1. Upper Gastrointestinal Lesions in Smoker – An Endoscopic Study

HK Madaan, MM Gupta, C Gupta, S Utreja, SK Sachdeva
Government Medical College, Patiala, Punjab – 147 003

Background : Smoking affects both structure and function of esophagus, stomach and duodenum. UGI endoscopy reveals these defects with precision which may not be evident clinically.

Aim : To study and compare the findings of UGI endoscopy in dyspeptic smokers and dyspeptic non-smokers and to find whether there is a correlation between the UGI lesions and smoking.

Material and Methods : Forty smokers and non-smokers each with dyspeptic symptoms were taken up for the study in the OPD/wards of RH Patiala. UGI endoscopy was also performed in the same institute.

Inclusion Criteria : Smokers who had been smoking cigarette or bidi for at least one year and who had continued to smoke till UGI endoscopy was performed on them.

Results : Significantly more oesophageal 23% (Oesophagitis), gastric 32.5% (gastritis, gastric erosions) and duodenal lesions 30% (duodenitis, duodenal erosion and duodenal ulceration) were seen in dyspeptic smokers than in dyspeptic non-smokers (7.5%, 12.5% and 10% respectively).

Conclusion : Dyspeptic smokers have significantly higher incidence of UGI lesions than dyspeptic non-smokers and that there is a cumulative effect of increase in smoking on the severity of these lesions.

2. Clinical Profile of Acute Upper Gastro Intestinal Bleeding

K Lakhani, S Mundhara, R Sinha, Y Gamit, R Sharma
BJ Medical College, Ahmedabad.

Objects : To analyse etiology and clinical profile of acute upper gastrointestinal bleeding (UGIB) in our medical college.

Methodology : Hundred patients above 12 years of age with acute UGIB (, 7 days duration) admitted at our hospital were studied. Detailed history of bleeding, alcoholism and NSAID use was taken and upper GI endoscopy was done in all patients.

Results : Mean age of patients was 42.44 years and male to female ratio was 2.44:1 Approximately one fourth of patients had history of alcoholism and NSAID each. Hematemesis was the leading presentation (55%). Other symptom was malaena (32%) and abdominal pain (34%). On endoscopy maximum number of patients had esophageal varices (37%). Others had erosive gastritis (14%), duodenal ulcer (14%) esophagitis (7%) and malignancy (9%).

Conclusion : Three main causes of acute UGIB in the present study were esophageal varices, erosive gastritis and duodenal ulcer.

3. Clinical Profile and Outcome in Primary Intracerebral Hamorrhage

PK Routray, BL Parija, BN Mohapatra, G Ray, P Patra
SCB Medical College, Cuttack.

During the study period of two years (Sept. 2004 – Sept. 2006) a total of 300 cases of primary intracerebral hemorrhage (confirmed by CT scan) admitted to medicine ward of SCB Medical College were selected randomly. Hemorrhagic infarction and tumour hemorrhage were excluded. Incidence of hemorrhage among CVA patients was 64.52%. commonest age group affected was 60-69 years with Male-Female ratio 1.56:1. Hypertension was found to be the commonest risk factor (47.3%). Focal neurological deficit was found in 83% cases. On follow up for 6 months in 50 cases, 8 cases were in grade 5 glasgow outcome scale and 9,10,6 and 17 cases were found n grade 4,3,2 and 1 glasgow outcome scale respectively. Volume of supratentorial hemorrhage correlates directly with prognosis (p<0.001).

4. Oesophageal Carcinoma – A Teaching Hospital Based Study in the Kumaon Region of Uttarakhand, India

SC Joshi, A Joshi, SR Saxena, P Nigam, SP Rai, VN Satyawali, VK Singh
Gastro-enterology Unit, Department of Medicine and Surgery, UFHT Medical College, Haldwani, Uttarakhand.

Introduction : Gastro-intestinal malignancy is a major health problem and in India its incidence varies between 15 to 25% of all cancer burdens. Oesophageal carcinoma is more common in Southern part of India i.e. Karnataka, Tamil Nadu and Kerala and also now it is also commonly seen in Assam and Jammu and Kashmir because of their particular dietary pattern. The importance of diet and nutrition in the etiology of GI malignancy
has now gained acceptance.

Aim : The present study was undertaken to determine the risk factors specially the diet and nutrition associated with oesophageal cancer in the Kumaon region of Uttarakhand, India.

Method : Ninety four cases who were diagnosed endoscopically in 780 patients who underwent upper GI Endoscopy during the period of January 2005 to December 2006. An equal number of healthy individuals constituted the control group. Diet pattern during the preceding 10-15 years prior to diagnosis was assessed using the standard food frequency questionare method. Information of alcohol, smoking and tobacco and/or betel lead chewing was taken in detail.

Results : Of these 780 patients who had undergone upper GI Endoscopy, 94 patients (12.05%) were of oesophageal carcinoma histopathology revealed 6th and 7th decade (24 cases or 25.5% and 28 cases or 29.8% respectively) with male (62 cases) to female (32 cases) ratio of 2.9:1. Amongst the risk factors, beedi smoking (68 cases or 72.3% and alcohol consumption (51 cases or 54.2%) were most common factors. Other risk factors like tobacco and/ or betel leaf chewing also came across and some of them used to sleep with tobacco and betal leaf in night. Fifteen cases (15.8%) used to take hot tea or soup, etc. and more spicy vegetables and fried food. Majority of them (64 cases or 68.1%) were having more than one factor i.e. contribution of 2 or 3 factors.

Conclusion : Cancer in general is multifactorial in origin. Interaction of several environmental factors is possible. Smoking and alcohol consumption were the main contributing factor along with dietary factor in the etiology of oesophageal carcinoma.

5. Clinical Correlation between Symptoms and Anorectal Manometry in Evacuation Disorders

Shine Sadasivan, G Pande, V Sooraj, G Rajesh, M Geetha, S Chatni, I Siyad, VA Narayanan, P Nair, V Balakrishnan
Department of Gastroenterology, Amritha Institute of Medical Sciences, Cochin.

Introduction : Anorectal manometry is done to evaluate patients with anorectal cause of constipation and fecal incontinence. It also helps to identify patients with Hirschsprung’s disease. Patients with anorectal dyssynergia and fecal incontinence biofeedfack is a very useful tool.

Aim of the Study : To assess the correlation of symptoms and anorectal manometry findings of evacuatory disorders. Materials and Methods : Total of 27 patients underwent anorectal manometry during the period of October 2006 to December 2006, came to the department of Gastroenterology in Amritha Institute of medical sciences. Twenty-seven patients underwent anorectal manometry for the evaluation of chronic constipation. All patients with chronic constipation were previously diagnosed to have functional bowel disease. Detailed history was documented in all patients with chronic constipation. Indicators of evacuatory disorder were also noted, during study. These include prolonged straining, excessive straining, history of digital evacuation, feeling of obstruction, heaviness in perineum, perianal or vaginal pressure and unusual posture at the toilet.

Results : History of digital evacuation was present in 10 patients. Nine patients gave history of applying pressure over the buttocks to evacuate the stool. All patients were using laxatives with 4 patients requiring enema intermittently. Change in the posture while defecating was seen in 5 patients. Excess time was spent in the latrine with hard stools in 22 patients. All the patients with dyssynergic defecation were previously considered to be functional bowel disease. Eleven patients had normal anorectal manometry study. Ten patients were detected to have paradoxical increase in anal canal pressure on attempted defecation suggestive of dyssynergic defecation. Four patients were found to have hyposensitive rectum. One patient was found to have absent Recto anal inhibitory reflex (RAIR) suggestive of Hirsprung’s disease; full thickness biopsy confirmed the diagnosis. Of the 10 patients with dyssynergic defecation 5 patients underwent Biofeed back and showed good symptomatic improvement with 40% reduction of the sphincter pressure in 3- 4 settings. Of the 26 patients with chronic constipation 10 patients had symptoms suggestive of evacuatory disorder. Anorectal manometry confirmed Dyssynergic defecation in all these patients.

Conclusion : In this study very good clinical correlation is shown between the history of evacuatory disorder and anorectalmanometry findings. Careful history taking itself helps to identify evacuatory disorders.

6. Strongyloides Infestation Presenting as Intestinal Pseudo-obstruction

J Chakraborty, Seena Vengalil, D Suvarna, G Bhat, G Pai
Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal.

Strongyloidiasis is a chronic intestinal infection caused by the nematode strongyloides stercoralis which is widespread in the tropical countries. Usually asymptomatic, the disease can progress to hyper-infestation of the gut wall leading to systemic spread and consequent life threatening sepsis, especially in the presence of immuno-suppression. We present data on 2 patients presenting as intestinal pseudo-obstruction caused by strongyloides infestation. Two adult men aged 29 and 32 years presented with upper abdominal pain, vomiting of stale food and significant weight loss of 2-3 months duration. Neither had any premorbid illnesses or risk factors for immuno-suppression. Physical examination was unremarkable. Gastroscopy was normal and hence subacute intestinal obstruction was suspected. Barium meal follow through showed dilated bowel loops without any strictures. Biopsies from the duodenum revealed strongyloides infestation. There was complete resolution of symptoms in both with Tab Ivermectin 6 mg OD for 2 days given twice 14 days apart. The patients are maintaining well on follow up.

Conclusion : Strongyloides infestation should be considered as an important cause in patients presenting with features of intestinal obstruction without strictures.

7. A Rare Case of Hemoglobin E Homozygous State with Megaloblasts

R Dewan, R Kochhar, D Manocha, Shailesh, P Kathuria, S Bhattacharya, T Singh
Departments of Medicine and Pathology, Maulana Azad Medical College, New Delhi.

Background : HbE, a beta-chain structural mutant (b26 Glu → Lys) is prevalent in Bangladesh 1, Indonesia, Malaysia, Myanmar, Singapore and Thailand. In India, HbE is prevalent in the Eastern states. Hb E either in heterozygous (Hb AE trait) or homozygous (Hb E disease) condition presents as mild anaemia or without anaemia, microcytosis and hypochromia of erythrocytes with morphological resemblance to erythrocytes in beta thalassaemia trait.

Presentation : Twenty five years old man presented with recurrent jaundice for past 10 months. It was associated with dragging sensation in left upper abdomen since last 4 months. There was generalized weakness and palpitations over last 3 months. On physical examination there was icterus along with marked pallor. There was no LAP cyanosis or raised JVP. On abdominal examination there was mild hepatomegaly and moderate spleenomegaly. Blood investigations showed HB-6.1 g/dl, TLC-12500, DLC-P69 L18 M1 E12, platelets-1.6 lac. Peripheral smear showed anisopoikilocytosis with microcytic to macrocytic hypochromic RBC’s, with fair number of target cells, tear drop cells and fragmented RBC’s suggestive of hemolytic anaemia. S.BIL.-(T)-3.1 (D)-1.1 mg/dl ALT/AST-30/45 U/L, ALP-13 ka unit. S. LDH-572 U/L. Coombs test was negative. USG abd revealed hepatospleenomegaly with cholelithiasis. Bone marrow examination showed erythroid hyperplasia with megaloblastic anaemia. Serum Vit. B12 was normal. S. Folate level was decreased 1.2 ng/ml (6-20). HB. Electrophoresis showed HbF-4.9%, with homozygous HbE on.

Patient’s father and brother were found to be heterozygous for HbE on detailed evaluation. Patient improved on folate and iron supplementation.

8. IBD Presenting as Leucocytoclastic Vasculitis

R Porkodi, VR Reddy, PK Siva, A Yelsangikar
SMC, Chennai.

Inflammatory bowel disease is associated with various skin manifestations of which vasculitic purpura is uncommon. We describe a patient who presented with palpable purpura, fever and blood and mucus diarrhea of six months duration.

9. Splenomegaly with Renal Lesion

VR Reddy, RP Senthil, PR Sowmini, A Yelsangikar
SMC, Chennai.

Splenomegaly in a young adult is caused by various diseases ranging from infections like malaria to malignancies like leukemia. We describe a patient who presented with splenomegaly and a renal lesion on ultrasound. Doppler was diagnostic of EHPVO. Procoagulant workup revealed presence of Protein C and antithrombin deficiency.

Prevalence of Anti-HAV, Anti-HEV and Helicobacter Pylori Antibodies in Cochin, India SS Chatni, P Nair, Harish Kumar, VU Menon, VA Narayanan, V Balakrishnan Amrita Institute of Medical Sciences and Research Centre, Cochin – 682 026, Kerala, India.

Background and Aim : The prevalence of feco-orally transmitted infections – hepatitis A virus (HAV), hepatitis E virus (HEV) and helicobacter pylori – is a measure of sanitation hygiene in a country. The aim of the present study was to determine the prevalence of HAV, HEV and H. pylori infection among adults in Cochin (Kerala, India).

Methods : Amrita Diabetes and Endocrine Population Survey (ADEPS 2002-2005) was conducted in South Central Kerala in three randomly selected areas of the Ernakulam District in order to obtain a representative sample. Samples were randomly collected from 4 places i.e. Cheranellur (Panchayat), Paroor (Municipality), Kalamasherry (Municipality) and Cochin (Corporation). One hundred and ninety nine subjects between 18-78 years selected randomly from a community survey were tested for IgG antibodies against HAV, HEV and H. pylori. Univariate and multivariate analysis examined the association between different socio-demographic variables and HAV, HEV or H. pylori infection, and multivariate regression analysis was done to determine the factors independently associated with prior infection.

Results : The study population considered of 115 (57.8%) females and 84 (42.2%) males with a median age of 44 (range 18- 78). Majority of the subjects 160 (80.4%) were between age group of 21-40 years, 124 (62.3%) lived in area covered by municipal corporation, 102 (51.3%) had a nuclear family, 106 (53.3%) were from middle socio-economic group, 163 (81.9%) were non-manual workers, 35 (17.6%) had a past history of jaundice, 8 (4%) had history of peptic ulcer disease, 98 (49.2%) were regularly eating outside food, 156 (78.4%) were seropositive for HAV, 43 (21.6%) were seropositive for HEV and 55 (27.6%) were seropositive for H. pylori. Of the 84 males, 47 (55.9%) were alcoholics and 42 (50%) smokers.

Antibodies to H. pylori : For H. pylori outcome following subjects i.e. age less than 40 (OR 1.12, 95% CI .57-2.19, p=.71), Christians (OR 3.24, 95% CI 1.45-7.30, p=.001) and Muslims (OR 2.78, 95% CI 1.12-6.9, p=.013) and alcoholics (OR 2.48, 95% CI 1.17-5.23, p=.008) were associated with increased risk of acquiring H. pylori infection.

Antibodies to HAV : For HAV outcome place of residence was associated with increased risk of HAV. As compared to subjects living in panchayats, subjects living in municipal areas had increased risk of acquiring HAV infection with odd ratio of 2.64 (95% CI 1.09-6.39, p=.016) and odds ratio of 8.87 (95% CI 2.03- 44.46, p=.0004) for subjects living in corporation.

Antibodies to HEV : For HEV outcome subjects alcoholics and past history of peptic ulcer disease was seen to be associated with increased risk of acquiring HEV infection.

As compared to subjects with no history of peptic ulcer disease, subjects with history of peptic ulcer disease had increased risk of acquiring HEV, odds ratio of 3.90 (95% CI .78-19.63, p=.046) and alcoholics had odds ratio of 1.15 (95% CI 0.49-2.66, p=.73) as compared to non-alcoholic.

Conclusion : Low prevalence of anti-HEV IgG in the study population (21.6%), particularly when compared with anti-HAV IgG (78.4%), likely reflects more sporadic than epidemic type occurrence.

10. Serum Pancreatic Lipase to Amylase Ratio : A Useful Index to Differentiate Alcoholic from Nonalcoholic Acute Pancreatitis

BL Samaga, Rithesh
Department of Medicine, KMC Manipal, India.

To determine whether the lipase : amylase ratio differentiates alcoholic from nonalcoholic pancreatitis, we conducted a retrospective review of case records with the diagnosis of acute pancreatitis at Kasturba Medical College Hospital, Manipal between January 2005 and May 2007. A total of 134 out of 162 records were reviewed, 43 (32%) and 91 (68%) respectively alcoholic and nonalcoholic cases of acute pancreatitis. The diagnosis of acute pancreatitis was based on characteristic clinical symptoms and one of the following: a threefold elevation of serum amylase or lipase levels or characteristic computerized tomographic (CT) or ultrasonographic findings. Data collected included history of alcohol consumption, age, sex, race, admission serum amylase and serum lipase (from this the amylase: lipase ratio was calculated), peak serum amylase and serum lipase, and number of days of abdominal pain before admission. Patients with alcoholic pancreatitis had significantly lower serum amylase and higher lipase levels and significantly higher lipase: amylase ratios (ranging from 1.10 to 17.39, mean ratio of 9.35) than those with nonalcoholic pancreatitis (ranging from 1.10 to 17.39, mean ratio of 9.35) than those with nonalcoholic pancreatitis (ranging from 0.44 to 9.2, mean ratio of 4.3) (p value for ratio of = >3 being < 0.002, Pearson Chi-Square; P<0.003 Fisher’s Exact Test). Serum lipase was many fold more raised consistently in the alcoholic than in the nonalcoholic group. The higher the lipase: amylase ratio, the greater the specificity of alcohol as the etiology of acute pancreatitis. Only patients with alcoholic acute pancreatitis had lipase: amylase ratios > 5.0 (sensitivity 42%, specificity 99%). Our data point to the clinical utility of the lipase: amylase ratio in differentiating alcoholic from nonalcoholic acute pancreatitis and its value in cases when the etiology is seemingly multifactorial.

11. A Case of Necrotizing Esophagitis

SR Jaya, R Philip, R Choudhury, GD Ravindran, C Ross
Department of Medicine, St. John’s Medical College, Bangalore.

Necrotizing esophagitis is a rare condition as per as world literature. Less than hundred cases have been reported so far. A 39 year old lady who is a known case of Type I Diabetes Mellitus and Schizophrenia on treatment presented to the hospital with vomiting of 1 month duration. On examination there were no clinical causes for vomiting. Endoscopy was suggestive Necrotizing esophagitis. Patient was managed conservatively and she improved.

12. Spectrum of Upper Gastrointestinal Manifestations in HIV Disease

K Rudresh, U Jalihal, S Raikar, S Aslam
MS Ramaiah Medical College, Bangalore.

Background : HIV positive patients, frequently report upper gastrointestinal (GI) symptoms such as nausea, vomiting, upper abdominal pain, heartburn, early satiety, bloating and anorexia; however, their prevalence and diagnostic approach are unknown. Objectives : To study clinical, endoscopic and histopathologic changes in HIV positive patients with upper gastro intestinal symptoms and to compare them with non-HIV infected group with upper gastrointestinal symptoms.

Material and Methods : We evaluated about 35 cases of HIV positive patients and 35 cases of HIV negative age and sex matched controls with upper gastrointestinal symptoms. All patients answered questionnaires assessing upper GI symptoms, frequency, severity and impact of symptoms on quality of life, and under went upper gastrointestinal endoscopy with mucosal biopsies wherever indicated.

Results and Conclusions : Anorexia, nausea, vomiting, weight loss, dysphagia were frequent among HIV patients. Intensity and impact of symptoms on quality of life were higher in this group. Dyspeptic symptoms were frequent among HIV negative controls. Oral candidiasis was the most common oral lesion. Esophageal candidiasis was the commonest upper gastrointestinal endoscopic finding in patients with HIV/AIDS. Opputunistic diseases were related to lower CD 4 count.

13. Assessment of Pattern of Antimicrobial Resistance in Patients (Helicobacter Pylori Positive) of Dyspepsia

RK Jain, VK Sharma, TN Dubey, A Arya, A Shende, VK Ramnani, Y Malhotra
Gandhi Medical College, Bhopal.

Objective : Assessment of the pattern of antimicrobial resistance in patients (helicobacter pylori positive) of dyspepsia attending gastroenterology out patient division, Hamidia Hospital, Bhopal.

Methods : Sixty cases were included in present study, with history suggestive of dyspepsia. Each patient underwent upper GI Endoscopy and gastric biopsy for rapid urease test and culture. Isolated bacteria were analyzed for their levels of antibiotic susceptibility to Metronidazole, Tinidazole, Omidazole, Furazolidone, Clarithromycin, Amoxycillin, Ciprofloxacin and Tetracycline. The pattern of single and multiple resistance were
analyzed.

Results : Out of 60 cases rapid urease test was positive in 38 cases and culture was grown in 26 cases. The antibiotic resistance of helicobacter pylori (H. pylori) in culture positive cases in our study showed 84.6% were resistant to Metronidazole, 38.5% to Tinidazole, 7.6% to Omidazole, 32.8% to Amoxicillin, 3.8% to Tetracycline, 19.2% to Clarithromycin, 11.5% to furazolidone and 3.8% to Ciprofloxacin.

Conclusion : Antimicrobial resistance of helicobacter pylori is rapidly changing in different geographical areas and needs to define the resistance pattern in particular geographical area.

14. Evaluation of Aminotransferases Enzyme Level – A Positive Clue for the Aetiological Diagnosis of Hepatitis

KC Mathew, K Pavanan, VK Subhadra
Amala Institute of Medical Sciences, Amalanagar, Thrissur, Kerala – 680 555.

Object of Study : To study the pattern of Hepatic enzymes with special reference to AMINOTRANSFERASES in Heaptitis- A infection during 7-9-2004 to 5-1-2006, being compared with Hepatitis B and Leptospirosis.

Methodology : Twenty seven serologically proved cases of Hepatitis A during the above period being compared with 27 Non Hepatitis A cases which included 13 cases of serologically proved Hepatitis B and 14 cases of serologically proved Leptospirosis. Apart from clinical assessment, we planned the following investigations – Haemogram, Liver Function Tests, Prothrombin Time, INR, Relevant Serological Studies, USG in cases where indicated. Symptomatic and supportive treatment given.

Summary of Results :

Conclusion : By observing AMINOTRASNFERASES (AST/ SGOT and ALT/SGPT) level alone in a case of Jaundice one can reasonably suspect HAV infection if the levels are beyond 1000 U/L. This is in comparison with HBV infection and Leptospirosis.

15. Clinical Profile of Chronic Liver Disease with Special Reference to Etiology

D Mujumdar, G Ray, S Pal, S Ghosal
BR Singh Hospital and Medical Education and Research Centre, Sealdah, Kolkata – 700 028.

Introduction : Large numbers of CLD are diagnosed in day to day clinical practice but their clinical profile and etiology remain obscure in most of the cases.

Objectives : To determine the prevalence of various presentation of CID with the prevalence of their Etiologies in three Tertiary Referral Hospital of Kolkata retrospectively in a period of three years.

Materials and Methods : Two hundred and fifty cases of CLD were screened clinically, Biochemically, Serologically, Sonologically, Endoscopically and Histologically as follows: Sr. HBsAg, Anti- HBcAb, HBV-DNA for CHB: Sr. Anti-HCV-Ab, HCV-RNA for CHC; H/O Alcohol intake > 80 gram (M)/40 gram (F)/day for > 8 years for Alcoholic CLD; BMI > 30 Kg/sq.m, FBG > 110 mg%, BP > 130/85 mmHg with dyslipidemia for NASH; clinical profile
of Autoimmune Diseases + Sr. ANA, ASMA/AMA for Autoimmune CLD including PBC; H/o intake of culprit Drug with +ve dechallenge test for Drug related CLD; Sr. Ferritin > 350 mg% with H/o diabetes, arthritis, CVS involvement in Iron Overload States; Sr. Ceruloplasmin < 20 mg%, Urinary Cu > 100 microgm/24 hrs, K-F Ring for Wilson’s Ds.; Alpha-1-Anti-Trypsin < 20 micromol/L with Lung Complications for Alpha-1 Anti- Trypsin deficiency induced CLD. The severity of CLD is assessed by C-T-Ps’ Class Chart.

Observations : Is shown in the Pie-chart (Chart 1): CHB – 116%, CHC – 8%, Alc. CLD – 13.2%, NASH – 8.4%, Drug-CLD- 3.6%, Wilsons-2.8%, Cryptogenic – 48%, Others – 2.8% C-T-Ps’ Class; C-44.4%; B-34.8%; A-20.8% M-56%, F-44%.

Conclusion : Further studies are needed for reproducibility of this profile. Additional parameters are to be included in the Clinical Profile like those of OSA, Sleep Abnormality and NASH for identifying the Etiology of “Cryptogenic” Cirrhosis.

16. Should We Follow the Centres for Disease Control and Prevention (CDC) and the World Health Organisation (WHO) Recommendation of Hepatitis A Vaccination in Patients with Chronic Liver Disease in India?

P Roy, S Dutta, BP Chakravarty, M Agarwala, S Islam
Gauhati Medical College and Hospital, Guwahati, Assam – 781 018.

Objective : HAV vaccination is recommended by the CDC and the WHO for patients with chronic liver disease because of an increased morbidity and mortality associated with HAV superinfection. In India, the indications for HAV vaccinations are not clear due to lack of data on HAV sero-prevalence in patients with chronic liver disease.

Methodology : Patients with chronic liver disease were tested to ascertain prior HAV infection by the presence of anti-HAV antibody in their sera.

Results : Nearly all (96.23%) patients tested positive for anti- HAV antibody.

Conclusion : We may not be benefited from the routine recommendation of HAV vaccination in patients with chronic liver disease in India.

17. Complications in Viral Hepatitis – A Infections

M Chandramohan, SC Vivekananthan, D Sivakumar, P Selvam
Kamarajar Jaundice Liver Hospital and Research Centre, Madurai, Tamil Nadu – 625 001.

Our endeavor to stress on the medical fraternity that even viral hepatitis A virus (HAV) infection usually mild with excellent prognosis, still can lead on to complications and early anti-viral therapy will avert the complications and save them; even though they occur in small minority.

Study period 3 years, 830 patients with viral hepatitis A infection and Anti HAV IgM ELISA assays positive; Male 512, Female 318, age between 2 yrs. 6 months and 71 yrs. Complications noted in 27 (3.25%); they are prolonged hepatitis 6 months to 4 years in 3; with high total Bilirubin > 20 mg in 3; and high SGPT > 1000 1u in 3; with high Prothrombin time and > 3 sec higher than control in 7; with serum Albumin and Globulin reversal in 3; in spite of anti viral therapy longest time to clean Anti HAV IgM 1 yr and 18 days in 1; Acute painful peripheral neuritis with bilateral foot drop in 1; haemolytic jaundice in 1 and a fatal aplastic anaemia in 1. Early and effective anti viral combination therapy reverting the serum Albumin: Globulin, reversal in 8 days is an excellent example. Therapy given was chloroquine (Sheet anchor, since a new evaluation that it has nine modes of anti viral actions against 12 human pathogenic viruses including our world first report of its anti viral action against hepatitis C virus with, a collaborative work with Prof. E. De. Clercq of Belgium) along with Amantadine and/or Ribavirin. Prompt and effective treatment of HAV infection and regular active immunization against HAV should be mandatory.

18. Profile of Alcoholic Liver Disease

R Manjunath, YC Lakshmanakumar, V Lakshmaiah
Sri. Devaraj URS Accademy of Higher Education and Research, Kolar, Karnataka – 563 101.

Alcoholism is a major public health problem, both in developed and developing nations. Liver disease due to Alcohol is devastating and has poorer prognosis than many cancers. Aims : To know the clinical features and laboratory investigations in Alcoholic Liver Disease (ALD) and to analyse their relevance.

Methods : Prospective clinical study of 50 cases of ALD. Clinical examination and investigations to assess and to diagnose of ALD and to rule out other causes of liver disease were planned.

Results : Of the 50 cases of ALD, 66% were cirrhosis, 18% were Hepatitis and 16% were fatty liver. All were males with the commonest age group in 5th decade. Average Alcohol consumption was 100-160 gm/day for 10-20 years. Most patients were poor and consumed low quality Alcohol. Commonest histopathological feature was Alcoholic cirrhosis. Hyperbilirubinemia, prolonged PT, AST/ALT ratio is >2, raised GGT, hypoalbuminaemia are observed with Alcoholic cirrhosis.Most of the complications with ALD are portal hypertension (64%) and Hepatic encephalopathy (58%). 94% of alcoholic cirrhosis cases were in class C Child Pugh score and all 100% had jaundice.

Conclusions : Progression to cirrhosis and hepatic decompensation was early in poorly nourished patients with
consumption of low quality liquor. Anaemia is commonest feature with ALD.

19. Clinical and Aetiological Spectrum of Fulminant Hepatic Failure in Upper Assam

AK Das, PK Zameer, DK Singh, L Roslin, SR De, R Kumar, V George
Assam Medical College, Dibrugarh.

Aims and Objectives : To study the clinical manifestations, complications and aetiology of fulminant hepatic failure in Upper Assam.

Materials and Methods : The study was conducted at Assam Medical College, Dibrugarh, from July 2005 to May 2007. A total of 40 patients of more than 12 years of age, who developed hepatic encephalopathy within 8 weeks of onset of initial symptoms, with no previous history of liver disease, were selected for the study. Necessary investigations were done to find out the aetiology and complications.

Results and Observations : Fulminant hepatic failure was found to be more common in young males. The most common aetiologies were Hepatitis A (46.4%) and Hepatitis E (17.8%). The most common complications were coagulopathy (53.57%), cerebral oedema (39.28%), upper gastrointestinal bleed (39.28%) and renal failure (28.57%). The overall mortality rate was 54%.

Conclusion : Fulminant hepatic failure, although resulting from a primary liver insult, is a multi-organ disease, with a myriad of systemic complications and high mortality.

20. The Effect of Herbal Medicine in the Course of Disease in Patients Suffering from Jaundice due to Various Etiologies

D Das, BD Goswami, S Ali, C Baruah, D Sarmah
Gauhati Medical College and Hospital, Guwahati, Assam – 781 032.

Aims and Objectives : To study the clinical and laboratory profiles of the patients with jaundice, who had taken herbal medicines.

Methodology : All patients with jaundice attending Medicine Dept., GMCH, who had history of consuming herbal medicines were evaluated by clinical and laboratory means which included liver biopsy in selected cases. Patients were followed up at weekly intervals.

Results : Incidence of herbal drug intake was 30% of all jaundice patients. Duration of the disease was prolonged (40-90 days in 67% and > 90 days in 27.1%). Symptoms included low grade fever (67%), itching (65.8%), pain abdomen (41.1%), high grade fever (11.8%). Mean values of laboratory parameters were – Total bilirubin 23.1 mg/dl (mostly direct), AST 195.1 u/l, ALT 181.4 u/l, ALP 324.9 u/l. in 20% cases TLC was > 1100/cmm and 12.9% cases had S. create > 1.5 mg/dl. 34.1% cases had major complications e.g. ARF, pancreatitis, hepatic encephalopathy, etc. Liver biopsy done in 2 cases showed cholestatic hepatitis in one and acute hepatitis like picture in the other.

Conclusion : Intake of herbal medicines for jaundice is associated with increased morbidity and prolonged duration of the disease.

21. Some Observations on Diurectic Response and Large Volume Paracentesis (LVP) in Patients of Ascites Cause Cirrhosis of Liver

A Rawat, R Mishra, Mam Chandra, A Chandra
Department of Medicine, CSM Medical University, Lucknow.

Aim : To assess the patient who are diuretic responsive and those who are diuretic resistant and predisposing factors. And also to compare the safety and efficacy of large volume paracentesis under 25% albumin and 3.5% hammecoel and to compare the pre and post paracentesis biochemical parameters and predisposing factors.

Method : Fourty patients are divided in two groups diuretic responsive and diuretic resistant and among these tense ascitis and mild-moderate ascitis.

Result : Thirty patients were diuretic responsive and 10 were diuretic resistant. In diuretic responsive patient 16 underwent LVP for tense ascitis. Ten diuretic resistant patients seven underwent LVP. Fully analysed result will be available by APICON-2008.