Euroasian Journal of Hepato-Gastroenterology

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2012 | January-June | Volume 2 | Issue 1

ORIGINAL ARTICLE

Chanchal Kumar Ghosh, Fakhrul Islam, Ershaduddin Ahmed, Dilip Kumar Ghosh, Azizul Haque, QT Islam, MA Zahir

Etiological and Clinical Patterns of Isolated Hepatomegaly at Rajshahi, Bangladesh

[Year:2012] [Month:January-June] [Volume:2] [Number:1] [Pages:4] [Pages No:1 - 4]

PDF  |  DOI: 10.5005/jp-journals-10018-1021  |  Open Access |  How to cite  | 

Abstract

Background: Hepatomegaly, a common clinical finding, is usually associated with splenomegaly. However, sometimes there may be isolated hepatomegaly without splenomegaly in different pathological conditions. An account of that at Rajshahi, Bangladesh has been given in this study. Materials and methods: This prospective study was carried out in different medicine units of Rajshahi Medical College Hospital, Rajshahi, Bangladesh on consecutive 100 hospitaladmitted patients having isolated hepatomegaly. Results: Most common cause of isolated hepatomegaly was liver abscess (34.0%) followed by congestive cardiac failure (30.0%). Viral hepatitis accounted for about 14% cases of isolated hepatomegaly. Fatty liver and hepatocellular carcinoma were also responsible for isolated hepatomegaly in some patients. Conclusion: Taken together, isolated hepatomegaly varies from comparatively benign condition like fatty liver to fatal condition like hepatocellular carcinoma. Multicenter study with large sample size is warranted to develop more insights about diagnosis and management of isolated hepatomegaly.

ORIGINAL ARTICLE

Nishat Afroz, Meher Rizvi, Mohd Azam, MR Ajmal, Abida Malik, Indu Shukla

Role of Interferon-gamma and Interleukin-12 in the Immunopathogenesis of Hepatitis B Virus Infection

[Year:2012] [Month:January-June] [Volume:2] [Number:1] [Pages:5] [Pages No:5 - 9]

PDF  |  DOI: 10.5005/jp-journals-10018-1022  |  Open Access |  How to cite  | 

Abstract

Objective: To study the role of interleukin (IL)-12 and interferon (IFN)- in immunopathogenesis of hepatitis B virus (HBV) infection. Materials and methods: One hundred and fifty-seven patients with hepatitis B were screened by serological and molecular markers for HBV. Serum IL-12 and IFN- levels were estimated. Results: Among patients with acute HBV (AHB), the mean levels of IFN- (52.35 pg/ml) and IL-12 (57.12 pg/ml) were significantly higher in patients with nonnecrotizing inflammation (NNI) compared to those in patients with necrotizing inflammation (NI) (32.17 pg/ml and 42 pg/ml for IFN- and IL- 12 respectively). In chronic HBV (CHB) with NI, IFN- levels were much higher than the same in AHB. However, no significant difference was found in IL-12 levels. IL-12 levels (25.76 pg/ml) were lower in NNI of CHB patients, while the levels of IL-12 were comparable between NI patients with AHB and CHB. Both IFN- and IL-12 were higher in hepatitis B e-antigen (HBeAg)-negative patients than HBeAg-positive patients. . Conclusion: Both IFN- and IL-12 appear to play a role in AHB and HBeAg negativity, however, further study will be required to get their precise role.

ORIGINAL ARTICLE

Kalyan Debnath, Pradip Bhaumik

Prevalence of Hepatitis B and C among Hemodialysis Patients of Tripura, India

[Year:2012] [Month:January-June] [Volume:2] [Number:1] [Pages:4] [Pages No:10 - 13]

PDF  |  DOI: 10.5005/jp-journals-10018-1023  |  Open Access |  How to cite  | 

Abstract

Introduction: Hemodialysis is a trusted intermediate procedure for management of chronic kidney disease (CKD) patients. As such CKD is an immune-deficient state, hence, they may be infected by hepatitis B virus (HCV) and hepatitis C virus (HCV) during hemodialysis. Eventually, HBV and HCV infection is an important cause of morbidity and mortality among patients of hemodialysis. Prevalence of HBV and HCV infection among hemodialysis patients is highly variable. Aim of the study: This study was designed to see the prevalence of HBV and HCV among hemodialysis patients of Tripura, India and to evaluate the mode of transmission. Materials and methods: This is a single center prospective study among the patients who has come for hemodialysis at the Dialysis Unit of Agartala Government Medical College and Govinda Ballav Pant Hospital during the period of January 2011 to June 2011. Results: Male predominance has been observed among the hemodialysis patients and mean age of the patients was 48.16 years. New HBV infection was found in 5.5% of the hemodialysis patients (cumulative 7.3%) and 10.9% (cumulative 12.12%) of patients got new HCV infection during hemodialysis. Coinfection with both HBV and HCV was found among 1.2% of hemodialysis patients. History of blood transfusion was found in 100% of newly infected HBV and HCV patients. Discussion: The evaluation suggests that blood transfusion may be the single most important risk factor for HBV and HCV infection among hemodialysis patients. Newer methods of screening of blood in blood bank like nucleic acid test or polymerase chain reaction amplification of nucleic acids should be adopted to prevent HBV and HCV transmission

ORIGINAL ARTICLE

Rajesh Mahajan, Prithpal Singh Matreja, Ajitpal Singh Gill, Rajoo Singh Chinna, Deepinder Kaur Chhina

Spontaneous Bacterial Peritonitis in Alcoholic Cirrhosis: An Indian Perspective

[Year:2012] [Month:January-June] [Volume:2] [Number:1] [Pages:6] [Pages No:14 - 19]

PDF  |  DOI: 10.5005/jp-journals-10018-1024  |  Open Access |  How to cite  | 

Abstract

Background: Spontaneous bacterial peritonitis (SBP) is commonly associated with cirrhosis of liver, and has been associated with high mortality. Model for end-stage liver disease (MELD) scoring system has been applied as a marker of disease severity and predictor of mortality in patients with alcoholic cirrhosis. Recent studies have estimated a prevalence of 10 to 30% SBP in cirrhotic patients with ascites admitted to hospitals but the data is lacking on Indian population. Hence, the present study was designed to evaluate the profile of SBP in patients with alcoholic cirrhosis in North India according to MELD score. Materials and methods: The prospective study was conducted in patients admitted in the department of medicine. A total of 100 patients suffering from alcoholic cirrhosis with ascites were enrolled in the study. All subjects underwent the following test for biochemical parameters, abdominal ultrasonography, chest X-ray, endoscopic findings and paracentesis was performed and analyzed. MELD score was calculated for all the patients. Results: Out of total patients, 24% reported with SBP. Patients suffering from SBP had statistically significant (p < 0.05) higher MELD score, International normalized ratio (INR) and serum creatinine levels. Also, the patients with SBP had significantly (p < 0.05) lower platelet count as compared to patients without SBP. All the other parameters were comparable in both the groups. Conclusion: SBP is a common complication of alcoholic cirrhosis of Indian patients and measures should be taken for their containment.

ORIGINAL ARTICLE

Yahia Zakaria Gad, Amany Mohammad Hassan

CagA Helicobacter pylori Seropositivity in Asymptomatic, Apparently Healthy, Young Adult Egyptian Food Handlers

[Year:2012] [Month:January-June] [Volume:2] [Number:1] [Pages:4] [Pages No:20 - 23]

PDF  |  DOI: 10.5005/jp-journals-10018-1025  |  Open Access |  How to cite  | 

Abstract

Background/Aim: Infection with CagA Helicobacter pylori (H. pylori) positive strain is a risk factor for the development of atrophic gastritis and gastric adenocarcinoma. This study investigated the seroprevalence of H. pylori and its virulent strains CagA in Egyptian food handlers. Subjects and methods: A total of 365 eligible male subjects participated in the initial study. Venous blood samples were collected from all participants for assessment of H. pylori specific IgG and serum CagA antibodies. Results: Out of 365 subjects, 310 were reactive to H. pylori. Out of them, CagA was detected in 143 H. pylori-infected subjects. CagA antibodies were more common in cigarette smokers (< 0.001), living in high crowding index (< 0.001), with low family income (< 0.01) and sharing their bedrooms during childhood (< 0.001). Conclusion: Our data revealed a high prevalence of CagA virulent strains among asymptomatic apparent food handlers of Egypt. Emergency surveillance mechanisms should be developed for containment of H. pylori infection in Egypt.

ORIGINAL ARTICLE

Nehad M Tawfik, Mona A Hegazy, Inas A Abdel Maksoud, Aml S Nasr

Iron Load and Serum Hepcidin in Hepatitis C Virus-Related Hepatocellular Carcinoma

[Year:2012] [Month:January-June] [Volume:2] [Number:1] [Pages:4] [Pages No:24 - 27]

PDF  |  DOI: 10.5005/jp-journals-10018-1026  |  Open Access |  How to cite  | 

Abstract

Background: Hepatocellular carcinoma (HCC) is a major cause of death worldwide, and chronic inflammatory stress caused by hepatitis viruses plays a major role in HCC carcinogenesis. The aim of the present study was to investigate the expression of serum hepcidin and its correlation with iron overload in HCC. Study design: The study was carried out on 50 hepatitis C virus (HCV)-related HCC cirrhotic patients (Group I) and 20 age-matched non-HCC liver cirrhosis patients as control (Group II). Serum hepcidin was measured in all samples with a commercial immunoassay. The extent of iron deposition was evaluated in liver histochemically. Results: There was no relationship between the serum hepcidin level and the histological grade of HCC (p = 0.1492), or multiplicity of focal lesion (p = 0.0719), however, hepatic iron deposition was significant higher in HCC than non-HCC cirrhotic patients (p < 0.005). Conclusion: The current study suggests a positive association of hepatic iron score, but the role of hepcidin in this context remains to be elucidated.

ORIGINAL ARTICLE

Mona Abdolhamid Tehrani, Rohollah Valizadeh, Mehdi Zarghami

The Effects of Aerobic Exercise on Pulmonary Indexes in Obese Women from Iran

[Year:2012] [Month:January-June] [Volume:2] [Number:1] [Pages:2] [Pages No:28 - 29]

PDF  |  DOI: 10.5005/jp-journals-10018-1027  |  Open Access |  How to cite  | 

Abstract

Background: The aim of this research was to assess effect of 8 weeks aerobic exercise on pulmonary indexes of force vital capacity (FVC) and force expiratory volume in one second (FEV1) in obese women. Methods: Initially, a total 200 women of National Iranian South Oil Company (name of the place) were enrolled in this study. Subsequently, 40 women with body mass index ranging from 25 to 29.9 were selected as study population. The study population was devided in 2 groups, each with 20 women. One group (experimental group) performed aerobic exercise for 8 weeks and the other group did not perform any specific physical exercise. FVC and FEV1 were measured in all subjects before the commencement of the study and after the end of the study. Results: The age of the subjects ranged from 40 to 50 years. There was no significant difference in values of FVC and FEV1 between experimental study population and control group at start of the study. However, the levels of both FVC and FEV1 increased significantly in experimental group compared to control group.

ORIGINAL ARTICLE

Morikazu Onji, Mamun Al-Mahtab, Sheikh Mohammad Fazle Akbar, Shiyi Chen, Masanori Abe, Osamu Yoshida, Yoshio Ikeda, Yoichi Hiasa

Suppression of Inflammatory Mucosal Milieu by Administration of Regulatory Dendritic Cells in an Animal Model of Primary Biliary Cirrhosis

[Year:2012] [Month:January-June] [Volume:2] [Number:1] [Pages:5] [Pages No:30 - 34]

PDF  |  DOI: 10.5005/jp-journals-10018-1028  |  Open Access |  How to cite  | 

Abstract

Background/Aim: Primary biliary cirrhosis (PBC) is an autoimmune disease of the liver for which a curative therapy is still lacking. The aim of this preclinical study was to assess if down regulation of host immunity by regulatory dendritic cells (DC) bears therapeutic implications in a murine model of PBC. Methods: An animal model of PBC was established by injecting 5 mg/kg polyinosinic polycytidylic acid (poly I:C) twice a week in female C57BL/6 mice. Regulatory DC were produced by culturing bone marrow DC with interleukin-10 and lipopolysaccharides without or with pyruvate dehydrogenase complex (PDC, 1 μg/ml). Regulatory DC and PDC-pulsed regulatory DC were injected intraperitoneally trice (8, 12 and 20 weeks after starting of poly I:C administration) to PBC model mice. Antimitochondrial antibody (AMA) was checked in the sera and liver histology was assessed to evaluate the effect of regulatory DC on inflammatory hepatic mucosal milieu. Results: AMA in the sera and progressive infiltration of mononuclear cells were detected in all C57BL/6 due to administration of poly I:C. Injection of regulatory DC or PDCpulsed regulatory DC for 3 times caused significant reduction of infiltrating mononuclear cells in 4 of 5 PBC model mice. However, the effect of regulatory DC on AMA negativity was not documented in murine model of PBC. Conclusion: This pilot study inspires optimisms that regulatory DC may be an immune therapeutic approach for treating PBC, however, further study about nature of antigens, dose of antigens, duration of therapy and protocol of administration of regulatory DC need further analyses.

ORIGINAL ARTICLE

Mehdat Assem, M Yousri

Impact of Pentoxifylline and Vitamin E on Ribavirin-induced Hemolytic Anemia in Chronic Hepatitis C Patients: An Egyptian Survey

[Year:2012] [Month:January-June] [Volume:2] [Number:1] [Pages:6] [Pages No:35 - 40]

PDF  |  DOI: 10.5005/jp-journals-10018-1029  |  Open Access |  How to cite  | 

Abstract

Background: The present study aimed to elucidate the impact of combined pentoxifylline and high-dose vitamin E supplementation on Ribavirin (RBV)-induced hemolytic anemia in patients with chronic hepatitis C (CHC). Patients and methods: A total of 200 treatment-naïve chronic CHC patients were randomized into two groups to receive either the standard antiviral therapy and pentoxifylline (800 mg) and high-dose vitamin E (1000 IU) daily (combined group) or standard antiviral therapy and placebo (control group). They were followed-up to assess occurrence of anemia and virological responses respectively. Results: Dose modification of RBV due to anemia was significantly lower in combined group (8.5%) compared to control group (21.5%) (p < 0.05). Withdrawal from therapy due to severe anemia (Hb < 8.5 gm/dl) was recorded only in six (28.6%) patients of the control group. Both end of treatment response (ETR) and sustained virological response (SVR) were significantly higher in combined group compared to control (p < 0.05). Conclusion: Pentoxifylline and vitamin E can ameliorate RBVassociated hemolysis; improve compliance and virologic clearance, when combined with the standard antiviral therapy in patients with CHC.

REVIEW ARTICLE

Santosh Man Shrestha, Shobhana Shrestha

Subacute Hepatic Failure: Its Possible Pathogenesis

[Year:2012] [Month:January-June] [Volume:2] [Number:1] [Pages:6] [Pages No:41 - 46]

PDF  |  DOI: 10.5005/jp-journals-10018-1030  |  Open Access |  How to cite  | 

Abstract

Background: Subacute hepatic failure (SAHF) is a complication of acute hepatitis (AH) characterized by progressive jaundice and development of ascites within 24 weeks of the onset of icterus. Its pathogenesis is unknown and its treatment is unsatisfactory. This study highlights on the possible pathogenesis of the disease. Materials and methods: Thirty-two with SAHF among 798 patients of AH who had tests for markers of acute hepatitis A, B, C and E had blood and ascitic fluid study and ultrasonogram (US) of liver. US and risk factors for infection were compared with consecutive uncomplicated AH. Blood culture was done in consecutive 307 AH patients at the time of the first visit. Patients with SAHF and control were followed for at least 6 months. Results: SAHF developed in 4% of the patients with AH. Bacteremia was detected in 50% and ascitic fluid showed features of hepatic venous outflow obstruction (HVOO) and bacterial peritonitis. Thrombus was detected in IVC in all. Seventy-five percent of the patients who received antibiotic recovered. Recurrence of the symptoms in five and development of cirrhosis in seven patients were noted at follow-up but none among patients with uncomplicated acute hepatitis (AH). Bacteremia was also detected in 25% of consecutive AH patients presenting with fever, with high incidence in those with complications. Conclusion: Bacteremia was common among patients with AH. Clinical features of SAHF could be explained by occurrence superadded bacterial infection that caused thrombophlebitis of hepatic portion of the IVC resulting in HVOO.

CASE REPORT

Salimur Rahman, ABM Shakil Gani, M Mahbub Hossain, Md Kamal

Immunoproliferative Small Intestinal Disease: First Case Report from Bangladesh

[Year:2012] [Month:January-June] [Volume:2] [Number:1] [Pages:4] [Pages No:47 - 50]

PDF  |  DOI: 10.5005/jp-journals-10018-1031  |  Open Access |  How to cite  | 

Abstract

A case of immunoproliferative small intestinal disease (IPSID) was diagnosed and treated at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Although this rare disease entity has been reported from different countries, there are paucity of information about IPSID from Indian subcontinent. Careful assessment of patient and supportive laboratory investigations are required for its diagnosis. The patient is passing a comparatively good smooth course after getting medications.

CASE REPORT

Sebahat Basyigit,, Metin Küçükazman, Ayse Kefeli, Abdullah Özgür Yeniova, Yasar Nazligül

Duodenal Diverticular Bleeding Stopped Spontaneously: Case Report and a Brief Review of Literature

[Year:2012] [Month:January-June] [Volume:2] [Number:1] [Pages:3] [Pages No:51 - 53]

PDF  |  DOI: 10.5005/jp-journals-10018-1032  |  Open Access |  How to cite  | 

Abstract

Duodenal diverticula (DD) are the most common acquired diverticula of small bowel. DD usually remain silent, but only 5% of those cause symptoms because of obstruction in neighbor organs, inflammation and hemorrhage. Although bleeding from DD is uncommon, it can be fatal. Therapeutic managements and options for diverticular bleeding and detailed recommendations are lacking. We reported a case of bleeding from eroded mucosa within a duodenal diverticulum located in the second part of duodenum, and which was stopped spontaneously.

CASE REPORT

Vijay Agarwal, CA Shashirekha, K Krishnaprasad

Evisceration of Small Bowel through Femoral Triangle Following Exanguinating Bull Gore Injury

[Year:2012] [Month:January-June] [Volume:2] [Number:1] [Pages:2] [Pages No:54 - 55]

PDF  |  DOI: 10.5005/jp-journals-10018-1033  |  Open Access |  How to cite  | 

Abstract

Bull gore injuries are a common feature among farmers and revellers in rural India as well as in the West, such as Pamplona, Spain.1 All types of bull gore injuries of varying severity, both penetrating and blunt types, sometimes causing death are described. One such successfully managed case of bull gore injury of abdomen through right femoral triangle, surprisingly sparing the femoral vessels but causing exanguinating contusion and laceration of mesorectum and mesentery and evisceration of small bowel through femoral triangle is being reported to highlight the varied presentation of bull gore injuries, our rural folk face day in and day out. Successful outcome is inevitable following prompt and learned surgical intervention.

CASE REPORT

Salimur Rahman, Mamun Al-Mahtab, Fazal Karim, Faroque Ahmed

Successful Treatment of Severe Hepatitis E with Ribavirin: A Case Report from Bangladesh

[Year:2012] [Month:January-June] [Volume:2] [Number:1] [Pages:2] [Pages No:56 - 57]

PDF  |  DOI: 10.5005/jp-journals-10018-1034  |  Open Access |  How to cite  | 

Abstract

A case of severe acute hepatitis E was treated with antiviral drugs. The clinical course and prognosis would be reported.

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