Background: Liver histology remains the gold standard for assessing nonalcoholic fatty liver disease (NAFLD). Noninvasive serological markers have been developed to evaluate steatosis to avoid biopsy. In NAFLD patients, serum resistin was higher than those in control lean and obese patients. Objective of the study: To investigate serum resistin and its receptor gene expression in liver biopsy as predictors for NAFLD severity. Patients and methods: This study was conducted on 54 obese patients, with suspected fatty liver by ultrasound (excluding diabetic, alcoholic, hepatitis C virus antibody (HCVAb) or hepatitis B surface antigen (HBsAg) positive patients). They were subjected to anthropometric measurements, laboratory studies including serum resistin, abdominal ultrasonography (US) and liver biopsy. The 15 lean subjects were included as a control group. According to biopsy results, patients were subdivided into nonalcoholic steatohepatitis (NASH) group (46 patients) and non-NASH group (8 patients). Results: Significantly higher levels of resistin were detected in NAFLD patients compared to control subjects (p = 0.0001). Also, higher levels of resistin were recorded in NASH group compared to the non-NASH group; however, the difference was not statistically significant (p = 0.584). Serum alanine aspirate aminotransferase (AST), alanine aminotransferase (ALT) and gamma-glutamyl transpeptidase (GGT) were higher in NASH patients than non-NASH group (p = 0.223, p = 0.005 and p = 0.006 respectively). Abdominal US showed high sensitivity in NAFLD diagnosis (sensitivity of sonar in detecting steatosis grade compared to biopsy was 61% in grade 1, 25% in grade 2 and 75% in grade 3). Conclusion: Serum resistin can be combined with other noninvasive markers to predict the presence of NASH as an alternative to liver biopsy.

Aim: To compare the efficacy of quadruple and sequential therapy in eradication of Helicobacter pylori (H. pylori) in a randomized study. Method: Three hundred H. pylori positive patients were enrolled into the study. These patients were randomly divided into two groups: group I (n = 150) received quadruple therapy (20 mg omeprazole bid, 240 mg bismuth subcitrate bid, 1,000 mg tetracycline bid and 500 mg metronidazole bid) for 14 days, group II (n = 150) received sequential therapy (20 mg omeprazole bid, 1,000 mg amoxicillin bid for 5 days, followed by 20 mg omeprazole bid, 500 mg metronidazole bid, 500 mg clarithromycin for the other 5 days). H. pylori status was assessed by histology and rapid urease test at baseline. Follow-up breath test by 14C urea breath test (UBT) was performed 4 weeks after completion of treatment. Eradication was defined as negative results on UBT. Results: Successful eradication was achieved in 245 patients. In each group, five patients did not tolerate the regimen and were excluded from analysis. About 29 (20%) patients who received sequential therapy and 21 (14.5%) of the quadruple group tolerated mild side effects (p = 0.21). Per-protocol analysis demonstrated eradication rates of 86.9% for sequential therapy and 82.7% for quadruple therapy (p = 0.26). Results according to the intention to treat analysis were 84 and 79.5% in the sequential and quadruple group respectively. Eradication rate differences were not significant. Conclusion: The success rate of sequential therapy is comparable with quadruple therapy. Sequential therapy due to the short duration and lesser drug usage is a good alternative for eradication of H. pylori in the country.

Aim: Acute pancreatitis (AP) is an inflammatory disorder, the incidence of which has been increasing over recent years. Mean platelet volume (MPV) is an index of platelet activation and influenced by inflammation. The objective of the present study is to assess whether MPV would be convenient parameters for predictor factor of patients with AP. Materials and methods: A total of 140 AP patients (male/female: 63/77) and 70 healthy subjects (male/female: 23/47) were enrolled in this study. The following data were extracted from the hospital medical records, including age, sex, platelet count, MPV, were recorded at the time of admission and as well as at the 1st day of remission of the disease. Results: Mean platelet volume levels at onset and remission of AP were 7.8 ± 1.6 and 7.7 ± 0.9 respectively, and there was no statistically significant difference between these groups. Platelet count at onset and remission of AP and control subjects was 203 ± 74 × 103/μl, 234 ± 76 × 103/μl and 251 ± 87 × 103/μl, respectively, and there was statistically significant difference between these groups. Platelet count at onset and remission of AP was statistically lower than control subjects. Conclusion: Some studies in literature suggest that MPV might be a useful parameter to be used as an indicator for AP and a prognostic factor for AP, but, in this study, it was revealed that MPV values do not change at AP compared with controls. Therefore, further prospective studies investigating the factors affecting the platelet size are required to determine whether MPV has a clinical implication and for predictor value of patients with AP.

Hepatitis B core antigens (HBcAg) and hepatitis B surface antigens (HBsAg) are the main structural antigens of hepatitis B virus (HBV). Both antigens are potent immunogens for experimental animals as well as in acutely infected patients. A novel formulation based on the combination of HBsAg and HBcAg has been developed as a therapeutic vaccine candidate, aimed at inducing an immune response capable of controlling the infection. An immunization schedule was conducted to evaluate the immunogenicity of this formulation after simultaneous immunization by the intranasal and parenteral routes using different schedules and doses. Humoral and cellular immune responses generated in blood and spleen were evaluated by engyme-linked immunosorbent assay (ELISA) and enzymeliked immunospot (ELISPOT) assays respectively. A first experiment evaluated two groups of mice simultaneously immunized by intranasal (IN) and subcutaneous (SC) routes, one including alum by SC route and, in the other, the formulation was injected without adjuvant. As a result, alum adjuvant did not increase the immunogenicity under the studied conditions. In fact, the group without alum induced the most potent immune response. The immune response was enhanced by combining IN and SC immunization compared to the SC route alone. In a second experiment, mice were immunized by different mucosal routes at the same time, and compared to the simultaneously (IN/SC) immunized groups. It was demonstrated that there is no improvement on the resulting immune response by using multiple routes of immunizations simultaneously; however, the increase of the antigen dose induced a superior immune response. Interestingly, the increase of antigen dose only by SC route did not favor the resulting immunogenicity. In conclusion, the use of HBsAg transgenic mice has proven useful to optimize the formulation, avoiding the unnecessary use of alum as adjuvant as well as provided information of the role of different mucosal immunization routes and antigen dose on the resulting immune response.

Background: Blood-borne viral infections, like hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV), are most common during blood transfusion. Morbidity and mortality resulting from the transfusion of infected blood have far reaching consequences not only for the recipients themselves but also for their families, communities and the wider society. Aims: The study was designed to determine the prevalence of HBV, HCV and HIV among voluntary and replacement blood donors of Tripura, India, and to study the trends of HBV, HCV and HIV infections in the population. Materials and methods: This study is a retrospective cross-sectional study. The data was collected for consecutive 8 years from 2005 to 2013. Analyses were done in respect of total blood collection and HBV, HCV and HIV infections among the donors. Results: Among all donors, 91.8% was voluntary donors and 8.2% was replacement donors. The average HBV, HCV and HIV positivity was 1.2% (95% CI: 1.155-1.255), 0.109% (95% CI: 0.095- 0.125) and 0.093% (95% CI: 0.080-0.108) respectively. Among these, HBV seropositivity was 1.19% among voluntary donors and 1.33% among replacement donors and, in case of HCV and HIV, the seropositivity among voluntary and replacement donors were 0.109%, 0.11% and 0.089%, 0.145% respectively. HBV positivity was reduced in 8 years, whereas those of HCV and HIV remain unchanged. Conclusion: The most important observation of this study is gradual decrease in prevalence of HBV (p = 0.0018), whereas change in prevalence of HCV and HIV was not statistically significant. This might be due to mass hepatitis B vaccination program in Tripura.

The efficacy of mesenchymal stem cells transplantation on regeneration activity of cirrhotic liver was evaluated in an animal model of cirrhotic liver. Autologous stem cells were obtained from bone marrow. Transplantation was performed 1 week after surgery by introducing stem cells into the liver. Immunohistochemical staining (proliferative activity, myofibroblast activation and sinusoidal capillarization) was evaluated to assess the efficacy of transplantation. It was found that, 2 months after stem cell transplantation, the severity of perisinusoidal fibrosis, inflammation of the liver and the number of myofibroblasts were reduced. Stem cell transplantation may be one of the new treatment modalities for cirrhotic liver.

Background and aim: Assessment of therapeutic response is important for monitoring the prognosis and to take decision for cessation of nucleoside analogues therapy in chronic hepatitis B patients. In addition to serum alanine aminotransferase (ALT), hepatitis B virus (HBV) deoxyribonucleic acid (DNA) load and HBeAg status, identification of molecular markers associated with host immune response would be essential to assess therapeutic response. In this regard the current study was performed with the aim to detect expression of platelet endothelial cell adhesion molecule (PECAM)-1 gene in peripheral blood monocytes (PBMCs) of treated chronic hepatitis B patients and also to correlate expression of this gene with serum HBV DNA load and serum ALT levels. Materials and methods: The study analyzed 60 chronic hepatitis B (CHB) patients, including 30 untreated and 30 nucleoside analogs treated and 10 healthy controls. PECAM-1 gene expression/ transcripts were detected by conventional RT-PCR. Results: The expression PECAM-1 mRNA in the PBMCs of CHB patients was significantly higher in untreated (3.17 ± 0.75) than the treated patients (1.64 ± 0.29) (p < 0.01). Expression of PECAM-1 was positively correlated with serum ALT levels of both untreated (r = 0.580) and treated (r = 0.566) CHB patients. Moreover, in both untreated and treated groups, these gene expressions were positively correlated to serum HBV DNA load with the correlation coefficient r = 0.545 and r = 0.591 respectively. Conclusion: PECAM-1 may be used as a biomarker for assessment of inflammatory activity as well as therapeutic response in CHB patients.

Despite the existence of effective prophylactic vaccines, hepatitis B virus (HBV) infections remain a major public health problem. It has been estimated that about 370 million people are chronically infected with this virus worldwide. These individuals act as a reservoir for viral spread and chronic infection also increases the risk of liver diseases, such as cirrhosis and hepatocellular carcinoma. Current antiviral therapies fail to control viral replication in the long term in most patients. Viral persistence has been associated with a defect in the development of HBV-specific cellular immunity. The limitations of the current available therapies underline the need for alternative therapies. Specific immunotherapeutic strategies target not only the induction or stimulation of CD4(+) and CD8(+) T-cell responses but also the induction of proinflammatory cytokines capable of controlling viral replication. Therapeutic vaccination has been extensively studied in chronic hepatitis B (CHB) based in the properties of hepatitis B surface antigen (HBsAg) and taking advantage of its previous use in preventive vaccination. In this sense, pioneer studies were carried out employing HBsAgbased vaccines, including prophylactic commercial vaccines and HBsAg-based formulations with novel adjuvants. The results and general knowledge coming from these studies are discussed in the present review. The decision on developing new generations of vaccines including new antigens or formulations should take into account the experience with HBsAg-based vaccine formulations in order to decide about changing the vaccine antigen or adding new antigens to improve the composition.

Esophageal leiomyoma is the most common benign intramural tumor of esophagus. Although its incidence is not exactly known, it is very rare (0.006%-0.1% in autopsy series). It is generally asymptomatic and detected incidentally. Here, we present a rare case report describing coexistence of megaloblastic anemia and esophageal leiomyoma.

We report the case of a 69-year-old man with a spontaneous gastrobiliary fistula. Internal biliary fistulas are usually the result of longstanding, untreated choledocholithiasis, cholecystolithiasis, peptic ulcers or rarely neoplasia. This patient’s unspecific clinical picture led to a late diagnosis, which was made during surgery.

Crohn’s disease is a chronic, or long lasting inflammatory disease in the gastrointestinal (GI) tract. Most commonly, Crohn’s disease affects the small intestine and the beginning of the large intestine. Treatment for Crohn’s disease usually involves drug therapy or, in certain cases, surgery. Several side effects develop from the use of drugs. A case with Crohn’s disease refractory to 5-ASA, corticosteroid and azathioprine treatments who developed breast carcinoma following infliximab treatment is being presented in this report. Case: SE, aged 44 years, presented to our polyclinic with weight loss, abdominal pain and flatulence. The patient had no response to mesalazine, steroid and azathioprine therapy. Upon identifying inflammatory stricture with abdominal MR, the medicines the patient has been using was discontinued and anti-TNF alpha (infliximab) treatment was initiated after receiving the consent of the patient. At 3rd month of treatment, the patient detected a small mass at the left breast. Mastectomy was performed and axillary lymph nodes were resected. Because breast cancer was detected following infliximab treatment in this case, we believe that a breast examination (physical examination, mammary USG) must be performed in female patients prior to infliximab therapy.

Amyloidosis can involve all the segments of the gastrointestinal system (GIS) from mouth to anal canal. We present a case of amyloidosis that is detected by gastric biopsy taken in esophagogastroduodenoscopy (EGD) performed to investigate the etiology of weight loss, nausea and vomiting. It is worth emphasizing that random gastric biopsy is important in gastric evaluations.

An 11-year-old boy underwent ligation of sac for left congenital hydrocele. In the immediate postoperative period, he developed bleeding per rectum and obstructive features. Intramural hematoma of sigmoid colon was detected in diagnostic laparoscopy and confirmed by laparotomy. Sigmoidectomy with colorectal anastomosis was done. Postoperative period was uneventful.

Malignant mucinous neoplasms of the appendix is an infrequently encountered entity. Extraappendiceal spread of these tumor is one of the commonest etiology of pseudomyxoma peritonei, which demands a hightened vigilance in their early diagnosis. Although low-grade appendiceal mucinous neoplasms (LAMNs) largely stay confined to the appendix, but they can spread to the peritoneum as pseudomyxoma peritonei leading to an unpredictable outcome. Due to the rare occurrence of low-grade appendiceal neoplasm only tenuous and limited information is present in the medical literature. We report a case of LAMN with pseudomyxoma peritonei in a 45-year-old male, who presented with the complaints of abdominal distension associated with abdominal pain and constipation. Clinical examinations and computed tomography (CT) scan were suggestive of pseudomyxoma peritonei. Peroperative findings and histopathological examination rendered a conclusive diagnosis of low-grade appendiceal neoplasm.