RESUMEN
Globally, around 150 million people are infected with hepatitis C virus (HCV). India contributes a large proportion of this HCV burden. The prevalence of HCV infection in India is estimated at between 0.5% and 1.5%. It is higher in the northeastern part, tribal populations and Punjab, areas which may represent HCV hotspots, and is lower in western and eastern parts of the country. The predominant modes of HCV transmission in India are blood transfusion and unsafe therapeutic injections. There is a need for large field studies to better understand HCV epidemiology and identify high-prevalence areas, and to identify and spread awareness about the modes of transmission of this infection in an attempt to prevent disease transmission.
RESUMEN
The estimated prevalence of hepatitis C virus (HCV) infection in India is between 0.5 and 1.5% with hotspots showing much higher prevalence in some areas of northeast India, in some tribal populations and in certain parts of Punjab. Genotype 3 is the most prevalent type of infection. Recent years have seen development of a large number of new molecules that are revolutionizing the treatment of hepatitis C. Some of the new directly acting agents (DAAs) like sofosbuvir have been called game-changers because they offer the prospect of interferon-free regimens for the treatment of HCV infection. These new drugs have not yet been approved in India and their cost and availability is uncertain at present. Till these drugs become available at an affordable cost, the treatment that was standard of care for the whole world before these newer drugs were approved should continue to be recommended. For India, cheaper options, which are as effective as the standard-of-care (SOC) in carefully selected patients, are also explored to bring treatment within reach of poorer patients. It may be prudent to withhold treatment at present for selected patients with genotype 1 or 4 infection and low levels of fibrosis (F1 or F2), and for patients who are non-responders to initial therapy, interferon intolerant, those with decompensated liver disease, and patients in special populations such as stable patients after liver and kidney transplantation, HIV co-infected patients and those with cirrhosis of liver.
RESUMEN
The aetiological profile of paediatric portal hypertension in our hospital, a tertiary care centre in South India, showed that the commonest causes were extrahepatic portal venous obstruction (EHPVO) and cirrhosis. Wilson's disease was the most common cause of cirrhosis.
Asunto(s)
Várices Esofágicas y Gástricas/complicaciones , Degeneración Hepatolenticular/complicaciones , Hospitales/estadística & datos numéricos , Hipertensión Portal/etiología , Cirrosis Hepática/complicaciones , Vena Porta/patología , Niño , Preescolar , Várices Esofágicas y Gástricas/epidemiología , Femenino , Degeneración Hepatolenticular/epidemiología , Humanos , Hipertensión Portal/epidemiología , India/epidemiología , Cirrosis Hepática/epidemiología , MasculinoRESUMEN
Eosinophilic cholangiopathy is an unusual and benign form of biliary disease characterized by peripheral blood eosinophilia and cholangitis. Dramatic response to steroids is the hallmark of the disease. We present two cases of eosinophilic cholangiopathy.
Asunto(s)
Colangitis/diagnóstico , Eosinofilia/diagnóstico , Absceso Hepático/diagnóstico , Adolescente , Adulto , Biopsia con Aguja , Colangiopancreatografia Retrógrada Endoscópica , Colangitis/terapia , Eosinofilia/terapia , Humanos , MasculinoRESUMEN
Melioidosis is a suppurative chronic infection caused by a gramnegative bacterium, Burkholderia pseudomallei. We report two patients who presented with isolated liver abscesses caused by this pathogen. Both patients presented with high-grade fever and abdominal pain. On examination they were toxic and had tender hepatomegaly. Investigations showed leucocytosis and a shift to the left. Early diagnosis of melioidosis was made by culture and growth of Burkholderia pseudomallei from aspirated pus from the abscesses and the patients were treated with ceftazidime and co-trimoxazole. Despite institution of antibiotics both the patients succumbed to their illness. Melioidosis is an emerging infection in the Indian subcontinent and can cause isolated liver abscesses.
Asunto(s)
Burkholderia pseudomallei/aislamiento & purificación , Absceso Hepático , Melioidosis , Antibacterianos/uso terapéutico , Ceftazidima/uso terapéutico , Complicaciones de la Diabetes/tratamiento farmacológico , Complicaciones de la Diabetes/microbiología , Complicaciones de la Diabetes/patología , Resultado Fatal , Humanos , Absceso Hepático/tratamiento farmacológico , Absceso Hepático/etiología , Absceso Hepático/microbiología , Absceso Hepático/patología , Masculino , Melioidosis/tratamiento farmacológico , Melioidosis/microbiología , Melioidosis/patología , Persona de Mediana Edad , Combinación Trimetoprim y Sulfametoxazol/uso terapéuticoRESUMEN
The association between severe and persistent strongyloidiasis with human T cell lymphotropic virus type I (HTLV-1) infection is well documented in reports from HTLV-1 endemic regions like Japan and Jamaica. But there are no reports from non-endemic areas like India. We report a case of severe intestinal strongyloidiasis in a 45-year old Keralite man, living in Sikkim. Despite standard treatment with many courses of albendazole, his stool persistently showed Strongyloides stercoralis larvae. In the absence of other immunosuppressive conditions, human T cell lymphotropic virus type I infection was considered and determined positive. Subsequently, treatment with 2 courses of ivermectin achieved eradication of the infection. On follow-up, 3 years later, his stools again revealed Strongyloides stercoralis larvae.
Asunto(s)
Infecciones por HTLV-I/complicaciones , Infecciones por HTLV-I/diagnóstico , Estrongiloidiasis/complicaciones , Estrongiloidiasis/diagnóstico , Farmacorresistencia Microbiana , Infecciones por HTLV-I/terapia , Humanos , India , Masculino , Persona de Mediana Edad , Estrongiloidiasis/terapiaRESUMEN
BACKGROUND: Transjugular intrahepatic porto-systemic shunt (TIPS) for Budd-Chiari syndrome (BCS) can be inserted from inferior vena cava or hepatic vein to portal vein. The former is performed when hepatic veins are not suitable and is technically more challenging. METHODS: In this retrospective study, 7 patients with chronic BCS needed cavo-portal shunt as hepatic veins were neither amenable to plasty nor provided access for TIPS placement. Simultaneous fluoroscopic and trans-abdominal ultrasound guidance was used at the time of portal vein puncture. RESULTS: Technical success and clinical improvement were obtained in all patients. Median 3 (range 1-4) attempts were needed to puncture the portal vein. There were no significant complications. Uncovered stents were used in six patients and stent occlusion was common, but could be managed by re-intervention. CONCLUSION: Cavo-portal shunt is an effective technique for patients with BCS uncontrolled by medical therapy. Additional trans-abdominal ultrasound in oblique parasagittal plane keeps the procedure safe.
Asunto(s)
Síndrome de Budd-Chiari/diagnóstico , Síndrome de Budd-Chiari/cirugía , Derivación Portosistémica Intrahepática Transyugular/métodos , Adulto , Síndrome de Budd-Chiari/diagnóstico por imagen , Niño , Femenino , Fluoroscopía , Venas Hepáticas/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , UltrasonografíaRESUMEN
BACKGROUND AND AIM: The differentiation between Crohn's disease (CD) and tuberculosis (TB) of the intestine can be difficult in areas where both diseases occur. The present study examined histological criteria that would enable the diagnosis in mucosal biopsies. METHODS: Colonoscopic biopsies from 33 patients with TB and 31 patients with CD were examined for several specific histological features and their distribution. RESULTS: The salient distinguishing features of TB were granulomas larger than 400 microm in maximum dimension, more than four sites of granulomatous inflammation per site, cessation, a band of epithelioid histiocytes in ulcer bases and location of granulomas in the caecum. The salient features of CD were granulomas not showing any of the above features, focally enhanced colitis, pericryptal granulomatous inflammation, and the presence of architectural alteration/activity/chronic inflammation/deep ulceration at sites that did not show granulomatous response in the same or adjacent segments. Although granulomas in CD were distributed throughout the colon, they were more frequent in the rectosigmoid than in TB. All biopsies from endoscopically abnormal sites did not show distinguishing features of TB or CD, emphasizing the need for multiple biopsies. There was an accrual in the number of diagnoses made with increasing numbers of biopsies from rectum to ileum. CONCLUSIONS: Histology of mucosal biopsies can aid in the differentiation of TB from CD, but multiple biopsies from different colonic segments are important for complete evaluation.
Asunto(s)
Enfermedades del Colon/patología , Colonoscopía , Enfermedad de Crohn/patología , Enfermedades del Íleon/patología , Mucosa Intestinal/patología , Tuberculosis Gastrointestinal/patología , Adulto , Biopsia/métodos , Enfermedades del Colon/microbiología , Diagnóstico Diferencial , Estudios de Seguimiento , Humanos , Enfermedades del Íleon/microbiología , Estudios RetrospectivosRESUMEN
A 16-year-old boy presented with pericardial effusion, bilateral pleural effusion and mediastinal fluid collection. CT scan of abdomen revealed pancreatic calcification and a fistulous tract from a pseudocyst going along the inferior vena cava wall up to the pericardial cavity. After initial pericardiocentesis and pleurocentesis, lateral pancreatico-jejunostomy with Roux-en-Y loop was performed. The patient is well at 6 months follow up.
Asunto(s)
Fístula/etiología , Cardiopatías/etiología , Fístula Pancreática/etiología , Pancreatitis/complicaciones , Pericardio , Adolescente , Calcinosis , Enfermedad Crónica , Humanos , Masculino , Conductos Pancreáticos/patología , Derrame Pleural/diagnóstico por imagen , Derrame Pleural/etiología , Tomografía Computarizada por Rayos XAsunto(s)
Fucosa/sangre , Fucosa/orina , Hepatitis B/complicaciones , Cirrosis Hepática/sangre , Cirrosis Hepática/orina , Hepatopatías/sangre , Hepatopatías/orina , Enfermedad Aguda , Biomarcadores/sangre , Biomarcadores/orina , Colorimetría , Humanos , Cirrosis Hepática/etiología , Cirrosis Hepática Alcohólica/sangre , Cirrosis Hepática Alcohólica/orinaRESUMEN
We report a 40-year-old man with rheumatic heart disease who presented with abdominal pain for three weeks and hematemesis for 24 hours. CT scan showed a large splenic artery aneurysm without evidence of pancreatitis. Mycotic aneurysm due to infective endocarditis was considered and confirmed by echocardiogram, which showed aortic and mitral valve regurgitation and vegetations. He was managed successfully with coil embolization of the aneurysm and antibiotics.