Us Responses to China Pakistan Economic Corridor

Every state adopts a policy in response to an issue or in reaction to other state’s policy. But when two states come up with a divert policy responses to the same issue, it raises many questions in the academic and intellectual community. The aim of the study is to inquire why two or more states adopt different policy responses to a similar issue. In specific, the study tried to investigate the policy responses of India, Russia and America towards CPEC. Additionally, the study is designed to answer what are the differences in their policy responses and why. Lastly, the study also probes into their channels or sources through they are communicating their policy responses over CPEC. Factor analysis method was used for answering the research questions to explore the level of variations in the policy responses of India, Russia and America to CPEC. To support the study from theoretical perspective, Decision Making Theory, articulated in the Schematic Model, was applied. In its methodology, the research designed to thoroughly analyze CPEC by investigating its origin, rationale, interests of Beijing and Islamabad, short and long term planning, challenges and opportunities and its political, economic and strategic implications for both the Iron Brothers and for the regions including, South Asia, Middle East and Central Asia. Secondly, a comparative analysis of rationale and sources of Indian, Russian and American policy responses over CPEC have been presented. It was found that the diversity in the policy responses of India, Russia and USA to CPEC shaped by multiple internal and external factors. The three states have different interests in China and Pakistan and their joint project, CPEC. For New Delhi, both states are rival and hostile since its inception and CPEC is the question of their security and integrity. For Moscow, China is a strategic partner while Pakistan is a new emerging ally in South Asia while CPEC is just another opportunity and a trade corridor that connects Eurasian region with the rest of the World. For Washington, China an economic rival that has challenged US hegemony across the globe; while Pakistan is a trustless ally throughout the Cold War and post 9/11. America considers CPEC as part of Beijing OBOR initiative and does not welcome it as it undermines its economic and strategic interests in the regions of SA, CARs and Middle East. Keeping in mind the theoretical questions, the study found that the spectrum of factors shaping the responses of the three countries are; political structure, political culture, diversity in traditions, norms and values, priorities, perception of threats, differences in capacity and skills of policy makers, political and economic dependency, geographic position, choice and time, idiosyncratic factor, leadership skills and the capacity of policy makers and their decision-making dexterity. In response to the policy responses of New Delhi, Moscow and Washington to CPEC, it was found that for India, CPEC is the issue of sovereignty as the project passes through GB which New Delhi claims an integral part of Jammu and Kashmir. Moscow’s response to CPEC is mixed, as on the one hand Moscow did not join the project but on the other hand it supported the idea of integration that ultimately supports Russian Eurasian vision. Washington response to CPEC was initialy ambiguous, but the new administration came up with a clear message and rejected both OBOR; and CPEC on the grounds of Indian rationales. From rationales and sources analysis, the study found, New Delhi never miss any platform at global, regional and national level where it could voice their response to CPEC, thus, adopting a rigid stance against both China and Pakistan about the construction of CPEC and its implications. Russia mostly used state run official sources of communications to come up with a response to CPEC through electronic and print media to count its soften attitude and balance approach. The US issues its official stance through the offices of Sectary of State, Defense Sectary and White House to show their concerns about the Chinese OBOR and, specifically, CPEC.