Hepatic encephalopathy syndromes.

Hepatic encephalopathy (HE) is a neuropsychiatric complication of acute and chronic liver failure. Its clinical spectrum ranges from minimal (subclinical) to overt encephalopathy. Psychometric and electrophysiological tests are helpful in diagnosing minimal HE. However, changes in metabolites in the brain, such as depletion of myo-inositol and accumulation of glutamine, appear to be very sensitive and specific in diagnosing this form. Positron emission tomography has been useful in studying brain ammonia metabolism. The main focus of medical treatment has been to modify ammonia metabolism. Reduction in ammonia production can be achieved by, among others, a diet rich in vegetable protein and carbohydrate, and oral lactulose, oral antibiotics and sodium benzoate. L-ornithine-L-aspartate provides critical substrates for both ureagenesis and glutamine synthesis, the key pathways for ammonia detoxification. Recent trials have shown its effectiveness in the treatment of HE.

Prevalence of hepatitis B virus infection in healthy persons in North India.

BACKGROUND. There is scant information on the main methods through which hepatitis B virus infection is transmitted in India. We, therefore, studied the prevalence of hepatitis B surface antigen and antibody to hepatitis B surface antigen in voluntary blood donors as well as in those healthy groups who have a high risk of contracting this infection. METHODS. The groups at risk studied included commercial sex workers (635), eunuchs (28), truck drivers (217), professional blood donors (1117) and health care workers (1313). In addition, 20,435 voluntary blood donors were also studied. RESULTS. Hepatitis B surface antigen (and its antibody) was positive in 2.6% (14%) of voluntary blood donors, 3.6% (19%) of commercial sex workers, 5% (16%) of truck drivers, 12% (9%) of professional donors, 1.4% (19%) of health care workers and none (18%) of the eunuchs. Except professional donors and truck drivers, none of these groups had a higher positivity than the normal population (2.6%). CONCLUSIONS. Our results indicate that in India the so-called high risk groups, other than truck drivers and professional blood donors, are unlikely to represent major sources of infection.

Chronic hepatitis in a large Indian hospital.

BACKGROUND. In developed countries as well as in Southeast Asia, the hepatitis B and C viruses are the main causes of chronic hepatitis. In India, however, there have been no major investigations on the aetiology of chronic hepatitis. (The hepatitis E virus which is responsible for half the sporadic and most of the epidemic cases of acute viral hepatitis in India does not cause chronic disease.) We, therefore, studied the profile of chronic hepatitis in India. METHODS. The clinical presentation, aetiology, serology and histological changes were studied prospectively in 48 patients with chronic hepatitis admitted to the All India Institute of Medical Sciences, New Delhi. Of these, 44 (92%) had chronic active hepatitis, 3 (6.3%) had chronic persistent hepatitis and 1 (2%) had chronic lobular hepatitis. RESULTS. The hepatitis B virus was the aetiological agent in 24 (50%) of these patients, the hepatitis D virus in association with hepatitis B virus in 10 (21%), the hepatitis C virus in 7 (15%) and the non-A, non-B viruses other than the hepatitis C virus in 6 (13%). One patient (2.0%) had autoimmune chronic active hepatitis. Jaundice at presentation was seen in 33 (69%) patients and more than half had hypoalbuminaemia (< 3 g/dl) with a prolonged prothrombin time. Alanine aminotransferase levels were less than 5 times above normal in over two-thirds of the patients. The highest alanine aminotransferase values were observed in patients with hepatitis D virus infection whereas the lowest were seen in patients with non-A, non-B related chronic active hepatitis. Histological examination revealed bridging necrosis in 40 (91%) patients with chronic active hepatitis indicating a severe form of disease. Replication of the hepatitis B virus was seen in 13 patients with chronic hepatitis, 5 of whom had hepatitis D virus-induced chronic hepatitis. Patients with hepatitis B virus replication had higher alanine aminotransferase values and more severe bridging necrosis than patients who did not have replicating viruses. Higher alanine aminotransferase values, ascites and oesophageal varices were encountered more frequently in patients with hepatitis B and D virus than in those with non-A, non-B related chronic hepatitis. CONCLUSION. Chronic hepatitis is not uncommon in India. It presents with evidence of severe disease and, as elsewhere, is most frequently caused by the hepatitis B virus.

A preliminary open trial on interferon stimulator (SNMC) derived from Glycyrrhiza glabra in the treatment of subacute hepatic failure.

The efficacy of the interferon stimulator named Stronger Neo Minophagen-C (SNMC) derived form the plant G. glabra was studied at a dose of 40 or 100 ml daily for 30 days followed by thrice weekly intravenously for 8 wk in 18 patients of subacute hepatic failure due to viral hepatitis. The survival rate amongst these patients was 72.2 per cent, as compared to the earlier reported rate of 31.1 per cent in 98 patients who received supportive therapy (P < 0.01). Death in four of the five patients was due to associated infections leading to hepatorenal failure and terminal coma. Further studies are necessary to standardize the dose and duration of therapy with SNMC in subacute hepatic failure.

Prevalence of HBsAg & anti-HBs in children & strategy suggested for immunisation in India.

The prevalence of HBsAg and anti-HBs was studied in sera from 982 children of different age groups below 5 yr. HBsAg was detected in 0.9, 2.3, 4.1, 2.3 and 1.6 per cent children of 0-1, 2-6, 7-12, 13-36 and 37-60 months age groups respectively. Anti-HBs in these five groups was noted in 17.0, 12.9, 18.4, 14.2 and 13.7 per cent children, respectively. The findings suggest that the carrier pool is built up in the preschool age group, particularly, below the age of 6 months. Perinatal transmission and the relative role of transplacental need re-evaluation. Cost analysis does not permit inclusion of HBV in the Expanded Programme of Immunisation.

Hospital malnutrition: a prospective evaluation of patients during hospitalisation.

Nutritional Status of 89 patients was assessed during their course of hospitalisation. All patients consumed diet deficit in protein and calories. The mean daily intake of calories was 819 +/- 425 Kcals and of protein was 22 +/- 19 g per day. 74.13 per cent patients lost weight while 31.25 per cent gained. 50% patients had fall in SKFT values during their hospital stay.