ABSTRACT
AIM: To molecularly characterize hepatitis B virus (HBV) isolates from Kerala and to relate them to the clinical manifestation of infection. METHODS: Sera and clinical data were collected from 91 patients diagnosed with chronic HBV infection and HBV-related hepatocellular carcinoma (HCC). HBV from 44 HCC, 22 cirrhotic and 25 chronic hepatitis patients were genotyped by sequencing of the complete S region or by restriction fragment length polymorphism assays. The basic core promoter/precore region was sequenced. The complete surface DNA sequences were assembled and aligned manually, and then compared with the sequences of HBV of genotypes (A-J) from GenBank. The evolutionary history was inferred using the Neighbor-Joining method and the evolutionary distances computed using the Kimura 2-parameter method. Bootstrapping was performed using 1000 replicates. The TaqMan BS-1 probe was used to quantify HBV DNA at a lower detection limit of approximately 20 IU/mL. Continuous variables were compared using an independent Student's t test. The χ² test or Fisher's exact test was used to compare categorical variables. The differences were considered statistically significant at P < 0.05. RESULTS: Irrespective of disease status, the predominant genotype was A (72%); 95% belonging to subgenotype A1, followed by genotypes D (27%) and C (1%). HCC patients infected with subgenotype A1 were significantly younger than those infected with D. Mutation A1762T/G1764A was significantly associated with HCC in both genotypes A and D. Mutation G1862T was more frequent in subgenotype A1 (P < 0.0001), and in combination with A1762T/G1764A, it was significantly associated with HBV from HCC patients. Mutation C1766T/T1768A was significantly associated with genotype A (P = 0.05) and HCC (P = 0.03). The preS2 start codon M1T/I mutation was unique to genotype A strains (15.6%) from all disease groups and occurred at a higher frequency in isolates from HCC patients (P = 0.076). A higher frequency of preS deletion mutants (33.3%) was observed in genotype A from HCC compared with non-HCC patients, but did not reach statistical significance. The preS2:F22L mutation was found in genotypes A and D. CONCLUSION: Kerala is the first Indian state in which subgenotype A1 has been found to predominate in liver disease patients who developed HCC at a relatively young age.
Subject(s)
DNA, Viral/analysis , Hepatitis B virus/genetics , Hepatitis B, Chronic/virology , Adolescent , Adult , Age of Onset , Carcinoma, Hepatocellular/diagnosis , Carcinoma, Hepatocellular/epidemiology , Carcinoma, Hepatocellular/virology , Chi-Square Distribution , Cross-Sectional Studies , DNA, Viral/blood , Disease Progression , Evolution, Molecular , Female , Genotype , Hepatitis B Surface Antigens/genetics , Hepatitis B, Chronic/blood , Hepatitis B, Chronic/diagnosis , Hepatitis B, Chronic/epidemiology , Humans , India/epidemiology , Liver Neoplasms/diagnosis , Liver Neoplasms/epidemiology , Liver Neoplasms/virology , Male , Middle Aged , Mutation , Odds Ratio , Phenotype , Phylogeny , Protein Precursors/genetics , Risk Factors , Young AdultABSTRACT
BACKGROUND: Since, there is scanty data on manometric spectrum of fecal incontinence (FI) from India, ano-rectal manometry (ARM) parameters of patients with FI attending a tertiary care hospital were analyzed retrospectively. METHODS: Data on 140 consecutive patients with FI (age 44.8 +/- 17.4 y, 89 male) referred for ARM were analyzed and interpreted according to standard criteria. RESULTS: Low resting pressure (mainly due to internal sphincter; < 40 mmHg) and squeeze pressure (mainly due to external sphincter; < 60 mmHg) were found in 88/140 (63%) and 44/140 (31.4%) patients, respectively. Low squeeze pressure indicating external sphincter defect was more commonly found in female than male [23/51 (45.1%) vs. 21/89 (23.6%), p = 0.013] though other parameters on ARM were comparable among the two genders. CONCLUSION: Parameters of ano-rectal functions were abnormal in varying combinations on ARM in a large proportion of patients with FI attending a tertiary care center and females more often had low squeeze pressure indicating external sphincter defect than males though anal resting pressure, length of the high pressure zone and tolerability to intra-rectal balloon distension were comparable.
Subject(s)
Anal Canal/physiopathology , Fecal Incontinence/physiopathology , Manometry , Adult , Female , Humans , India , Male , Middle Aged , Reference Values , Retrospective StudiesABSTRACT
Pancreatic pseudocysts are relatively common complications of acute pancreatitis. However, extension of pseudocysts into the mediastinum rarely occurs. In such situations they commonly present with chest pain or shortness of breath. We herein report the case of a patient with a pseudocyst presenting with dysphagia. The clinical presentation, current modalities of diagnosis and management of mediastinal pancreatic pseudocyst is reviewed in this article.
