Etiology and outcome of patients with viral-induced acute liver failure

Background: Acute liver failure (ALF) is a rare medical emergency and devastating clinical syndrome associated with high mortality in the absence of immediate intensive supportive care, specific treatment, or liver transplantation. Viral hepatitis is still one of the main causes of ALF in the India as well in world. We aimed to determine the etiology of Viral-ALF and to compare the outcome and clinical and biochemical variables in patients with hepatitis E and non HEV group in this prospective study.Methods: A total of 37 patients with a diagnosis of viral-ALF were included in the study. The variables evaluated were demographic, signs and symptoms, biochemical parameters, severity of liver injury, outcome, complications and duration of hospital stay.Results: Out of 37 Viral-ALF patients, Acute HEV-induced ALF (48.6%) was most common followed by HBV (24.3%) and HAV (21.6%). There were significantly more females in HEV group (61.1%) than non HEV group (21.1%) (P = 0.014). Overall mortality was 20 (54.1%). Mortality was higher in non HEV group (73.7%) than HEV group (33.3%) (P = 0.015). The mean age in HEV group was 30±12.7 years and in non HEV group was 38.1±10.4 years (P = 0.042). Bilirubin, ALT, mean grade of coma and interval between jaundice and encephalopathy were significantly higher in non HEV group than HEV group. MELD Score was higher in non HEV group 32.6±7.9 than HEV group 26.3±7.2 (P = 0.012). Sepsis and renal failure occurred more frequently in non HEV group than HEV group. Duration of hospital stay was also significantly more in non HEV group 11.3±3.3 days versus HEV group was 7.9 ± 2.9 (P = 0.002).Conclusions: HEV was the most frequently associated with Viral-ALF. HEV related ALF disproportionately affected young women. Mortality was higher in non HEV group (73.7%) than HEV group (33.3%). The marked difference in spontaneous survival between HEV and non HEV group can be explained by the severity of hepatic dysfunction on admission and more frequent complications

Comparison of cardiac autonomic response in different ABO blood groups of young adults

Background: ABO blood group has been associated with various disease phenotypes, particularly cardiovascular disease. Abnormal autonomic response also plays a role in cardiac morbidity. Increasing attention is being focused on the role of autonomic nervous system in health and disease. The literature lacks data on the association of blood groups and cardiac autonomic function. The aim of the study was to find out the association between different blood groups and cardiovascular autonomic functions in young adults.Methods: 150 healthy young students of MMU aged 18-25 years, divided into four groups based on ABO blood grouping, determined by agglutination test (group A, group B, group O and group AB). Various autonomic function tests done were lying to standing test, Valsalva maneuver, Hand grip test (HGT) and Cold pressor test (CPT).Results: The mean baseline heart rate was significantly higher in group O as compared to group A. No parasympathetic alteration between different ABO blood groups was seen. Blood pressure response to HGT and CPT was not statistically significant between different blood groups.Conclusions: Present study revealed no alteration in cardiac autonomic function with regards to ABO blood grouping in young adults

A prospective study of N-acetylcysteine treatment in drug-induced fulminant hepatic failure

Background: Acute liver failure (ALF) is a rare but severe, life-threatening, complex, multisystemic gastroenterological emergency. Its rapid progression and high mortality demand early diagnosis and expert management. Drug-induced ALF (DI-ALF) remains the uncommon cause of ALF in India. To date, there is no established treatment for DI-ALF other than liver transplantation and little is known about the use of N-acetylcysteine (NAC) in DI-ALF. A prospective case-control study was carried with the aim to determine the effect of NAC on mortality of DI-FHF patients and also to evaluate the safety and efficacy of NAC use.Methods: A total of 18 patients with a diagnosis of DI-FHF were included in the study. 10 patients received NAC infusion for 72 hours whereas the control group received placebo. The variables evaluated were demographic, signs and symptoms, biochemical parameters, outcome and length of hospital stay.Results: Out of 18 DI-FHF patients, 13 (72.2%) had anti-tuberculosis therapy (ATT) induced FHF and 5 (27.8%) patients had ayurvedic induced FHF. The two groups were comparable for the various baseline characteristics (age, INR, alanine aminotransferase, creatinine, albumin, grade of encephalopathy, etc.). The mortality decreased to 20% with the use of NAC versus 75% in the control group (P=0.023). Use of NAC was associated with a shorter length of hospital stay of survived patients (P=0.043). Moreover, the overall survival was improved by NAC (P=0.023) in DI-FHF. ATT induced FHF showed better outcome as compared to ayurvedic induced FHF use (P=0.019).Conclusions: Author recommended the use of NAC along with conventional treatments in patients with DI-FHF in non-transplant centers while awaiting referrals. ATT induced FHF showed better outcome as compared to ayurvedic induced FHF with NAC administration and its use was safe

Socio-demographic correlation with overweight and obesity among children of North India

Background: Nutritional and epidemiological evolution over the past 3 decades has resulted in weight changes. The dramatic rise in childhood obesity is one of its adverse outcomes. Objectives: The aim of the study was to assess the prevalence and socio-demographic correlates of overweight and obesity among school children in the age group of 6–14 years in rural and urban Jammu. Methods: This cross-sectional community-based study was conducted in school going children of both sex aged 6–14 years in rural and urban areas of Jammu region. After explaining the purpose of the study, students were interviewed by the investigator and needful information regarding socio-demographic variables collected. Following the anthropometric assessment, body mass index (BMI) percentiles were obtained from the WHO age and gender-specific BMI charts. Among socio-demographic variables age, gender, residential area, type of school, type of family, education of parents, mother’s occupation, family size, and birth order were analyzed for their relationship with overweight and obesity. Results: Of the 230 children surveyed in the age group of 6–14 years, which included 107 from urban and 123 from rural areas, the overall overweight and obesity observed was 8.2%. Conclusion: Sociodemographic and socioeconomic factors affect the nutritional status of children and adolescents. Overnutrition, as one of its adverse outcome, needs to be addressed with priority so as to prevent the pandemic of obesity and its metabolic consequences

The Menace of Aflatoxin: Understanding the Effects of Contamination by <em>Aspergillus Species</em> on Crops and Human Health and Advancements in Managing These Toxic Metabolites

Food security and safety are essential global issues that require collaboration from governments, private industry, and individuals to ensure there is enough safe and nutritious food to meet the needs of a growing population. The three main elements impacting food security and safety are the availability of food, access to safe food, and the utilization of food for a healthy life. Aflatoxins, harmful mycotoxins produced by certain fungi, damage a significant proportion of the world’s food supply, which is a factor in food insecurity. Effective strategies to prevent and manage aflatoxin contamination in crops include promoting sustainable and diversified agricultural practices, improving crop management, post-harvest handling and storage, and strict regulation and monitoring of food quality and safety. To date, there have been 20 different types of aflatoxins identified, with B1, B2, G1, and G2 being the most prevalent and dangerous. To mitigate the impact of aflatoxins, it is important to understand the mechanisms of contamination, the impact of aflatoxins, and the management strategies that can be employed to reduce contamination. An updated review on aflatoxin contamination, its impact and management strategies can provide valuable information for researchers, policymakers, and food safety professionals

Vaccine-Elicited Mucosal and Systemic Antibody Responses Are Associated with Reduced Simian Immunodeficiency Viremia in Infant Rhesus Macaques

ABSTRACT Despite significant progress in reducing peripartum mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) with antiretroviral therapy (ART), continued access to ART throughout the breastfeeding period is still a limiting factor, and breast milk exposure to HIV accounts for up to 44% of MTCT. As abstinence from breastfeeding is not recommended, alternative means are needed to prevent MTCT of HIV. We have previously shown that oral vaccination at birth with live attenuated Mycobacterium tuberculosis strains expressing simian immunodeficiency virus (SIV) genes safely induces persistent SIV-specific cellular and humoral immune responses both systemically and at the oral and intestinal mucosa. Here, we tested the ability of oral M. tuberculosis vaccine strains expressing SIV Env and Gag proteins, followed by systemic heterologous (MVA-SIV Env/Gag/Pol) boosting, to protect neonatal macaques against oral SIV challenge. While vaccination did not protect infant macaques against oral SIV acquisition, a subset of immunized animals had significantly lower peak viremia which inversely correlated with prechallenge SIV Env-specific salivary and intestinal IgA responses and higher-avidity SIV Env-specific IgG in plasma. These controller animals also maintained CD4 + T cell populations better and showed reduced tissue pathology compared to noncontroller animals. We show that infants vaccinated at birth can develop vaccine-induced SIV-specific IgA and IgG antibodies and cellular immune responses within weeks of life. Our data further suggest that affinity maturation of vaccine-induced plasma antibodies and induction of mucosal IgA responses at potential SIV entry sites are associated with better control of viral replication, thereby likely reducing SIV morbidity. IMPORTANCE Despite significant progress in reducing peripartum MTCT of HIV with ART, continued access to ART throughout the breastfeeding period is still a limiting factor. Breast milk exposure to HIV accounts for up to 44% of MTCT. Alternative measures, in addition to ART, are needed to achieve the goal of an AIDS-free generation. Pediatric HIV vaccines constitute a core component of such efforts. The results of our pediatric vaccine study highlight the potential importance of vaccine-elicited mucosal Env-specific IgA responses in combination with high-avidity systemic Env-specific IgG in protection against oral SIV transmission and control of viral replication in infant macaques. The induction of potent mucosal IgA antibodies by our vaccine is remarkable considering the age-dependent development of mucosal IgA responses postbirth. A deeper understanding of postnatal immune development may inform the design of improved vaccine strategies to enhance systemic and mucosal SIV/HIV antibody responses

COVID-19 Vaccination Among Diverse Population Groups in the Northern Governorates of Iraq

Objectives: The present study was carried out to investigate COVID-19 vaccination coverage among populations of internally displaced persons (IDPs), refugees, and host communities in northern Iraq and the related underlying factors.Methods: Through a cross-sectional study conducted in five governorates in April–May 2022, 4,564 individuals were surveyed. Data were collected through an adapted questionnaire designed to gather data on participants.Results: 4,564 subjects were included (59.55% were 19–45 years old; 54.51% male). 50.48% of the participants (51.49% of host communities, 48.83% of IDPs, and 45.87% of refugees) had been vaccinated with at least one dose of COVID-19 vaccine. 40.84% of participants (42.28% of host communities, 35.75% of IDPs, and 36.14% of refugees) had been vaccinated by two doses, and 1.56% (1.65% of host communities, 0.93% of IDPs, and 1.46% of refugees) were vaccinated with three doses.Conclusion: Sociodemographic factors including age, gender, education, occupation, and nationality could affect vaccination coverage. Moreover, higher acceptance rate of vaccination is associated with belief in vaccine safety and effectiveness and trust in the ability of the vaccine to prevent complications

Effect of isometric exercise on heart rate variability in prehypertensive young adults

Background and Objective: Heart rate variability (HRV) is a sensitive and specific non-invasive tool to evaluate the degree of heart rate variation under the balanced influence of sympathetic and parasympathetic components of the cardiac autonomic nervous system. The aim was to study the effect of isometric hand grip exercise on HRV in prehypertensive young adults and to find a correlation of HRV with body mass index (BMI). Materials and Methods: This observational study was done on 60 healthy young adults aged 18–30 years. All the subjects were divided into three groups of 20 each on the level of their BMI and systolic and diastolic blood pressures. Group I were subjects with BMI 25 and prehypertensive. HRV analysis (Chart HRV module, ADInstruments Pty Ltd) was performed with the following parameters calculated: low-frequency power (LF), high-frequency power (HF), and LF/HF ratio. Results: LF/HF ratio was significantly increased (P<0.001) in prehypertensive subjects (groups II and III) when compared with the normotensive subjects (group I), which indicates a heightened sympathetic discharge in prehypertensives. A positive correlation between anthropometric parameters and cardiac autonomic activity parameters and increased sympathetic activity in obese subjects were noted. Conclusion: An increase in anthropometric indices is associated with a change in cardiac autonomic activity, especially toward sympathetic activity. Regular anthropometric assessment can prevent the development of cardiac abnormalities and the incidence of sudden cardiac death

Demography and clinical outcome of pulmonary tuberculosis in Kashmir; 2 year prospective study

Introduction: Tuberculosis (TB) is caused by Mycobacterium tuberculosis, primarily affecting lungs. One-third of the world’s population is currently infected with the TB bacillus. Tuberculosis is one of the three primary diseases of poverty. The risk of developing tuberculosis is higher in immunocompromised persons and is a chronic debilitating disease. Aims and objectives: To study the demographic features and clinical outcome of pulmonary tuberculosis. Materials and methods: A prospective study involving 72 pulmonary tuberculosis patients above 18 years. Results: In our study 45 were below the age of 40 years with a mean age of 47 years ±12.39, with a male to female ratio of 1.4:1.61; patients were from rural areas and 18 were labourers. Two were HIV positive; fever was the main presenting complaint. Mean haemoglobin was 11.2 ± 2.48. Mean ESR was 45.2 ± 12.55. Bronchoscopy was done in 13 patients and 4 had bronchoalveolar lavage positive for AFB. All patients received a daily regimen of ATT. 4 were treated as Cat II, rest were treated as Cat I. 64 patients (88.8%) were cured, 8 (11.1%) are on follow up. No resistance was documented in any of the patients. Treatment related complications were seen in 43 (30.8%). Conclusion: Tuberculosis most commonly occurs in younger patients, especially from rural areas. Due to the low prevalence of HIV in Kashmir association with HIV was low. The Commonest presentation was fever. Most patients had a good response to daily regimen and the most common drug related side effect was hepatitis