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Home > Sonographic Estimation of the Prevalence of Hepatic Steatosis in Hiv Monoinfected Patients at Aga Khan University Nairobi.

Sonographic Estimation of the Prevalence of Hepatic Steatosis in Hiv Monoinfected Patients at Aga Khan University Nairobi.

Thesis Info

Author

Muthee, Bernadette Wambui

Department

Imaging and Diagnostic Radiology (East Africa)

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2016

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728067587

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Introduction: Human immunodeficiency virus disease (HIV) is a worldwide health problem. It is estimated that 38.6 million people are infected with HIV globally. It has remained endemic in the African continent for close to 20 years and is a long term developmental challenge in Africa which bears 69 % of the HIV/AIDS global burden. The introduction of highly active antiretroviral therapy (HAART) has caused dramatic improvement in prognosis of HIV disease. Consequently, this has resulted in substantial reduction in Acquired Immune Deficiency Syndrome (AIDS) related morbidity and mortality. In contrast, this has been accompanied by an upsurge in liver- related morbidity and mortality. Studies have shown that deaths resulting from liver diseases rank second to AIDS-related mortality. Liver cirrhosis and hepatocellular carcinoma are the leading causes. Others are steatohepatitis secondary to fatty liver disease. Studies on liver diseases in HIV patients have been done predominantly in those who are coinfected with hepatitis B virus/hepatitis C virus (HBV/HCV). These have shown high coinfection rates in the western countries. On the other hand, Sub-Saharan Africa has lower rates of HIV coinfection with HBV and HCV. Therefore, HIV-monoinfected patients are the majority, yet, there is scarcity of data on liver diseases in these patients. This study aimed to estimate the prevalence of hepatic steatosis and the factors associated with hepatic steatosis in HIV monoinfected patients of African descent at Aga Khan University Hospital Nairobi. Objectives: Primary objective - To determine the prevalence of hepatic steatosis in HIV monoinfected patients of African descent on grey scale ultrasonography Secondary objectives – To determine factors associated with hepatic steatosis in HIV monoinfected patients of African descent on grey scale ultrasonography. Methods: This was a prospective cross-sectional study done between April 2015 and November 2015 through consecutive enrolment of 109 eligible HIV monoinfected patients of African descent at Aga Khan University hospital Nairobi (AKUH, N). The study was carried out in AKUH, N HIV clinic and radiology department. Results: Hepatic steatosis was diagnosed in 11% of the 109 patients (95% CI 5.5 - 17.4%). Male patients had a significantly higher prevalence of hepatic steatosis (19.3%) compared to the females (1.9%), AOR 15.4 (95% CI 1.7-138.0), p=0.014. Patients on HAART had a significantly lower prevalence of hepatic steatosis (6.5%) compared to those patients who were HAART naïve (37.5%), AOR 0.1 (95% CI 0.0-0.4), p=0.001. Other patient characteristics such as alcohol consumption, viral load, BMI and hyperlipidemia were not
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مولانا حفیظ الرحمن واصف

مولاناحفیظ الرحمن واصف
گذشتہ مہینے (۱۳ مارچ) کواجڑنے اور باربار بسنے والی دلّی کی ایک اور فخر روزگار شخصیت مولانا حفیظ الرحمن واصف کی شکل میں اس دنیا سے اٹھ گئی اور دلّی کی بساط علم و دین اورادب وشعر پرچھایا ہوا اندھیرا کچھ اور گہرا ہوگیا، ان کی وفات پر محدود صحافتی اورعلمی حلقوں میں اضطراب اور ہلچل کی کمزورسی کیفیت نظر آئی جو مولانا حفیظ الرحمن واصف جیسی جلیل القدر شخصیت کے ماتم کے لیے نہ صرف ناکافی بلکہ کہناچاہیے کہ ان کی رفعت شان سے حددرجہ کم تر تھی۔ وہ ان ٹمٹماتی ہوئی شمعوں میں سے ایک شمع تھے جوآزادی سے پہلے اورآزادی کے بعد کی دہلی کی تمدنی تبدیلیوں اورلسانی اورسماجی تلاطم کی نوعیت اور کیفیتوں کی عکاس تھی اوروہ خود آزادی سے پہلے اور آزادی کے بعد کے درمیان نہ صرف حدِ فاصل کی حیثیت رکھتے تھے بلکہ ان کاشمارسماجی انقلاب حال کے مشہور ماتم گساروں اور میرؔ،سوداؔ، غالبؔ ،حالیؔ اورداغؔ جیسے نوحہ خوانوں میں ہوتاتھا۔
وہ اس خانوادۂ علم وشریعت کے چشم وچراغ تھے، جس نے ۱۸۵۷ء میں اجڑنے والی دہلی کواز سر نوسجانے اور بہاروں سے آراستہ کرنے میں حصہ لیا تھااور ایک پورے تمدن کی تباہی کے بعد اس کے ملبہ سے نئی اوردلآویز عمارت تعمیر کرنے کی ہمت دکھائی تھی۔
وہ حضرت مولانا مفتی کفایت اﷲ کے فرزند دلبند اوران کی سیرت اور خصلت کے بے شمار پہلوؤں میں ان کے حقیقی وارث اور جانشین تھے۔انہوں نے آنکھ کھول کراپنے یگانہ روزگار والد کے علاوہ جن لوگوں کی آنکھیں دیکھی تھیں، اور جن کی صحبتوں سے فیض اٹھایا تھاوہ سب وہ لوگ تھے کہ اب ان کا ثانی، دہلی کی سرزمین پرشاید ہی چشم فلک کوکبھی دیکھنا نصیب ہو۔
آج کی دہلی میں ان کاوجود بہاروں کی یادگار یاغالب کے الفاظ میں داغِ فراق صحبت شب کی...

پاکستان میں رائج جبری شادیوں کا تعارف اور شرعی جائزہ

The Islamic Jurisprudence has given a great importance to the existence of family system of life. That is why the Qur‘ān has described the laws of family life with details in comparison with worship of Allah. In family system of life, marriage has a great importance but marriage is not only essential part of worship. Its purposes one the existence   of human generation along with the survival society where there must be modesty and justice but it is only possible if the family system of life is established on everlasting principles. That is why our Islamic Jurisprudence has declared the willingness of both bridegroom and bride and their family more importance in the marriages. Such marriages are always durable and permanent. On the contrary, if there is no willingness of both the bridegroom and bride in marriages. Then such marriages are not durable and permanent. In marriage a girl is a party and the Islamic jurisprudence has given a great deal of importance to her willingness but in pusthoon society, sometimes such marriages are conducted in which the bride concerned has no approval rather she is forced to accept that bond of marriage such marriages are commonly called “Forced Marriages”. The article below is defining the different kinds of forced marriages in vogue and is trying to find out their religious and dogmatic status as well.

Development and Pharmacokinetic Evaluation of Ph Sensitive Raft Forming Bilayer Tablets of Proton Pump Inhibitor and Antiemetic Drugs

Gastroesophageal reflux disorders (GERD) along with peptic ulcers are most common health problems in developing countries. The present study aimed to evaluate the raft forming bilayer tablets of sustained release (SR) pantoprazole sodium sesquihydrate (PSS) and immediate release (IR) domperidone maleate (DM). The box behnken design (BBD) was used with three independent and dependent variables. The independent variables were sodium alginate (X1), pectin (X2) and HPMC K100M (X3) while the dependent variables were percentage drug release at 2 (Y2), 4 (Y4) and 8 h (Y8). The powdered blend and prepared granules of SR and IR layer were evaluated for their micromeritic properties. The bilayer tablets were evaluated for thickness, diameter, weight variation, hardness, friability and disintegration time. The alginate-pectin rafts were evaluated for their physical, chemical and swelling properties. The alginate-pectin rafts were characterized by their strength, weight, volume, resilience, reflux resistance, thickness, buffering capacity, neutralizing capacity, floating lag time (FLT) and total floating time (TFT). The alginate and pectin contents within the raft, acid neutralization capacity (ANC), neutralization profile and effect of raft structure on the neutralization profile of alginate-pectin rafts were evaluated. The drug release studies of PSS and DM were carried out in simulated gastric fluid (SGF) pH 1.2. The release kinetics of PSS was determined by different in vitro kinetics models such as zero order, first order, higuchi and Korsmeyer-peppas model. The release kinetics of DM was calculated by zero order, first order and weibull model. The drugs, polymers, bilayer tablets and alginate-pectin rafts were further characterized by Fourier Transform Infrared Spectroscopy (FTIR), X-ray Diffractometry (XRD), Differential Scanning Calorimetry (DSC) and Scanning Electron Microscopy (SEM). The High Performance Liquid Chromatography (HPLC) method was developed for the separation of PSS and DM by using C18 column with UV detection at 285 nm in mobile phase as well as in rabbit’s plasma. Assay of the bilayer tablets were performed by already developed HPLC methods in mobile phase as well as in rabbit’s plasma. The optimized formulation R9 was selected on the basis of the physico-chemical characteristics of alginate-pectin raft, release pattern and release kinetics. The accelerated stability studies were performed on optimized formulation R9 for a period of 6 months in stability chamber at 40 ºC temperature and 75±5 % relative humidity. Albino rats were used for the histopathological examination of rat’s stomach by aspirin ulcer induced method of the test and reference formulation. Albino rabbits were used to study the pharmacokinetics of PSS and DM. The prepared bilayer tablets were evaluated for in vivo analysis on healthy albino rabbits using Latin square crossover design. The time to reach maximum concentration of PSS and DM in plasma (tmax), maximum concentration of PSS and DM (Cmax), area under the curve (AUC) from 0-t and 0-∞, area under the first movement curve (AUMC) and mean residence time (MRT) were calculated. The non-compartmental analysis was used to calculate the pharmacokinetic parameters using PK solver Microsoft excel adds in program. The statistical approaches such as descriptive statistics, ANOVA and tukey test were used. In ANOVA all results were considered statistically significant if the p value was less than 0.05. the tukey test was used for means of different groups means. The PSS release at 2 h (Y2), 4 h (Y4) and 8 h (Y8) were ranged from 16.58±0.090-47.78±0.121 %, 45.12±0.102-69.19±0.163 % and 77.45±0.021-98.76±0.071 % respectively. The physical tests of all compressed formulations were within pharmacopoeial limits. The alginatepectin raft was effectively formed in SGF pH 1.2. Observed raft strength of optimized formulation R9 was 6.43±0.019 g, reflux resistance was 2490±0.004 g, thickness of raft was 4.8±0.245 cm and raft resilience was found to be greater than 480 min. Rapid FLT i.e. 55 s was observed and delayed 8 h TFT was observed in R9 optimized formulation. The buffering and neutralizing capacity were 11.20±1.01 meq and 6.5±0.56 meq respectively. The percent contents of sodium alginate and pectin of R9 formulation were found to be 99.20 % and 97.20 % respectively. The ANC, duration of neutralization and nature of R9 alginate-pectin raft were 8.0±0.356 (p value is less than 0.001), 100 min and absorbent. The R9 formulation showed 97.98 % swelling at 8 h (p=0.001). The cumulative percentage release of optimized formulation R9 was found to be 98.76 % for PSS and 98.45% for DM. The PSS followed the first order kinetics and non-fickian diffusion was observed as value of n was greater than 0.7 in korsmeyer-peppas. The release kinetics of DM showed first order release and weibull model indicated the parabolic shape of drug release curve. FTIR spectra of drugs, polymers, bilayer tablets and raft showed no interaction between them. The XRD presented diffraction lines indicates crystalline nature of drugs and disappearance of the diffraction lines in bilayer tablets and raft indicates the drugs were uniformly distributed. DSC thermograms showed endothermic peaks at 250 ºC for PSS and 220 ºC for DM. SEM images showed porous nature of raft. The SEM images of bilayer tablets showed compact nature of tablets and SEM micrograph of the raft showed a highly porous surface, this indicate the diffusion of the drug from raft to the surface. The separation of PSS and DM with good resolution and retention time less than 7 min were attained in mobile phase as well as in plasma. Quadratic outcome of flow rate, composition of mobile phase and pH of buffer on retention time (p ˂0.001) and percentage recoveries of PSS and DM (p =0.0016) were significant. The regression values obtained from linearity curve of PSS and DM were 0.999 and 0.9994 respectively. Percentage recoveries of PSS and DM were ranged from 96.79 to 99.52 % and 95.51 to 99.52 % respectively. The assay of optimized R9 formulation showed the percentage of PSS and DM were found to be 98.89±0.5 % and 99.89±0.5 % respectively. The stability studies showed the bilayer tablets and alginate-pectin rafts were stable under accelerated conditions for up to 6 months. Histopathological studies showed the optimized R9 formulation possessed more antiulcerant activity as compared to the marketed products of PSS. The tmax of the test and reference formulations of DM were 1.00±0.093 h and 1.00±0.120 h respectively. Observed Cmax of the test formulation of DM was 15.11±1.608 µg/ml, which was greater as compared to reference formulation i.e. 12.06±1.234 µg/ml. The AUC(0-t) and AUC(0-∞) of the test formulation of DM was 59.02±2.240 µg×h/ml and 80.15±6.042 µg×h/ml respectively. AUC(0-t) and AUC(0-∞) of the reference formulation of DM was 56.31±1.406 µg×h/ml and 78.94±5.939 µg×h/ml respectively. The tmax for the test formulation of PSS was 8.00±2.135 h (P=0.0001) and the tmax of the reference was 4.00±1.301 h (P=0.0024). The peak plasma concentration of PSS of R9 test and reference formulation were 48.06±0.347 µg/ml and 46.31±0.398 µg/ml respectively. The observed AUC(0-t) of PSS of the R9 test formulation was 525.39±3.437 µg×h/ml which was higher than the AUC(0-t) of reference formulation i.e. 364.63±2.014 µg×h/ml indicating the bioavailability of test formulation was higher than the reference formulation. AUC(0-∞) values of test and reference formulations of PSS were 554.61±8.974 µg×h/ml and 394.14±7.239 µg×h/ml respectively. One-way ANOVA was applied on pharmacokinetic data and value of p was less than 0.05 and results were statistically significant. The obtained p value of tmax and Cmax were 0.0011 and 0.0024 respectively indicates the results are statistically significant. AUC(0-t) and AUC(0-∞) showed p value less than 0.05 indicates the results are statistically significant.