Clinicoepidemiologic Features of Chronic Urticaria in Patients with versus without Subclinical Helicobacter pylori Infection: A Cross-Sectional Study of 150 Patients.

BACKGROUND: The Helicobacter pylori infection is linked to chronic urticaria in nearly 60% of patients. We studied clinicoepidemiologic features in patients with chronic urticaria with and without H. pylori infection. METHODS: Endoscopic antral biopsy for the rapid urease test (RUT) and histopathology, and serum IgG ELISA for H. pylori infection were performed in 150 patients (male:female ratio 1:2.4) of chronic urticaria aged 18-68 years. Clinicoepidemiologic features including age, gender, age of onset and duration, frequency and distribution of wheals, urticaria severity score, and systemic symptoms were analyzed in patients with and without H. pylori. The results of serum IgG ELISA for H. pylori were compared with 106 age- and gender-matched healthy adult controls. RESULTS: The RUT in 84 patients (56%), histopathology in 76 patients (50.6%), and H. pylori IgG ELISA in 94 patients (62.6%) were positive. H. pylori IgG ELISA was positive only in 35 (33%) controls, suggesting that chronic urticaria patients were more likely to have asymptomatic H. pylori infection than normal controls. Although not statistically significant, patients with H. pylori had a higher mean urticaria severity score, number of urticaria/angioedema episodes per year, and involvement of more body sites, particularly the scalp, palms, and soles. The constitutional or gastrointestinal symptoms were statistically higher in patients with H. pylori infection than those without it. CONCLUSION: A subset of chronic urticaria patients appears to have asymptomatic H. pylori infection. However, its implications in chronicity, recurrences, the severity of urticaria, other systemic manifestations, and management remains conjectural in view of 33% of controls also having positive H. pylori ELISA and the endemicity of infection in developing countries.

Gastrointestinal Leishmaniasis in Non-Endemic Region.

We report a case of visceral leishmaniasis (VL) in an immunocompetent native from non-endemic region of India that presented with chronic diarrhoea. VL was not a differential diagnosis and was unexpectedly diagnosed as intestinal leishmaniasis through the identification of the Leishman-Donovan (LD) bodies in duodenal and colonic mucosa. The patient expired before receiving antileishmanial therapy.

Probiotic VSL#3 reduces liver disease severity and hospitalization in patients with cirrhosis: a randomized, controlled trial.

BACKGROUND & AIMS: Little is known about whether probiotics can affect outcomes of patients with cirrhosis and hepatic encephalopathy (HE). We assessed the efficacy of a probiotic preparation in preventing the recurrence of HE (primary outcome) and reducing the number of hospitalizations and severity of liver disease in patients with cirrhosis. METHODS: We performed a double-blind trial at a tertiary care hospital in India. Patients with cirrhosis who had recovered from an episode of HE during the previous month were assigned randomly (using computer-generated allocation) to groups given a probiotic preparation (VSL#3, 9 × 10(11) bacteria; CD Pharma India Private Limited, New Delhi, India) (n = 66) or placebo (n = 64) daily for 6 months. RESULTS: There was a trend toward a reduction in the development of breakthrough HE among patients receiving the probiotic (34.8% in the probiotic group vs 51.6% in the placebo group; hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.38-1.11; P = .12). Fewer patients in the probiotic group were hospitalized for HE (19.7% vs 42.2%, respectively; HR, 0.45; 95% CI, 0.23-0.87; P = .02) or for complications of cirrhosis (24.2%) than in the placebo group (45.3%) (HR, 0.52; 95% CI, 0.28-0.95; P = .034). Child-Turcotte-Pugh and model for end-stage liver disease scores improved significantly from baseline to 6 months in the probiotic group, but not in the placebo group. There were no adverse events related to VSL#3. CONCLUSIONS: Over a 6-month period, daily intake of VSL#3 significantly reduced the risk of hospitalization for HE, as well as Child-Turcotte-Pugh and model for end-stage liver disease scores, in patients with cirrhosis. ClinicalTrials.gov number: NCT01110447.

The Association Between Chronic Plaque Psoriasis and Nonalcoholic Fatty Liver Disease in Indian Patients: Results of a Pilot Study.

Background: Psoriasis is a chronic dermatosis with potential to cause systemic disease by triggering dysmetabolism, such as metabolic syndrome and nonalcoholic fatty liver disease (NAFLD). We studied the relationship and associations between NAFLD and clinical features, including age, gender, disease duration, and severity of psoriasis in our patients. Methods: This cross-sectional study comprised 61 (m:f, 43:19) patients without pre-existing comorbidities and matched 24 (m:f, 16:8) healthy controls aged between 20 and 68 years. Disease severity was graded as mild, moderate, and severe by psoriasis area and severity index score and body surface area (BSA) involvement. The grades of fatty liver and liver fibrosis were assessed using liver ultrasonography (USG) and transitional vibration-controlled elastography (Fibroscan). Results: Overall, 67.2% of patients were aged >40 years, and the duration of disease was <5years in 60.7% of patients. Mild and moderate to severe psoriasis occurred in 78.7% and 21.3% of patients, respectively. BSA was >10% in 57.5% patients. The proportion of NAFLD was 27.9% and 32.8% by USG and Fibroscan compared with 20.8% in controls. Statistically, there was no significant difference or association between the prevalence of NAFLD among patients and controls, and gender, age (mean ± standard deviation, 47.5 ± 13.8 vs. 45.2 ± 15.7), duration, severity of psoriasis, and arthritis between psoriatic patients with and without NAFLD. Conclusion: This was a pilot study because of the numerosity of sample and highlights trends for possible link between psoriasis and NAFLD, but the results need cautious interpretation and clinical application. Whether NAFLD can be attributed to overall systemic inflammatory process of psoriasis or it occurs as an epiphenomenon of concurrent metabolic syndrome needs elucidation with well-designed studies. Cross-sectional study design, small number of patients, and controls remain major limitations. The study did not compare its findings with liver biopsy.

A Case of Acute-on-Chronic Liver Failure (ACLF) Due to An Uncommon Acute And Chronic Event.

Acute on Chronic Liver Failure (ACLF) is an acute worsening of patients with chronic liver disease resulting in liver failure. Usually these patients have cirrhosis as the underlying liver disease with alcohol being the most common etiology. Common hepatitic illnesses causing acute worsening in Indian patients of ACLF include alcoholic hepatitis, acute viral hepatitis related to hepatitis E virus and acute flare in chronic hepatitis B. We report an adult case of ACLF due acute viral hepatitis related to hepatitis A virus infection superimposed on nonalcoholic steatohepatitis without cirrhosis.

Clinical and biochemical profile of patients hospitalized with jaundice: Experience from a teaching hospital in north India

Background: Jaundice is a common problem in both medical and surgical practice. For best line of management, it is very essential to differentiate all types of jaundice. The cause can often be correctly anticipated clinically but usually biochemical and radiological imaging investigations are required for confirmation. Here we present a study on clinical and biochemical profile of jaundice patients admitted in a tertiary care hospital.Methods: It was an observational study and all patients admitted with jaundice in the department of medicine meeting inclusion/exclusion criteria were enrolled. Data was collected on a self-designed, pretested and structured format.Results: Out of 100 patients, 77 were males, and median age of 47.5 years. Apart from jaundice, anorexia was the most common presenting complaint (90%), while ascites was the most common finding. Cirrhosis (60%) was the most common cause of jaundice. The mean total bilirubin was 7.9 mg%. Mean Hemoglobin in patients with cirrhosis was 9.7gm/dL. 78% patients of cirrhosis revealed esophageal varices. Majority (80%) showed hypoproteinemia. PT was prolonged >3sec in 87% of cases. On USG shrunken liver was noted in all patients with cirrhosis, enlarged liver was found in two patients of liver abscess while altered echotexture was seen in 66% cases. 90 patients improved, 9 died and only one was referred.Conclusions: Alcoholic liver disease was the leading cause of cirrhosis (92%). Jaundice in general and alcoholic cirrhosis in particular affects mostly the productive age group of the male population and has a high economic burden on our society.

Profile of acute upper gastro intestinal bleed: a referral hospital-based study in sub Himalayan region

Background: Acute upper gastrointestinal bleeding (UGIB) is one of the most common medical emergencies and remains a major cause of morbidity and mortality. We are likely to see more of it in coming years with ageing population, patients with liver disease, increasing use of NSAIDs, single or multiple antithrombotic agents and novel anticoagulants, the present study was designed with the aim to assess the clinical profile of UGIB presenting to the Department of Medicine in sub Himalayan region.Methods: Study done over 12 months included all patients presenting with acute hematemesis and/or melena. Detailed history, clinical examination, blood tests and Upper GI Endoscopy was done in all patients.Results: One hundred seventy-five patients were included in the study, 129 (73.7%) were males. The commonest age group was 41-60 years contributing to 44%, male to female ratio 2.8:1. The commonest presentation was melena, patients with hematemesis presented earlier, with mean duration 1.46 days. 42.3% of patients were hemodynamically unstable at admission. The mean hemoglobin (Hb) was 8.224±2.78 g%. The cause of bleed was shared by ulcer, varices, non-ulcer non-variceal approximately 1/3rd each, major cause being ulcer in 39.4%. Varices was common in age 30-40 yrs, ulcer in age 51 to 70 years.Conclusions: UGI bleed was more frequent in males age between 41-60 yrs, peptic ulcer being the leading cause in our study, presence of signs of liver failure were associated with varices.