Prevalence of hepatitis C virus infection and the IL28B genotype polymorphism among blood donors and high-risk populations

INTRODUCTION@#To study the prevalence of hepatitis C virus (HCV) infection in blood donor (BD), haemodialysis (HD) and intravenous drug user (IVDU) populations in Singapore and assess the IL28B polymorphism if HCV positive.@*METHODS@#The BD population were healthy volunteers, the HD population were patients who were on haemodialysis for at least six months of follow-up between January 2009 and December 2014. IVDU population was from inmates at halfway houses who consented.@*RESULTS@#Between 2011 and 2014, of 161,658 individuals who underwent screening prior to blood donation, 95 (0.059%) were positive for HCV. Of the 42 sera available, common genotypes (GTs) were GT-3 (47.6%) and GT-1 (31.0%). Of 1,575 HD patients, 2.2% were anti-HCV positive. The HCV GT distribution was HCV GT-1 (32.4%), HCV GT-3 (20.5%) and GT-6 (8.8%). 83 halfway house inmates were screened. Of the 47 IVDUs, 36.2% were anti-HCV positive with predominant GT-3 (%). IL28B polymorphism was noted to be CC predominantly 85.3%.@*CONCLUSION@#Prevalence of HCV infection has decreased in both the BD and HD populations. However, it remains high in the IVDU population. GT-1 remains the most common in the HD population; however, GT-3 infection is now more common among the BD population in Singapore. IL28B - CC is the predominant variant among the HCV-infected individuals in Singapore.

Understanding the hepatitis B core positive liver donor

The increasing number of patients on the Singapore national liver transplant waiting list and the lack of donor livers have necessitated a review of the limited use of marginal donor liver grafts. Some grafts are of good quality but are considered marginal due to positive donor antibody to hepatitis B virus core protein serology, and negative hepatitis B surface antigen (HBsAg) and hepatitis B DNA. The fear is of viral reactivation during periods of intense immunosuppression. This is made possible by the ability of the hepatitis B virion to reside in a dormant state within the hepatocyte nucleus despite HBsAg clearance, i.e. the occult hepatitis B infection (OBI). In truth, appropriate selection of recipients and effective post-transplantation immunoprophylaxis significantly reduce the risk of hepatitis B viral reactivation. This article explains the confusion surrounding OBI and reviews current recommendations on how to manage such donor liver grafts.

Mirizzi's syndrome: lessons learnt from 169 patients at a single center

BACKGROUNDS/AIMS: Mirizzi's syndrome (MS) poses great diagnostic and management challenge to the treating physician. We presented our experience of MS cases with respect to clinical presentation, diagnostic difficulties, surgical procedures and outcome. METHODS: Prospectively maintained data of all surgically treated MS patients were analyzed. RESULTS: A total of 169 MS patients were surgically managed between 1989 and 2011. Presenting symptoms were jaundice (84%), pain (75%) and cholangitis (56%). Median symptom duration s was 8 months (range, <1 to 240 months). Preoperative diagnosis was possible only in 32% (54/169) of patients based on imaging study. Csendes Type II was the most common diagnosis (57%). Fistulization to the surrounding organs (bilio-enteric fistulization) were found in 14% of patients (24/169) during surgery. Gall bladder histopathology revealed xanthogranulomatous cholecystitis in 33% of patients (55/169). No significant difference in perioperative morbidity was found between choledochoplasty (use of gallbladder patch) (15/89, 17%) and bilio-enteric anastomosis (4/28, 14%) (p=0.748). Bile leak was more common with choledochoplasty (5/89, 5.6%) than bilio-enteric anastomosis (1/28, 3.5%), without statistical significance (p=0.669). CONCLUSIONS: Preoperative diagnosis of MS was possible in only one-third of patients in our series. Significant number of patients had associated fistulae to the surrounding organs, making the surgical procedure more complicated. Awareness of this entity is important for intraoperative diagnosis and consequently, for optimal surgical strategy and good outcome.

Matrix metalloproteinase 7 expression in ampullary carcinoma.

Background: Matrix metalloproteinase 7 (MMP7) has largely been studied in pancreatic cancer which is the most common component of periampullary cancer in the western population. In India, the ampullary carcinoma is seen as the most common periampullary cancer in resected pancreaticoduodenectomies. We aimed to study the expression of MMP7 and its correlation with clinicopathological features in ampullary cancer. Materials and Methods: Consecutive cases of all ampullary cancer in a 3-year period were reviewed for histological differentiation (intestinal and pancreatobiliary) by morphology and immunohistochemistry (CDX2, MUC2, cytokeratin 20 [CK20], MUC1, cytokeratin 7 [CK7], and cytokeratin 17 [CK17]). All cases were stained for MMP7 and expression was correlated with histological variables, differentiation, and overall survival. Results: There were a total of 91 ampullary carcinomas (36 intestinal, 44 pancreatobiliary and 6 other types). Ampullary carcinoma showed MMP7 expression in 63.7% cases. Two-third of intestinal type and half of the pancreatobiliary type cancers showed MMP7 expression. MMP7 expression was signifi cantly higher in low pathological T-stage of total ampullary carcinomas; however, it was seen more commonly in higher overall stage of the pancreatobiliary type compared to intestinal type of ampullary carcinoma. Overall survival in patients with MMP7 expression was lower compared to MMP7 negative patients. Conclusions: This is the fi rst study on MMP7 expression in ampullary cancer. MMP7 expression was seen in nearly 64 % of ampullary cancer and showed a signifi cant correlation with low pathological (T-) stage and high overall stage with a shorter survival. MMP7 can be explored as a target for MMP inhibitor therapy in the future.

Evaluation of Genetic Variability in Adansonia digitata L. by RAPD Analysis.

Baobab (Adansonia digitata L.) belonging to Bombacaceae family, is one of the most widely used indigenous tree species in sub-Saharan Africa. The objective of the present study was to assess molecular variation among A. digitata and to determine the level of genetic similarity among them. The yield of DNA ranged from 15-40 μg/mg of leaf tissue and the purity was between 1.1- 2.9, indicating minimal levels of contaminating metabolites. The technique was ideal for isolation of DNA from A. digitata and the DNA isolated was used for randomly amplified polymorphic DNA (RAPD) analysis using the primer OPB07. The bands obtained ranged in size from 54-795 bp. Two clusters were observed, one group with 8 bands and the other with 11 bands. Present study could be important in domestication, conservation, management & improvement strategies of A. digitata.

Metabolic syndrome in schizophrenia: how much is attributable to drug treatment.

Background: This study was planned to investigate new onset metabolic syndrome (MS) and its various components associated with two widely used second generation antipsychotics i.e. olanzapine and quetiapine in the management of schizophrenia using International Diabetic Federation (IDF) criteria. Methods: A total of 60 drug naïve patients with ICD-10 diagnosis of first episode schizophrenia, divided in two groups of 30 patients each, were randomly allocated to receive two different treatments i.e. olanzapine and quetiapine. Metabolic parameters were measured at day 0, then at 6 and 12 weeks. For categorical variables, ‘Chi-square test’ was used for comparison between the two groups. For continuous variables student’s t-test was used. Results: At 6 weeks none of the patient, treated with olanzapine, developed Metabolic Syndrome (MS), but among quetiapine group 3.33% (1 out of 30) developed MS. At the end of 12 weeks, 20% patients (i.e. 6 out of 30) had MS in olanzapine treatment group and 10% (3 out of 30) in quetiapine treatment group. Conclusion: Both olanzapine and quetiapine were found to cause comparable metabolic derangement and metabolic syndrome.

Docosahexaenoic acid supplementation: a need or a commercial hype.

Docosahexaenoic acid (DHA) is an important component of the brain and is essential critical for optimal brain health and function. With revealing of its benefi cial effects on cognitive function, neurological, cardiovascular system and anti-infl ammatory benefi ts, DHA has recently gained huge attention. As a result, the market is stocked with products supplemented with DHA claiming various health benefi ts. This review attempts to elucidate the current fi ndings of DHA supplementation as a pharmacological agent with both preventive and therapeutic value.

Antibacterial activity of bark extracts of Moringa oleifera Lam. against some selected bacteria

The methanol, chloroform, ethyl acetate and aqueous bark extracts of Moringa oleifera were evaluated for their antibacterial activity against four bacteria viz. Staphylococcus aureus, Citrobacter freundii, Bacillus megaterium and Pseudomonas fluorescens using erythromycin as positive control. The activity was analyzed using paper disc diffusion method at different concentration of the extract. The study revealed that all the bark extracts irrespective of their types, in different concentrations inhibited growth of the test pathogens to varying degrees. Ethyl acetate extract showed maximum activity against all the bacterial strains followed in descending order by chloroform, methanol and aqueous extracts. The activity decreased with decrease in concentration of the extract. Staphylococcus aureus was found to be the most sensitive test organism to different extracts of Moringa oleifera. Looking to these results it may be concluded that M. oleifera may be a potential source for the treatment of different infections caused by the resistant microbes

Risk Factors for Development of Biliary Stricture in Patients Presenting with Bile Leak after Cholecystectomy

BACKGROUND/AIMS: This study was aimed at determining the factors associated with the development of benign biliary stricture (BBS) in patients who had sustained a bile duct injury (BDI) at cholecystectomy and developed bile leaks. METHODS: A retrospective analysis of 214 patients with BDI who were referred to our center between January 1989 and December 2009 was done. RESULTS: One hundred fifty-three (71%) patients developed BBS (group I), and 61 (29%) were normal (group II). By univariate analysis, female gender (p=0.02), open cholecystectomy as the index operation (p=0.0001), delay in the referral from identification of injury (p=0.04), persistence of an external biliary fistula (EBF) beyond 4 weeks (p=0.0001), EBF output >400 mL (p=0.01), presence of jaundice (p=0.0001), raised serum total bilirubin level (p=0.0001), raised serum alkaline phosphatase level (p=0.0001), and complete BDI (p=0.0001) were associated with the development of BBS. Furthermore, open cholecystectomy as the index operation (p=0.04), delayed referral (p=0.02), persistent EBF (p=0.03), and complete BDI (p=0.001) were found to predict patient outcome in the multivariate analysis. CONCLUSIONS: For the majority of patients with BDI, the risk of developing BBS could have been predicted at the initial presentation.