Euroasian Journal of Hepato-Gastroenterology

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2014 | January-June | Volume 4 | Issue 1

ORIGINAL ARTICLE

Siros Hosseini, Roholla Valizade, Fateme Daraei Heydarabadi

Comparison of Bone Mineral Density among Alcoholism and Nonalcoholism Athlete and Nonathlete Subjects

[Year:2014] [Month:January-June] [Volume:4] [Number:1] [Pages:3] [Pages No:1 - 3]

PDF  |  DOI: 10.5005/jp-journals-10018-1086  |  Open Access |  How to cite  | 

Abstract

Background: The aim of this study was to compare bone mineral density among alcoholic, nonalcoholic and nonathlete subjects. Materials and methods: The group consisted of physically active people. A questionnaire was given to both alcoholics and nonalcoholics and 28 persons were randomly selected (15 members who consumed alcohol and 13 who did not). In order to collect the data on mineral aggregation, a testing device (DEXA) was used. The data were analyzed using SPSS software. Results: It was found that higher bone aggregation in each of the two athletic group in comparison with the nonathletic group (p < 0.05). Conclusion: Exercise may have a positive impact on bone mineral density.

ORIGINAL ARTICLE

Salimur Rahman, Munira Jahan, Shahina Tabassum

Epidemiology of Hepatitis E Virus in an Urban Community in Dhaka City

[Year:2014] [Month:January-June] [Volume:4] [Number:1] [Pages:3] [Pages No:4 - 6]

PDF  |  DOI: 10.5005/jp-journals-10018-1087  |  Open Access |  How to cite  | 

Abstract

of acute hepatitis E occur in this country almost regularly. Although the real magnitude of HEV prevalence has not been documented in Bangladesh, HEV infections and HEV-related acute hepatitis of Bangladeshi origin have been reported from different parts of the world. Methods: The study was conducted in Mirpur area of Dhaka city, which is a major residential area of the capital of Bangladesh. Three hundred adults were randomly included in the study. None had any history of jaundice or complains of liver diseases. Results: The study revealed 30% prevalence of HEV in this population. The prevalence increased with age, but there was no gender difference. Conclusion: HEV is a highly prevalent disease in Bangladesh as elsewhere in the developing world. Since there is no specific treatment for HEV, improvement of personal hygiene and ensuring supply of safe food and drinking water remain most important approach to sustain the virus.

ORIGINAL ARTICLE

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

General Properties of Colon Polyps in Central Anatolia

[Year:2014] [Month:January-June] [Volume:4] [Number:1] [Pages:4] [Pages No:7 - 10]

PDF  |  DOI: 10.5005/jp-journals-10018-1088  |  Open Access |  How to cite  | 

Abstract

Aim: Polyp is called formations protruding into the lumen in the gastrointestinal tract. In this study, we aimed to determine frequency, anatomic distribution within the large bowel and pathologic types of colon polyps based on the colonoscopy results. Materials and methods: The colonoscopy reports between 2010 and 2011 were analyzed retrospectively. Complaint of the patients on admission, the presence of polyps, anatomic distribution of polyps, polyp type and polyp size were evaluated. Result: A total of 4000 colonoscopy reports were examined. The largest proportion of polyps occurred in the left colon (74.4%), followed by the ascending colon (11.5%). Eighty-five were adenomatous polyps, 71 were hyperplastic polyps, 12 were inflammatory polyps, 12 were serrated adenoma, 3 were adenocarcinoma, and 8 were tubulovillous adenomas. Discussion: In light of like this study, the development of screening and follow-up programs in Turkey will be useful to reduce the incidence and mortality of colorectal cancer.

ORIGINAL ARTICLE

Ram Abhinav Kannan

Feasibility of Concurrent Chemoradiation in Patients treated for Esophageal Carcinoma: A Single Institutional Experience

[Year:2014] [Month:January-June] [Volume:4] [Number:1] [Pages:3] [Pages No:11 - 13]

PDF  |  DOI: 10.5005/jp-journals-10018-1089  |  Open Access |  How to cite  | 

Abstract

Background: Chemoradiation has shown superior overall survival when compared with radiation alone in esophageal carcinoma. Due to compromised nutritional status, radiation therapy in esophageal cancer patients itself is a challenge and addition of concurrent chemotherapy leads to severe side effects even when standard dose regimens are used. The tolerance of chemoradiation for carcinoma esophagus in Indian patients is still unclear. This study is an effort to know feasibility of chemoradiation in patients treated for esophageal carcinoma in our hospital. Materials and methods: A total of 47 consecutive patients of histologically proven esophageal carcinoma who were treated in MS Ramaiah Hospital were reviewed retrospectively from January to August 2013. Out of 47 patients, 20 patients were treated with concurrent chemoradiotherapy. Patients were assessed for number of days of treatment interruptions in radiation schedule and number of planned vs executed cycles of chemotherapy. Results: Out of the 20 patients treated with concurrent chemoradiotherapy, 13 patients were male (65%) and 7 (35%) were female. Median age of patients was 60 years (25-75 years). Squamous cell carcinoma was noted in majority of cases (19/20 cases). A total of 18 of 20 patients completed the planned dose of radiation and only 3/20 patients completed all planned cycles of chemotherapy. Mean number of days of interruption in radiation schedule in patients receiving chemoradiotherapy was 4.4 days. Conclusion: There was poor tolerance to chemoradiotherapy leading to reduction in the number of executed chemotherapy cycles as opposed to planned cycles, although there were no significant interruptions in radiation treatment.

ORIGINAL ARTICLE

Mohammed Forhad Abedin, Mohammad Mahfuzul Hoque

Chronic Liver Disease is One of the Leading Causes of Death in Bangladesh: Experience by Death Audit from a Tertiary Hospital

[Year:2014] [Month:January-June] [Volume:4] [Number:1] [Pages:4] [Pages No:14 - 17]

PDF  |  DOI: 10.5005/jp-journals-10018-1090  |  Open Access |  How to cite  | 

Abstract

Background: In industrialized countries, the audit has become an integral part of medical care. The experience from developing countries like Bangladesh is still inadequate. This study had been carried out to find out relation among some factors like age, sex, causes, diurenal variation, duration of hospital stay with death and errors in certification process. Materials and methods: It was a cross-sectional study conducted at the Department of Medicine, Sir Salimullah Medical College (SSMC) and Mitford Hospital from March 2010 to August 2010. Information of consecutive 100 deaths was collected in a predesigned clinical data sheet within half an hour of every occurrence. Necessary data were collected from hospital case records (admission registrar, case files and death certificates) using structured checklist. Patients who were brought dead were excluded from the study. Results: Among 100 deaths, 48% were males (n = 48) and 52% were females (n = 52). Within this group, 66.7% were males and 33.3% were females. First day (within 24 hours of admission) death accounted for 46% (n = 46) of all death and by the second day 23% (n = 23) of all deaths occurred. The highest underlying cause of death was cerebrovascular diseases (29% of total death), infectious disease contributed 20%, chronic liver disease 13%, malignancy 7%, poisoning 6%, cor pulmonale 5%, while others were 20%. Conclusion: In this studychronic liver disease was found to be one of the leading causes of death in our hospital and most of them occurred due to hepatic encephalopathy. So, early detection of hepatic encephalopathy and treatment is necessary to reduce hospital mortality.

ORIGINAL ARTICLE

Muthupillai Karuppanan, Manigandan Krishnan, Pavankumar Padarthi, Elangovan Namasivayam

Hepatoprotective and Antioxidant Effect of Mangifera Indica Leaf Extracts against Mercuric Chlorideinduced Liver Toxicity in Mice

[Year:2014] [Month:January-June] [Volume:4] [Number:1] [Pages:7] [Pages No:18 - 24]

PDF  |  DOI: 10.5005/jp-journals-10018-1091  |  Open Access |  How to cite  | 

Abstract

Background: To explore the antioxidant and hepatoprotective effect of ethanolic Mangifera indica (EMI) and methanolic Mangifera indica (MMI) leaf extracts in mercuric chloride (HgCl2) induced toxicity in Swiss albino mice. Materials and methods: Toxicity in mice was induced with HgCl2 (5.0 mg/kg, i.p.), followed by oral intervention with EMI and MMI extracts (25 mg and 50 mg/kg. body wt.) for 30 days. Results and discussion: The extent of liver damage was assessed from the extents of histopathological, morphological, antioxidant and liver enzymes. Mercuric chloride-induced mice showed an increased cellular damage whereas leaf extracts of EMI and MMI-treated mice showed recovery of damaged hepatocytes. Mercuric chloride intoxicated mice exhibited a significant (p < 0.05) elevation in the liver enzymes (Aspartate amino transferase and Alanine amino transferase) and gradual decline in the cellular radical scavenging enzyme levels (Catalase, Glutathione-s-transferase and Glutathione peroxidase. The combined treatment with EMI and MMI leaf extracts significantly (p < 0.05) reversed these parameters. However, the effects of MMI leaf extract (50 mg/kg) were superior to those of EMI- treated mice possibly due to its potent radical scavenging property. These results suggest that oral supplementation of Mangifera indica extract remarkably reduces hepatotoxicity in mice possibly through its antioxidant potentials.

ORIGINAL ARTICLE

Salimur Rahman, Mohammad Faroque Ahmed, Mohammad Jamshed Alam, Mohammad Izazul Hoque, Chitta Ranjan Debnath

Distribution of Liver Disease in Bangladesh: A Cross-country Study

[Year:2014] [Month:January-June] [Volume:4] [Number:1] [Pages:6] [Pages No:25 - 30]

PDF  |  DOI: 10.5005/jp-journals-10018-1092  |  Open Access |  How to cite  | 

Abstract

Introduction: ‘Hepatology’, as an independent discipline of medical science, has recently been established in Bangladesh. The aim of this study was to formulate the distribution of pattern of liver diseases in this country. Materials and methods: In this retrospective study, data regarding patients of liver diseases from the seven different administrative divisions of Bangladesh between January 2012 and 2013 were compiled. Results: The study included 59,227 patients (age ranged 15-95 years). Majority of the patients were males (67.9%). Although all patients appeared at the department of hepatology, 13.2% were diagnosed with liver diseases, but a vast majority of patients (77.35%) were suffering from nonulcer dyspepsia or irritable bowel syndrome. Patients with liver diseases were mostly suffering from chronic liver diseases (CLDs) (37 - 69%). Complication of CLD, like hepatic encephalopathy, was less frequent in regions with better healthcare system. Nonviral infections, like liver abscess and biliary ascarisis, were not uncommon. Acute hepatitis was another very common entity and contributed to approximately 20% cases. Conclusion: This study provides insight about heterogeneous distribution pattern of liver diseases in different regions of Bangladesh.

ORIGINAL ARTICLE

Farjana Majid, Munira Jahan, Ahmed Lutful Moben, Shahina Tabassum

Comparison of Hybrid Capture 2 Assay with Real-time-PCR for Detection and Quantitation of Hepatitis B Virus DNA

[Year:2014] [Month:January-June] [Volume:4] [Number:1] [Pages:5] [Pages No:31 - 35]

PDF  |  DOI: 10.5005/jp-journals-10018-1093  |  Open Access |  How to cite  | 

Abstract

Background: Both real-time-polymerase chain reaction (PCR) and hybrid capture 2 (HC2) assay can detect and quantify hepatitis B virus (HBV) DNA. However, real-time-PCR can detect a wide range of HBV DNA, while HC2 assay could not detect lower levels of viremia. The present study was designed to detect and quantify HBV DNA by real-time-PCR and HC2 assay and compare the quantitative data of these two assays. Materials and methods: A cross-sectional study was conducted in between July 2010 and June 2011. A total of 66 serologically diagnosed chronic hepatitis B (CHB) patients were selected for the study. Real-time-PCR and HC2 assay was done to detect HBV DNA. Data were analyzed by statistical Package for the social sciences (SPSS). Results: Among 66 serologically diagnosed chronic hepatitis B patients 40 (60.61%) patients had detectable and 26 (39.39%) had undetectable HBV DNA by HC2 assay. Concordant results were obtained for 40 (60.61%) out of these 66 patients by real-time-PCR and HC2 assay with mean viral load of 7.06 ± 1.13 log10 copies/ml and 6.95 ± 1.08 log10 copies/ml, respectively. In the remaining 26 patients, HBV DNA was detectable by real-time-PCR in 20 patients (mean HBV DNA level was 3.67 ± 0.72 log10 copies/ml. However, HBV DNA could not be detectable in six cases by the both assays. The study showed strong correlation (r = 0.915) between real-time-PCR and HC2 assay for the detection and quantification of HBV DNA. Conclusion: HC2 assay may be used as an alternative to real-time-PCR for CHB patients.

ORIGINAL ARTICLE

M Mancini-Bourgine, G Guillen, ML Michel, JC Aguilar

Impact of the Immunogen Nature on the Immune Response against the Major HBV Antigens in an HBsAg and HLA-humanized Transgenic Mouse Model

[Year:2014] [Month:January-June] [Volume:4] [Number:1] [Pages:9] [Pages No:36 - 44]

PDF  |  DOI: 10.5005/jp-journals-10018-1094  |  Open Access |  How to cite  | 

Abstract

Hepatitis B chronic carriage remains as a major public health problem. Protein and DNA vaccines are now widely used in therapeutic vaccine candidates. Although, the hepatitis B surface antigen (HBsAg) based vaccines have been largely studied, candidates comprising both HBsAg and core (HBcAg) either protein- or DNA-based approaches deserve further immunological characterization. In the present study, a repeated dose administration schedule for protein or DNA immunogens was conducted in order to characterize the resulting immune response in a humanized and HBsAg-tolerized setting. A novel transgenic (Tg) mice that express the HBsAg, human MHC class I (HLA-A*0201) and MHC class II (HLA-DRB1*01) molecules and devoid of endogenous murine class I and II molecules was used as a model of HBV chronic carrier. Mice were immunized by subcutaneous (protein) or intramuscular (DNA) routes and the humoral and cellular responses were evaluated. Protein or DNA immunization induced humoral immune responses against both HBsAg and HBcAg. The systematic analysis of epitopes that activate CD4+ and CD8+ T lymphocytes confirmed the accuracy of the model. Cellular immune responses were detected differing in their nature. CD8 T-cell responses were induced mostly after DNA immunization while CD4 T-cell responses were predominant in protein based immunizations. In addition, the intensity of HLA-A2-restricted CD8+ T cell responses was reduced in Tg mice expressing HBsAg when compared to control Tg mice. In conclusion, our results indicate that cellular immune responses necessary for the development of protective immunity can be achieved by DNA or protein immunization. However, important differences in their nature arise when immunogens are administered several times.

REVIEW ARTICLE

Hikmet Akkiz

The Emerging Role of MicroRNAs in Hepatocellular Carcinoma

[Year:2014] [Month:January-June] [Volume:4] [Number:1] [Pages:6] [Pages No:45 - 50]

PDF  |  DOI: 10.5005/jp-journals-10018-1095  |  Open Access |  How to cite  | 

Abstract

Hepatocellular carcinoma (HCC) is common malignancy and a leading cause of cancer death worldwide. Recent epidemiological data have demonstrated that liver cancer incidence is continuously rising and will continue to do so for more than a decade, not only South Africa and Mainland China but also in North America and Europe. Molecular profiling of changes in gene expression has improved our understanding of the HCC mechanism. MicroRNAs (miRNAs) are a class of small regulatory RNAs that function to modulate protein expression. This control allows for fine-tuning of the cellular phenotype, including regulation of proliferation, cell signaling and apoptosis. Recently, investigators have demonstrated decreased or increased expression of particular miRNAs in hepatobiliary cancer cells. Many studies have highlighted the role of miRNA in physiological processes and cancer development. Several studies have reported that some miRNAs may play a role in the development and progression of HCC. Recent investigations have suggested that the presence of single nucleotide polymorphisms in miRNA genes, their processing machinery and target binding sites affect cancer risk, treatment efficacy and patient prognosis. This review will discuss the emerging critical role of miRNAs in hepatocarcinogenesis, HCC progression and clinical outcome.

MINI REVIEW

Rohit Gundamaraju, Ravichandra Vemuri

Pathophysiology of Greedy Colon and Diabetes: Role of Atropine in worsening of Diabetes

[Year:2014] [Month:January-June] [Volume:4] [Number:1] [Pages:4] [Pages No:51 - 54]

PDF  |  DOI: 10.5005/jp-journals-10018-1096  |  Open Access |  How to cite  | 

Abstract

Greedy colon which is a synonym of constipation is a serious condition in the human body which may lead to complications, like damage of the rectal tissue, cellular dehydration and colorectal cancer. Diabetes mellitus, although a systemic disease with diverse clinical symptoms, is also related with cellular dehydration. Understanding the pathophysiological aspects of diabetes mellitus and greedy colon may shed light in the management of either of these conditions. The main purpose of this article is to demonstrate an association of tissue dehydration during diabetes mellitus and constipation. The adverse side effects of atropine will be discussed due to its M3 blockage effect and reduction in peristalsis keeping in mind the importance of these facts in the context of public health importance, especially in geriatric health.

CASE REPORT

Aswini Kumar Sahoo, Sudhasmita Rauta, Subash Chandra Mohapatra

Portal Vein Thrombosis: A Rare Finding in a Noncirrhotic Patient

[Year:2014] [Month:January-June] [Volume:4] [Number:1] [Pages:3] [Pages No:55 - 57]

PDF  |  DOI: 10.5005/jp-journals-10018-1097  |  Open Access |  How to cite  | 

Abstract

Portal vein thrombosis (PVT) is a rare cause of abdominal pain, typically associated with cirrhosis or thrombophilia. A 18-year-old female presented with abdominal pain for 10 weeks. The diagnosis was confirmed with contrast-enhanced computed tomography (CECT) abdomen after an ultrasound showed dilated and obstructed portal vein. This unexpected finding prompted investigation for intrinsic hepatic disease and potential hypercoagulable disorders. Laboratory analysis revealed an elevated serum homocysteine level, an identified risk factor for venous thrombosis. Current literature describes the following factors as indications for anticoagulation: acute thrombus, lack of cavernous transformation, absence of esophageal varices and mesenteric venous thrombosis. PVT is an uncommon cause of abdominal pain, and in the absence of hepatic disease should raise the index of suspicion for an underlying thrombophilia.

CASE REPORT

Gayatri Madhab, Jette Madsen, Eva Brems Dalgaard, Arindam Bharadwaz

Superior Mesenteric Artery Syndrome: A Rare Mimic of Common Causes of Upper Gastrointestinal Obstruction

[Year:2014] [Month:January-June] [Volume:4] [Number:1] [Pages:3] [Pages No:58 - 60]

PDF  |  DOI: 10.5005/jp-journals-10018-1098  |  Open Access |  How to cite  | 

Abstract

Rare causes of common symptoms often pose a diagnostic dilemma which can lead to unwanted loss of precious time in proper diagnosis and management. Superior mesenteric artery (SMA) syndrome is such a rare disorder. It typically presents with signs and symptoms of upper gastrointestinal (GI) obstruction which can be mimicked by a variety of clinical conditions, such as peptic ulcer, chronic pancreatitis, mesenteric ischemia and systemic lupus erythematosus (SLE). A high degree of clinical suspicion is required to direct proper investigations to narrow down to the correct diagnosis. Multidetector CT (MDCT) proves to be invaluable not only in ruling out more common conditions mimicking SMA syndrome but also in arriving at the correct diagnosis quickly and effectively with great clinical accuracy and thereby removing confusion and delay in proper management.

CASE REPORT

Bora Aktas, Sebahat Basyigit,, Metin Küçükazman, Hülya Demirkaynak Simsek, Gulçin Güler Simsek

Early Gastric Cancer: A Demonstrative Case Report

[Year:2014] [Month:January-June] [Volume:4] [Number:1] [Pages:1] [Pages No:61 - 61]

PDF  |  DOI: 10.5005/jp-journals-10018-1099  |  Open Access |  How to cite  | 

Abstract

With early detection of gastric cancer, mortality from gastric cancer has decreased. Endoscopists should be more suspicious about these lesions because these can be easily neglected. We reported a case which has endoscopic appearance of benign lesion but possessed malignant histological features.

LETTER TO EDITOR

Arunkumar Krishnan, Vimalraj Velayutham, Jeswanth Satyanesan

Endoscopic Management of Postoperative Stapled Anastomosis Bleeding

[Year:2014] [Month:January-June] [Volume:4] [Number:1] [Pages:2] [Pages No:62 - 63]

PDF  |  DOI: 10.5005/jp-journals-10018-1100  |  Open Access |  How to cite  | 

Abstract

Knowledge has evolved and the use of staplers in gastrointestinal surgery is now widespread. They are associated with low rates of postoperative complications. Postoperative anastomotic complications with stapling devices are relatively rare, with a reported incidence between 0 and 2.5%.

SHORT COMMUNICATION

Rohollah Valizadeh,, Siroos Hosseini Askarabadi, Sedigheh Karampour, Mona Abdolhamid Tehrani

The Effect of 10 Weeks Resistance Training on Cholesterol and Blood Triglyceride Levels of Patients with Fatty Liver Disease

[Year:2014] [Month:January-June] [Volume:4] [Number:1] [Pages:2] [Pages No:64 - 65]

PDF  |  DOI: 10.5005/jp-journals-10018-1101  |  Open Access |  How to cite  | 

Abstract

The present study aims to consider the effect of 10 weeks resistance trainings on cholesterol and blood triglyceride (TG) levels of patients with having fatty liver, aged 50 to 60 in National Iranian South Oil Company (NISOC). This research is practical and its plan has been done experimentally with pretest and post-test on experimental and control groups. In this study, 20 samples from 100 patients who referred to sonography clinic in NISOC with distinction of fatty liver were selected randomly and divided into two groups of control (n = 10) and experimental (n = 10). Cholesterol and blood triglyceride were measured as pretest. Test of normality for TG was (p = 0/200) by Kolmogorov-Smirnov and (p = 0/070) for cholesterol by Shapiro-Wilk test. After 10 weeks resistance trainings, the analysis and resolution of data were done by computer and SPSS (16) software as well as the descriptive and statistical methods (t-test). Comparison between these two groups showed that 8 weeks resistance trainings with a ≤ 0.05 causes significant decrease in the amount of TG but did not any significant effect on cholesterol of fatty liver patients.

SHORT COMMUNICATION

Dulal Chandra Podder, Paban Kumar Saha

An Outbreak of Acute Hepatitis in a Medical Facility of Bangladesh

[Year:2014] [Month:January-June] [Volume:4] [Number:1] [Pages:2] [Pages No:66 - 67]

PDF  |  DOI: 10.5005/EJOHG-4-1-66  |  Open Access |  How to cite  | 

Abstract

A total of 45 patients with acute hepatitis were detected in a medical facility of Bangladesh over a period of 6 months. All of them were physicians, nurses, students or employees of the hospital. About 50% of these patients suffered from acute hepatitis within a period of 2 months. All of them had clinical and biochemical evidences of acute hepatitis. All of them shared common working places as well as common dining and cooking facilities. Although the disease was supposed to be caused by hepatitis viruses, none of them were expressing IgM type antibody to hepatitis B core antigen (IgM anti-HBc) or hepatitis C virus (IgM anti-HCV). IgM type antibody to hepatitis A virus (IgM HAV) was detected in one patient and IgM type antibody to hepatitis E virus (anti-HEV IgM) were found in 14 patients. In conclusion, diagnosis of etiological agent of viral acute hepatitis constitutes a formidable challenge to the existing health care delivery system in developing countries as available serological and routine screening fails to find the proper etiological agent.

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