Hepatology and Pancreatic Science

Gastroenterology is the branch of medicine Related to the GI tract (stomach and intestines) and the accessory organs of digestion (from the mouth to the anus) focused on the digestive system and its disorders. Some of the conditions treated under this specialty include but are not limited to Crohn’s disease, Gastroesophageal reflux disease (GERD), inflammatory bowel disease, irritable bowel syndrome, peptic ulcer disease, celiac disease, colon cancer, heartburn, gastric cancer, diverticulitis, and ulcerative colitis. Gastrointestinal diseases refer to diseases involving the gastrointestinal tract, namely the esophagus, stomach, small intestine, large intestine and rectum, and the accessory organs of digestion, the liver, gallbladder, and pancreas. For more details, please visit: https://europegastroenterology.gastroconferences.com/ The global gastrointestinal therapeutics market size is expected to reach USD 65.1 billion by 2025, according to a new report by Grand View Research, Inc., registering a 6.6% CAGR during the forecast period. Growing geriatric population prone to gastrointestinal indications is one of the key factors anticipated to contribute to market growth. According to a report by WHO, colon cancer caused nearly 694,000 deaths in 2014.

Background: Hepatitis B and C viral infections during pregnancy are associated with high risk of maternal complications and mortality. Almost 40,000 children are born every year to HCV-infected women, resulting in up to 4000 new perinatally infected children yearly [6]. Several studies have shown an improvement in the biochemical markers of liver damage in HCV infected women during pregnancy . НLs phenomenon was seen during hemo dilution in pregnancy because the transaminase levels returned to pre-pregnancy levels shortly D�?�?er delivery. However, changes in the immune response during pregnancy can possibly play a sLJnLficDnt role in HCV interaction [8]. Contrary to the improved indices of liver dysfunction, a linear increase in HCV viremia has been reported throughout pregnancy [9], a fact that may be compatible with impaired immune reactivity. Several studies around the world have recommended that pregnant women should be screened for hepatitis B and C before delivery, as this reduces another generation from being infected by the viruses Нe sexual transmission of hepatitis B and C has also been described, and the transmission of the hepatitis B virus has been found to be the more prevalent in this regard [12]. Many countries have already adopted proper blood screening procedures that have minimized the risk of such viruses being transmitted through blood transfusion HBV and HCV positive mothers with an HBsAg and anti-HCV positive status can vertically transmit the infections to their infants [There is high prevalence of vertical transmission causing fetal and neonatal hepatitis which can have serious effects on the neonate, leading to impaired physical and mental health later in life. This study was aimed at evaluating HBsAg and Anti-HCV prevalence of these viruses among pregnant women accessing antenatal care in Federal Medical Centre, Keffi, Nigeria.

Materials and methods: Study area and population Нe study area for this research was Ke . �?¹ It is approximately 68 Km from Abuja, the Federal Capital Territory and 128 Km from LDfiD, the capital of Nasarawa State. Ke  �?¹ is located between latitude 8 5’N of the equator and longitude 7 8’E and situated on an altitude of 850 M above sea level [17]. A total of 200 pregnant women accessing antenatal care at Federal Medical Centre Ke �?¹ participated in this prospective cross sectional study D�?�?er an informed consent were obtained from each participant. НeLr demographic information was obtained by oral interview before sample collection. Sample collection About 5 ml of blood was collected from each participant by venipuncture into a labeled plain tube. НLs was allowed to clot at room temperature and spun for 5 minutes at 3000 rpm. Нe sera were harvested into well labeled cryovials and stored at -200°C until ready for use. This prospective cross sectional study took place between May-July 2016. A total of 200 blood samples were collected from pregnant women after informed consent and self-administered questionnaires were completed. Blood samples were analyzed using HBsAg and anti-HCV immunochromatographic screening kits (Fastep Polymed Therapeutics Inc, USA). Chi square test (Smith’s Statistical Package Version 2.80,California, USA) was used for assessing the association of risk factors with the infections.

Results: The overall level of positivity for both viruses in the study population was 14.0%. The prevalence of HBsAg was 8.0% while Anti-HCV was 6.0% and no woman was coinfected with the 2 viruses. The infection rate was highest among those aged 21-30 years old and 31-40 years old for HBV and HCV respectively (p>0.05). Нese might be attributed to socio-demographic dL�?�?�?´erences, cultural and behavioural dL�?�?�?´erences for the risk factors of HBV infections, methodological dL�?�?�?´erence and natural dL�?�?�?´erence linked with various geographical situations. Of note is also the fact that the prevalence reported in this study did not account for occult HBV infection. Similarly, the anti-HCV detection in this study was 6.0. It helps in making useful decision and sourcing of information concerning health and healthy living. More improved level of hygiene is related to higher levels of education. Mutagoma et al. [8] in Rwanda and Desalgn et al. [18] in Ethiopia reported same in a similar study. Нe infections were not associated with stage of pregnancy (p>0.05). It was highest (15.6%) in 2nd trimester pregnant women for HBV infection while HCV prevalence was highest among pregnant women on their 1st trimester (8.6%). НLs might be due to vertical transmission which is thought to be a major route of transmission among pregnant women in endemic areas. Such was also reported in similar study in Tanzania [19,21] and in Ghana [16]. Types of marriage, parity and surgical/dental procedure are not possible predictors for Hepatitis B and C viruses among the study population (p>0.05) although surgical/dental procedure was a predictor for HCV infection (p There was a statistically significant association between the viral infections and history of blood transfusion (p<0.05). Surgical/dental procedure was also a predictor for HCV infection (p<0.05) and was not a predictor for HBV infection (p>0.05) in this study. However, educational status, stage of pregnancy, type of marriage, parity and scarification marks did not show any statistically significant association with HBV and HCV infections (p>0.05), although there werearithmetic differences among the studied risk factors (p>0.05).

Conclusion: The study confirms a high prevalence of HBsAg and Anti-HCV among pregnant women in Central  Nigeria which is a serious public health problem that cannot be downplayed. Therefore, there is need for establishment of public health measures in order to reduce disease burden and vertical transmission, including routine screening of all pregnant women for these viruses.

The incidence of obesity is increasing like epidemic. 65%of adults in USA are obese and approximately 5.2-37% in different states India. One out of five children is obese (COED- organisation of economic co-operation and development) and the rate of obese females is three times that of male. We as clinicians and anaesthesiologists have to deal with this problem more and more day by day. Obesity is a major health problem affecting almost all organ systems. Most affected systems are cardiovascular, respiratory, endocrine, airway, OSA, hepatic, renal, musculo-skeletal etc. Obese patients have higher rate of post-operative complications like myocardial infarct, neuropathy, infection, DVT, pulmonary embolism etc. Morbidly obese are with BMI more than 40Kg/sq.m or super-obese with BMI more than 50Kg/sq.m are to be preoperatively prepared for better perioperative outcome. In superobese patients preoperative preparation may require 6-8 weeks of controlled diet, exercises and medical treatment. Preoperative workup aims at controlling systemic diseases, optimising cardio-respiratory status, stabilizing endocrinal abnormalities and improving nutrition, effort tolerance and psychological state of mind of the patient. Minimum of 10% weight reduction preoperatively with improved effort tolerance and cardiorespiratory status decreases perioperative complications and hospital stay and cost. Regular assessment and Psychological support during preoperative optimization prepares the super obese patient physically and mentally to undergo complex bariatric surgery

The incidence of obesity is increasing like epidemic. 65%of adults in USA are obese and approximately 5.2-37% in different states India. One out of five children is obese (COED- organisation of economic co-operation and development) and the rate of obese females is three times that of male. We as clinicians and anaesthesiologists have to deal with this problem more and more day by day. Obesity is a major health problem affecting almost all organ systems. Most affected systems are cardiovascular, respiratory, endocrine, airway, OSA, hepatic, renal, musculo-skeletal etc. Obese patients have higher rate of post-operative complications like myocardial infarct, neuropathy, infection, DVT, pulmonary embolism etc. Morbidly obese are with BMI more than 40Kg/sq.m or super-obese with BMI more than 50Kg/sq.m are to be preoperatively prepared for better perioperative outcome. In superobese patients preoperative preparation may require 6-8 weeks of controlled diet, exercises and medical treatment. Preoperative workup aims at controlling systemic diseases, optimising cardio-respiratory status, stabilizing endocrinal abnormalities and improving nutrition, effort tolerance and psychological state of mind of the patient. Minimum of 10% weight reduction preoperatively with improved effort tolerance and cardiorespiratory status decreases perioperative complications and hospital stay and cost. Regular assessment and Psychological support during preoperative optimization prepares the super obese patient physically and mentally to undergo complex bariatric surgery..

Background & Objective: Inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC) is an immune-mediated chronic intestinal disorder with an unknown etiology. The overexpression of proinflammatory factors such as proinflammatory cytokines is believed to have pivotal role in development of UC. Among them tumor necrosis factor alpha (TNF-α) is identified as a key cytokine. Also it has indicated that the levels of expression of NF-κB reflect development and progression of UC. It has no cure until now and the purposes of treatments are to alleviate signs, lengthening remission and improvement in quality of life in these patients. Different mechanisms for the effects of vitamin D on inherent and acquired immune systems are supposed to reduce inflammation, promote immunological tolerance and increase the intestinal epithelial integrity. Thus this study was designed to determine the effects of vitamin D supplementation on TNF-α, serum hs-CRP and NF-κB in patients with UC.

Materials & Methods: In this randomized, doubleblind, placebo-controlled study, 50 patients with UC were divided into two groups which the case group received two pearls of vitamin D (2000IU) once/day for 12 weeks and the control group received one placebo capsule and one pearl of vitamin D (1000IU) per day. Serum inflammatory markers, serum hs-CRP and NF-κB were assessed at baseline and the end of the study. Dietary intake and physical activity of patients is assessed by a valid questionnaire. Anthropometric and diet measurements were assessed in this study. The SPSS was used for data analysis.

Results: In this study, 24 patients in case group and 22 in control group. Among 50 participants completed the intervention. At the beginning of study, no significant differences were seen in baseline variables between two groups. At the end of 12 weeks there were no significant differences in serum hs-CRP, TNF-α between the case and control group after adjustment for confounders. The level of NF-κB in both groups increased, but this increase in the low dose group was statistically significant at the end of the study comparing to the beginning (P value=0.006).

Conclusion: Supplementation with 2000IU vitamin D daily for 12 weeks made no changes in serum hs-CRP. Serum TNF-α, remained with no change in both groups after adjustment. We recommend supplementation of vitamin D with appropriate dosage in all patients with UC in order to take advantage of its great therapeutic benefits