Joel Lavine

Cholestasis in newborns


Published On:- 09-28-2022

The newborn liver may be impacted by neonatal cholestasis, leading to severe consequences. It is brought on by several viruses, metabolic liver illnesses, and hereditary conditions. The liver's function is hampered by certain conditions, including Alagille syndrome and alpha-1-antitrypsin deficiency. Studies have shown that hereditary factors, which run in 15 to 20% of families, may be involved.

Neonatal cholestasiemia should be identified at a young age. Delay in diagnosis may lead to needless diagnostic testing and worse patient outcomes. In actuality, though, this is not always feasible. The misinterpretation of breastfed-associated jaundice and early hospital release without proper follow-up are just a few variables that can delay the diagnosis.

Neonatal cholestasis can show in various ways depending on the cause, but common symptoms include persistent jaundice, acholic stools, dark yellow urine, and hepatomegaly. After the delivery of indirect bilirubin, jaundice may gradually get better. The existence of extrahepatic biliary blockage is suggested by pigmented stools rather than cholestasis, which is not always indicated by acholic stools.

Surgical management is used based on the cause of the condition and its symptoms. Biliary diversion and liver transplantation are examples of surgical interventions. These treatments can alter the course of the illness and stop additional problems. Neonatal cholestasis is a very uncommon liver condition. Hyperbilirubinemia conjugate is the main symptom. The reason, which can be identified through laboratory testing, liver biopsy, or hepatobiliary ultrasonography, will decide the course of treatment. Cholestasis is rarely fatal. However, it should still be assessed as soon as feasible.

Surgery, biliary diversion, or liver transplantation are all options for treating neonatal cholestasis. A delayed presentation or referral may lead to a poor result. The outcome is better the earlier the diagnosis is made. When infants with cholestatic illness present, this is particularly true. Neonatal cholestasis treatment might be challenging. It might not be easy to distinguish between the syndrome and other conditions, such as biliary atresia. Ultimately, diet and fat-soluble vitamins are crucial in treating newborn cholestasis. Neonatal cholestasis should not be treated with the Kasai operation because it has no positive effects on outcomes.

One in every 2500 term infants suffers from the potentially fatal illness known as neonatal cholestasis. At the first symptom of jaundice or another biliary issue, it is best to seek medical attention. The child's life can be saved by early diagnosis and treatment. Elevated serum bilirubin levels signify poor bile flow and generation and characterize neonatal cholestasis, an acute illness. Numerous conditions, including biliary atresia, surgical issues, and genetic factors, can result in neonatal cholestasis. Therefore, it's crucial to determine the cause and start therapy every once to diagnose newborn cholestasis.

Neonatal cholestasis has been related to adult liver illness, even though its genetic sources are unknown. Researchers found 61 genes linked to cholestasis in a study of 141 neonatal cholestasis patients, and in 22% of cases, they established a tentative diagnosis. Another study that looked at 66 genes in 716 kids with cholestasis and liver illness of unclear etiology found a single pathogenic variation and a positive molecular diagnosis in 11.7% of the kids. Mutations in the genes involved in the synthesis and transport of bile acids are among the genetic causes of newborn cholestasis. Many of these genes regulate the transport and metabolism of enterohepatic bile acids. Additionally, several more recent investigations have shown disease-causing gene variations related to canalicular transport.

An invasive liver biopsy is used to diagnose neonatal cholestasis in infants. It helps with management in about a third of situations. To ascertain the ideal timing for this surgery, more research is necessary. Percutaneous cholangiography may be more beneficial in some subgroups of patients. Seventy patients are involved in the trial. Twenty-one of these patients weren't cholestasis. Fifty-eight patients nevertheless received biopsies. Of these, 13 were completed during surgical operations, and 45 were completed by interventional radiologists using ultrasound guidance.

Traditionally, liver biopsies have been utilized to identify the source of newborn cholestasis. However, liver biopsy is frequently unreliable, especially when diagnosing biliary atresia. Furthermore, liver biopsies are not always accurate in identifying disorders like neonatal cholestasis and others connected to it. But before having surgery or operational cholangiography, a liver biopsy can help rule out other disorders and is the cornerstone of the diagnostic process for infants with cholestatic jaundice. However, because there are so many potential diseases, liver biopsy in neonatal cholestasis has poor accuracy. For neonates with cholestasis, the average accuracy rate ranges from 60% to 95%.

ICD-10 Codes for Metabolic Liver Disease


Published On: - 09-15-2022


An illness that affects the liver is known as metabolic liver disease. Cirrhosis, genetic predisposition, and environmental factors can all contribute to this illness. You should see a doctor for more information if you have the ailment.


The ICD-10 code range K70 to K77 covers liver diseases. This group of codes represents illnesses with many causes, such as chronic hepatitis. For reimbursement purposes, codes within this range may be allocated to the same patient or group.

Cirrhosis is a major public health concern and the last stage of liver disease. Its increasing prevalence harms people's quality of life all around the world. Cirrhosis kills around one million individuals each year. Cirrhosis accounts for one to five million years of life lost in the United States alone. The most common cause is the hepatitis B virus. Despite the high prevalence of cirrhosis, most people who catch the virus do not develop symptoms for decades.

Cirrhosis has several causes. HCV was the major cause of cirrhosis in 2000, accounting for 59% of incident cases. NAFLD was the second biggest cause of cirrhosis in 2019. It was the second-leading cause of the disease in 2000, after ALD. HCV was the fourth biggest cause of cirrhosis in 2019.

Alanine aminotransferase (ALT) is a transaminase enzyme in the liver and blood. It is a key indicator of hepatocellular damage. Elevated ALT levels have been linked to non-alcoholic fatty liver disease. This disease is distinguished by hepatic steatosis and includes a wide spectrum of clinical disorders. Asymptomatic steatosis can proceed to non-alcoholic steatohepatitis, fibrosis, or cirrhosis, which can be fatal.

An automated approach employing ICD-10 codes was utilized to identify patients with suspected DILI to determine the prevalence of DILI. The system discovered 182 examples, 61 of which were false positives and 121 true positives. It exhibited a 66.5% positive predictive value and was appropriate for resource-limited settings. Further research incorporating natural language processing may improve the algorithm's utility.

Certain genetic variations in liver cells influence genetic vulnerability to metabolic liver disease. Previous research has linked genes to bile acid transport, lipid and carbohydrate metabolism, glycobiology, and the immune system. However, identifying other routes and processes will require a deeper knowledge of the hereditary risk for metabolic liver disease. Studies on genetic risk for liver illnesses are currently confined to very small cohorts.

Genetic variations linked to cirrhosis were discovered in this investigation. There were five previously known genes and seven newly discovered ones among these variations. In addition, an APOE gene missense variant and a noncoding mutation near the EFN1A gene were shown to be related to an increased risk of cirrhosis. A total of twelve variations were examined and classified as polygenic risk. Individuals with high polygenic risk were substantially more likely to develop cirrhosis.

Environmental factors have a significant impact on the development of metabolic liver disease. In addition, these risk factors may impact the disease's prevalence in different groups. Even if the risk factor is not the primary cause, the existence of specific environmental risk factors can influence the overall disease burden. Environmental risk variables were found to be related to IHD and diabetes in this study.

Alcohol use has been established as a significant risk factor for liver disease, with excessive alcohol consumption occurring in various nations. Alcohol use disorders are frequently misdiagnosed, and effective pharmacological and psychological therapies may help to minimize the burden of alcohol use. Liver disease is a serious global health issue in the twenty-first century and an essential indication of the health environment.

Hepatitis C and metabolic liver disease (NAFLD) are linked to an elevated risk of cardiovascular disease. Both are distinguished by aberrant lipids, fibrosis, and diminished liver sponginess. Both of these disorders are frequently associated with elevated blood cholesterol levels. Both disorders affect the liver and are frequently related to other health issues, such as diabetes.

The global burden of HCV and related disorders is enormous, with over one million people dying due to the disease each year. Each year, the disease claims about one million years of life in the United States. Cirrhosis is more common in developing countries but is becoming more widespread in developed countries.

Job Description for a Medical Consultant.

Published On: - 09-05-2022


A pharmaceutical consultant works with the pharmaceutical industry on projects promoting product development, clinical trials, and drug development. They could also help with eQMS software or commissioning procedures. This individual is a tremendous asset to the pharmaceutical industry because of their extensive knowledge of how it works. A pharmaceutical consultant's job entails advising clients on developing and marketing pharmaceutical products. Consultants can help pharmaceutical companies develop new products and strategies and support regulatory submissions. They can also help with commissioning procedures and allow companies to improve their fundamental drug development processes. To be a successful pharmaceutical consultant, you must have excellent communication skills. The benefits of pharmaceutical items, for example, and the most recent research must be explained. Furthermore, because part of your job may involve providing critical feedback on improving already-available pharmaceutical products or lessening their adverse effects, this role necessitates a wide range of problem-solving abilities.



Because the pharmaceutical industry has a severe shortage of highly skilled professionals, there is a high demand for experienced pharmaceutical consultants with strong technical skills and knowledge of how pharmaceutical products work. Consultants must also be business-savvy and have strong interpersonal skills. It would help if you had expertise in the pharmaceutical sector and a degree in a relevant discipline to work as a pharmaceutical consultant. Pharmacy school is a standard option for those interested in this profession, but other academic paths may also lead to employment in the pharmaceutical sector. Some consultants, for example, have medical backgrounds and began their careers as clinical researchers or pharmaceutical sales representatives. However, to be a successful pharmaceutical consultant, you must have a degree in science or medicine. A pharmaceutical consultant will be assigned various tasks such as research, proposal creation, and presentation delivery. To complete tasks on time and maintain a work-life balance, adequate time management and analytical skills are required. The consultant may also be asked to assess the advantages and disadvantages of pharmaceutical products. In addition, the job entails managing the production process and collaborating with the marketing department.



A pharmaceutical consultant must be highly analytical and thoroughly understand the technical and commercial aspects of the pharmaceutical companies. A consultant must also be able to interact with various people and communicate effectively with clients. Higher education is advantageous in this regard. Pharmaceutical consultants must meet different educational requirements depending on their country and industry. A consultant usually has a master's or doctorate in a relevant field. Pharmaceutical consultants should also have a solid understanding of the pharmaceutical industry and a natural business acumen. Pharmaceutical consultants must also have strong computer skills, be self-assured, and make sound decisions. They may also have certifications in their field of expertise. Regardless of location, the education required for a pharmaceutical consultant job description must be appropriate. A candidate must be familiar with ICH guidelines, regulatory requirements, and market trends. They must also be familiar with modern methods used in safety assessment research.



Pharmaceutical consultants must be skilled at problem-solving and have excellent communication abilities. This is because they must provide clients access to the information and study findings. Their personal and professional lives will have to be balanced as well. For example, consultants may be asked to investigate and evaluate pharmaceutical products to provide helpful feedback on their benefits and drawbacks. As a pharmaceutical consultant, you will advise clients throughout the product's lifecycle. Your responsibilities may include predicting the cost of drug development or detecting operational issues in pharmaceutical companies. Your responsibilities will also include ensuring compliance with regulatory authorities. During this procedure, you will be able to learn a lot about the most recent advancements in the pharmaceutical industry. 



To work as a pharmaceutical consultant, you must have a degree in a related field. Most consultants begin their careers as pharmacists or in other appropriate positions. After that, five years of relevant job experience is required. You should also be self-assured, strategic, and capable of completing tasks promptly. It would help if you also were computer literate. Specific qualifications in manufacturing or biotechnology can also be sought. Pharmaceutical consultants must have advanced critical thinking skills to assess data successfully and identify risks. They must also possess good business acumen and a comprehensive grasp of the pharmaceutical sector. They must also be able to work independently and in large groups.


Frontiers in Clinical and Translational Hepatology and the Gastroenterology Impact Factor

Published on : 08-04-2022

When assessing research, a journal's impact factor is a crucial consideration. Journal rankings are a better measure of a journal's quality than its absolute quantity since they are used to assess a journal's quality rather than its amount of citations. The impact factor of the Annals of Gastroenterology and Digestive Diseases is discussed in this article. You might want to examine if any of the journals listed below have entries that rank highly.

The ratio of invited and unsolicited submissions, the number of approved papers, and other factors determine the gastroenterology impact factor. One of the highest impact factors in the medical area, this publication scores 3.461. However, other factors outside the impact factor also impact journal rankings. A variety of additional factors can influence the number of articles published in a journal, in addition to the impact factor.

The Annals of Gastroenterology and Digestive Disorders are also available for three-year, four-year, five-year, and real-time impact factors. The number of citations in an article published in 2018 or 2019 is not always the same as the number of sources in the journal that year because both criteria depend on citation counts for articles published in the journal over the preceding two years.

A journal's impact factor is a numerical assessment of its scholarly excellence. The two-year Impact Factor is the most widely used metric. This metric represents the times the journal has been cited during the previous two years. This metric, however, lacks objectivity and has a low correlation with perceived greatness. As a result, comparing the journal impact factors of publications in different specialties is not a reliable indicator of their quality. In addition, a publication's review content may inflate a review journal's impact factor, and authors can fiddle with the figures.

More citations appear in journals with higher impact factors. A journal's impact factor reveals how significant it is in the industry. An article with a high impact factor will have a more substantial impact than one published in a journal with a lower impact factor. Additionally, it shows the caliber of the research presented in a journal. To ensure a journal is relevant to its readers, it is crucial to look at its impact factor.

An esteemed publication in the field of digestive disorders is gastroenterology. Gastroenterology, the official journal of the American Gastroenterological Association, offers reliable coverage on the subject of gastroenterology. It includes news on the most recent disease therapies and papers published by top professionals. Gastroenterology's original research is divided into three categories: basic-translational content, clinical content, and the digestive system. The publication delivers in-depth analyses, commentary, and spotlight articles on crucial subjects in the industry.

The world's oldest and most read journal is The New England Journal of Medicine. Its objective is to provide health educators and physicians with recent findings. The impact factor of all general medical journals is most significant with this journal. An article published a year ago with an Impact Factor of 1.0 has received one citation. Additionally, if the Impact Factor is 2.5 or above, at least two sources have been made. The New England Journal of Medicine, PLOS ONE, and the New England Journal of Medicine are other high-impact journals.


    Mayo Clinic's Best Gastroenterologist and Gastroenterologist

    Published on : 08-04-2022

    People seek the services of a gastroenterologist and hepatologist for various reasons. These doctors specialize in liver, pancreas, and gallbladder disorders. As a result, they are well-equipped to deal with any issues that may arise within these systems. Here's a quick rundown of what hepatology and gastroenterology are all about. If you want to learn more about your treatment options, talk to a gastroenterologist in your area right away.

    Many papers were examined for the effectiveness of the methods used in a recent meta-analysis of gastroenterology studies. Researchers evaluated the included studies' quality by comparing study years and assessing the PRISMA statement. In addition, the authors provided information about the study's year and funding source. Researchers identified a few critical factors associated with the quality of the articles after reviewing 127 studies.

    The Department of Hepatology and Gastroenterology at Johns Hopkins Medical School offers comprehensive care to patients with gastrointestinal, pancreatic, liver, and bile duct disorders. In both departments, advanced technology is available to provide patients individualized care. The United Kingdom has seven liver transplant centers. They include London's Royal Free Hospital, Birmingham's King's College Hospital, Leeds' St James's University Hospital, and Newcastle's The Freeman Hospital.

    The open access journal ARC Journal of Hepatology and Gastroenterology publishes high-quality, original research papers in the field. Peer-reviewed articles on "hot topic" issues are also included. In addition, the journal publishes case studies, commentaries, and book reviews. The journal publishes relevant articles in gastroenterology, hepatology, and endoscopy due to its broad reach.


    Dr. David Katz is a gastroenterologist and hepatologist. He received his medical degree from the University of Pennsylvania and finished his internal medicine residency at Mount Sinai Hospital in New York. There, he worked extensively on the liver transplant service and attended Virginia Commonwealth University for fellowships in gastroenterology and hepatology. Dr. Hudes has provided digestive healthcare to the Atlanta metro area for over two decades. His clinical work has been featured in the Best Self and Appen newspapers.


    Stony Brook Medicine's Division of Hepatology specializes in liver and biliary system diseases. This medical specialty focuses on liver, pancreas, and gallbladder disorders. Patients with liver disease may also require surgery. Hepatologists are also surgeons. However, this is still considered a subspecialty of gastroenterology. As a result, seeking a specialized doctor in the field is critical to getting the most out of your treatment.


    In addition to being closely related fields, gastroenterology and hepatology frequently collaborate. Many gastroenterologists and hepatologists collaborate on the same treatment plan and see each other as part of their care. Therefore, hepatologists are also known as gastroenterology subspecialists. Hepatologists, in addition to gastroenterologists, frequently collaborate with gastroenterologists to diagnose and treat patients.


    Dr. Singal is a well-known gastroenterologist and hepatologist. The National Institute of Diabetes and Digestive and Kidney Diseases funded his research (NIDDK). He has been a member of the United European Gastroenterology Association since 2011 and is currently the Special Section Editor of the Journal of Hepatology on its Scientific Committee. He earned a Ph.D. in Biochemistry from the University of Navarra and is now co-editing Guidelines on Hepato-Gastroenterology.


    Dr. Esmat is a well-known hepato-gastrointestinal specialist and former president of the International Association for the Study of the Liver. He also serves on the board of WHO's STAC-Hep. His diverse research interests have resulted in 142 original papers and over 190 reviews and book chapters. He is also the Director of Xinhua Hospital's Department of Gastroenterology and the Principal Investigator of the Shanghai Key Lab of Pediatric Gastroenterology and Nutrition.


    If you suspect you have liver disease, consult your primary care physician to find the right specialist. Hepatology and gastroenterology are closely related fields, and your primary care physician should be able to refer you to a qualified specialist. However, finding a reputable specialist with a proven track record and the necessary skills to treat your condition is critical.


    There is no specific board certification for hepatology in the United States; hepatologists must complete their internal medicine residency and meet continuing education requirements to be certified. Many hepatologists must also complete an internal medicine residency program, which focuses on diagnosing and treating digestive system diseases. Hepatologists receive additional training in transplant hepatology after completing a general gastroenterology fellowship.

    This is a block description. To edit, click and type the text or replace it with your own custom content or paste the copied text here


      Gastroenterology Specialist - Locate the Best Gastroenterologist in My Area

      07-22-2022

      A gastroenterology specialist is someone who performs diagnostic tests and treatments on the digestive tract. Patients can be referred to a gastroenterologist by their primary care physician or consult one on their own. Typically, initial visits include a consultation about general health issues. Patients should bring a list of their current medications as well as any drug allergies they may have. The doctor will then perform a thorough physical examination, which will include a review of the patient's medical history and symptoms.


      A gastroenterology specialist specializes in digestive tract disorders such as esophageal reflux, ulcers, and other digestive issues. They can also perform medical procedures such as endoscopy, which involves using a flexible tube with a camera to examine the inside of the esophagus. While gastroenterologists are not surgeons, they frequently collaborate with them.


      A gastroenterology specialist is also a colon cancer expert. Regular screenings are essential for people over the age of 50. Those with a family history of the disease should also see a gastroenterologist as soon as possible. A gastroenterologist is an excellent choice if you or a loved one has a history of colon cancer. There are over 13,000 members of the American College of Gastroenterology worldwide. These doctors share a passion for the field and offer educational resources to help them become better doctors.


      Gastroenterologists are board-certified by the American Board of Internal Medicine (ABIM). The American Board of Internal Medicine has high expectations for medical professionals. Gastroenterologists must pass a series of exams to become certified. These exams assess knowledge and clinical judgment in gastroenterology-related areas. Once board-certified, gastroenterologists are considered the best in their field. They must be properly trained to treat any digestive disorder.


      Patients suffering from autoimmune diseases and inflammatory bowel disease can also benefit from the services of a gastroenterologist. Fever, skin rashes, and arthritis can all be symptoms of GI disorders like Crohn's disease. There are also numerous systemic liver disorders. The liver can be damaged by lupus, pancreas, and biliary system disorders. So, if you suspect you have a disease, you should see a gastroenterologist.


      When selecting a gastroenterology specialist, make sure to look into the doctor's credentials. Learn about the procedure's specifics, as well as the benefits and risks associated with it. Inquire about the doctor's years of experience as well as his or her board certification. These factors will assist you in locating a doctor who best meets your medical needs and is concerned about your specific condition. A doctor should have more experience if they are certified by the American Board of Internal Medicine (ABIM).


      Another reason to see a gastroenterology specialist is if you are constipated. While constipation can be caused by straining during bowel movements in some patients, it can also be caused by neurological or muscular problems. Pregnancy may also be to blame. For a comprehensive treatment plan, consult a gastroenterology specialist. Constipation may be alleviated by dietary and lifestyle changes. In addition, your gastroenterologist may prescribe medications to help you manage your condition.


      Gastroenterology specialists learn how to diagnose and interpret biopsy results during their fellowship. They can also prescribe medication to prevent or treat diseases such as cancer. Some gastroenterologists receive advanced training in endoscopic procedures such as biliary tract ultrasound. Endoscopic procedures can assist in the removal of stones without the need for surgery. Furthermore, gastroenterologists are experts at evaluating gastrointestinal tumors. In order to preserve a patient's health, gastroenterologists frequently recommend minimally invasive treatments or surgery.


      Heartburn is another common issue. When stomach acid backs up into the esophagus, it can make swallowing difficult. If this occurs frequently, a gastroenterology specialist may recommend anti-reflux surgery. Surgery, on the other hand, may be the only option if the symptoms are severe enough. If the condition has recurred, a gastroenterology specialist can also diagnose cancer.


      While stomach pain is common, it can be an indication that your digestive system is in trouble. A gastroenterologist can identify the underlying cause and recommend the best treatment for your specific condition. Some gastrointestinal disorders can result in severe abdominal pain. If these symptoms are severe, you should seek medical attention right away. You could have an infection or be experiencing appendicitis. If the symptoms of a gastroenterologist's visit are unbearably painful, you should never ignore them.


      While most of us will have digestive issues at some point in our lives, it is unlikely that we will never require the services of a gastroenterologist. We are not immune to gastrointestinal problems, despite our best efforts. Even with specialized training, the majority of people will encounter one at some point in their lives. However, if you're lucky, your gastroenterologist will be able to assist you. They will recommend a treatment that will allow you to return to a healthy lifestyle while avoiding the discomfort and expense of surgery.

      Expert Witness Jobs for Physician Assistants

      Published On: 06-30-2022

      Joel Lavine thinks that PA expert witness jobs are a great way for PAs to make more money and have more freedom with their schedules. PAs can make their lives more unique and work around their own schedules by using their clinical and expert witness skills. Here are some tips for PAs who want to work as experts at court. Here are some of the most common reasons why a PA might be hired for this job. Also, think about how much you would be willing to pay for this kind of job.


      There are different kinds of jobs that a physician assistant can do as an expert witness. Some are only about court cases, while others cover a wider range of topics. Physician assistants can give expert witness testimony about urgent care, emergency medicine, COPD, diabetes, and the practice of family medicine. Most of the time, lawyers will call PA experts directly to help them with a case. Some of them even work for the defense. Once a case is chosen, PAs can give important information at trial.

      Most of the time, a PA is called as an expert witness in a case of medical malpractice to talk about the standard of care. Most of the time, doctors aren't allowed to say anything about how much care PAs should give. Physician assistants should have experience in the area that the civil case is about. PAs can also talk about the role of a PA when it comes to evaluating and diagnosing a patient. PAs aren't allowed to testify about what caused something, but an experienced and Board-certified PA can be a great help in figuring out what PAs can and can't do in different states.

      PAs with a lot of experience need to do a big job when they pick a medical expert witness. Many networks want physician assistants to have specialties in medicine, like pediatrics. To be an expert witness, you need to be board certified in your field. Getting a certificate in the field you want to work in will help you be more successful. You can also decide if you want to be an expert witness in a criminal case or not. But before you apply, you should think about what kinds of cases you would be interested in. Depending on who you are and where you come from, it might be best to pick a side that is not your own.

      PAs are often asked for their advice on a wide range of legal issues. Joel Lavine asserts that a physician assistant's opinion can be very helpful in the early stages of a case, when issues have been set up and motions have been filed. At this point, the lawyer can tell the expert about the case and ask for their opinion. PAs are usually less biased than doctors and lawyers in court, so their experience can be very helpful.

      An assistant is a skilled doctor, which gives them the freedom to make their own medical decisions. So, PAs can focus on areas like emergency care, urgent care, occupational medicine, pain management, neurology, and much more. The PA's job may change over time, but for now, it's mostly about taking care of patients. PAs can also work in a nursing home to take care of patients for the long term.

      Dr. Murphy has only had two jobs as a PA in her whole life. Since he graduated, he has joined the Michigan Academy of Physician Assistants, the American Academy of Physician Assistants, and the National Commission on Certification of Physician Assistants. Since he graduated, he has kept his certification. To keep their certification, PAs have to take a test every six years. The National Commission on Certification of Physician Assistants (ACPA) has set the educational requirements and standards for PAs.

      A job as an expert witness is almost as wide-ranging as the field itself. There are many things you can do in this job, and the pay is good. Experts should be paid based on how long they spend looking over medical facts. A physician assistant expert witness could be helpful in a number of cases, such as medical malpractice, personal injury, disability claims, wrongful death, and workers' compensation. Many physician assistants work for expert witness networks, which are made up of medical professionals with very specific skills.

      Do you want to become an expert witness as a physician's assistant? Find out what kinds of cases they can help with. Joel Lavine stated that the job requires training in different areas of medicine. In the United States, there are more than 200 accredited medical programs. To become a PA, you have to finish a program that is recognized by the government and pass a national test. You will have passed the National Commission on Certification of Physician Assistants (NCCPA) exam by the time you graduate.

      Opportunities for Medical Expert Witnesses

      Published On: 06/08/2022

      Joel Lavine pointed out that if you are interested in medicine, you could look into becoming a medical expert witness. This employment might give you with a second source of money. It's also a wonderful method to tailor your clinical schedule to your personal and professional objectives. You may live your dream life this way. Here are a few ideas on how you might use your talents and knowledge to become an expert witness. Let's take a closer look at them.

      Consider the advantages of being a medical expert witness first. Most doctors already have the knowledge required to be a qualified expert. Working as a medical expert may be a fulfilling side business that pays well, is less stressful, and does not need you to work nights, weekends, or holidays. Furthermore, the extra effort might help you avoid burnout and enhance your medical abilities. There are several case kinds accessible, ranging from a few chart reviews through extensive court testimony.

      Another option is to enroll in a medical expert witness training. The training is intended for medical professionals with no prior experience who want to become expert witnesses. You must be clinically active, have time to commit to non-clinical activities, and have solid writing and teaching abilities in order to enroll. Medical expert witnesses are experienced authors and educators who seek to augment their clinical job and make additional money. You may also enroll in one of the various training courses provided by specialists.

      A medical specialist cannot be an expert in every situation. Indeed, physicians who have specialized in a certain medical field are sometimes uninformed of the numerous sorts of patients that may require their knowledge. This is why they are in great demand. Lawyers frequently engage experts for a variety of matters. As a result, you must consider the sorts of cases you are interested in and select the best strategy to approach them. Before responding to any inquiries from attorneys, you should think about the sorts of cases you are interested in.

      Joel Lavine underlined the need of having the proper qualifications to serve as a medical expert witness as a freelance writer. You should not remark on a physician's standard of care if you are not a medical professional. The best method to assure your eligibility is to demonstrate that you have the analytical and balanced abilities required to provide appropriate opinions. You should never state a case's facts and expect the jury to agree with you. Instead, offer an opinion based on the balance of probabilities.

      There are various paths that one might take to become a medical expert witness. You can serve as a medical expert committee member or as an independent witness. You can pick from a number of medical subspecialties based on your area of expertise. It might be a terrific method to boost your chances of becoming an expert witness if you have knowledge in one field of medicine. You can consult with other medical professionals on different fields of medicine in addition to offering advice on specific parts of medicine.

      You will be requested to evaluate medical records and other material relevant to a court dispute as a medical expert witness. You may be required to produce a written report on the merits of a case. You may also be requested to provide a written judgment on whether the standard of care was appropriately followed. Your viewpoints should be objective, reasonable, and believable. You could even be called to testify in court!

      Joel Lavine emphasized that if you want to be a medical expert witness, you should learn more about malpractice legislation. Medical malpractice attorneys typically want responses to queries concerning a medical professional's standard of care. A medical expert witness can assist in determining whether the defendant is responsible for the patient's damages and breach of duty to treat. Your participation will also be determined by whether or not the defendant violated a standard of care. This is critical to the case's success.

      Medical expert witness prospects are nearly endless. It is critical that you choose an expert in your industry who can provide you with an objective and complete examination of the facts. Your testimony should be founded on the most recent scientific facts and acknowledged medical standards in the field. The medical expert witness should be able to differentiate between medical malpractice and probable unfavorable consequences that were not the result of carelessness. In rare situations, a physician may be required to analyze a deceased litigant's medical records.

      Guidelines for the treatment of neonatal cholestasis

      Published on: 05-17-2022
      Cholestasis in the newborn period is a potentially life-threatening illness that occurs when the baby's bile ducts get blocked and bile cannot flow freely. As a consequence, military chemicals build up in the liver, blood, and other tissues outside of the liver. Insufficient follow-up of bilirubin levels or early referral of newborns for assessment of cholestasis might delay the identification of neonatal cholestasis.
      According to Joel Lavine, deficiencies in fat-soluble vitamins may be seen as early as four to 12 months of age when cholestasis is present in infancy. Vitamin levels and prothrombin time must be continuously watched throughout therapy, since the condition may cause hepatitis or brain damage. Neonates may have neurological or hepatic issues if their vitamin A levels are too high.
      When diagnosing newborn cholestasis, a comprehensive abdominal ultrasound is essential. This test may evaluate the anatomy of the bile ducts, gallbladder, and liver. The triangular cord sign should be present, and the liver should be inspected for a choledochal cyst if the bile ducts are dilated or in a bile duct. Biliary atresia is uncommon if the gallbladder is healthy. Military arteriopathy may occur even if the gallbladder is not depigmented, and it is the most probable diagnosis if the gallbladder is not depigmented.
      A greater incidence of newborn cholestasis has been linked to the use of soy lipid emulsions in parenteral feeding. phytosterols and omega-6 fatty acids in soy lipid emulsion suppress bile secretion and have anti-inflammatory effects on the liver. In a recent research, the quantity of emulsion given to preterm newborns was decreased from three to one g/kg/d twice a week in order to save money. There was no sign of development in the babies beyond this time span.
      Joel Lavine pointed out that neonatal cholestasis is most often caused by an A1-antitrypsin deficiency. Blood and hepatocyte destruction may be slowed down by this proteinase inhibitor. Emphysema is a common complication in children with this condition. They have a higher risk of having a baby with a low birth weight in the womb. Neonatal cholestasis therapy is determined on the newborn's genetics and liver function.
      Cholestasis in babies is often not life-threatening and may be treated simply. Treatment relies heavily on nutritional assistance and vitamin supplements. The outlook for afflicted newborns is typically bright; up to 90% of them will be well by the time they are a year old. It has also been highlighted that instances of neonatal cholestasis are seldom genetically transmitted and there is low risk for chronic liver disease in a parent or sibling who has been impacted by the condition.
      A disorder known as biliary atresia occurs when the bile duct is not correctly developed. Biliary cirrhosis is inevitable as a result of this condition. Neonatal cholestasis, if left untreated, may result in liver failure. The illness may proceed to biliary atresia in rare situations. These include jaundice, portal hypertension, and liver failure in newborns with cholestasis.
      Joel Lavine described that a research including 37 children with cholestatic illness and a control group was conducted. Among patients with intrahepatic cholestasis, 27 percent required a liver transplant. However, 20% of newborns with cholestatic liver disease will die as a result of their condition. Hepatocellular carcinoma, a malignancy of the liver, may occur in as many as one in five of these newborns by the time they reach the age of 20. However, the results aren't entirely clear.
      For newborn cholestasis, treatment choices vary depending on the underlying etiology. To prevent malnutrition and address deficits in macro and micronutrients despite the absence of particular therapy, vulnerable children might benefit from nutritional assistance to avoid malnutrition. Pre-transplant nutritional health has also been linked to lower mortality and morbidity, according to research. A diet rich in vital nutrients, including branched-chain amino acids, long-chain polyunsaturated fatty acids, and protein, may help improve general health and avoid the illness.
      Premature infant death and morbidity are linked to neonatal necrotizing enterocolitis. Liver failure and mortality are the top causes of death in the Western world. Cirrhosis may develop and need a liver transplant after two years of follow-up. This research reveals that newborn cholestasis may not be as common as previously believed.

      Metabolic Liver Disease: Causes and Pathophysiology in Children is examined.

      Published on: 04-26-2022

      According to Joel LavineThe liver is affected by a number of metabolic diseases. These illnesses disrupt pathways that aid in the breakdown and processing of food and nutrients, as well as their transport and storage throughout the body. They are all genetically determined, and some have more than one. Learn about the various metabolic abnormalities and how to recognize them in yourself. This article will look at some of the most prevalent causes of metabolic liver disease. Once you've identified these factors, you may take steps to preserve your liver and general health.
      Because the symptoms of genetic/metabolic liver disorders sometimes resemble other ailments, they can be difficult to identify. Young people may have acute infections or intoxications that are not related to liver disease, but elderly patients may have chronic liver problems. To make the right diagnosis, a high level of suspicion is required. To alleviate the symptoms of metabolic disorders, a liver transplant may be required in some circumstances. Consult your doctor as soon as you believe you have a fatty liver.
      Joel Lavine believe that, your kid has metabolic liver disease, you should seek medical attention straight once. Because liver enzymes cannot be detected until the neonatal period is complete, diagnostic testing in young infants might be difficult to acquire. Diagnostic studies for metabolic abnormalities in children might take hours or even days. Intravenous glucose, on the other hand, can aid in evaluating whether metabolic liver disease is the source of your child's symptoms. If you fear your kid has this illness, you should think about a liver transplant.
      Another prevalent cause of fatty liver is glycogen storage disease. They cause low blood sugar, as well as muscular weakness and discomfort. The mitochondria, the powerhouses of our cells, are damaged in youngsters. Friedreich ataxia can result in heart failure, immobility, and nerve damage. Organic acidemias can cause dehydration, mild diseases, and a variety of other symptoms. When detected early, these therapies can save a person's life.
      Genetic abnormalities are another cause of metabolic liver disease. Some reasons, such as HT-1a, are inherited. Some are inherited, while others are learned. Genetic testing is required to confirm the diagnosis. Many liver illnesses, on the other hand, are treatable. Consult a physician if you feel you have metabolic liver disease. Before making any judgments, you should explore all treatment possibilities. Your doctor can also do additional tests to rule out other possible causes of liver disease.
      In the Western Hemisphere, A1AT deficiency is the most prevalent hereditary cause of metabolic liver disease. The SERPINA1 gene, which codes for A1AT, is inherited in an AR pattern. The liver is damaged with this condition as a result of a misfolded protein within the hepatocyte. The disease is also linked to lung damage caused by the unopposed activity of neutrophil elastase. There is currently no conventional medical therapy for this liver condition.
      In a person with a family history of metabolic liver disease, other inherited metabolic illnesses may emerge. People who have mets are at a higher risk of getting cardiovascular disease and diabetes, as well as liver cancer. It has been linked to the development of liver cancer. There is, however, little evidence that MetS is directly linked to the development of cirrhosis. In certain circumstances, patients with this syndrome develop it after having chronic liver disease.
      Acute liver failure can happen suddenly and in persons who don't have any underlying liver illness. Drugs and hepatitis viruses are the most prevalent culprits. However, some individuals may have no obvious cause and may suffer from serious problems such as excessive bleeding or a rise in brain pressure. Treatment may be required in certain circumstances. A liver transplant may be the only way to treat the illness in some cases. Consult a medical practitioner if you have any of these symptoms.
      Medication and lifestyle modifications may be used to treat this problem. The objective is to avoid additional liver injury and to inhibit the formation of scar tissue. In severe circumstances, a liver transplant may be required to preserve the patient's life. In general, therapy seeks to alleviate symptoms while lowering the chance of significant consequences. If you already have these symptoms, a liver biopsy can be a life-saving tool in your treatment. A liver biopsy, on the other hand, is not a reliable sign of whether you have cirrhosis.
      Joel Lavine pointed out that, there are several metabolic liver disease reasons that can be fatal. Hereditary Fructosemia is one such disorder. This illness generates elevated bilirubin levels, which leads to bridging fibrosis and liver damage. Galactosemia is another disorder that can harm the liver. Galactosemia is characterized by nodules and fatty changes, and it can progress to cirrhosis.

        A Retrospective Investigation of Metabolic Liver Disease

        04/08/2022

        According to Joel Lavine, A disorder of the liver known as alcoholic hepatitis is metabolic liver disease. It helps the body digest food and affects the process of removing poisons from the blood. Depending on the cause, this disorder can be acquired or congenital. It can also be caused by an endocrine disorder or the failure of a metabolically vital organ. The type of liver damage and the severity of the patient's illness will determine the treatment and outcome of this disease.
         
        Despite widespread recognition that metabolic risk factors are under-recorded, the reasons for this remain unknown. Understanding the limitations of the International Classification of Diseases (ICD) codes can aid in the improvement of health-care database quality. NAFLD and cirrhosis, for example, have highly specific ICD-10-AM codes, but their prevalence is underestimated by 42.9 percent. As a result, a retrospective study is required to determine the codes' accuracy.
         
        Joel Lavine described that, ICD-10-CM K71.9 is billable for reimbursement purposes. This code's 2022 edition went into effect on October 1, 2021. For reimbursement claims submitted after October 1, 2015, it is required.
         
        The NAFLD/NASH ICD-10-AM codes were cross-checked against the databases of two major Australian tertiary hospitals. The accuracy of the ICD-10-AM codes was tested by comparing the data from the patient encounters with the ICD-10-AM codes. In comparison to ALD, the ICD-10-AM codes had a high sensitivity and specificity. The ICD-10-AM codes had a high NPV and sensitivity, with a positive predictive value of 99.7% for each group of patients. Although there were five false positives, the overall results were excellent.
         
        Joel Lavine revealed that, We can also use ICD-10-AM codes to look into the prevalence of NAFLD/NASH cirrhosis in Australia. We can better plan our public health strategies and allocate resources based on this information. However, there are still difficulties. Meanwhile, we can't ignore the fact that diagnosing NAFLD is impossible without sufficient population-based data. The advantages extend beyond ICD-10-AM and ICD-10 codes.