ABSTRACT
Introduction: Hepatitis B virus (HBV) is the most common aetiological factor causing hepatocellular carcinoma (HCC). HBx gene plays an enigmatic role in HBV-related HCC. In this study we have analysed amino acid substitutions in HBx from HBV-infected individuals of different clinical stages. Materials and Methods: HBV-infected individuals (n = 93) were recruited in the study. DNA was extracted from plasma, amplified, and DNA sequencing was performed using specific primers targeting HBx gene (540 bp). Results: Among the study participants, 57% had chronic HBV infection, 30% had chronic liver disease (CLD) and 13% had HBV related HCC. Genotypes such as D1, D2, D3, A1, C2 and B2 were identified of which genotype D2 was predominant (78%). HBxC-terminal deletion was observed in four hepatitis B e antigen (HBeAg) negative participants with CLD. The frequency of aminoacid substitution in proapoptotic domain was higher in HBeAg negative participants including I127V (34%), K130M (34%), V131I (40%). The frequency of double mutation (K130M+V131I) and triple mutation (I127V+K130M+V131I) were found to be higher (32% and 36%) in HBeAg negative participants. Also, we identified L5M substitution (4.3%) in HBeAg positive participants with advanced liver disease. Conclusion: In HBx gene, aminoacid substitutions at positions 127, 130, 131 are associated with poor expression of HBeAg. We suggest screening for HBx aminoacid substitutions especially in patients with HBeAg negative chronic HBV infection to predict the clinical outcome and enable early treatment to prevent disease progression.
ABSTRACT
Background: Acute lower respiratory tract infections are a common cause of morbidity and mortality in children. Respiratory infections in infants and small children are of great importance because of small airways. Infection may cause a further narrowing and may lead to respiratory distress. To evaluate the etiological factors, clinical profile and outcome of acute respiratory distress in the age group 2 months to 2 years.Methods: This study was conducted in the Paediatric department of Government Mohan Kumarmangalam medical college hospital, Salem, Tamil Nadu, India in the year September 2017-March 2018. Totally 183 cases of acute respiratory distress children were included in the study. A thorough clinical examination was done at the time of admission and management details were recorded into the proforma. Respiratory distress is defined as per WHO protocol as respiratory rate more than 50/minute in infants from 2 months to 12 months of age, and more than 40/minute in children from 13 months to 24 months of age.Results: Of the 72 cases of bronchiolitis, 32 cases (44%) tested positive for IgM at the time of admission and no cases in the control population tested positive for IgM. Of the 72 cases of bronchiolitis in the study population, 52 cases (72%) tested positive for ELISA IgG at the time of admission and 2 cases among the controls tested positive for ELISA IgG.Conclusions: Pneumonia was the most common cause of respiratory illness in the study population. Overcrowding was the major risk factor contributing to acute respiratory illness. Incidence of acute respiratory distress was high among undernourished children.
ABSTRACT
Background: The Pediatric Risk of Mortality (PRISM) Score has been devised to predict outcome and risk of mortality. The PRISM III score is one of the most recent scoring systems of pediatric mortality. This was developed involving 32 PICUs. Physiological data included the most abnormal values from the first 12 and second 12 hours of the PICU stay. To evaluate the mortality rate in children with altered sensorium by applying PRISM III (pediatric risk of mortality) score.Methods: This study was done in the paediatric intensive care unit of the Department of Paediatrics, Government Mohan Kumaramangalam Medical College Hospital, Salem, Tamil Nadu, India on 100 children of both sexes aged between 1 month and 13 years. The study was carried out for a period from December 2017 to July 2018. PRISM III scoring scale was applied for every child in his/her first 24 hours of PICU admission and their calculated score was recorded into the proforma. The clinical details at admission, laboratory data were recorded into the proforma.Results: Three major groups that contributed to the bulk of the admissions were acute CNS infection, seizure disorder and, bites and stings. They constituted to around 54% of our total admissions. As PRISM III Score increases there is a steady increase in the mortality rate. This table shows that the mortality rate is 0% for the 0-9 group and that it increases to 100% for 20-29 and 30 and above groups as the PRISM III score increase.Conclusions: PRISM III score provides an objective assessment of the severity of illness. PRISM III, when performed well, is good to predict mortality in an Indian PICU. Scoring systems with fewer laboratory parameters will be more useful in author's context. Larger studies are needed to develop/validate a mortality prediction score for our country.