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New Delhi, India

Goel V.,Maulana Azad Medical College
Tropical gastroenterology : official journal of the Digestive Diseases Foundation | Year: 2010

Hepatic Osteodystrophy (HO) is a generic definition for the metabolic bone disease that may occur in individuals with chronic liver disease. Hepatic Osteodystrophy is an important but frequently overlooked complication, seen in chronic liver disease patients. This review article illustrates its significance, various causes and methods to diagnose this complication and recent advances and recommendations to treat Hepatic Osteodystrophy. Two distinct bone metabolic processes, osteoporosis (OP) and osteomalacia (OM) are combined together in various proportions in HO syndromes. It has been described in association with most types of chronic liver disease both cholestatic and non-cholestatic. Primary biliary cirrhosis (PBC) is the condition causing osteopenia more frequently, but other cholestatic liver diseases like primary sclerosing cholangitis (PSC), haemochromatosis and alcoholic liver disease are also frequently associated with this disorder. The pathogenesis of bone disease in both adults and children with chronic cholestasis is not completely understood. There has been considerable disagreement regarding the relative importance of osteomalacia versus osteoporosis as the factors leading to osteopenia of liver disease. It can significantly affect morbidity, and quality of life of these patients. Fractures are also associated with an excess mortality. Bone mineral density measurement is the best way to assess the presence and severity of osteopenia in CLD patients, while laboratory tests give important information about the metabolic status of the bone. Since advanced HO is difficult to treat and adversely affects both the quality of life and the long-term prognosis of patients with chronic liver disease, special care is required in order to prevent the development of clinical bone disease in individuals with advanced hepatic disease. CONCLUSION: Hepatic Osteodystrophy is under-recognized and less attended complication of CLD. Multiple factors contribute to the development of hepatic Osteodystrophy. Newer diagnostic modalities have improved the detection of HO and Vitamin D repletion, calcium supplementation and Bisphosphonates seem promising. The best course of management for these patients is to review the individual risk factors for osteoporosis, obtain a bone mass measurement, and prescribe age and disease-specific therapies. Source


Sonika U.,Maulana Azad Medical College
Tropical gastroenterology : official journal of the Digestive Diseases Foundation | Year: 2012

Tuberculosis is one of the most common diseases in India and has attained epidemic proportions. Tuberculosis and liver are related in many ways. Liver disease can occur due to hepatic tuberculosis or the treatment with various anti-tubercular drugs may precipitate hepatic injury or patients with chronic liver disease may develop tuberculosis and pose special management problems. Tuberculosis per se can affect liver in three forms. The most common form is the diffuse hepatic involvement, seen along with pulmonary or miliary tuberculosis. The second is granulomatous hepatitis and the third, much rarer form presents as focal/local tuberculoma or abscess. Tubercular disease of liver occurring along with pulmonary involvement as in disseminated tuberculosis is treated with standard regimen for pulmonary tuberculosis. Granulomatous hepatitis and tubercular liver abscess are treated like any other extra-pulmonary tubercular lesions without any extra risk of hepatotoxicity by anti-tubercular drugs. Treatment of tuberculosis in patients who already have a chronic liver disease poses various clinical challenges. There is an increased risk of drug induced hepatitis in these patients and its implications are potentially more serious in these patients as their hepatic reserve is already depleted. However, hepatotoxic anti-tubercular drugs can be safely used in these patients if the number of drugs used is adjusted appropriately. Thus, the main principle is to closely monitor the patient for signs of worsening liver disease and to reduce the number of hepatotoxic drugs in the anti-tubercular regimen according to the severity of underlying liver disease. Source


Aggrawal A.,Maulana Azad Medical College
Journal of Forensic and Legal Medicine | Year: 2011

Zoophilia is a paraphilia whereby the perpetrator gets sexual pleasure in having sex with animals. Most jurisdictions and nations have laws against this practice. Zoophilia exists in many variations, and some authors have attempted to classify zoophilia previously. However unanimity does not exist among various classifications. In addition, sexual contact between humans and animals has been given several names such as zoophilia, zoophilism, bestiality, zooerasty and zoorasty. These terms continue to be used in different senses by different authors, creating some amount of confusion. A mathematical classification of zoophilia, which could group all shades of zoophilia under various numerical classes, could be a way to end this confusion. Recently a ten-tier classification of necrophilia has been proposed to bring an end to a similar confusion extant among various terms referring to necrophilia. It is our proposition that various shades of zoophilia exist on a similar continuum. Thus, each proposed class of zoophilia can be "mapped" to a similar class of necrophilia already proposed. This classification has an intuitive appeal, as it grades all shades of zoophilia from the least innocuous behavior to the most criminal. It is hoped that it would also bring an end to the existing confusion among several zoophilia related terms. In addition, since each proposed class of zoophilia can be exactly "mapped" to classes of another paraphilia (necrophilia), it may point to an "equivalence" among all paraphilias not yet explored fully. This area needs further exploration. © 2010 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved. Source


Taneja D.K.,Maulana Azad Medical College
Indian Journal of Community Medicine | Year: 2014

Yoga has been the subject of research in the past few decades for therapeutic purposes for modern epidemic diseases like mental stress, obesity, diabetes, hypertension, coronary heart disease, and chronic obstructive pulmonary disease. Individual studies report beneficial effect of yoga in these conditions, indicating that it can be used as nonpharmaceutical measure or complement to drug therapy for treatment of these conditions. However, these studies have used only yoga asana, pranayama, and/ or short periods of meditation for therapeutic purposes. General perception about yoga is also the same, which is not correct. Yoga in fact means union of individual consciousness with the supreme consciousness. It involves eight rungs or limbs of yoga, which include yama, niyama, asana, pranayama, pratyahara, dharana, dhyana, and samadhi. Intense practice of these leads to self-realization, which is the primary goal of yoga. An analytical look at the rungs and the goal of yoga shows that it is a holistic way of life leading to a state of complete physical, social, mental, and spiritual well-being and harmony with nature. This is in contrast to purely economic and material developmental goal of modern civilization, which has brought social unrest and ecological devastation. Source


Nitin S.,Maulana Azad Medical College
Singapore Medical Journal | Year: 2010

Glycated haemoglobins are haemoglobins with an attached sugar moiety. They constitute the HbA1 fraction of the adult haemoglobin HbA. HbAIc is the predominant fraction of HbA1 and gives an estimate of the blood sugar levels of an individual over the last three months. It has been observed that an HbAIc value of less than seven percent reduces the microvascular complications in diabetic patients. However, HbAIc is not affected by blood sugar levels alone. Apart from blood sugar, there are other factors that affect HbAIc. This article reviews in detail the structure, formation, methods of measurement, factors affecting HbAIc levels and their clinical significance. Source

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