Association of Vitamin D Level With Disease Severity and Quality of Life in Newly Diagnosed Patients of Ulcerative Colitis: A Cross-Sectional Analysis.

Introduction Ulcerative colitis is an immunologically mediated disorder affecting the gastrointestinal tract. Vitamin D3 has been shown to modulate many immunological diseases, but its role in ulcerative colitis is not well documented. This study was done to find out if levels of vitamin D are associated with the severity of disease and quality of life in ulcerative colitis patients. Methods This cross-sectional study consists of two parts. The first part consists of having a comparative assessment of baseline parameters of newly diagnosed ulcerative colitis patients and healthy controls. The 2nd part consists of an evaluation of the association of levels of vitamin D3 with disease severity and quality of life in ulcerative colitis. Independent predictors of disease severity and quality of life were assessed using multiple linear regression. Results Vitamin D levels were significantly lower in healthy controls compared to newly diagnosed ulcerative colitis patients. Median ulcerative colitis disease activity index score was significantly higher in the vitamin D deficient group compared with those who had normal vitamin D levels (p-0.001). Quality of life was also poor in the vitamin D deficient group compared to those with normal vitamin D levels (p-0.000). Vitamin D levels were found to be independent predictors of ulcerative colitis disease activity scores and health-related quality of life scores. Conclusion Vitamin D may have some immunomodulating properties, which might be associated with decreased ulcerative colitis disease activity index and better quality of life.

A 10-year-old child presenting with syndromic paucity of bile ducts (Alagille syndrome): a case report.

BACKGROUND: Alagille syndrome, a rare genetic disorder with autosomal dominant transmission, manifests with five major features: paucity of interlobular bile ducts, characteristic facies, posterior embryotoxon, vertebral defects, and peripheral pulmonary stenosis. Globally, only 500 cases have so far been reported, with only five cases reported in the Indian subcontinent. Rarely, Alagille syndrome also presents with skin manifestations and early-onset chronic liver disease, which was found in our case. We believe that we report what could be the first case of Alagille syndrome presenting with café au lait spots, as no such published case report could be found in the literature. CASE PRESENTATION: We report an unusual case of childhood cholestatic jaundice with neonatal onset of jaundice. A 10-year-old boy from the Indian subcontinent presented with obstructive jaundice from early infancy. He also had recurrent fractures of his upper limb bones, intermittent bleeding from his nose, productive cough, decreased night vision, hyperpigmented spots over his skin, and progressive enlargement of his abdomen. Histological examination of a liver biopsy specimen revealed a paucity of bile ducts and changes suggestive of chronic liver disease. Our patient was diagnosed with Alagille syndrome and managed conservatively but died 1 year after the final diagnosis. CONCLUSIONS: This particular syndromic form of paucity of bile duct disorder has been rarely reported in the Indian literature so far. Our case is notable because the child had café au lait spots and very early onset of chronic liver disease, which is quite rare in Alagille syndrome. We believe this to be the first case report on Alagille syndrome manifesting with café au lait syndrome and such early onset of chronic liver disease.

Acute-on-Chronic Liver Failure (ACLF) in Coastal Eastern India: "A Single-Center Experience".

BACKGROUND AND OBJECTIVES: Acute-On-Chronic liver failure (ACLF) is an emerging entity. The present study was undertaken to analyze the clinical profile and natural course of ACLF patients. PATIENTS AND METHODS: ACLF was defined as per Asia Pacific Association for the Study of Liver consensus criteria 2009. Patients fulfilling these criteria with some deviations were included and prospectively evaluated for clinical profile, etiologies of acute decompensation (AD) and underlying chronic liver disease, and short-term natural course [3 months]. RESULTS: Out of 123 patients with ACLF (mean age: 45.83 ± 12.05 years; male:female 109:14), 45.53% cases had prior history of AD, and 54.47% presented for the first time as ACLF. Etiologies of cirrhosis were alcohol, cryptogenic, and chronic hepatitis B virus infection in 65.04%, 23.57%, and 11.38% cases, respectively. Recent history of alcohol intake (within 4 weeks) [42.27%] followed by bacterial infections [36.58%] were the common etiologic precipitants for AD. Only 87 (70.73%) out of 123 cases could be followed up for a duration of 3 months; 62 (71.26%) cases died by 3 months. Most deaths occurred in the alcoholics compared to nonalcoholics [(43/53) 81.13% vs. (19/34) 55.88%; P = 0.01]. No significant difference in mortality rate was observed between ACLF cases with history of prior AD compared to newly diagnosed ACLF cases [30/40 (75%) vs. 32/47 (68.09%); P = 0.477]. The prognostic markers [MELD, MELD-Na, CTP] were not significantly different between survivors and nonsurvivors. CONCLUSION: ACLF patients in our population had high short-term mortality rates with majority of deaths in alcoholics. Alcohol intake and bacterial infections were mainly responsible for AD in our study.

Telbivudine plus tenofovir in combination therapy in patients with chronic hepatitis B infection--an Indian experience.

OBJECTIVE: To investigate the efficacy and safety ofTelbivudine +Tenofovir combination therapy in chronic hepatitis B patients, over a period of 52 weeks, in real life clinical settings. METHODS: HBeAg-positive and HBeAg-negative adult CHB patients, with hepatitis B virus (HBV) DNA > 4 log10 copies/ml and ALT 1.2 times above upper limit of normal (> 30 IU/L) were started on a combination of Telbivudine 600 mg + Tenofovir 300 mg in a real life clinical setting. The reduction in serum HBV DNA levels from baseline was evaluated at Week 24 and 52. The HBV DNA was measured using the PCR test with a lower limit of detection of 100 IU/ml RESULTS: 21 (2 female/19 male) patients, with mean (SD) age of 46.2 (13.2), were prescribed this regimen. 70% of them were HBeAg negative at baseline. Data of 11 out of 21 patients was available at week 52. The mean HBA-DNA reduction from baseline to week 24 (n = 15) was 2.6 log10 copies/mL (p = .000) and 4.0 log10 copies/mL (p = .001) at week 52 (n = 11). By the end of study visit at week 52, 10 out of 11 patients had achieved the HBV-DNA levels of < 100 lu/ml. The mean ALT levels came down by 101.4 IU/L (p = .005) at week 24 (n = 15) and by 104.6 IU/L at week 52 (n = 11). 7 patients achieved ALT normalisation (ALT < 40 IU/L) at week 24, with additional 4 achieving the goals at week 52. Combination therapy was well tolerated, with no safety related concerns. No cases of virological breakthrough or primary treatment failure were observed. Being a real life setting, there were certain limitations: Out of 10 patients whose data was not available at 52 weeks, 5 patients were lost to follow-up; another 2 coming from far off remote areas were unable to report for follow-up every 3 months. 1 patient who was on chemotherapy expired due to progression of the malignancy, another patient with decompensated liver disease expired due to disease progression. Yet another patient was a pregnant lady on therapy who stopped treatment post partum to breast feed the baby. CONCLUSION: Chronic hepatitis B patients treated with Telbivudine + Tenofovir combination exhibited significant virologic and biochemical responses, over the period of 1 year. However, the mean decline in HBV DNA over 1 year with combination therapy was not higher than that seen with monotherapy.