Pattern of Alcohol Consumption in Patients of Alcoholic Liver Disease in India

Background: Alcohol-related chronic liver disease (ALD) and its complications are major causes of morbidity and mortality. Predisposing factors for ALD include the amount, type, duration of alcohol consumption, patient’s genetic predisposition, race, sex, and other comorbid conditions. Aims: To study the dose, duration, and type of alcohol consumption in ALD and the effect of these parameters on severity and outcome Methods: This was a prospective study conducted at the Department of Gastroenterology, SMS hospital, Jaipur, between December 2017 to December 2018. All patients with alcoholic liver disease admitted in the department were consecutively enrolled. Data relating to dose, duration, type, alcohol intake pattern, biochemical, ultrasonographic, and clinical parameters were analysed. Results: One hundred ten patients (age 43.5±9.9, all-male) were studied. Mean alcohol consumption was 130.47±35.37gm/day. Sixty-three (57.3%) patients consumed <120gm, 25(22.7%) between 120-239gm, while 22(20%) patients consumed =240gm of alcohol per day. The mean duration of alcohol consumption was 15.89±6.57 years. Fifty-nine (53.63%) patients consumed country-made spirit, 25 (22.72%) branded spirit, 23 (20.91%) mixed or variable type, while three (2.73%) patients consumed only wine. The occurrence of hepatic encephalopathy (HE) was significantly associated with dose (p <0.001) and type (p <0.001) of alcohol consumption. MELD Na score significantly correlated (r=0.48, p <0.001) with dose of alcohol. Conclusion: Our study found a dose-dependent relationship of alcohol intake with hepatic encephalopathy and MELD-Na score. The incidence of ALD did not change with the type of alcohol consumed. Low lymphocyte counts were significantly associated with dose and duration of alcohol intake.

Seroepidemiology and role of polymerase chain reaction to detect viremia in an epidemic of hepatitis E in Western India.

AIM: In an outbreak of hepatitis E affecting 859 individuals, we evaluated the titres of serological markers (IgM anti-HEV and IgG anti-HEV) and hepatitis E virus (HEV) RNA by reverse transcriptase polymerase chain reaction. METHODS: Serological markers for acute hepatitis were evaluated in 294 icteric patients (Group A) and 300 apparently healthy controls (Group B). HEV RNA was measured by RT nPCR in 19 patients in the first week of illness in patients with negative IgM anti-HEV. FINDINGS: None of the patients were positive for hepatitis A or B. In Group A, IgM anti-HEV was positive in 80.2%, 71.4% and 26.8% and IgG anti-HEV was positive in 58.3%, 77.1% and 86% of patients who were in their first, second and third weeks of illness, respectively. In Group A, amongst the 19 IgM anti-HEV negative patients in their first week of illness, 16 were positive for HEV RNA. In Group B 63.6% cases were positive for IgM anti-HEV. In the same village there had been a similar epidemic 4 years ago; none of the 93 patients traced from that time developed acute hepatitis during the present epidemic and all demonstrated the presence of IgG anti-HEV. This suggests that IgG anti-HEV was perhaps protective. CONCLUSION: During the first week of illness patients may display HEV viremia while testing negative for IgM and IgG anti-HEV. The presence of IgG anti-HEV may play a protective role against HEV infection and in the absence of IgM may help in diagnosing acute hepatitis E. Over 3 weeks of illness the IgM anti-HEV titres fall progressively whilst IgG anti-HEV titres gradually rise.

Prevalence of occult hepatitis B & C in HIV patients infected through sexual transmission.

BACKGROUND: Prevalence of Hepatitis B virus (HBV) and Hepatitis C virus (HCV) markers including active and occult infection has not been described in diverse cohorts among HIV-infected patients in India. Earlier studies have explained the role of HBV/HCV co-infection in cohorts of injection drug users (IDUs) but the sexual co-transmission of HBV/ HCV is not completely understood. OBJECTIVE: The objective of this study was to assess the prevalence of occult HBV & HCV infection in HIV positive sexually acquired transmission risk group. MATERIALS AND METHODS: 58 sexually acquired HIV positive patients were taken up for the study of occult HBV/HCV co-infection. Data on demographics, sexual behaviour, sexually transmitted diseases (STD), medical history, laboratory tests viz., serum ALT and CD4 count were recorded. HBV serology included HBsAg, anti HBs, IgG anti HBc and HBV DNA (PCR). HCV serology included anti HCV & HCV RNA (RT-PCR). RESULTS: Occult HBV infection (HBV DNA) was observed in 12.2% (7/58 with HBsAg -ve and IgG anti HBc +ve subjects) while an overall prevalence of HBV DNA was 13.7% (12% occult & 1.7% in HBsAg+ve patients). Out of 58 HIV positive patients 29.3% demonstrated reactivity for any marker of past or current HBV infection. (HBsAg 1.7%, anti HBs 10.3% anti HBc IgG 17.2%). 4/58 (6.8%) revealed anti HCV positivity along with HCV RNA positivity by RT-PCR while 6/58 (10.3%) individuals revealed an occult HCV infection (anti HCV negative). The overall HCV RNA prevalence was 17.2%. 2 out of 58 (3.4%) individuals were positive for occult infection of both HBV DNA & HCV RNA (Triple infection HIV/HBV/ HCV). The HBV/HCV co-infected group (n = 18) showed a significantly high ALT (114.3 + 12.3 U/I) & low CD4 count (202.5 + 33.7 cells/mm3). The percent prevalence of HBV/ HCV co-infection was higher in the illiterate group, in men less than 30 years of age, and in those who were married and exhibited polygamous activity. CONCLUSIONS: The study demonstrated that in HIV infected patients testing only serological viral markers like HBsAg, antiHBcIgG & anti HCV, fails to identify the true prevalence of co-infection with HBV & HCV. Qualitative PCR for HBV DNA & HCV RNA detects co-infection in patients who are negative for serological markers. Also, in subjects who had only a sexual risk factor for parenterally transmitted infections, HIV may enhance the sexual transmission of HBV and HCV.

Comparison of nutritional status between patients with alcoholic and non-alcoholic liver cirrhosis.

OBJECTIVE: The aim of the study was to assess and compare the nutritional status of alcoholic and non alcoholic cirrhotic patients. METHODS: 81 patients with liver cirrhosis--41 alcoholic (AC) & 40 non alcoholic (NAC), were selected. Nutritional status was assessed using anthropometric measurements viz. skin fold thickness, arm and muscle circumferences and areas. Food intake was evaluated using 48 hour dietary recall. Creatinine Height Index and Lean Body Mass were calculated from 24 hour urinary creatinine excretion. RESULTS: Mean values of Mid Arm Muscle Area, for both AC and NAC (2947+/-8.12 mm(2) v/s 3534+/-6.96 mm(2) respectively), were below the 5th percentile of Frisancho's cut off, with significant reduction in alcoholics (P = 0.00). Creatinine Height Index (CHI) and Lean Body Mass (LBM) were higher in patients without fluid retention as compared to those with fluid retention. Patients without Ascites showed a positive correlation between body weight and Lean Body Mass (r=0.471; rho=0.438; P=0.00). CONCLUSIONS: Malnutrition is widely prevalent in cirrhotics, with greater impairment in alcoholics. A positive correlation could be elicited between Lean Body Mass & Actual Body Weight in patients without ascites. Creatinine Height Index and Lean Body Mass may be more reliable parameters for the assessment of nutritional status in patients with liver cirrhosis.

Management of ingested foreign bodies in upper gastrointestinal tract: report on 170 patients.

BACKGROUND: Ingestion of foreign bodies (FB) is commonly encountered in gastrointestinal practice. METHODS: Retrospective analysis of data on endoscopic removal of FB in 170 patients (124 children) who were managed at a tertiary referral center over a six-year period. OUTCOME: Coins were the most common FB removed (n=134). Dentures (12), food boluses (19), sharp objects such as needles and pins (7), and certain unusual FB (12) made up the remainder. Esophagus was the most common site of FB lodgement (56%). Most patients with esophageal FB complained of FB sensation, dysphagia, odynophagia or chest pain. Gastric and duodenal FB produced no symptoms. FB could be successfully removed endoscopically in 166 patients (97.6%) without morbidity or mortality. Four patients required surgical removal of FB. Certain Innovative methods like loop basket, electrocautery and suction retrieval were used to remove some FB. CONCLUSION: Endoscopic removal of FB in the esophagus and stomach is safe but often requires the use of innovative techniques and accessories.