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For this purpose he built the first floor of his house at a cost of Rs.2,00,000 and invested a further sum of Rs.3,50,000 in this business.He wanted to start with 12 computers costing Rs.40,000 each.He approached ICICI Bank and secured a loan to the extent of 75 of the cost of computers.It was agreed that the loan will be repaid in four annual instalments as follows: At the end of First Year: Rs.90,000 Rs.36,000 for interest At the end of Second Year: Rs.90,000 Rs.27,000 for interest At the end of Third Year: Rs.90,000 Rs.18,000 for interest At the end of Fourth Year: Rs.90,000 Rs.
He started business on 1st April,2012. He purchased Computers and paid 25 of the value of computers from his bank and Rs.3,60,000 out of bank loan availed. He deposited Rs.10,000 for the electric connection with the Electricity Board and also deposited Rs.1,50,000 with the VSNL for internet and telephone connection. Economics: Significance of Economics, Micro and Macro Economic Concepts, Concepts and Importance of National Income, Inflation, Money Supply in Inflation, Business Cycle, Features and Phases of Business Cycle. Nature and Scope of Business Economics, Role of Business Economist, Multidisciplinary nature of Business Economics. Patients with CHB were enrolled in the treatment group if they were being treated with NUCs for the first time and were enrolled in the discontinuation group if they had fulfilled the criteria by stopping medication treatment. However, whether benefits from the improved HRQoL that occurs after antiviral treatment or drug discontinuation outweigh the risks of viral relapse is an unanswered question. The aim of this study was to evaluate the HRQoL among patients with CHB during antiviral treatment and withdrawal of treatment. Patients and methods: There were 102 patients who met the enrollment criteria with 54 patients in the treatment group and 48 patients in the discontinuation group. The 36-Item Short-Form Health Survey (SF-36), European Quality of Life-5 Dimensions, and Beck Depression Inventory (BDI) were adopted to evaluate life quality and mental health. Results: In the treatment group, SF-36 showed that the physical functions were significantly increased. In the discontination group, the psychological functions showed improvement. A multivariate regression analysis indicated that baseline SF-36 score was a predictor for improvement in HRQoL (odds ratio 1.17, P 0.003) and baseline BDI score was a factor for remission of depression (odds ratio 0.75, P 0.005) after medical intervention. When the cutoff value of SF-36 score was set at 79.5, the sensitivity and specificity to predict improvement in HRQoL were 82.8 and 74.0, respectively. When the cutoff value of BDI was found as 8.5, the sensitivity and specificity to predict alleviation of depression were 58.6, and 76.0, respectively. Conclusion: Antiviral treatment benefits the physical health of the patients with CHB, while conferring no obvious improvement in their psychological condition. Improved psychological interventions for patients with CHB, especially for those with lower baseline SF-36 scores and higher BDI scores, may improve their quality of life. Keywords: chronic hepatitis B, health-related quality of life, antiviral treatment, mental disorder, depression. Nucleos(t)ide analogs (NUCs) are safe and effective antiviral drugs, and they are recommended for first-line treatment of CHB by most guidelines. Although NUCs are potent inhibitors of HBV replication, they do not eliminate HBV. Before starting long-term NUC treatment in patients with CHB, issues of compliance, economic burden, and quality of life (QoL) should be taken into consideration, especially in low-income populations. As modern medical practice has evolved from traditional biomedical models to modern biopsychosocial medical paradigms, health-related quality of life (HRQoL) has emerged as an important consideration in the care of patients with CHB. Chronic diseases, and especially CHB, impose a heavy psychosocial burden, including worse HRQoL, depression, and anxiety. A study reported that HBV carriers have significantly lower social function than healthy controls. Furthermore, it has been reported that HRQoL of patients, as assessed by European Quality of Life-5 Dimensions (EQ-5D) and 36-Item Short-Form Health Survey (SF-36) questionnaires, decreases as CHB progresses to its more severe stages, from chronic inactive hepatitis to HCC. In addition, depression and anxiety were also more common in patients with CHB than in healthy controls. Only one prospective study has been published that shows that subjects with CHB had an improvement in HRQoL after 24 weeks of antiviral treatment. This improvement was more obvious in females and hepatitis B e antigen (HBeAg)-positive subjects. In addition, few studies have addressed the predictors or risk factors for low HRQoL and depression in patients with CHB. There are several problems associated with long-term NUC treatment, including development of drug resistance, poor adherence, economic burdens, and psychological stressors. The Asian Pacific Association for the Study of the Liver (APASL) Guidelines recommend that NUC treatment for CHB could be considered successful after serum HBV DNA is undetectable, HBeAg seroconversion has occurred, and alanine aminotransferase levels have normalized for at least 12 months. Treatment is then completed after another 12 months (HBeAg-positive patients) or 18 months (HBeAg-negative patients) of medication. However, relapse occurs in 50 of HBV patients after withdrawal of NUCs, even when the recommendations are followed. European association for the study of the liver (EASL) guidelines recommend that discontinuation of NUC treatment can be considered when hepatitis B surface antigen (HBsAg) seroconversion occurs. However, the possibility of HBsAg seroconversion during NUC therapy is limited and requires at least a decade of treatment. But long-term NUC treatment may lead to low HRQoL in patients with CHB. Thus, in summary, we speculate whether the ongoing NUC treatment increases HRQoL in patients with CHB and whether treatment interruption in patients with CHB will correlate with depressive symptoms, which is measured by Beck Depression Inventory (BDI). Our study examines whether, 1) ongoing NUC treatment enhances the HRQoL of patients with CHB, and 2) drug withdrawal benefits their psychological well-being. The patients were included in our study when it was convenient and they fulfilled the inclusion criteria. We defined the diagnosis of CHB as serum HBsAg-positive for at least 6 months combined with a repeated or continued increase in the serum alanine aminotransferase level. Patients were excluded if they had cirrhosis; HCC; metabolic liver disease; co-infections with hepatitis C virus, hepatitis D virus, or HIV; autoimmune hepatitis; were suffering from heavy alcohol abuse; were pregnant; or were previously treated with interferon.
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