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Objective: To study the anatomical status and functional outcome of Pars Plana Vitrectomy surgery in rhegmatogenous retinal detachment (RRD) at a tertiary eye care center in India. Material, Patients and Method: This is a prospective, noncomparative, consecutive, interventional study of rhegmatogenous retinal detachment managed with Pars Plana Vitrectomy surgery performed in the Regional Institute of Ophthalmology, Prayagraj, India. 40 patients of 40 eyes (26 phakic 65%, 14 pseudophakic 35%) with retinal detachment were treated by primary pars plana vitrectomy with 6 months of follow-up. Result: A total of 40 patients (40 eyes) were operated, 18 males and 2 females, with age, ranges from 17 years to 90 years. After surgery, anatomically retinal reattachment was achieved in 40 (100%). Improved best-corrected visual acuity (BCVA) was seen in 38 (90%) patients, whereas in 2 (5%) patient BCVA was not improving and deteriorated from pre-operative in another 2 (5%) patient. There was no significant difference was found in the pseudophakic and phakic eye in functional outcome. Conclusion: Rhegmatogenous retinal detachment is one of the common causes of visual impairment and blindness. Timely surgical management with Pars Plana Vitrectomy surgery can give good anatomical and visual outcome.

The quote “no hoof, no horse is entirely true. Without solid, sound feet, you have no horse, so understanding hoof anatomy is extremely important. The hoof of horse is anatomically complex designed and highly specialized digital end organ. Compare the size and weight of a horse relative to the size of a hoof, and how fast horses can run or how high they can jump; it’s amazing how so much is supported by so little. Knowledge of functional anatomy of the hoof and all its internal structures is of paramount importance in being able to assess the condition of the horse health and performance. The different parts of hoof serving a different purpose, yet working in symmetry to keep the horse sound and healthy. Numerous factors can affect hoof structure and health, including genetics, hoof conformation, environmental influences, and athletic performance of the animal.

Seed of 9 induced mutant lines of lentil (Lens culinaris Medik. L.) were used for the experimental purpose. These mutants were isolated from variety K -75 with gamma ray and EMS treatment. The self-seeds of all mutants were sown in randomized block designed in three replications at Agricultural Research Farm, Institute of Agricultural sciences, B.H.U, Varanasi, during Rabi 2017-18.Distance between row to row and plant to plant was maintained 30cm and 5cm respectively. In genotypic path analysis, the secondary branches showed the highest positive direct effect (0.991) on grain yield followed by test weight (0.8706) and number of pods per plant (0.2640) in year 2017-18. In phenotypic path analysis, the number of pods per plant showed highest positive direct effect (1.054) followed by days to 50% flowering and test weight (0.0436) in year 2017-18. So that maximum importance of these characters might be given in selection program me.

Ocular toxocariasis is an uncommon worldwide parasitic infection that affects mostly children and is found in both rural and metropolitan areas. In many parts of the world, parasitic infections of the eye are a major cause of blindness. The diagnosis of toxocariasis is essentially clinical, based on the lesion morphology and supportive laboratory data such as serum enzyme-linked immunosorbent assay (ELISA) titers and ELISA Toxocara titers on aqueous humor; other diagnostic methods are imaging studies including optical coherence tomography, fluorescein angiography, computed tomography, and ocular ultrasound. Treatment is directed at complications arising from intraocular inflammation and vitreous membrane traction. Early vitrectomy may be of value both diagnostically and therapeutically.

The Indian Society of Gastroenterology developed this evidence-based practice guideline for management of gastroesophageal reflux disease (GERD) in adults. A modified Delphi process was used to develop this consensus containing 58 statements, which were generated by electronic voting iteration as well as face-to-face meeting and review of the supporting literature primarily from India. These statements include 10 on epidemiology, 8 on clinical presentation, 10 on investigations, 23 on treatment (including medical, endoscopic, and surgical modalities), and 7 on complications of GERD. When the proportion of those who voted either to accept completely or with minor reservation was 80% or higher, the statement was regarded as accepted. The prevalence of GERD in India ranges from 7.6% to 30%, being

IntroductionThese Asian Working Group guidelines on diet in inflammatory bowel disease (IBD) present a multidisciplinary focus on clinical nutrition in IBD in Asian countries.MethodologyThe guidelines are based on evidence from existing published literature; however, if objective data were lacking or inconclusive, expert opinion was considered. The conclusions and 38 recommendations have been subject to full peer review and a Delphi process in which uniformly positive responses (agree or strongly agree) were required.ResultsDiet has an important role in IBD pathogenesis, and an increase in the incidence of IBD in Asian countries has paralleled changes in the dietary patterns. The present consensus endeavors to address the following topics in relation to IBD: (i) role of diet in the pathogenesis; (ii) diet as a therapy; (iii) malnutrition and nutritional assessment of the patients; (iv) dietary recommendations; (v) nutritional rehabilitation; and (vi) nutrition in special situations like surgery, pregnancy, and lactation.ConclusionsAvailable objective data to guide nutritional support and primary nutritional therapy in IBD are presented as 38 recommendations.

Makhana (Euryale ferox Salisb.) cultivation in field conditions has just begun, making it imperative to develop an integrated nutrient management (INM) package for realizing the yield potential of makhana in north Bihar. A three year experiment was carried out. Application of NPK @75:45:30 kg ha-1 led to a yield improvement of 10% over control, with an additional improvement of 8.2% by NPK @100:60:40 kg ha-1, which was 19% higher than the yield under control. No yield increment was recorded with further increase in NPK i.e. @125:75:50 kg ha-1. However, T3 in combination with FYM @20 t ha-1 caused 22% yield enhancement over NPK @100:60:40 kg ha-1 and 45.2% over control. Even the sole application of FYM @20 t ha-1 resulted in 28% higher yield compared to control and 7.6% yield advantage over NPK @100:60:40 kg ha-1. Clearly, makhana yield was boosted by both NPK and FYM, applied alone or in combination. However, the effect of FYM was more pronounced than that of NPK, implying that the yield of makhana was not limited as much by NPK availability as by the factors contributed by FYM application. FYM-induced increases in organic C and micronutrients could be credited for better yield boosting effect of FYM. To conclude, an INM package consisting of NPK @100:60:40 kg ha-1 with FYM @20 t ha-1 is recommended for materializing the yield potential of makhana in field conditions of north Bihar.

A field experiment was conducted to evaluate the influence of limited and adequate irrigation and moisture conservation practices (rice straw mulch and hydrogel) on yield and water use efficiency in wheat. Though, maximum wheat yield (3.92 t/ha) and water use efficiency (15.72 kg/ha/mm) was recorded with four irrigations at crown root initiation stage, tillering, late jointing, and milk stage, two irrigations applied at tillering and flowering and soil mix drilling of 7.5 kg/ha hydrogel (a synthetic polymer) at sowing produced comparable yield (3.34 t/ha) with less water use, enhancing the water use efficiency (15.45 kg/ha-mm). The higher net return and B : C ratio were found in the treatment 2.5 kg/ha hydrogel. Thus, from present study it may be concluded that under limited irrigation conditions, water conservation practices like soil mix drilling of hydrogel and rice-straw mulching are beneficial for maintaining optimum moisture in soil to enhance wheat yield and water use efficiency.

Background Type 2 diabetes mellitus (T2DM) is a global major health problem resulting from interaction of environmental and genetic factors, examples of the latter being KCNJ11 (coding for part of the ATP-sensitive potassium channel) and SDF-1β (coding for chemokine CXCL12). Our case-control study was conducted to assess whether recessive, dominant or additive genotype model associations of KCNJ11 (E23K, rs5219) and SDF-1β (G801A, rs1801157) were more strongly linked to type 2 diabetes. Subjects & Methods Genetic polymorphism analysis was performed by polymerase chain reaction-restriction fragment length polymorphism. Alleles and genotype frequencies between 200 cases and 200 controls were determined and compared. Results The dominant (EE v EK + KK, p = 0.022) and additive (EK v EE + KK, p = 0.021) models, but not the recessive model (KK v EE + EK, p = 0.727) of KCNJ11 were linked to diabetes. Similarly, the dominant (GG v GA + AA, p

Introduction The poor nutritional status of under five children has been considered a serious problem in Nepal for many years. Children need adequate nutrition for their proper physical, emotional as well as psychological development. Objective The objective of this study was to assess and compare the nutritional status of under five children and explore its socio demographic determinants. Methodology An analytical cross-sectional study was conducted in Eastern Terai, ecological belt of Nepal. Predesigned, pretested interview schedule was used to collect the information. Information was collected from 720 Dalit as well as Non-dalit mothers about their youngest children. The nutritional status was measured byusing anthropometric measurements. Results In bi-variate analysis the significant difference were observed among children's nutritional status between castes as well as a number of socio-demographic variables however in multivariate analysis only caste, number of Children Ever Born (CEB) and mother's education were found significant determinants of height for age, mother's education was found significant determinant for weight for height and caste, age of children and mother's education were found significant determinants of weight for age of children. Conclusion Dalit children were found much more malnourished than Nondalit. The castes, age of child, CEB to mother and mothers' education were found as the determinants of nutritional status among under-five children. Birat Journal of Health Sciences Vol.2/No.1/Issue 2/ Jan - April 2017, Page: 117-126

The recommendations 31 which recommend "VSL#3®", refer only to the product used in the cited literature and equivalent products independent from the present product labelings. This product is now known by the generic name "De Simone Formulation".

“Katarni Rice” is the most prevalent, ceremonial and finest quality scented rice of Bihar. It is famous for its aromatic flavour, palatability and chura (beaten rice) making qualitiesofGeographical area of production of Katarni Rice includes districts of Munger, Banka and South Bhagalpur of Zone IIIA of Bihar. The unique features of Katarnirice is developed only when it is grown in its territory areas. It has an immense scope of trading in local as well as export market. But, the available Katarni rice is poor yielder (25-30 t/ha) and farmers are tending towards the cultivation of non-aromatic high yielding rice varieties. Hence, in order to save this landrace from extinction and promote and protect the interest of Katarni growers, attempts were made to get its geographical indication (GI). With objective of providing exclusive right to the farmers for growing this premium quality rice and getting remunerative price through its marketing, an application for getting the tag of geographical indication was submitted by a Katarnigrowers’ association. Bihar Agricultural University, Sabour as a technical facilitator for this application, served to characterize and document this rice landrace on the basis of morphological, biochemical and genetical traits. The present study deals with purification, documentation and characterization of Katarni rice which helped in getting the GI tag in 2018 from the office of Intellectual Properties Rights, New Delhi, India.

Psoriasis is an immune mediated inflammatory skin disease with complex etiology involving interplay between environmental and genetic risk factors as disease initiating event. Enhanced understanding on genetic risk factors, differentially expressed genes, deregulated proteins and pathway-targeted therapeutics have established multiple axis of psoriasis pathogenesis. So far, loci in 424 genes are reported to be associated with psoriasis alongside copy number variations and epigenetic alterations. From clinical perspective, presence of specific genetic trigger(s) in individual psoriasis patient could aid in devising a personalized therapeutic strategy. Therefore, the review presents an updates on reported genomic alterations and their subsequent course of cutaneous inflammations that potentially drive to psoriasis.

Diabetic nephropathy (DN) has become the leading cause of end-stage renal disease worldwide. Non-diabetic renal disease (NDRD), is known to occur in diabetic patients. The renal and retinal relationship in type 2 diabetes mellitus (T2DM) with nephropathy is not uniform. This study was carried to study the histological spectrum of nephropathy in type 2 diabetic patients with proteinuria and its relationship with diabetic retinopathy (DR). Total 31 (males - 26; females - 5) proteinuric type 2 diabetic patients were studied. Average age of patients was 50.7 years. Nephrotic syndrome was noted in 21 (67.7%) patients. Overall, isolated DN, NDRD and NDRD superimposed on DN (mixed lesion) were observed in 12 (38.7%), 13 (41.9%) and 6 (19.4%) cases, respectively. DR was absent in 21/31 (67.7%) cases. The spectrum of nephropathy in patients without DR included: DN in 6 (28.57%), NDRD in 12 (57.14%) and mixed lesion in 3 (14.29%). Kidney histology in patients with DR (n-10) revealed DN in 6 (60%), NDRD in 1 (10%) and mixed lesion in 3 (30%) patients. Thus, absence of DR favors NDRD but does not exclude DN because isolated DN was noted in 28.57% cases in absence of DR. Similarly biopsy proven NDRD (pure NDRD; 10% and mixed lesion; 30%) was noted in 40% of cases in presence of DR. In summary, patients with T2DM had higher incidence of NDRD. DR is less frequent (32.3%) in type 2 diabetes and is a poor predictor of type of nephropathy. Hence, renal biopsy is essential for precise diagnosis of nephropathy in patients with T2DM.

Attributes of Himalayan Forest Ecosystems: They are not Temperate Forests

Background Hepatitis B Virus (HBV) X protein (HBx) is known to be involved in the initiation and progression of hepatocellular carcinoma (HCC) through modulation of host gene response. Alterations in miRNA expressions are frequently noted in HCC. This study is aimed to examine the role of HBx protein in the modulation of oncogenic miRNA-21, miRNA-222 and tumor suppressor miRNA-145 in malignant hepatocytes. Methods Expressions of miRNA-21, miRNA-222 and miRNA-145 were measured in HepG2 cells transfected with HBx-plasmid (genotype D) and with full length HBV genome (genotype D) and also in stably HBV producing HepG2.2.15 cells using real time PCR. Their target mRNAs and proteins - PTEN, p27 and MAP3K - were analyzed by real time PCR and western blot respectively. miRNA expressions were measured after HBx/D mRNA specific siRNA treatment. The expressions of these miRNAs were analyzed in liver cirrhosis and HCC patients also. Results The study revealed a down-regulation of miRNA-21 and miRNA-222 expressions in HBx transfected HepG2 cells, pUC-HBV 1.3 plasmid transfected HepG2 cells as well as in HepG2.2.15 cells. Down regulation of miRNA-21 and miRNA-222 expression was observed in patient serum samples. Down regulation of miRNA-145 expression was observed in HepG2 cells transiently transfected with HBx and pUC-HBV1.3 plasmid as well as in patient samples but the expression of miRNA-145 was increased in HepG2.2.15 cells. Target mRNA and protein expressions were modulated in HepG2 cells and in HepG2.2.15 cell line consistent with the modulation of miRNA expressions. Conclusion Thus, HBx protein differentially modulated the expression of miRNAs. The study throws light into possible way by which HBx protein acts through microRNA and thereby regulates host functioning. It might suggest new therapeutic strategies against hepatic cancer.

Globally, around 150 million people are infected with hepatitis C virus (HCV). India contributes a large proportion of this HCV burden. The prevalence of HCV infection in India is estimated at between 0.5% and 1.5%. It is higher in the northeastern part, tribal populations and Punjab, areas which may represent HCV hotspots, and is lower in western and eastern parts of the country. The predominant modes of HCV transmission in India are blood transfusion and unsafe therapeutic injections. There is a need for large field studies to better understand HCV epidemiology and identify high-prevalence areas, and to identify and spread awareness about the modes of transmission of this infection in an attempt to prevent disease transmission.

EDTA is useful to assess mobile metal pools in polluted soils and sediments. There is a need to enhance our understanding of the significance of metal fractions released. The impact of single reagent extraction with 0.05 mol L−1 EDTA on the solid phase distribution of trace metals in surface soils sampled from confined dredged sediment disposal sites was investigated. Not extracted and EDTA extracted soils were subjected to sequential extraction to fractionate the total contents into: (1) easily exchangeable and carbonate bound fraction; (2) reducible fraction; (3) oxidisable fraction; and (4) residual fraction. With EDTA, significant portions of metals associated with the acid extractable and reducible fractions were released. The oxidisable and residual fractions remained unaffected for most of the investigated metals except for the organic matter associated metals (Cu and Pb). A decrease in the residual fraction after EDTA-extraction for Cu and Pb was attributed to artifacts of the sequential e...

Accumulation of heavy metals by plants causes concern because it is a major pathway by which metals can enter into the food chain. Extractability and bioaccumulation in rye grass of Cd, Cu, Mn, Pb and Zn in dredged sediment derived surface soils were studied in a greenhouse experiment. The soils were extracted with 0.01 mol L−1 CaCl2, 1 mol L−1 NH4OAc, 0.02 mol L−1 NH4OAC—EDTA, 0.005 mol L−1 DTPA and 0.1 mol L−1 HCI. Extracted metal contents were correlated with concentrations in rye grass, harvested after 1 and after 2 months. The extractability of Cd, Mn and Zn decreased in the order NH4OAC-EDTA > HCI > DTPA > NH4OAC > CaCl2. For Cu and Pb, the order was similar except that DTPA extracted higher amounts than HCI. No significant differences in dry matter yield were observed between the soils upon the first harvest. In the second harvest, the dry matter yield was significantly lower for the soils highest in clay content. Elevated concentrations of Cd and Zn were observed in the plant material and ...

AIM Toll like receptors plays a significant anti-viral role in different infections. The aim of this study was to look into the role of toll like receptor 4 (TLR4) in hepatitis B virus (HBV) infection. METHODS Real time PCR was used to analyze the transcription of TLR4 signaling molecules, cell cycle regulators and HBV DNA viral load after triggering the HepG2.2.15 cells with TLR4 specific ligand. Nuclear factor (NF)-κB translocation on TLR4 activation was analyzed using microscopic techniques. Protein and cell cycle analysis was done using Western Blot and FACS respectively. RESULTS The present study shows that TLR4 activation represses HBV infection. As a result of HBV suppression, there are several changes in host factors which include partial release in G1/S cell cycle arrest and changes in host epigenetic marks. Finally, it was observed that anti-viral action of TLR4 takes place through the NF-κB pathway. CONCLUSION The study shows that TLR4 activation in HBV infection brings about changes in hepatocyte microenvironment and can be used for developing a promising therapeutic target in future.

© 2011, INASL 8 Results: The IC50 of the monoherbal preparations found out to be 1 mg/mL, 20 uM and 10 uM for Phyllanthus amarus, Andrographis paniculata and Silybum marianum, respectively as obtained from the decline in viral load in the soups collected from HepG2 2.2.15 cell lines. Conclusion: The above monoherbal preparations found to have a significant decline in viral proliferating markers. In comparison with the control, herbal treatment proved to have an efficacious effect and IC50 was calculated for them. Thus the herbs could be beneficial against HBV with least side effects in comparison to synthetic drugs. However it’s a preliminary data and further studies are needed to prove it. Conflict of Interest: None Clinical Spectrum of Hepatitis B Infection in Southern India B Siva Subramaniam, V Arul Selvan, K Arun Kumar, V Jayanthi Department of Gastroenterology and Hepatology, Stanley Medical College and Hospital, Chennai Background: Hepatitis B is a global problem, affecting over 400 million populations. Large numbers of cases are referred to our center. Aim: To determine the spectrum of hepatitis B infection amongst patients attending the Liver Clinic at a tertiary GI and Hepatology center. Method: All patients who were diagnosed as HBsAg positive were included in the study. Baseline evaluation included LFT, ultrasound, alphafetoprotein estimation and virological profile for hepatitis B (HBeAg, quantification of HBsAg, HBV DNA), hepatitis C (anti-HCV antibody) and HIV status. Family members were also screened for the above markers if found to be HBsAg positive. Based on the viral profile, transaminase levels, patients were categorized into immunotolerant, inactive carriers, immune clearance and reactivation phase and risk factors were also looked for. Patients with incomplete virological profile were excluded from the study. Results: One hundred and thirteen patients were fulfilled the criteria. Among the 113 patients 38 (33.6%) patients were in immunotolerant phase, 15 (13.2%) patients in immune clearance phase, 57 (50.4%) patients were inactive carriers and 3 (2.6%) patients were in reactivation phase. Twenty patients had cirrhosis, 2 patients were presented with hepatocellular carcinoma and 7 patients were pregnant. HBV DNA levels are low in patients with cirrhosis and HCC. Table Different phases of HBV infection Variables Immunotolerant Immune clearance Inactive carrier Reactivation phase (n = 38) (33.6%) (n = 15) (13.2%) (n = 57) (50.4%) (n = 3) (2.6%) Mean age 32 (median) 40 (mean) 36 (mean) 55.33 (mean) Sex ratio 24:14 (M:F) 13:2 (M:F) 19:38 (M:F) 3 males ALT 52.4 137.3 34.7 174.6 HBsAg quantification 10905.4 3206.567 5885.958 9368.615 HBV DNA 2672419 856432 313.9963 4491218 Conclusion: The spectrum of hepatitis B infection observed in Southern India was similar to the spectrum seen in West. The immunotolerant phase extends up to 32 years and virus starts clearing in between 32 and 40 years. So far, no similar data is available from South India. Conflict of Interest: None Frequency of Hepatitis B Virus Surface Gene Variant Circulating Among HBsAg Negative Individuals in Coastal Eastern India: A Preliminary Report MK Panigrahi, SK Kar, B Misra, SP Singh, HS Das, C Panda Department of Gastroenterology, SCB Medical College, Cuttack, Orissa, India Background: Genetic mutation might account for the presence of hepatitis B virus (HBV) DNA among HBsAg negative individuals. The aim of the study was to assess the prevalence and significance of surface gene mutations among HBsAg negative chronic liver disease cases (CLD) who attended the Gastroenterology OPD at SCB Medical College, Cuttack. Methods: Twenty HBsAg negative CLD sera of adults (mean age 44.8 ± 12.1; range 28–70 years) were included in this study. Surface gene region were amplified and surface gene was analyzed after direct sequencing. Results: Out of the total 20 CLD cases studied, only 5 samples were found to be HBV DNA positive (5/20; 25.0%). Genotype D was the prevalent genotype found in the study with no prevalence of other genotypes. In all 5 patients, substitutions within as well as outside 03_JCEH-Abstract.indd 8 3/18/2011 11:13:03 AM

The study included 200 healthy age and sex matched controls (120 healthy volunteers and 80 healthy antenatal cases without any bad obstetric history) and 300 cases comprising patients with bad obstetric history (BOH) 80 cases, seizure or encephalitis 50 cases, cervical lymphadenopathy 30 cases, congenital deformity 30 cases, HIV infected 80 cases and patients on long term immunosuppression 30 cases. Anti-toxoplasma IgG & IgM were measured by ELISA and individuals found positive for anti Toxoplasma gondii IgM or with high titre of IgG were subjected to repeat testing after 3 weeks for rise in titre. True sero-prevalence of T gondii infection was found to be 19% and it increased with increasing age in the population. 2.33% patients were found to have acute toxoplasma infection. Statistical significance was seen only in patients with BOH and children born with congenital abnormality.

Anomalous coronary arteries cause only uncharacteristic symptoms and are therefore often an incidental finding during conventional coronary angiography, with an incidence of 0.3-0.8%. The commonest anomaly is an aberrant origin of the main left or right coronary artery from the wrong sinus of Valsalva. Rarely there is a fistula draining into one of the cardiac cavities (right ventricle, right atrium, left ventricle or, rarely, superior vena cava) or displaced connection, as seen in anomalous origin of coronary artery from the pulmonary artery, resulting in a left-to-right shunt. In congenital heart disease, especially Fallot's tetralogy, the incidence of abnormal coronary arteries may be 2% or more. The proximal course in the former category may be misdiagnosed in up to 50% of cases. Aortic root injection with subtraction angiography, further detailed investigation with transoesophageal echocardiography or magnetic resonance angiography are therefore required as these have potential implications on subsequent surgery. Because of the abnormal course between aorta and pulmonary artery/outflow tract of the right ventricle and acute angulation there is a risk of angina, acute myocardial infarction or sudden death during or after exercise. It is therefore important to identify the exact cardiac anatomy, particularly in patients undergoing angioplasty, stenting or cardiac surgery.

Background: Nonalcoholic fatty liver disease (NAFLD) is fast becoming one of the top concerns for clinicians due to the obesity epidemic and it's potential to progress to chronic liver disease which has significant impact on liver-related morbidity and mortality. Advanced fibrosis that accompanies NAFLD leads to the development of Cirrhosis and hepatocellular carcinoma. Objectives: There is a need to identify patients who are likely to have fibrosis. Methods: Two hundred and sixteen cases were selected for liver biopsies taking into account the clinical parameters andorUltrasonographyfindingsof fatty liver. Formalinfixed paraffin embedded tissue sections were stained with Haematoxylin andEosin, Reticulin andMasson's Trichrome.Histopathologic scoringwasdone asperBrunt et al scoringsystem. Result: Out of 216 biopsy proven NAFLD patients, 183 were male and 33 female. On histopathological study, fibrosis was found in 48.216 (22%) cases. On evaluation of metabolic profile, two third (59%) were obese (BMI > 23), 75% had transaminitis, 93% had dyslipidemia, 23% were diabetic and 20% were hypertensive. Inspite of these metabolic derangements, only 36% had moderate fatty change on ultrasonography and rests were mild. Metabolic syndrome was present in only 45% of patients. Conclusion: At present, liver biopsy is the only diagnostic method to detect progression to fibrosis stage in NAFLD cases. Early detection of fibrosis can reverse the pathogenetic mechanism with prompt institution of therapy. Factors associated with fibrosis in our study were higher age i.e, age >40 years, female gender, high BMI >23 and moderate fatty change on ultrasonography.

Background Before 2008 GUM provision in BFG comprised one central and two satellite GUM clinics. Run by a F/T consultant and 3 or 4 nurses, it covered an area the size of Scotland with little primary care input. Since 2008 Guy9s and St. Thomas9 [GSTT] and SSAFA Forces Help have held the contract to provide GUM services to the BFG population. The contract was for a nurse-led service with consultant cover provided remotely and through monthly visits from the UK. Aim To increase provision of screening and management of STIs across BFG by the new [reduced] staff. Objectives To modernise the GUM service; to develop the 15 primary care medical centres across the region to provide level 1 and 2 GUM service, and to offer out-reach screening to soldiers and school children. Methods The labs replaced routine cultures and chlamydia PCR with dual NAATs making it cost neutral. We modernised the GUM service and encouraged testing, especially for HIV. Training for primary care providers included STIF courses. Once trained, GPs supported their nurses to deliver screens. The GUM nurses visited medical centres to encourage and support provision. We also instituted young peoples9 services for schools and targeted screening to soldiers at Health Fairs. Results 60 multi-professionals have attended our STIF courses, mean evaluation score is 4.4/5. We used figures from the lab servicing the majority of BFG. Despite a steep decline in the community [soldiers, their dependants and contractors] from 46k in 2008 to 36k in 2011, there has been a marked improvement in all measures of SH provision. The GUM workload has also risen and HIV tests have doubled. Conclusions We describe a successful, innovative, cost effective model for a nurse-led GUM service which could be used elsewhere. There is now a vastly increased availability of STI screening for our scattered, high-risk population. We will present data for 2008–2011 by age and gender (see abstract P131 table 1).