Infliximab in patients with severe steroid-refractory ulcerative colitis: Indian experience.

INTRODUCTION: The role of infliximab in the treatment of acute severe ulcerative colitis is established. However, all the data available in the literature are from western countries. This is the first report on the use of infliximab in patients with severe steroid-refractory ulcerative colitis from India. METHODS: Retrospective analysis of 28 patients who had received infliximab therapy for induction of remission, with three doses of 5 mg/kg at 0, 2, and 6 weeks, was performed. RESULTS: Twenty-four (85.6 %) patients had shown a clinical response by week 8 and, hence, avoided urgent colectomy. In 2 years of follow up, 9/16 (56 %) patients had not required colectomy. CONCLUSION: Infliximab averted colectomy in a proportion of patients with severe steroid-refractory ulcerative colitis.

Low hygiene and exposure to infections may be associated with increased risk for ulcerative colitis in a North Indian population.

BACKGROUND: Previous studies have attempted to link hygiene hypothesis with IBD. However most of these studies come from developed countries where the level of hygiene is high and universal. Very little data is available from developing countries. The present study explores the truth of hygiene hypotheses and other risk factors for ulcerative colitis (UC) in a North Indian population where the prevalence of UC has been increasing. METHODS: A total of 518 patients diagnosed with UC and 188 age-matched controls were included in the study. A structured questionnaire concerning socio-demographics and level of hygiene was completed by all participants. Logistic regression analysis was used to study the association between hygiene-related factors and the risk for UC. Odds ratios and 95% confidence intervals were estimated. RESULTS: There was a higher proportion of females (P<0.001), and a higher educational status (P=0.01) in UC patients compared with controls. A family history of IBD was present in 7.2% of cases and non-existent in controls. On multivariate analysis, after accounting for potential confounders, having a private bed (P<0.001), and having better toilet facilities [(RCA versus none, P=0.01; Flush toilet versus none, P=0.01), (RCA LATRINE as a toilet technology used in rural areas where no flush facility exists. It was developed under RCA project)] were inversely associated with risk for UC whereas owning a pet (P=0.01) and stressful events like a death in the family (P=0.01) were associated with greater risks for UC. CONCLUSION: Our study does not provide definitive evidence to support hygiene hypothesis and rather suggests that the rising incidence of UC in North India may be attributable to inadequate sanitary measures or other as yet unidentified factors.

Perinatal transmission of hepatitis C virus in northern India.

Data on transmission of HCV infection from mother to infant in India are limited. Between July 2006 to June 2007, women attending our hospital in the third trimester of pregnancy were screened for anti-HCV. Those testing positive for anti-HCV were tested for HCV RNA. Infants of mothers with HCV infection were followed for up to 24 months. Eight of 488 pregnant women (1.6%) tested positive for anti-HCV; of these, seven had detectable HCV RNA. Two of 7 (29%) children born to HCV-infected mothers had persistently positive HCV RNA, indicating perinatal transmission; one additional child had transient HCV positivity. Passive transfer of HCV antibodies was observed in five babies. HCV infection was detected in 1.4% of pregnant women, and perinatal transmission of HCV to newborns was detected in 29% of such cases.

How sustained is sustained viral response in patients with hepatitis C virus infection?

BACKGROUND: Sustained virological response (SVR) is achieved in a high proportion of patients with chronic hepatitis C infection, particularly those with genotype 2 or 3 HCV infection. However, data on long-term durability of virological response in patients who achieve SVR are limited. AIM: To evaluate the long-term durability of virological response in patients who have achieved SVR with interferon-based combination therapy. METHODS: One hundred patients with chronic HCV infection who had obtained SVR after IFN and ribavirin combination therapy were followed up for up to 8 years with annual HCV RNA testing. RESULTS: During a followed up of 6 months to 8 years, 8 of 100 patients with initial SVR developed late relapse of HCV infection. Relapse was more common in patients who had cirrhosis (5/28 [18%] vs. (3/72 [4%] with no cirrhosis; p=0.037). CONCLUSION: SVR is durable in most patients, but some patients do have late relapse; long term follow up may be particularly important in a subset of patients with HCV infection who have liver cirrhosis.