A case of thyrotoxic hypokalemic paralysis

An Indian male patient with acute quadriplegia with hypokalemia as a rare initial presentation of thyrotoxicosis is presented in this case report

Infection with hepatitis G-virus and viral hepatitis in India

Association of a new non-A-E hepatitis virus designated as hepatitis G virus (HGV) or GBV-C with acute and chronic hepatitis, particularly with fulminant hepatic failure is not clearly understood. In view of paucity of data on the prevalence of HGV in India where viral hepatitis is a major public health problem, we have examined the presence of HGV infection in patients with acute viral hepatitis (AVH), fulminant hepatic failure (FHF) and in normal healthy blood donors. HGV-RNA sequences were detected in patient's serum by reverse transcription plus nested polymerase chain reaction (RT-PCR) using primer sequences located in the conserved NS3 helicase region of the HGV genome. Serum samples collected from 36 acute viral hepatitis, 16 fulminant hepatic failure and 50 healthy voluntary blood donors who did not have symptoms of viral infection or liver disease were recruited for the study. HGV-RNA was detected in 6 (37.5%) of 16 patients with fulminant hepatic failure, in 7 (19.4%) of 36 acute viral hepatitis, and two (4%) in 50 control blood donors. Of the 6 HGV positive FHF patients, only one (1/6; 16.6%) was in non A-E category while 5 (20.0%) patients were HGV positive out of the 25 non A-E AVH cases. In both AVH and FHF, HGV was more frequently detected in (8/13; 61.5%) patients co-infected with other hepatotropic viruses and the most common co-infections were found to be HEV (6/8; 75%) and HBV (5/8; 62.5%). The frequency of hepatitis G virus is found to be certainly higher (37.5%) in fulminant hepatic failure than that in any other type of viral hepatitis in India. But since the virus is often detected in co-infection with either hepatitis B or E virus, which are known potential hepatitis agents, the role of HGV as an independent hepatitis agent is uncertain

High viral load and deregulation of the progesterone receptor signaling pathway: association with Hepatitis E-related poor pregnancy outcome

Background & Aims: Hepatitis E virus (HEV) infection is associated with high maternal and fetal mortalities. A prospective study was undertaken to evaluate the role of viral and host factors in HEV related pregnancy outcomes. Methods: The study included HEV infected pregnancy cases; acute viral hepatitis (AVH), n = 100 and fulminant hepatic failure (FHF), n = 43, and healthy pregnancy cases, n = 50. HEV genotypes and viremia were studied by nucleotide sequencing and real time PCR, respectively. Progesterone receptor (PR) gene mutations (PROGINS) were studied by PCR, PR expression at the mRNA and protein levels in the placenta were studied by semi-quantitative RT-PCR and immunohistochemistry, respectively. Progesterone induced blocking factor (PIBF) expression was studied by RT-PCR in blood. Serum interleukin-10 (IL-10) and interleukin-12 (IL-12) levels were assayed by ELISA. Results: HEV viral load was significantly higher in FHF than AVH (p <0.001) and in cases with fetal mortality in AVH (p = 0.001) and FHF (p = 0.018). PROGINS were predominant in FHF compared to AVH (p = 0.26) and showed reduced mRNA and protein expression. The risk of fetal mortality in AVH was two times higher (OR, 2.190; CI, 0.303-15.85) and maternal and fetal mortalities in FHF were 4-fold (OR, 4.0; CI, 0.363-44.113) increased in PROGINS carriers. PR and PIBF expression was lower in AVH and even lower in FHF compared to healthy controls. The higher IL-12/IL-10 ratio observed in FHF compared to other groups correlated with fetal mortality in AVH and FHF (p < 0.001). Conclusions: In conclusion, reduced expression of PR and PIBF, a higher IL-12/IL-10 ratio, and a high viral load results in poor pregnancy outcome in Hepatitis E

Hepatitis G virus fnfection in gemodialysis patients from Urban Delhi

This study was designed to evaluate the seroprevalence of hepatitis G virus (HGV) infection, its impact, and its relationship with other hepatotropic viruses among chronic renal failure patients undergoing hemodialysis at the Lok Nayak Hospital, New Delhi. The study group consisted of 100 consecutive cases of patients with chronic renal failure undergoing hemodialysis and equal healthy controls matched for age and sex. The patients were included on the basis of detailed history, clinical examination, and liver function profile. HGV RNA was detected in serum samples of all patients as well as of healthy controls using nested reverse transcription polymerase chain reaction (RT-PCR). The primers used were derived from the NS3 helicase region of the viral genome. Serological assay was used for screening the viral markers for hepatitis B and C (HbsAg and Anti HCV). A history of blood transfusion was recorded in 65% of the cases. HGV RNA was detected in only six out of 100 (6%) cases of chronic renal failure. The seroprevalence of HCV infection was detected in 27 (27%), while HBV infection was seen in 10 (10%) out of 100 cases. The mixed infection of HGV and HCV was seen in 33.3% (two out of six) of the chronic renal failure cases, while the coinfection between HGV and HBV was not observed. In the 100 cases of healthy controls, HGV RNA was detected in only three (3%) subjects. Serological markers for Anti HCV antibody and HbsAg were positive in only one (1%) and two (2%) of the subjects, respectively. The seroprevalence of HGV infection in chronic renal failure was found to be statistically nonsignificant when compared to that of healthy controls. Also, there was no difference in clinical course and liver function profile of HGV-positive and HGV-negative cases. However, alanine aminotransferase (ALT) was significantly out of range in HCV-positive patients compared with HCV-negative patients. The presence of HGV infection reflected a postparental exposure to blood and blood-contaminated products in hemodialysis patients. It is suggested that HGV infection in cases of chronic renal failure is unlikely to influence the course of the disease and may be considered an innocent bystander

Role of CYP2E1 gene polymorphisms association with hepatitis risk in Northeast India

AIM: To investigate hepatitis virus, genetic and environmental factors, and their interactions in predisposing patients to liver diseases in Northeast India

Hepatic Myelopathy in a Patient with Decompensated Alcoholic Cirrhosis and Portal Colopathy

Cirrhotic or hepatic myelopathy is a rare neurological complication of chronic liver disease usually seen in adults and presents as a progressive pure motor spastic paraparesis which is usually associated with overt liver failure and a surgical or spontaneous systemic portocaval shunt. We describe the development of progressive spastic paraparesis, in a patient with alcoholic cirrhosis with portal hypertension and portal colopathy who presented with the first episode of hepatic encephalopathy. The patient had not undergone any shunt procedure

The role of centralized reading of endoscopy in a randomized controlled trial of mesalamine for ulcerative colitis

Background & Aims: Interobserver differences in endoscopic assessments contribute to variations in rates of response to placebo in ulcerative colitis (UC) trials. We investigated whether centralized review of images could reduce these variations. Methods: We performed a 10-week, randomized, double-blind, placebo-controlled study of 281 patients with mildly to moderately active UC, defined by an Ulcerative Colitis Disease Activity Index (UCDAI) sigmoidoscopy score ≥2, that evaluated the efficacy of delayed-release mesalamine (Asacol 800-mg tablet) 4.8 g/day. Endoscopic images were reviewed by a single expert central reader. The primary outcome was clinical remission (UCDAI, stool frequency and bleeding scores of 0, and no fecal urgency) at week 6. Results: The primary outcome was achieved by 30.0% of patients treated with mesalamine and 20.6% of those given placebo, a difference of 9.4% (95% confidence interval [CI], -0.7% to 19.4%; P =.069). Significant differences in results from secondary analyses indicated the efficacy of mesalamine. Thirty-one percent of participants, all of whom had a UCDAI sigmoidoscopy score ≥2 as read by the site investigator, were considered ineligible by the central reader. After exclusion of these patients, the remission rates were 29.0% and 13.8% in the mesalamine and placebo groups, respectively (difference of 15%; 95% CI, 3.5%-26.0%; P =.011). Conclusions: Although mesalamine 4.8 g/day was not statistically different from placebo for induction of remission in patients with mildly to moderately active UC, based on an intent-to-treat analysis, the totality of the data supports a benefit of treatment. Central review of endoscopic images is critical to the conduct of induction studies in UC; ClinicalTrials.gov Number, NCT01059344. © 2013 by the AGA Institute