Addis Ababa, Ethiopia
Addis Ababa, Ethiopia

Unity University is the first privately owned institute of higher learning to be awarded full-fledged university status in Ethiopia by the Ministry of Education. It is also the first private university in the country to offer postgraduate programs leading to master’s degree in business administration and development economics . Wikipedia.


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Bernardi M.,University of Bologna | Moreau R.,French Institute of Health and Medical Research | Moreau R.,University Paris Diderot | Moreau R.,Unity University | And 6 more authors.
Journal of Hepatology | Year: 2015

The peripheral arterial vasodilation hypothesis has been most influential in the field of cirrhosis and its complications. It has given rise to hundreds of pathophysiological studies in experimental and human cirrhosis and is the theoretical basis of life-saving treatments. It is undisputed that splanchnic arterial vasodilation contributes to portal hypertension and is the basis for manifestations such as ascites and hepatorenal syndrome, but the body of research generated by the hypothesis has revealed gaps in the original pathophysiological interpretation of these complications. The expansion of our knowledge on the mechanisms regulating vascular tone, inflammation and the host-microbiota interaction require a broader approach to advanced cirrhosis encompassing the whole spectrum of its manifestations. Indeed, multiorgan dysfunction and failure likely result from a complex interplay where the systemic spread of bacterial products represents the primary event. The consequent activation of the host innate immune response triggers endothelial molecular mechanisms responsible for arterial vasodilation, and also jeopardizes organ integrity with a storm of pro-inflammatory cytokines and reactive oxygen and nitrogen species. Thus, the picture of advanced cirrhosis could be seen as the result of an inflammatory syndrome in contradiction with a simple hemodynamic disturbance. © 2015 European Association for the Study of the Liver.


Moreau R.,French Institute of Health and Medical Research | Moreau R.,University Paris Diderot | Moreau R.,Unity University | Moreau R.,University of Paris Pantheon Sorbonne | Moreau R.,Hospital Clinic
Digestive Diseases | Year: 2015

Patients with cirrhosis are prone to developing bacterial infections. Moreover, bacterial infection is the most common identifiable trigger of acute-on-chronic liver failure (ACLF), which is characterized by organ failures and a high risk of death. There is evidence of an excessive immune response of the host as a major mechanism leading to the development of organ failures in patients with cirrhosis. However, a role for direct tissue damage caused by bacterial toxins and virulence factors cannot be excluded. Failed tolerance mechanisms may also contribute to organ failures, although the involved mechanisms are unclear. A proportion of patients with infection-related ACLF have a prolonged stay in the intensive care unit. These patients have immune suppression, increased risk of superinfection and poor outcome. Immune suppression might be a consequence of the first infection episode that has led patients to be admitted to hospital. © 2015 S. Karger AG, Basel.


PubMed | Genosplice Institute Du Cerveau Et Of La Moelle Epiniere, Unity University, University of Paris Pantheon Sorbonne, Free University of Colombia and 3 more.
Type: | Journal: Journal of hepatology | Year: 2017

In immune cells, constitutively and acutely produced type I interferons (IFNs) engage autocrine/paracrine signaling pathways to induce IFN-stimulated genes (ISGs). Enhanced activity of IFN signaling pathways can cause excessive inflammation and tissue damage. We aimed to investigate the poorly known ISG expression in systemic immune cells from patients with decompensated alcoholic cirrhosis and its association with outcome.Peripheral blood mononuclear cells (PBMCs) from patients and heathy subjects were stimulated or not with lipopolysaccharide (LPS, an IFN inducer) or increasing concentrations of IFN-. RT-qPCR monitored expression of 48 ISGs and 10 non-ISG inflammatory cytokines.We developed an 8-ISG signature (IFN score) assessing ISG expression. The LPS-elicited ISG induction was significantly lower and that of non-ISG pro-inflammatory cytokines higher, in cirrhotic than in healthy PBMCs. The lower LPS-induced ISGs was not a result of decreased IFN production by cirrhotic PBMCs or neutralization of secreted IFN but of defective PBMC response to IFN. This defect was at least in part due to decreased constitutive ISG expression. Patients with the higher baseline IFN scores and ISG levels had the higher risk of death. At baseline, non-ISG cytokines did not correlate with outcome.PBMCs from patients with decompensated alcoholic cirrhosis exhibit down-regulated ISG expression, both constitutively and after an acute stimulus. Our finding that higher baseline PBMC ISG expression was associated with higher risk of death, suggests that constitutive ISG expression in systemic immune cells contributes to the prognosis of alcoholic cirrhosis.In immune cells, type I interferons (IFNs) engage autocrine/paracrine signaling pathways to induce IFN-stimulated genes (ISGs). Enhanced activity of IFN signaling pathways can cause excessive inflammation and tissue damage. Here we show that peripheral blood mononuclear cells (PBMCs) from patients with alcoholic cirrhosis exhibit a defect in both constitutively expressed and acutely induced ISGs. We found that higher baseline PBMC ISG expression was associated with higher risk of death, revealing a probable contribution of constitutive ISG expression in systemic immune cells to the prognosis of alcoholic cirrhosis.


Mookerjee R.P.,University College London | Pavesi M.,European Foundation for the Study of Chronic Liver Failure EF CLIF | Thomsen K.L.,University College London | Mehta G.,University College London | And 13 more authors.
Journal of Hepatology | Year: 2016

Background & Aims Non-selective beta blockers (NSBBs) have been shown to have deleterious outcomes in patients with refractory ascites, alcoholic hepatitis and spontaneous bacterial peritonitis leading many physicians to stop the drug in these cases. Acute-on-chronic liver failure (ACLF) is characterized by systemic inflammation and high mortality. As NSBBs may have beneficial effects on gut motility and permeability and, systemic inflammation, the aims of this prospective, observational study were to determine whether ongoing use of NSBBs reduced 28-day mortality in ACLF patients. Methods The study was performed in 349 patients with ACLF included in the CANONIC study, which is a prospective observational investigation in hospitalized cirrhotic patients with acute deterioration. The data about the use of NSBBs, its type and dosage was specifically recorded. Patient characteristics at enrollment significantly associated with treatment and mortality were taken into account as potential confounders to adjust for treatment effect. A logistic regression model was fitted. Results 164 (47%) ACLF patients received NSBBs whereas 185 patients did not. Although the CLIF-C ACLF scores were similar at presentation, more patients in the NSBB treated group had lower grades of ACLF (p = 0.047) at presentation and significantly more patients improved. Forty patients (24.4%) died in NSBB treated group compared with 63 patients (34.1%) (p = 0.048) [estimated risk-reduction 0.596 (95%CI: 0.361-0.985; p = 0.0436)]. This improvement in survival was associated with a significantly lower white cell count (NSBB: 8.5 (5.8); no NSBB: 10.8 (6.6); p = 0.002). No long-term improvement in survival was observed. Conclusions This study shows for the first time that ongoing treatment with NSBBs in cirrhosis is safe and reduces the mortality if they develop ACLF. Careful thought should be given before stopping NSBBs in cirrhotic patients. © 2015 European Association for the Study of the Liver.


Moreau R.,French Institute of Health and Medical Research | Moreau R.,University Paris Diderot | Moreau R.,Unity University | Moreau R.,University of Paris Pantheon Sorbonne | And 3 more authors.
American Journal of Gastroenterology | Year: 2014

Severe alcoholic hepatitis is a life-threatening liver disease. Although corticosteroid treatment is recommended and improves survival, mortality remains high and 35% of patients die within 6 months. There is no available medical treatment for patients who do not respond to corticosteroids. A new randomized pilot trial shows that the administration of the cytokine granulocyte colony-stimulating factor (G-CSF) improves liver function and 3-month survival in patients with severe alcoholic hepatitis. These results suggest a new therapeutic approach for severe alcoholic hepatitis. © 2014 by the American College of Gastroenterology.


Mark H.,Mark Electronics | Workman J.,Unity University
Spectroscopy (Santa Monica) | Year: 2014

Now that we have shown the relationships between different units for concentration, we continue by demonstrating their effects on the data we collected and used for our examples. We also begin our discussion on the ramifications and consequences of our findings. © 2014 Advanstar Communications Inc., All rights reserved.


Sauvanet A.,Beaujon Hospital | Sauvanet A.,University Paris Diderot | Sauvanet A.,Unity University | Gaujoux S.,Beaujon Hospital | And 19 more authors.
Annals of Surgery | Year: 2014

Objective: To assess the feasibility and outcomes of parenchyma-sparing pancreatectomy (PSP), including enucleation (EN), resection of uncinate process (RUP), and central pancreatectomy (CP), as an alternative to standard pancreatectomy for presumed noninvasive intraductal papillary and mucinous neoplasms (IPMNs). Background: Pancreaticoduodenectomy and distal pancreatectomy are associated with significant perioperative morbidity, a substantial risk of pancreatic insufficiency, and may overtreat noninvasive IPMNs. Methods: From 1999 to 2011, PSP was attempted in 91 patients with presumed noninvasive IPMNs, after complete preoperative work-up including computed tomography, magnetic resonance imaging, and endoscopic ultrasonography. Intraoperative frozen section examination was routinely performed to assess surgical margins and rule out invasive malignancy. Follow-up included clinical, biochemical, and radiological assessments. Results: Overall PSP was achieved with a feasibility rate of 89% (n = 81), including 44 ENs, 5 RUPs, and 32 CPs. Postoperative mortality rate was 1.3% (n = 1), and overall morbidity was noteworthy (61%; n = 47). Definitive pathological examination confirmed IPMN diagnosis in 95% of patients (n = 77), all except 2 (3%), without invasive component. After a median follow-up of 50 months, both pancreatic endocrine/exocrine functions were preserved in 92% of patients. Ten-year progression-free survival was 76%, and reoperation for recurrence was required in 4% of patients (n = 3). Conclusions: In selected patients, PSP for presumed noninvasive IPMN in experienced hands is highly feasible and avoids inappropriate standard resections for IPMN-mimicking lesions. Early morbidity is greater than that after standard resections but counterbalanced by preservation of pancreatic endocrine/exocrine functions and a low rate of reoperation for tumor recurrence. Copyright © 2014 Lippincott Williams & Wilkins.


Moreau R.,French Institute of Health and Medical Research | Moreau R.,University Paris Diderot | Moreau R.,Unity University | Moreau R.,University of Paris Pantheon Sorbonne
Seminars in Liver Disease | Year: 2016

Although systemic inflammation is a hallmark of acute-on-chronic liver failure (ACLF), its role in the development of this syndrome is poorly understood. Here the author first summarizes the general principles of the inflammatory response. Inflammation can be triggered by exogenous or endogenous inducers. Important exogenous inducers include bacterial products such as pathogen-associated molecular patterns (PAMPs) and virulence factors. Pathogen-associated molecular patterns elicit inflammation through structural feature recognition (using innate pattern-recognition receptors [PRRs]), whereas virulence factors generally trigger inflammation via functional feature recognition. Endogenous inducers are called danger-associated molecular patterns (DAMPs) and include molecules released by necrotic cells and products of extracellular matrix breakdown. Danger-associated molecular patterns use different PRRs. The purpose of the inflammatory response may differ according to the type of stimulus: The aim of infection-induced inflammation is to decrease pathogen burden, whereas the DAMP-induced inflammation aims to promote tissue repair. An excessive inflammatory response can induce collateral tissue damage (a process called immunopathology). However immunopathology may not be the only mechanism of tissue damage; for example, organ failure can develop because of failed disease tolerance. In this review, the author also discusses how general principles of the inflammatory response can help us to understand the development of ACLF in different contexts: bacterial infection, severe alcoholic hepatitis, and cases in which there is no identifiable trigger. © 2016 by Thieme Medical Publishers, Inc.


Study design:This is a retrospective hospital-based study.Objectives:The study aimed at a better understanding of the etiology, clinical presentation and treatment outcome of nontraumatic myelopathies in Ethiopian patients.Setting:Etiologies of nontraumatic myelopathies have not been evaluated extensively in most sub-Saharan African countries. The available studies in this region were conducted before the widespread clinical use of modern neuroimaging modalities. This study was conducted in Addis Abba, Ethiopia.Methods:We retrospectively analyzed medical files of patients with a diagnosis of myelopathy (age ⩾13 years) admitted or followed up at Tikur Anbesa Hospital between 1 January 2010 and 30 June 2013.Results:Records of 105 patients were analyzed. The male to female ratio was 1.7. The mean age was 38.5 years. Weakness, sensory symptoms (including sensory level), back pain and sphincter dysfunction were the dominant features. Etiologies were dominated by spinal tuberculosis (23.8%) followed by spinal cord neoplastic lesions (primary (10.5%) and secondary neoplasms 8.6%). Other important etiological causes were transverse myelitis (16.2%), degenerative cervical spondylotic myelopathy (15.2%), amyotrophic lateral sclerosis (4.8%) and neuromyelitis optica/multiple sclerosis (3.8%). The mortality rate was 9.5%. Among the patients who died, 40% had chest infection as a complication and 70% presented with complete weakness.Conclusion:Infections remain a major cause of spinal cord disease, and tuberculosis constitutes public health target for reducing the incidence of myelopathies. Early detection and treatment of complications may reduce the high rate of mortality and morbidity observed.Spinal Cord advance online publication, 29 December 2015; doi:10.1038/sc.2015.226. © 2015 International Spinal Cord Society


PubMed | Unity University and Addis Ababa Institute of Technology
Type: Journal Article | Journal: Spinal cord | Year: 2016

This is a retrospective hospital-based study.The study aimed at a better understanding of the etiology, clinical presentation and treatment outcome of nontraumatic myelopathies in Ethiopian patients.Etiologies of nontraumatic myelopathies have not been evaluated extensively in most sub-Saharan African countries. The available studies in this region were conducted before the widespread clinical use of modern neuroimaging modalities. This study was conducted in Addis Abba, Ethiopia.We retrospectively analyzed medical files of patients with a diagnosis of myelopathy (age 13 years) admitted or followed up at Tikur Anbesa Hospital between 1 January 2010 and 30 June 2013.Records of 105 patients were analyzed. The male to female ratio was 1.7. The mean age was 38.5 years. Weakness, sensory symptoms (including sensory level), back pain and sphincter dysfunction were the dominant features. Etiologies were dominated by spinal tuberculosis (23.8%) followed by spinal cord neoplastic lesions (primary (10.5%) and secondary neoplasms 8.6%). Other important etiological causes were transverse myelitis (16.2%), degenerative cervical spondylotic myelopathy (15.2%), amyotrophic lateral sclerosis (4.8%) and neuromyelitis optica/multiple sclerosis (3.8%). The mortality rate was 9.5%. Among the patients who died, 40% had chest infection as a complication and 70% presented with complete weakness.Infections remain a major cause of spinal cord disease, and tuberculosis constitutes public health target for reducing the incidence of myelopathies. Early detection and treatment of complications may reduce the high rate of mortality and morbidity observed.

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