Chandigarh,06.02.18-
Stem cell therapy a boon for liver disease patients
 
Stem cell therapy has been found to be useful in patients with alcoholic hepatitis and cirrhosis. 
Decompensated cirrhosis carries a high mortality. Liver transplantation (LT) is the treatment of choice for patients with decompensated cirrhosis; however, the limited availability of donor organs and high cost results in high waitlist mortality. Stem cells of one's own body help in liver regeneration(LR)and delay/avoid liver transplant.The cost of stem cell therapy is about Rs. 10000/- for multiple courses and only Rs.3000/- for single course. 
What do we do?
In cirrhosis or alcoholic hepatitis, liver is damaged. We stimulated the bone marrow by injection called Granulocyte Colony Stimulating Factor(GCSF) which produced new cells called hematopoietic stem cells. Total blood count increases many fold and some of these cells home into liver and take function of liver cells and result in liver regeneration. The same principle was used in these two studies which have been published in top hepatology journals this month. The study on decompensated cirrhosis has been published in Hepatology and on alcoholic hepatitis in Clinical Gastroenterology and Hepatology.
Outcomes after Multiple courses of Granulocyte-Colony Stimulating Factor and Growth Hormone in Decompensated Cirrhosis: Randomized Trial-Hepatology 2018
 The present study investigated the impact of multiple courses of granulocyte-colony stimulating factor (G-CSF) with or without growth hormone (GH) in these patients. Sixty-five patients with decompensated cirrhosis were randomized to standard medical therapy (SMT) plus G-CSF 3 monthly plus GH daily (group A; n=23) or SMT plus G-CSF (group B; n=21) or SMT alone (group C; n=21). There was a better 12-month transplant free survival, significant decrease in clinical scores, improvement in nutrition, better control of ascites, reduction in liver stiffness, lesser infection episodes and improvement in quality of life in groups A and B, at 12 months as compared to baseline. There was better control of diabetes also in diabetic cirrhotic patients. The therapies were very well tolerated. 
Efficacy of Granulocyte Colony Stimulating Factor and N-acetyl Cysteine(NAC) Therapies in Patients with Severe Alcoholic Hepatitis-Clinical Gastroenterology and Hepatology 2018
Patients with alcoholic hepatitis (AH) have high mortality, so new therapies are needed. We compared the efficacy of standard medical therapy with a combination of GCSF and standard medical therapy as well as to the combination of NAC, GCSF, and standard medical therapy in patients with severe AH.We performed an open-label study of 57 patients with severe AH. Patients were assigned to groups that received standard medical therapy plus GCSF for 5 days (GCSF group; n=18), standard medical therapy plus GCSF and intravenous (NAC) for 5 days (combination group; n=19), or standard medical therapy alone (n= 20). Significantly higher proportions of patients in the GCSF group (16/18) and the combination group (13/19) survived for 90 days than in the standard medical therapy group (6/20). In our study, we found administration of GCSF to improve liver function and increase survival times in patients with severe AH, compared to standard therapy. We found no evidence for benefit of adding NAC to GCSF. The therapies were very well tolerated. 
We also conducted a trial of 46 patients with severe alcoholic hepatitis and showed similar results which has been published in American Journal of Gastroenterology in 2014. 
Hematopoietic stem cell therapy “might act as a bridge for liver transplant” and can provide some time to the patients to arrange for liver transplant. However, if a person stops taking liquor or if the therapy goes on well, then a patient can lead a healthy life for many more years.
The team of doctors which conducted the trials comprise of Dr. Virendra Singh,Dr Ratiram Sharma, Dr NipunVerma , Dr. Amarjit Keisham,Dr Ashish Bhalla, Dr Navneet Sharma, Miss Amritjyot Kaur, Dr. Ritesh Agarwal, Dr Akash Singh and Dr Arka De. 
We are also running two projects on liver regeneration funded by Indian Council of Medical Research and Department of Science and Technology, Government of India.We are also shortly starting a liver regeneration clinic at PGI,Chandigarh.
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A MCI sponsored CME is going to be organized by Department of Obstetrics and Gynaecology & School of Public Health and, PGIMER, Chandigarh on “A capacity building seminar for strengthening communication skills of doctors for counseling of parents regarding birth defects" on 8th February, 2018"
 
Tertiary care hospitals are usually overburdened with patients. This overburden of the patients in the OPD’s compromises the quality of care provided to patients. In Gynaecology and Pediatrics OPD patients who have children with birth defect have many queries regarding diagnosis, treatment options available as well as the financial load upon them. The doctors should be trained in attitude and communication skills (ATCOM) regarding birth defects for building better doctor patient relationship. In Genetic  Clinic, Gynecology OPDs there is plenty of opportunity to practice health promotion. There is a definite need to stress upon decentralization of counseling services in OPDs. Against this backdrop to bring together various experts in this area, a MCI sponsored CME entitled “A capacity building seminar for strengthening communication skills of doctors for counseling of parents regarding birth defects" will be  organized on 8th February, 2018"  at Auditorium-Advanced Eye Centre, 2-5 pm. 
Dr.Neelam Aggarwal, Additional professor, Department Of OBG, PGIMER will be the Organising Secretary to this Seminar.   Dr. Amarjeet Singh, Professor, Department of Community Medicine, PGIMER and Dr. Alka (Research Scholar) from Centre for Public Health Panjab University will be Convener and Co-convener to the seminar respectively. 
Various Speakers from PGIMER, Panjab University will be sharing their experiences. Approximately, 100 participants from OBG department, School of Public Health, and NINE, PGIMER, Centre for Public Health, Panjab University, etc. are expected to attend the seminar. Lecture of expert speakers will be followed by interactive discussion with the audience.        
Special children from Sadhna Society NGO, Chandigarh will also showcase their talents to solicit advocacy for their rehabilitation.       
This initiative will help work towards removing barriers and making existing health care systems more inclusive and accessible to people having babies with birth defect.