Cadaveric study of portal and hepatic venous anatomy with special reference to territory of middle hepatic vein

Background: Liver transplantation has become the standard therapy for end-stage chronic liver disease and acute hepatic failure. The shortage of cadaveric donor organs deceased donor liver transplant (DDLT) has led to the development of living donor liver transplantation (LDLT). In LDLT the concept is based on the potential regenerative power of the human liver.Methods: This was an observational study done in department of surgery, Gandhi Medical College and Hamidia Hospital, Bhopal on 50 cadaveric liver specimens and dissection was carried out in department of Anatomy from March 2018 to February 2019.Results: In this study 50% of the specimens had all the three hepatic veins, while the remaining 50% had two hepatic veins: the right and left. The presence of one or more right accessory hepatic veins draining the right lobe was observed in all the cases. In most of the livers the LHV and MHV formed a common trunk, which joined the IVC (76.0%). In some cases, they drained independently into IVC (18%). In the present study of 38 adult cadaveric livers, termination of PV was observed as extra hepatic in 89.47 livers, Intrahepatic in 2.63% and at the capsule in 7.89% livers.Conclusions: There are three main hepatic veins: RHV, MHV and LHV. In this study 50% of the specimens had all the three hepatic veins, while the remaining 50% had two hepatic veins: the right and left. Thus significant variation was seen and it could definitely be helpful to hepatobilliary surgery and in liver transplant.

Emergence of pandemic 2009 influenza A H1N1, India.

Background & objectives: Pandemic H1N1 caused deluge of cases from 74 countries and prompted World Health Organization to raise warning to phase 6. The present study was conducted on throat and nasal swab samples received and tested at National Centre for Disease Control, Delhi, India during 2009-2010 to collect epidemiological and clinical information on positive cases. Methods: Throat and nasopharyngeal swabs from category C influenza A H1N1 patients during May 2009-September 2010 along with their clinico-epidemiological details were collected from identified hospitals from Delhi and other States. Samples were tested by Real time reverse transcriptase PCR using primers and probes developed at CDC, Atlanta for four influenza target genes. Results: A total of 33,751 samples, both throat and nasal swab samples from each patient were tested for H1N1 influenza virus, of which, 7943 (23.5%) were positive for pandemic influenza A H1N1 and 3759 (11.1%) were positive for influenza A (seasonal flu). Maximum number of positive cases (N=2792, 35.1%) were from 20-39 yr age group, comprising 1790 (22.5%) males and 1182 (14.8%) females. Only 2620 (33%) positive cases were close contact of influenza A H1N1 positive patient. Majority cases presented (N=2792, 35.1%) with fever 7005 (88.1%), followed by 6133 cases (77.2%) exhibiting fever and cough, 377 (4.7%) complained of fever, cough, nasal catarrh and 362 (4.5%) cases had fever with shortness of breath. Interpretation & conclusions: The study showed a peak of cases of pandemic influenza A H1N1 in December 2009 and indicated predominance of H1N1 positive cases among 20-39 yr age group and among males compared to females.

Investigation of an outbreak of chikungunya in Malegaon Municipal areas of Nasik district, Maharashtra (India) and its control.

BACKGROUND & OBJECTIVES: An outbreak of chikungunya fever occurred in Malegaon town of Nasik district of Maharashtra state, India during February and March 2006. A total of 4530 fever cases were reported during this period including 1781 cases which were admitted in different hospitals of the town. An entomological and epidemiological investigation was carried out in the affected villages during the outbreak to study the possible causes of the outbreak and to isolate the virus responsible. METHODS: Entomological evaluation was done as per WHO guidelines. Sera samples were collected by venipuncture from clinically suspected chikungunya patients in hospitals and also during house-to-house survey in affected villages. IgM antibodies to dengue virus were detected using IgM capture ELISA (PANBIO) and by "Haemagglutination inhibition test" for detection of antibodies against Chikungunya virus. Acute sera samples were inoculated in cell lines for virus isolation. The isolates were confirmed by RT-PCR. RESULTS: On investigation, it was found that water storage containers like cement tanks, plastic containers or earthen pots placed in front of the individual houses were the potential breeding sites for Aedes aegypti. Entomological survey carried out in the most affected areas revealed high Aedes indices. House, container and breteau indices were found to be 27.2, 16.19 and 35.1, respectively. Out of the 13 acute sera samples collected, virus was isolated in 10 samples. The isolates were confirmed by RT-PCR and sequencing using primers from nsP1 gene of Chikungunya virus (CHIKV, Accession No. EF077609, EF077610). Of the 17 convalescent sera tested, significant level of HI antibodies to CHIKV was detected in five samples. One sample was positive for IgM antibodies against dengue virus. Based on clinico-epidemiological features and laboratory findings, the illness was confirmed to be of chikungunya viral disease. CONCLUSION: Control measures targeting the vector population and personal protective measures against the mosquito bites were instituted. Extensive IEC campaign with the involvement of community and religious leaders helped in containment of the disease.

Occurrence & nucleotide sequence analysis of hepatitis G virus in patients with acute viral hepatitis & fulminant hepatitis.

BACKGROUND & OBJECTIVE: Association of hepatitis G virus (HGV) with acute viral hepatitis (AVH) and fulminant hepatitis (FH) is not clearly understood.This study was designed to asses the occurrence of HGV infection and its relationship with other hepatotropic viruses in patients with FH and AVH and also to determine the nucleotide sequence of HGV isolates. METHODS: The study included 100 patients of FH and 125 of AVH on the basis of clinical examination, liver function test and serology for hepatitis A, B, C and E virus. HGV RNA was detected by reverse transcriptase-polymerase chain reaction (RT-PCR) and direct sequencing for 4 randomly selected samples followed by phylogenetic analysis. RESULTS: Of the 100 patients with FH, 30 were negative for hepatitis viruses A, B, C and E by serology (non A-non E) while 60 were negative in the AVH group. In the non A-non-E hepatitis group, HGV was positive in 16.66 per cent (5/30) cases of FH, 10 per cent (6/60) cases of AVH and 6 per cent (6/100) of healthy controls. The difference in HGV seropositivity between FH and AVH patients was statistically not significant compared to healthy controls, while HBV and HCV infections were significant. The four isolates sequenced seemed to be of same type and close to Chinese strain of HGV (Y13755.1 Y13756.1 Y15407, and U67782) on phylogeny. INTERPRETATION & CONCLUSION: In HGV infection was not found to be clinically significant as well as nonpathogenic in the patients of FH and AVH and appeared to be an innocent bystander in the course of the disease. The four sequenced HGV isolates showed close pairing with Chinese strains.

Prompt laboratory diagnosis in timely containment of a plague outbreak in India.

A focal outbreak of pneumonic plague occurred in a hamlet of village Hatkoti, district Shimla, Himachal Pradesh in the first fortnight of February, 2002. A total of 16 cases with 4 deaths were reported. Diagnosis of plague was confirmed by the laboratory in 10 (63%) cases. Y. pestis was isolated from clinical samples of 3 cases and confirmed by bacteriophage lysis. Molecular tests confirmed the presence of Y. pestis specific pla and F1 genes in 4 cases; DNA fingerprinting had identity with the known sequence of plague bacilli. Paired samples from 5 cases showed more than 4 fold rise and 1 case showed more than 4 fold fall in antibodies against F1 antigen of Y. pestis. The present communication emphasises that timely and systematic laboratory investigations give confirmatory diagnosis in shortest possible time which forms the backbone of the outbreak control in a timely fashion and prevents confusion and controversy.

An outbreak of human anthrax in Mysore (India).

Anthrax is a zoonotic disease caused by Bacillus anthracis. Intestinal anthrax though a rare entity mostly ends with fatal outcome. Very few cases of intestinal anthrax are reported. Present outbreak of intestinal anthrax is unique in itself that four cases succumbed to the illness within a span of 48-72 hours in a small hamlet of Mysore district of Karnataka, after consuming diseased deer meat. Confirmation of the diagnosis was carried out at NICD, Delhi by bacteriological culture isolation, biochemical tests, animal pathogenicity and polymerase chain reaction (PCR). This outbreak clearly indicates surveillance of anthrax in animals in endemic areas is an essential part in the control of the disease with intersectoral coordination between the departments of health, animal husbandary, agriculture and forest.