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Kumar A, Acharya SK, Singh SP, Duseja A, Madan K, Shukla A, Arora A, Anand AC, Bahl A, Soin AS, Sirohi B, Dutta D, Jothimani D, Panda D, Saini G, Varghese J, Kumar K, Premkumar M, Panigrahi MK, Wadhawan M, Sahu MK, Rela M, Kalra N, Rao PN, Puri P, Bhangui P, Kar P, Shah SR, Baijal SS, Shalimar, Paul SB, Gamanagatti S, Gupta S, Taneja S, Saraswat VA, Chawla YK. 2023 Update of Indian National Association for Study of the Liver Consensus on Management of Intermediate and Advanced Hepatocellular Carcinoma: The Puri III Recommendations. J Clin Exp Hepatol 2024; 14:101269. [PMID: 38107186 PMCID: PMC10724697 DOI: 10.1016/j.jceh.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/12/2023] [Indexed: 12/19/2023] Open
Abstract
Hepatocellular carcinoma (HCC) presents significant treatment challenges despite considerable advancements in its management. The Indian National Association for the Study of the Liver (INASL) first published its guidelines to aid healthcare professionals in the diagnosis and treatment of HCC in 2014. These guidelines were subsequently updated in 2019. However, INASL has recognized the need to revise its guidelines in 2023 due to recent rapid advancements in the diagnosis and management of HCC, particularly for intermediate and advanced stages. The aim is to provide healthcare professionals with evidence-based recommendations tailored to the Indian context. To accomplish this, a task force was formed, and a two-day round table discussion was held in Puri, Odisha. During this event, experts in their respective fields deliberated and finalized consensus statements to develop these updated guidelines. The 2023 INASL guidelines offer a comprehensive framework for the diagnosis, staging, and management of intermediate and advanced HCC in India. They represent a significant step forward in standardizing clinical practices nationwide, with the primary objective of ensuring that patients with HCC receive the best possible care based on the latest evidence. The guidelines cover various topics related to intermediate and advanced HCC, including biomarkers of aggressive behavior, staging, treatment options, and follow-up care.
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Affiliation(s)
- Ashish Kumar
- Institute of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110060, India
| | - Subrat K. Acharya
- Department of Gastroenterology and Hepatology, KIIT University, Patia, Bhubaneswar, Odisha, 751 024, India
| | - Shivaram P. Singh
- Department of Gastroenterology, SCB Medical College, Cuttack, Dock Road, Manglabag, Cuttack, Odisha, 753 007, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Kaushal Madan
- Clinical Hepatology, Max Hospitals, Saket, New Delhi, India
| | - Akash Shukla
- Department of Gastroenterology, Seth GSMC & KEM Hospital, Mumbai, 400022, India
| | - Anil Arora
- Institute of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110060, India
| | - Anil C. Anand
- Department of Gastroenterology, Kalinga Institute of Medical Sciences (KIMS), Kushabhadra Campus (KIIT Campus-5), Patia, Bhubaneswar, Odisha, 751 024, India
| | - Ankur Bahl
- Department of Medical Oncology, Fortis Memorial Research Institute, Sector - 44, Opp. HUDA City Center, Gurugram, 122002, India
| | - Arvinder S. Soin
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, CH Baktawar Singh Road, Sector 38, Gurugram, Haryana, 122 001, India
| | - Bhawna Sirohi
- Medical Oncology, BALCO Medical Centre, Raipur Chattisgarh, 493661, India
| | - Debnarayan Dutta
- Radiation Oncology, Amrita Institute of Medical Sciences, Ponekkara, AIMS (P.O.), Kochi, 682041, India
| | - Dinesh Jothimani
- Department of Hepatology, Dr. Rela Institute & Medical Centre, #7, CLC Works Road, Chromepet, Chennai, 600044, India
| | - Dipanjan Panda
- Department of Medical Oncology, Apollo Cancer Centre, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, 110076, India
| | - Gagan Saini
- Radiation Oncology, Max Institute of Cancer Care, Max Super-Speciality Hospital, W-3, Ashok Marg, near Radisson Blu Hotel, Sector-1, Vaishali, Ghaziabad, 201012, India
| | - Joy Varghese
- Department of Hepatology & Transplant Hepatology, Gleneagles Global Health City, 439, Cheran Nagar, Perumbakkam, Chennai, Tamil Nadu, 600100, India
| | - Karan Kumar
- Department of HPB Sciences and Liver Transplantation, Mahatma Gandhi Medical College and Hospital, RIICO Institutional Area, Sitapura, Tonk Road, Jaipur, 302022, Rajasthan, India
| | - Madhumita Premkumar
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Manas K. Panigrahi
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, 751019, Odisha, India
| | - Manav Wadhawan
- Liver & Digestive Diseases Institute, Institute of Liver & Digestive Diseases, BLK Max Hospital, Delhi, 110 005, India
| | - Manoj K. Sahu
- Department of Medical Gastroenterology, IMS & SUM Hospital, K8 Kalinga Nagar, Shampur, Bhubaneswar, Odisha 751 003, India
| | - Mohamed Rela
- The Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, #7, CLC Works Road, Chromepet, Chennai, 600044, India
| | - Naveen Kalra
- Department of Radio Diagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Padaki N. Rao
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, No. 6-3-661, Punjagutta Road, Somajiguda, Hyderabad, Telangana, 500 082, India
| | - Pankaj Puri
- Fortis Escorts Liver & Digestive Diseases Institute (FELDI), Fortis Escorts Heart Institute & Research Centre, Okhla Road, New Delhi, 110025, India
| | - Prashant Bhangui
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, CH Baktawar Singh Road, Sector 38, Gurugram, Haryana, 122 001, India
| | - Premashis Kar
- Department of Gastroenterology and Hepatology, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh, 201 012, India
| | - Samir R. Shah
- Department of Hepatology and Liver Intensive Care, Institute of Liver Disease, HPB Surgery and Transplant Global Hospitals, Dr E Borges Road, Parel, Mumbai, 400012, India
| | - Sanjay S. Baijal
- Diagnostic and Interventional Radiology, Medanta The Medicity, CH Baktawar Singh Road, Sector 38, Gurugram, Haryana, 122 001, India
| | - Shalimar
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Shashi B. Paul
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Shivanand Gamanagatti
- Fortis Escorts Liver & Digestive Diseases Institute (FELDI), Fortis Escorts Heart Institute & Research Centre, Okhla Road, New Delhi, 110025, India
| | - Subash Gupta
- Centre for Liver & Biliary Sciences, Liver Transplant and Biliary Sciences, Robotic Surgery, Max Super Speciality Hospital, No. 1, 2, Press Enclave Road, Mandir Marg, Saket Institutional Area, Saket, New Delhi, Delhi, 110017, India
| | - Sunil Taneja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Vivek A. Saraswat
- Department of Gastroenterology and Hepatology, Mahatma Gandhi Medical College and Hospital, RIICO Institutional Area, Sitapura, Tonk Road, Jaipur, 302022, Rajasthan, India
| | - Yogesh K. Chawla
- Department of Gastroenterology, Kalinga Institute of Medical Sciences (KIMS), Kushabhadra Campus (KIIT Campus-5), Patia, Bhubaneswar, Odisha, 751 024, India
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Panda G, Ahuja D, Kumar S, Srivastava S, Kar P. Comparative Evaluation of Endoscopic Variceal Band Ligation and Carvedilol for Prevention of First Esophageal Variceal Bleed in High Risk Cirrhotics. J Gastrointestin Liver Dis 2023; 32:562-563. [PMID: 38147612 DOI: 10.15403/jgld-4909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/04/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND & AIMS: Endoscopic variceal ligation (EVL), and non-selective beta blockers (NSBBs) are the favourable options for primary prophylaxis of variceal bleed. Carvedilol causes higher reduction in portal pressure in comparison to other NSBBs. Our aim was to compare the outcomes of variceal bleed prevention by EVL, and carvedilol in high risk cirrhosis.
METHODS: Our randomised trial evaluated high risk cirrhotic patients at risk of bleeding without a past history of variceal bleed. Included patients underwent screening endoscopy, and those having high risk varices (grade III/IV) and/or showing red color signs were randomised (1:1 ratio) to receive either EVL or Carvedilol. Follow up was done after 1 year. Primary endpoint was first variceal bleed, and secondary end points included overall mortality due to any cause.
RESULTS: We studied 52 patients with 26 patients in each group with similar baseline characteristics. Majority of patients were Child-Pugh Class B followed by Child-Pugh Class A. Carvedilol group had lower variceal bleeding than EVL group (7.6% vs 19.2%, P=0.41) without any difference in mortality. Overall mortality in EVL arm was 15.38% (n=4), and Carvedilol arm was 11.53% (n=3). Bleeding related mortality was same in both groups i.e. 3.84% (n=1). One patient receiving Carvedilol developed syncope warranting cessation of therapy, otherwise well tolerated. Two patients who underwent EVL had post procedure bleeding.
CONCLUSIONS: We concluded similar or possibly higher efficacy of Carvedilol as prophylactic agent for variceal haemorrhage. Limitation of our study includes a smaller sample size. A higher patient data will help confirm our results.
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Affiliation(s)
- Gadadhar Panda
- Department of Medicine, Maulana Azad Medical College, New Delhi, India. .
| | - Dhruv Ahuja
- Department of Medicine, Maulana Azad Medical College, New Delhi, India.
| | - Suresh Kumar
- Department of Medicine, Maulana Azad Medical College, New Delhi, India.
| | - Siddharth Srivastava
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research.
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Samanta S, Sk MF, Koirala S, Kar P. Exploring molecular interactions of potential inhibitors against the spleen tyrosine kinase implicated in autoimmune disorders via virtual screening and molecular dynamics simulations. SAR QSAR Environ Res 2023:1-29. [PMID: 37881946 DOI: 10.1080/1062936x.2023.2266364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/19/2023] [Indexed: 10/27/2023]
Abstract
The spleen tyrosine kinase (Syk) plays a pivotal role in immune cells' signal transduction mechanism. While fostamatinib, an FDA-approved Syk inhibitor, is currently used to treat immune thrombocytopenia, the search for improved Syk-targeted medications to treat autoimmune diseases is still underway. Herein, we screened 38,493 compounds against Syk and selected eight leads based on the docking score and ADMET properties, and performed 3× 200 ns long molecular dynamics simulations of the apo and Syk-ligand complexes. We considered R406, the active component of fostamatinib, as a control. The molecular mechanics Poisson-Boltzmann surface area (MM-PBSA) calculations demonstrated the lead1 (Δ G b i n d = -30.35 kcal/mol) exhibited a similar binding free energy as the control (Δ G b i n d = -29.82 kcal/mol). The Syk stabilizing effect of lead1 was also indicated in its network features, sampling space, and residual correlation motion analysis. We further generated 100 structural analogues of lead1 using deep learning, and one of the analogues displayed a better binding free energy (Δ G b i n d = -47.58 kcal/mol) compared to the control or lead1, facilitated by more favourable van der Waals interactions and lesser binding-opposing net polar forces. This analogue may be further exploited to develop effective therapeutics against Syk-associated diseases after validation in vitro and in vivo.
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Affiliation(s)
- S Samanta
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Madhya Pradesh, India
| | - M F Sk
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Madhya Pradesh, India
- Theoretical and Computational Biophysics Group, NIH Resource for Macromolecular Modeling and Visualization, Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - S Koirala
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Madhya Pradesh, India
| | - P Kar
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Madhya Pradesh, India
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Kothari R, Khanna D, Kar P. To evaluate the prevalence of spontaneous portosystemic shunts in decompensated cirrhosis patients and its prognostic significance. Indian J Gastroenterol 2023; 42:677-685. [PMID: 37642937 DOI: 10.1007/s12664-023-01393-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 05/10/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Spontaneous portosystemic shunts (SPSS) are frequent in liver cirrhosis and their prevalence increases as liver function deteriorates, probably as a consequence of worsening portal hypertension, but without achieving an effective protection against cirrhosis complications. This study was conducted to detect the prevalence of portosystemic shunts in liver cirrhosis patients and analyze its prognostic role. METHOD We conducted a prospective observational study, where 92 patients with decompensated cirrhosis were evaluated based on history, physical examination, biochemical tests and abdominal computed tomography (CT) angiography findings. A follow-up was done after six months for the development of cirrhosis-related complications. RESULTS Of the 92 cirrhotic patients, 57.6% had SPSS (large SPSS + small SPSS) detected by multi-detector computed tomographic angiography. Overall, we found large SPSS in 24 (26.1%) patients, small SPSS in 29 (31.5%) patients and no shunt in 39 (42.4%) patients. Among the shunts, the splenorenal shunt is the most frequent type (25, 27.2%) followed by the paraumbilical shunt (20.7%). Previous decompensating events, including hepatic encephalopathy, ascites, spontaneous bacterial peritonitis and gastrointestinal bleed, were experienced more frequently by the large SPSS group followed by the small SPSS and without SPSS groups. Regarding follow-up, decompensating episodes of hepatic encephalopathy developed more frequently in patients with large SPSS (41.7%) than in patients with small SPSS (24.1%) followed by patients without SPSS (12.8%). CONCLUSION In summary, all cirrhotic patients should be studied with radiological imaging to detect the presence of portosystemic shunts. In several cases, patients with large SPSS had a more impaired liver function and more frequent complications of portal hypertension. So, these patients would probably benefit from a closer surveillance and more intensive therapy.
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Affiliation(s)
- Rishabh Kothari
- Department of Gastroenterology, Max Super Speciality Hospital, Vaishali, Ghaziabad, 201 012, India
| | - Deepanshu Khanna
- Department of Gastroenterology, Max Super Speciality Hospital, Vaishali, Ghaziabad, 201 012, India
| | - Premashis Kar
- Department of Gastroenterology, Max Super Speciality Hospital, Vaishali, Ghaziabad, 201 012, India.
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Kalita S, Kalita MJ, Hazarika G, Das PP, Dutta K, Rudola T, Das P, Talukdar AJ, Dutta S, Idris MG, Kar P, Medhi S. Altered expression of endosomal Toll-like receptors and HBeAg seropositivity may act synergistically towards the vertical transmission of HBV. Am J Reprod Immunol 2023; 90:e13747. [PMID: 37491930 DOI: 10.1111/aji.13747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 06/15/2023] [Accepted: 06/22/2023] [Indexed: 07/27/2023] Open
Abstract
PROBLEM Hepatitis B is one of the leading causes of mortality in India. Despite the mass vaccination programme, the burden of the infection is still increasing due to its vertical transmission. Asymptomatic nature of hepatitis B virus (HBV) infection owing to immune tolerance among pregnant women is a major issue in this regard. METHOD OF STUDY As such, this study aims to investigate the potential role of altered Toll-like receptor (TLR) expression (TLR-3, 7 and 9) along with peripheral blood HBeAg status in attaining differential cord blood (CB) HBV DNA status. RESULT Expression analysis reveals an overall downregulation of expression with mean ± SD value 1.14 ± 1.05, 0.86 ± 0.5 and 0.71 ± 0.4 (TLR 3, 7 and 9, respectively) upon comparison with healthy women. Further stratification based on CB HBV DNA status; the downregulation of expression was found to be significantly (p < .05) associated with positive CB HBV DNA status apart from peripheral HBeAg status. One hundred percent HBeAg positive parturiting women exhibit positive CB HBV DNA. Pearson's correlation analysis reveals a positive correlation between CB HBV DNA status and altered TLR expression, HBeAg status and mother HBV DNA status and as such can be associated with the potential risk of HBV vertical transmission. CONCLUSION This study suggests that the downregulation of TLR 3, 7 and 9 may be a risk factor for potential vertical transmission of HBV.
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Affiliation(s)
- Simanta Kalita
- Department of Bioengineering and Technology, Gauhati University, Guwahati, Assam, India
| | - Manash Jyoti Kalita
- Department of Bioengineering and Technology, Gauhati University, Guwahati, Assam, India
| | - Gautam Hazarika
- Department of Bioengineering and Technology, Gauhati University, Guwahati, Assam, India
| | - Partha Pratim Das
- Department of Bioengineering and Technology, Gauhati University, Guwahati, Assam, India
| | - Kalpajit Dutta
- Department of Bioengineering and Technology, Gauhati University, Guwahati, Assam, India
| | - Tanya Rudola
- Department of Bioengineering and Technology, Gauhati University, Guwahati, Assam, India
| | - Panchanan Das
- Department of Obstetrics and Gynaecology, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Anjan Jyoti Talukdar
- Department of Medicine, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Sangitanjan Dutta
- Department of Medicine, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Md Ghaznavi Idris
- Department of Bioengineering and Technology, Gauhati University, Guwahati, Assam, India
| | - Premashis Kar
- Department of Gastroenterology, Max Super Speciality Hospital, Ghaziabad, UP, India
| | - Subhash Medhi
- Department of Bioengineering and Technology, Gauhati University, Guwahati, Assam, India
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Khanna D, Kar P. Can the diagnostics of hepatitis in pregnant patients be improved? Expert Rev Mol Diagn 2022; 22:1053-1055. [PMID: 36462167 DOI: 10.1080/14737159.2022.2153039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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Sk MF, Kar P. Finding inhibitors and deciphering inhibitor-induced conformational plasticity in the Janus kinase via multiscale simulations. SAR QSAR Environ Res 2022; 33:833-859. [PMID: 36398489 DOI: 10.1080/1062936x.2022.2145352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
The Janus kinase (JAK) is a master regulator of the JAK/STAT pathway. Dysregulation of this signalling cascade causes neuroinflammation and autoimmune disorders. Therefore, JAKs have been characterized as an attractive target for developing anti-inflammatory drugs. Nowadays, designing efficient, effective, and specific targeted therapeutics without being cytotoxic has gained interest. We performed the virtual screening of natural products in combination with pharmacological analyses. Subsequently, we performed molecular dynamics simulations to study the stability of the ligand-bound complexes and ligand-induced inactive conformations. Notably, inactive kinases display remarkable conformational plasticity; however, ligand-induced molecular mechanisms of these conformations are still poorly understood. Herein, we performed a free energy landscape analysis to explore the conformational plasticity of the JAK1 kinase. Leonurine, STOCK1N-68642, STOCK1N-82656, and STOCK1N-85809 bound JAK1 exhibited a smooth transition from an active (αC-in) to a completely inactive conformation (αC-out). Ligand binding induces disorders in the αC-helix. Molecular mechanics Poisson Boltzmann surface area (MM/PBSA) calculation suggested three phytochemicals, namely STOCK1N-68642, Epicatechin, and STOCK1N-98615, have higher binding affinity compared to other ligand molecules. The ligand-induced conformational plasticity revealed by our simulations differs significantly from the available crystal structures, which might help in designing allosteric drugs.
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Affiliation(s)
- M F Sk
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Simrol, India
| | - P Kar
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Simrol, India
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Sharma SK, Karna R, Ahuja D, Kar P. Can thymosin β4 and soluble CD163 be used as biomarkers of the prognosis in acute on chronic liver failure? J Gastrointestin Liver Dis 2022; 31:143-145. [PMID: 35306550 DOI: 10.15403/jgld-4161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 12/28/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Sushil Kumar Sharma
- Department of Gastroenterology and Hepatology, Max Super Specialty Hospital, Vaishali, Ghaziabad, India. .
| | - Rahul Karna
- Department of Medicine, Maulana Azad Medical College, New Delhi, India; Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, US.
| | - Dhruv Ahuja
- Department of Medicine, Maulana Azad Medical College, New Delhi, India.
| | - Premashis Kar
- Department of Gastroenterology and Hepatology, Max Super Specialty Hospital, Vaishali, Ghaziabad, India.
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Mishra B, Purushotham P, Kar P, Payal P, Saha S, Ranjan J, Das S, Deshmukh V. Comparison of Cycle Threshold and Clinical Status Among Different Age Groups of COVID-19 Cases. Int J Infect Dis 2022. [PMCID: PMC8884758 DOI: 10.1016/j.ijid.2021.12.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose Aim of the study was to compare the viral load and clinical status among different age groups with COVID-19 infection Methods & Materials A retrospective cross-sectional study was carried out to analyse the Ct values of positive samples reported during April 2020 till May 2021. Result of 13,820 number of RT-PCR positive samples were included for analysis of Ct values. Ct values of confirmatory genes were taken into consideration and Ct values below 25, >25 to 30 and >30 was categorized as high, moderate and low viral load respectively. Age group was stratified into ≤18 years, 18-60 and >60 years as young, adult and elderly respectively. The data was analysed using SPSS windows version 25.0. Results The Mean Ct value was 27.9, 26, and 26.2 in young, adult and elderly age group respectively. Mean Ct value of young patients were significantly higher as compared to adult and elderly patients (p<0.05). The percentage of high viral load (Ct<25) was found to be significantly higher in adults and elderly (44.6% & 43.7%) as compared to young (32.2%) (p<0.001). Majority of the covid 19 positive cases belonging to <18 years age (75.9%) were asymptomatic as compared to 64.5% and 59.7% in adult and elderly age groups respectively. Conclusion Present study observed a significantly high proportion of viral load in the adult and elderly population which plays a substantial contribution to SARS CoV-2 transmission, whereas the majority of the young population being asymptomatic play major role as silent transmitters. The study reemphasizes the need for strict adherence to COVID appropriate behaviours.
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Jonniya NA, Sk MF, Roy R, Kar P. Discovery of potential competitive inhibitors against With-No-Lysine kinase 1 for treating hypertension by virtual screening, inverse pharmacophore-based lead optimization, and molecular dynamics simulations. SAR QSAR Environ Res 2022; 33:63-87. [PMID: 35078380 DOI: 10.1080/1062936x.2021.2023218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
The With-No-Lysine (WNK) has received attention because of its involvement in hypertension. Genetic mutation in the genes of WNK, leading to its overexpression, has been reported in Familial Hyperkalaemic Hypertension, and thus WNK is considered a potential drug target. Herein, we have performed a high-throughput virtual screening of ~11,000 compounds, mainly the natural phytochemical compounds and kinase inhibitory libraries, to find potential competitive inhibitors against WNK1. Initially, candidates with a docking score of ~ -10.0 kcal/mol or less were selected to further screen their good pharmacological properties by applying absorption, distribution, metabolism, excretion, and toxicity (ADMET). Finally, six docked compounds bearing appreciable binding affinities and WNK1 selectivity were complimented with 500 ns long all-atom molecular dynamic simulations. Subsequently, the MMPBSA scheme (Molecular Mechanics Poisson Boltzmann Surface Area) suggested three phytochemical compounds, C00000947, C00020451, and C00005031, with favourable binding affinity against WNK1. Among them, C00000947 acts as the most potent competitive inhibitor of WNK1. Further, inverse pharmacophore-based lead optimization of the C00000947 leads to one potential compound, meciadanol, which shows better binding affinity and specificity than C00000947 towards WNK1, which may be further exploited to develop effective therapeutics against WNK1-associated hypertension after in vitro and in vivo validation.
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Affiliation(s)
- N A Jonniya
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Indore, India
| | - M F Sk
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Indore, India
| | - R Roy
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Indore, India
| | - P Kar
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Indore, India
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Kar P, Sengupta A. Hepatitis E virus infection during pregnancy in South Asian countries: why is mortality so high? Future Virol 2022. [DOI: 10.2217/fvl-2021-0261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Premashis Kar
- Department of Gastroenterology & Hepatology, Max Super Speciality Hospital, Vaishali, Ghaziabad, UP, India
| | - Anando Sengupta
- Department of Gastroenterology & Hepatology, Max Super Speciality Hospital, Vaishali, Ghaziabad, UP, India
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Kar P, Goswami B, Mahanta J, Bhimo T, Das AK, Deka M, Lynrah KG, Kotwal MR, Bhaumik P, Jini M, Karna R, Karra VK, Kaur H. Epidemiology, Genotyping, Mutational and Phylogenetic Analysis of Hepatitis B Virus Infection in North-east India. J Clin Exp Hepatol 2022; 12:43-51. [PMID: 35068784 PMCID: PMC8766538 DOI: 10.1016/j.jceh.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 04/01/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND/OBJECTIVE Hepatitis B virus (HBV) infection is a major public health problem globally. Northeast India is home to indigenous tribes with different ethnicity and high rates of drug abuse and HIV infection. The study was designed to estimate the burden of HBV infection across various spectrums of liver diseases from this region. HBV genotypes and subgenotypes play a role in the chronicity of disease, response to treatment and its progression. As very limited data are available from this region, we tried to elucidate the role of HBV genotypes, HBV mutants and their phylogenetic analysis. METHOD We designed a prospective multicentric study, and included 7464 liver disease cases, 7432 blood donors and 650 health care workers, who were screened for HBV infection. HBV DNA positive patients were genotyped and subjected to surface protein, precore and core mutation and phylogenetic analysis. RESULTS The prevalence of HBV infection with respect to different types of liver diseases, blood donors and health care workers was 9.9% (1550/15,546). 49.5% (768/1550) cases were found to be HBV DNA positive. The most common genotype was found to be genotype D 74.2% (570/768), followed by genotype C 6.5% (50/768), A 4.4% (34/768) and I 0.9% (7/768). CONCLUSION This study highlights the high hepatitis B burden in Northeast India, reflecting lacunae in health care needs of the region. Also, the different genotype distribution and presence of mutations may translate into different rates of liver disease progression, prognosis and ultimately, clinical significance. However, further prospective cohort study from Northeast India is warranted, to elucidate the clinical significance of multiple genotypes and mutation in this unique population.
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Key Words
- AFP, alpha fetoprotein
- ALT, alanine transaminase
- AVH, acute viral hepatitis
- BCP, basal core promoter mutations
- CAH: chronic active hepatitis, CHB: chronic hepatitis B
- CLD, chronic liver disease
- DNA, deoxyribose nucleic acid
- EASL, European Association for the study of the liver
- FHF, fulminant hepatic failure
- FNAC, fine needle aspiration cytology
- HBV
- HBV, hepatitis B virus
- HBcAg, icosahedral core
- HBsAg, surface proteins
- HCC, hepatocellular carcinoma
- PCR, polymerase chain reaction
- RT, reverse transcriptase
- SGOT, serum glutamic oxaloacetic transaminase
- SGPT, serum glutamic pyruvic transaminase
- SHB, small hepatitis B surface antigen
- ULN, upper limit of normal
- epidemiology
- evolution
- genotype
- mutation
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Affiliation(s)
- Premashis Kar
- Maulana Azad Medical College, University of Delhi, New Delhi, India,Address for correspondence. Premashis Kar, Director Professor of Medicine Maulana Azad Medical College, University of Delhi, New Delhi, India.
| | - Bhabadev Goswami
- Department of Gastroenterology, Gauhati Medical College, Guwahati, Assam, India
| | | | - Thngam Bhimo
- Department of Medicine, Regional Institute of Medical Sciences, Regional Medical College, Imphal, Manipur, India
| | - Anup K. Das
- Department of Medicine, Assam Medical College, Dibrugarh, Assam, India
| | - Manab Deka
- Department of Biotechnology, Gauhati University, Assam, India
| | | | | | - Pradip Bhaumik
- Department of Medicine, Agartala Govt. Medical College, Agartala, Tripura, India
| | - Moji Jini
- General Hospital, Naharlagun, Arunachal Pradesh, India
| | - Rahul Karna
- Maulana Azad Medical College, University of Delhi, New Delhi, India
| | - Vijay K. Karra
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, Department of Health Research, New Delhi, India
| | - Harpreet Kaur
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, Department of Health Research, New Delhi, India
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13
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Sk MF, Haridev S, Roy R, Kar P. Investigating potency of TMC-126 against wild-type and mutant variants of HIV-1 protease: a molecular dynamics and free energy study. SAR QSAR Environ Res 2021; 32:941-962. [PMID: 34787532 DOI: 10.1080/1062936x.2021.1999318] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/25/2021] [Indexed: 06/13/2023]
Abstract
A detailed computational study was performed to investigate the conformational changes of flap region and the mechanism underlying the binding of the inhibitor TMC-126 to HIV-1 protease (PR1) and its mutant variants through molecular dynamics simulations in conjunction with the molecular mechanics Poisson-Boltzmann (MM-PBSA) free energy calculation. Further, we have studied the effectiveness of the inhibitor against HIV-2 protease (PR2). The MM-PBSA calculation suggests that TMC-126 loses its potency against mutant variants and PR2 compared to wild-type PR1 mainly due to the loss in intermolecular electrostatic interactions. The potency of the inhibitor decreases in the order: wild type PR1 > M46L > MDR20 > I50V > PR2 > V32I > A28S. Our study reveals that the flap of PR1 adopts a semi-open conformation due to the mutation I50V or MDR20. The dissimilar nature of the movement of the flap tip of both monomers is evident from the dynamic cross-correlation map. The protein structural network analysis displays that mutation causes structural rearrangements and changes the communication path between residues. Overall, we believe our study may help explore and accelerate the development of novel HIV-1/HIV-2 protease inhibitors with better potency.
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Affiliation(s)
- M F Sk
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Indore, India
| | - S Haridev
- Department of Physics, Indian Institute of Technology Indore, Indore, India
| | - R Roy
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Indore, India
| | - P Kar
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Indore, India
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Nath S, Panda G, Karna R, Kumar N, Saran RK, Kar P. Brunner's gland hamartoma presenting as large duodenal polyp. INDIAN J PATHOL MICR 2021; 63:334-335. [PMID: 32317551 DOI: 10.4103/ijpm.ijpm_650_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Smita Nath
- Department of Medicine, Maulana Azad Medical College, India
| | - Gadadhar Panda
- Department of Medicine, Maulana Azad Medical College, India
| | - Rahul Karna
- Department of Medicine, Maulana Azad Medical College, India
| | - Naresh Kumar
- Department of Medicine, Maulana Azad Medical College, India
| | - Ravindra K Saran
- Department of Pathology, Gobind Ballabh Pant Institute of Postgraduate Medical Education and Research, India
| | - Premashis Kar
- Department of Medicine, Maulana Azad Medical College, India
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15
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Sarma MP, Bharali D, Das A, Bhattacharjee M, Kar P. Single-nucleotide polymorphisms in dendritic cell (dendritic cell-specific intercellular adhesion molecule 3-grabbing nonintegrin) gene of hepatocellular carcinoma patients from India. J Cancer Res Ther 2021; 16:S201-S205. [PMID: 33380678 DOI: 10.4103/jcrt.jcrt_748_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective Hepatocellular carcinoma (HCC) is one of the major causes of morbidity and mortality in the world. Numerous genomic and proteomic studies have been carried out across the globe to understand cancer biology related to HCC. Dendritic cell-specific intercellular adhesion molecule 3-grabbing nonintegrin (DC-SIGN) is also known as cluster of differentiation 209. The current study was designed to investigate the association of mutation in DC-SIGN promoter region in HCC patients and healthy controls and to analyze the association of these mutations as a risk factor for HCC development from India. Materials and Methods total of 40 cases of HCC and 40 healthy controls without any underlying liver diseases were included in the study. A total of 5 ml of peripheral blood samples were collected, and genomic DNA was isolated using phenol-chloroform method. Polymerase chain reaction amplification was carried out for DC gene, and the amplicons were subjected to direct sequencing (Macrogen, Korea). Mutations were analyzed comparing these sequences with those published sequences from the database using bioinformatics software. Results A total of eight point mutations were observed in the HCC cases. The natures of mutation observed were deletion, transition, and transversion. All mutations were located in the 19th chromosome at nine different loci (51,079, 51,493, 51,561, 51,124, 51,125, 51,127, 51,169, 51,170, and 51,172). Conclusion Mutation in the promoter region of the DC-SIGN gene may be a possible risk factor for the development of HCC in India. The findings of the study reveal the possible role of these mutants with HCC, and future large-scale prospective studies will further validate the findings of the current study.
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Affiliation(s)
- Manash Pratim Sarma
- Department of Medicine, Maulana Azad Medical College, New Delhi; Department of Biotechnology, Assam Down Town University, Guwahati, Assam, India
| | - Dipu Bharali
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
| | - Akan Das
- Department of Bioengineering and Technology, Gauhati University-Institute of Science and Technology, Guwahati, Assam, India
| | | | - Premashis Kar
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
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16
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Rayman G, Lumb AN, Kennon B, Cottrell C, Nagi D, Page E, Voigt D, Courtney HC, Atkins H, Higgins K, Platts J, Dhatariya K, Patel M, Newland-Jones P, Narendran P, Kar P, Burr O, Thomas S, Stewart R. Dexamethasone therapy in COVID-19 patients: implications and guidance for the management of blood glucose in people with and without diabetes. Diabet Med 2021; 38:e14378. [PMID: 32740972 PMCID: PMC7436853 DOI: 10.1111/dme.14378] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/27/2020] [Indexed: 01/26/2023]
Affiliation(s)
- G Rayman
- The Ipswich Diabetes Centre, East Suffolk and North Essex NHS Foundation Trust, Colchester
| | - A N Lumb
- Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford
| | - B Kennon
- Department of Diabetes, Queen Elizabeth University Hospital, Glasgow
| | - C Cottrell
- Swansea Bay University Health Board, Port Talbot
| | - D Nagi
- Mid Yorkshire Hospital NHS Trust, Wakefield
| | - E Page
- Diabetes Centre, Ipswich Hospital NHS Trust, Ipswich
| | - D Voigt
- Ninewells Hospital, NHS Tayside, Dundee
| | | | - H Atkins
- University Hospitals of Leicester NHS Trust, Leicester
| | - K Higgins
- University Hospitals of Leicester NHS Trust, Leicester
| | - J Platts
- Cardiff and Vale University Health Board, Cardiff
| | - K Dhatariya
- Diabetes Centre, Norfolk & Norwich University Hospital NHS Trust, Norwich
| | - M Patel
- University Hospital Southampton NHS Foundation Trust, Southampton
| | - P Newland-Jones
- University Hospital Southampton NHS Foundation Trust, Southampton
| | - P Narendran
- Queen Elizabeth Hospital Birmingham, Birmingham
| | - P Kar
- NHS Diabetes Programme, NHS England
| | | | - S Thomas
- Diabetes Centre King's College Hospital, London
| | - R Stewart
- Gladstone Centre, Wrexham Maelor Hospital, Wrexham, UK
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17
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Kathuria P, Arora S, Karna R, Kumar N, Kumar S, Kar P. An Interesting Case of Autoimmune Liver Disease. Annals of the National Academy of Medical Sciences (India) 2021. [DOI: 10.1055/s-0040-1722105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Abstract
Autoimmune liver diseases (AILD) are part of a broad spectrum of liver diseases with autoimmune etiology, usually present individually but at times have overlapping features. We present the case of a 60-year-old lady presenting with fatigue, itching and right upper quadrant abdominal pain. Further investigation showed cholestatic pattern of liver enzymes and evidence of portal hypertension without any evidence of extrahepatic obstruction. Autoimmune markers and liver biopsy showed overlapping features of both autoimmune hepatitis (AIH) and primary biliary cirrhosis (PBC), which is a separate diagnosis known as overlap syndrome, but by applying appropriate criterion, we were able to make a definite diagnosis of PBC. Differentiating PBC from overlap syndrome was important as therapy of both are different.
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Affiliation(s)
- Paras Kathuria
- Department of Medicine, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Shilpa Arora
- Department of Medicine, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Rahul Karna
- Maulana Azad Medical College, New Delhi, India
| | - Naresh Kumar
- Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Suresh Kumar
- Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Premashis Kar
- Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
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18
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Kapoor N, Mehta V, Singh B, Karna R, Kumar S, Kar P. Prevalence of cirrhotic cardiomyopathy and its relationship with serum pro-brain natriuretic peptide, hepatorenal syndrome, spontaneous bacterial peritonitis, and mortality. Indian J Gastroenterol 2020; 39:481-486. [PMID: 33188455 DOI: 10.1007/s12664-020-01083-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 07/21/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study aims at estimating the prevalence of cirrhotic cardiomyopathy in a cohort of cirrhosis patients in northern India using the World Congress of Gastroenterology 2005 criteria and its relationship with grades of cirrhosis, its complications, and all-cause mortality. METHODS This was a prospective study in which 53 cirrhosis patients underwent the 2D color Doppler, and tissue Doppler echocardiography. Echocardiography findings were compared with thirty age- and sex-matched healthy controls. Additionally, serum pro-brain natriuretic peptide (pro-BNP) and troponin-T levels were measured. Patients were followed up for 6 months to look for complications and mortality. RESULT 2D echocardiography findings revealed that diastolic cardiomyopathy with no gross systolic dysfunction was significantly prevalent in cirrhosis patients. Using the Montreal criteria, we found the incidence of diastolic cardiomyopathy to be 56.6%. Tissue Doppler echocardiography findings were also correlated. Diastolic dysfunction correlated with the severity of cirrhosis, and patients with higher Child score had more diastolic dysfunction. Serum pro-BNP levels and QTc interval were also higher in patients with diastolic dysfunction. On survival analysis, patients with cirrhotic cardiomyopathy had shorter survival and greater frequency of encephalopathy and hepatorenal syndrome (HRS) episodes as compared with cirrhotic patients without cardiomyopathy, though the differences were not statistically significant. CONCLUSION The study showed that diastolic dysfunction was highly prevalent (56.6% of the study population) in cirrhosis patients. QTc interval and pro-BNP were also significantly raised. Also, complications of cirrhosis like HRS, spontaneous bacterial peritonitis, and hepatic encephalopathy were more common in the cirrhotic cardiomyopathy group.
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Affiliation(s)
- N Kapoor
- Department of Medicine, Maulana Azad Medical College and Lok Nayak Hospital, E23 Nivedita Kunj, Sector-10, R K Puram, New Delhi 110 002, India
| | - V Mehta
- Department of Medicine, Maulana Azad Medical College and Lok Nayak Hospital, E23 Nivedita Kunj, Sector-10, R K Puram, New Delhi 110 002, India
| | - B Singh
- Department of Medicine, Maulana Azad Medical College and Lok Nayak Hospital, E23 Nivedita Kunj, Sector-10, R K Puram, New Delhi 110 002, India
| | - R Karna
- Department of Medicine, Maulana Azad Medical College and Lok Nayak Hospital, E23 Nivedita Kunj, Sector-10, R K Puram, New Delhi 110 002, India
| | - S Kumar
- Department of Medicine, Maulana Azad Medical College and Lok Nayak Hospital, E23 Nivedita Kunj, Sector-10, R K Puram, New Delhi 110 002, India
| | - P Kar
- Department of Medicine, Maulana Azad Medical College and Lok Nayak Hospital, E23 Nivedita Kunj, Sector-10, R K Puram, New Delhi 110 002, India.
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19
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Abstract
Purpose of review We aim to provide the readers an up-to-date knowledge of the structure, epidemiology, and transmission followed by a detailed discussion on testing, diagnostics and management of hepatitis E virus infection. We have also included a comprehensive review of hepatitis E in pregnancy. Recent findings European Association for the Study of the Liver established clinical practice guidelines for testing and treatment of suspected hepatitis E virus infections in 2018. Evidence suggests chronic hepatitis E may follow a course similar to hepatitis B/C with progression to cirrhosis and possibly hepatocellular carcinoma in immunocompromised patients. Summary Hepatitis E virus is the most common cause of acute viral hepatitis worldwide. A combination of serology and nucleic acid amplification testing is the recommended strategy for suspected patients. Ribavirin therapy for a period of 3 months is the drug of choice for severe acute hepatitis, acute-on chronic liver failure, and chronic infections from hepatitis E virus in immunocompromised patients who are unresponsive to decreased immunosuppression. PEGylated interferon α can be used for ribavirin-resistant liver transplant patients with chronic hepatitis E. Further research in therapeutic options is essential considering the stormy course of hepatitis E infection during pregnancy and teratogenicity of all available options.
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Affiliation(s)
- P Kar
- Department of Gastroenterology and Hepatology, Max Super Specialty Hospital,Ghaziabad, Delhi, New Delhi 110017 India
| | - R Karna
- Maulana Azad Medical College & Lok Nayak Hospital, Bahadurshah Zafar Road, New Delhi, India
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20
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Rayman G, Lumb A, Kennon B, Cottrell C, Nagi D, Page E, Voigt D, Courtney H, Atkins H, Platts J, Higgins K, Dhatariya K, Patel M, Narendran P, Kar P, Newland-Jones P, Stewart R, Burr O, Thomas S. New Guidance on Managing Inpatient Hyperglycaemia during the COVID-19 Pandemic. Diabet Med 2020; 37:1210-1213. [PMID: 32418245 DOI: 10.1111/dme.14327] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2020] [Indexed: 01/18/2023]
Affiliation(s)
- G Rayman
- The Ipswich Hospital and Ipswich Diabetes Centre and Research Unit, East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | - A Lumb
- Oxford University Hospitals NHS Foundation Trust, OCDEM, Oxford, UK
| | - B Kennon
- Department of Diabetes, Queen Elizabeth University Hospital, Glasgow, Scotland
| | - C Cottrell
- Department of Diabetes, Swansea Bay University Health Board, Port Talbot, Wales
| | - D Nagi
- Department of Diabetes, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - E Page
- The Ipswich Hospital and Ipswich Diabetes Centre and Research Unit, East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | - D Voigt
- Tayside University Hospitals NHS Trust, Ninewells Hospital, Dundee, Scotland
| | - H Courtney
- Department of Diabetes, Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - H Atkins
- Department of Diabetes, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - J Platts
- Cardiff and Vale University Local Health Board, College of Medicine, Cardiff, Wales
| | - K Higgins
- Department of Diabetes, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - K Dhatariya
- Norfolk & Norwich University Hospital NHS Foundation Trust, Elsie Bertram Diabetes Centre, Norwich, UK
| | - M Patel
- Department of Diabetes, University Hospital Southampton NHS Trust, Southampton, UK
| | - P Narendran
- Department of Diabetes, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - P Kar
- Portsmouth Hospitals NHS trust and NHS England, NHS Diabetes Programme, Portsmouth, UK
| | - P Newland-Jones
- University of Southampton Faculty of Medicine, Diabetes and Endocrinology, Southampton, UK
| | - R Stewart
- Department of Diabetes, Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham, Wales
| | - O Burr
- Department of Diabetes, Diabetes UK, London, UK
| | - S Thomas
- Guy's and Saint Thomas' NHS Foundation Trust, Diabetes Centre, London, UK
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21
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Rayman G, Lumb A, Kennon B, Cottrell C, Nagi D, Page E, Voigt D, Courtney H, Atkins H, Platts J, Higgins K, Dhatariya K, Patel M, Narendran P, Kar P, Newland-Jones P, Stewart R, Burr O, Thomas S. Guidelines for the management of diabetes services and patients during the COVID-19 pandemic. Diabet Med 2020; 37:1087-1089. [PMID: 32365233 DOI: 10.1111/dme.14316] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2020] [Indexed: 01/16/2023]
Abstract
The UK National Diabetes Inpatient COVID Response Group was formed at the end of March 2020 to support the provision of diabetes inpatient care during the COVID pandemic. It was formed in response to two emerging needs. First to ensure that basic diabetes services are secured and maintained at a time when there was a call for re-deployment to support the need for general medical expertise across secondary care services. The second was to provide simple safe diabetes guidelines for use by specialists and non-specialists treating inpatients with or suspected of COVID-19 infection. To date the group, comprising UK-based specialists in diabetes, pharmacy and psychology, have produced two sets of guidelines which will be continually revised as new evidence emerges. It is supported by Diabetes UK, the Association of British Clinical Diabetologists and NHS England.
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Affiliation(s)
- G Rayman
- Ipswich Diabetes Centre, East Suffolk and North East Essex NHS Foundation Trust, Ipswich, UK
| | - A Lumb
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - B Kennon
- Queen Elizabeth University Hospital, Glasgow, UK
| | - C Cottrell
- Swansea Bay University Health Board, Port Talbot, UK
| | - D Nagi
- Mid Yorkshire NHS Trust, Wakefield, UK
| | - E Page
- Ipswich Diabetes Centre, East Suffolk and North East Essex NHS Foundation Trust, Ipswich, UK
| | - D Voigt
- Ninewells Hospital, Dundee, UK
| | - H Courtney
- Belfast Health & Social Care Trust, Belfast, UK
| | - H Atkins
- University Hospitals of Leicester, Leicester, UK
| | - J Platts
- Cardiff and Vale University Health Board, Cardiff, UK
| | - K Higgins
- University Hospitals of Leicester, Leicester, UK
| | - K Dhatariya
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - M Patel
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - P Kar
- Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - P Newland-Jones
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - R Stewart
- Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham, UK
| | | | - S Thomas
- Guy's and St Thomas' NHS Foundation Trusts, London, UK
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22
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Sinclair A, Dhatariya K, Burr O, Nagi D, Higgins K, Hopkins D, Patel M, Kar P, Gooday C, Howarth D, Abdelhafiz A, Newland‐Jones P, O’Neill S. Guidelines for the management of diabetes in care homes during the Covid-19 pandemic. Diabet Med 2020; 37:1090-1093. [PMID: 32369634 PMCID: PMC7267536 DOI: 10.1111/dme.14317] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 12/15/2022]
Abstract
The National Diabetes Stakeholders Covid-19 Response Group was formed in early April 2020 as a rapid action by the Joint British Diabetes Societies for Inpatient Care, Diabetes UK, the Association of British Clinical Diabetologists, and Diabetes Frail to address and support the special needs of residents with diabetes in UK care homes during Covid-19. It was obvious that the care home sector was becoming a second wave of Covid-19 infection and that those with diabetes residing in care homes were at increased risk not only of susceptibility to infection but also to poorer outcomes. Its key purposes included minimising the morbidity and mortality associated with Covid-19 and assisting care staff to identify those residents with diabetes at highest risk of Covid-19 infection. The guidance was particularly created for care home managers, other care home staff, and specialist and non-specialist community nursing teams. The guidance covers the management of hyperglycaemia by discussion of various clinical scenarios that could arise, the management of hypoglycaemia, foot care and end of life care. In addition, it outlines the conditions where hospital admission is required. The guidance should be regarded as interim and will be updated as further medical and scientific evidence becomes available.
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Affiliation(s)
| | - K. Dhatariya
- Norfolk and Norwich University Hospitals NHS Foundation Trust
| | | | | | - K. Higgins
- University Hospitals of Leicester NHS Trust
| | | | - M. Patel
- University Hospital Southampton NHS Foundation Trust
| | - P. Kar
- Portsmouth Hospitals NHS Trust
| | - C. Gooday
- Norfolk and Norwich University Hospitals NHS Foundation Trust
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Rayman G, Lumb A, Kennon B, Cottrell C, Nagi D, Page E, Voigt D, Courtney H, Atkins H, Platts J, Higgins K, Dhatariya K, Patel M, Narendran P, Kar P, Newland‐Jones P, Stewart R, Burr O, Thomas S. Guidance on the management of Diabetic Ketoacidosis in the exceptional circumstances of the COVID-19 pandemic. Diabet Med 2020; 37:1214-1216. [PMID: 32421882 PMCID: PMC7276743 DOI: 10.1111/dme.14328] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2020] [Indexed: 12/17/2022]
Affiliation(s)
- G. Rayman
- The Ipswich Hospital and Ipswich Diabetes Centre and Research UnitEast Suffolk and North Essex NHS Foundation TrustColchesterUK
| | - A. Lumb
- Oxford University Hospitals NHS Foundation TrustOCDEMOxfordUK
| | - B. Kennon
- Department of DiabetesQueen Elizabeth University HospitalGlasgowScotland
| | - C. Cottrell
- DiabetesSwansea Bay University Health BoardPort TalbotUK
| | - D. Nagi
- DiabetesMid Yorkshire Hospitals NHS TrustWakefieldUK
| | - E. Page
- The Ipswich Hospital and Ipswich Diabetes Centre and Research UnitEast Suffolk and North Essex NHS Foundation TrustColchesterUK
| | - D. Voigt
- Tayside University Hospitals NHS TrustNinewells HospitalDundeeScotland
| | - H. Courtney
- DiabetesBelfast Health and Social Care TrustBelfastUK
| | - H. Atkins
- DiabetesUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | - J. Platts
- College of MedicineCardiff and Vale University Local Health BoardCardiffUK
| | - K. Higgins
- College of MedicineCardiff and Vale University Local Health BoardCardiffUK
| | - K. Dhatariya
- Elsie Bertram Diabetes CentreNorfolk & Norwich University Hospital NHS Foundation TrustNorwichUK
| | - M. Patel
- DiabetesUniversity Hospital Southampton NHS TrustSouthamptonUK
| | - P. Narendran
- DiabetesQueen Elizabeth Hospital BirminghamBirminghamUK
| | - P. Kar
- Portsmouth Hospitals NHS trustPortsmouthUK
- NHS Diabetes ProgrammeNHS EnglandLondonUK
| | - P. Newland‐Jones
- Diabetes and EndocrinologyUniversity of Southampton Faculty of MedicineSouthamptonUK
| | - R. Stewart
- DiabetesWrexham Maelor HospitalBetsi Cadwaladr University Health BoardWrexhamUK
| | | | - S. Thomas
- Diabetes CentreGuy's and Saint Thomas' NHS Foundation TrustLondonUK
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Karna R, Hazam RK, Borkakoti J, Kumar A, Kar P. A 5-year Single-Center Experience of Hepatitis E Virus Infection During Pregnancy. J Clin Exp Hepatol 2020; 10:135-138. [PMID: 32189928 PMCID: PMC7067984 DOI: 10.1016/j.jceh.2019.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 09/15/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The study was designed to examine the hypothesis whether the course and severity of hepatitis E virus (HEV)-related liver disease is worse during pregnancy. METHOD The prospective study included 1088 patients (550 pregnant; 538 nonpregnant) with clinically and biochemically confirmed acute viral hepatitis (AVH) or acute liver failure (ALF) and were subjected to a complete panel of hepatitis serology. RESULTS In the pregnant cohort, HEV was the cause of infection in 80.36% (442/550) of cases, whereas non-HEV accounted for 19.63 (108/550) of cases. In the ALF pregnant group, the prevalence of HEV was observed in 73.38% (102/139) of cases, whereas other viruses accounted for 26.61% (37/139) of illness. Ninety-eight of 129 (75.96%) cases of HEV-infected pregnant women died, whereas non-HEV infection was responsible for only 31 of 129 (24.04%) cases' death in comparison. Serum viral load in the ALF group was also significantly higher than that in the AVH group in the pregnant (24578.6 ± 12410.3 vs. 6821.9 ± 1832.7, respectively) cohort and nonpregnant cohort (583.6 ± 187.34 vs. 298.68 ± 65.77, respectively). CONCLUSION HEV infection has a higher incidence, more severe course, and greater mortality in the pregnant cohort than in the nonpregnant cohort.
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Affiliation(s)
- Rahul Karna
- Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi
| | - Rajib K. Hazam
- Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi
| | - Jayanta Borkakoti
- Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi
| | - Ashok Kumar
- Department of Obstetrics and Gynaecology, Maulana Azad Medical College, University of Delhi, New Delhi
| | - Premashis Kar
- Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi
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Choudhary P, Campbell F, Joule N, Kar P. A Type 1 diabetes technology pathway: consensus statement for the use of technology in Type 1 diabetes. Diabet Med 2019; 36:531-538. [PMID: 30773681 DOI: 10.1111/dme.13933] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2019] [Indexed: 01/11/2023]
Abstract
In both adults and children with diabetes, technologies such as continuous subcutaneous insulin infusion using insulin pumps and continuous glucose monitoring can help improve diabetes control, reduce hypoglycaemia and improve quality of life. Access to these technologies in the UK is very variable. Some technologies are recommended by the National Institute for Health and Care Excellence, while others have not been appraised, and new technologies are emerging all the time. Additionally, different guidelines for adults and children further complicate access to diabetes technology in the transition from paediatric to adult care. Against this background, Diabetes UK and NHS England have brought together a multidisciplinary group of experts, including clinicians and people with diabetes, to develop this consensus guideline, combining the different technologies into a common pathway to aid clinical and policy decision-making. We created a pathway that supports the incremental addition of technology as monotherapy and then dual therapy in the same way that we incrementally add in therapeutic agents to support people with Type 2 diabetes to achieve their personalized glycaemic targets. The pathway emphasizes the importance of structured education, specialist support and appropriate access to psychological therapies, as essential pillars for optimized use of diabetes-related technology, and recommends the re-evaluation of its use when the individual is unable either to use the technology appropriately or to achieve the intended outcomes. This pathway is endorsed by UK-wide clinical and patient associations and we recommend that providers and commissioners use it to ensure the right individual with diabetes has access to the right technology in a timely way to help achieve better outcomes.
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Affiliation(s)
| | - F Campbell
- St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - P Kar
- Diabetes, NHS England, London, UK
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Bharali D, Banerjee BD, Bharadwaj M, Husain SA, Kar P. Expression Analysis of MicroRNA-21 and MicroRNA-122 in Hepatocellular Carcinoma. J Clin Exp Hepatol 2019; 9:294-301. [PMID: 31360021 PMCID: PMC6637083 DOI: 10.1016/j.jceh.2018.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 07/07/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/OBJECTIVE Hepatocellular carcinoma (HCC) is a multistep process starting from chronic hepatitis (CH) that progress through cirrhosis to HCC. The expression level of microRNA (miRNA) was found to be deregulated in HCC. The study was designed to find out whether the expression level of miR-21 and miR-122 was deregulated in HCC compared to controls without HCC. METHODS Real-time quantitative polymerase chain reaction was performed to find out the miRNA expression level using Ct value followed by statistical analysis where P value ≤ 0.05 was considered as significant. RESULTS Overexpression of miR-21 and miR-122 in HCC was detected. All changes in the expression level of miR-21 and miR-122 were due to HCC compared with healthy control, CH, and liver cirrhosis. Hence miR-21 and miR-122 are suitable to differentiate HCC with an efficient diagnostic power of sensitivity, specificity, and expression level, but they might not have any role in patients' survival. CONCLUSION miR-21 and miR-122 could be considered as potential markers of HCC screening molecule in addition to other approved markers. However the current study is limited to expression levels of miRNAs from serum; therefore, it needs further validated study in a large group of population to fulfill all the criteria of a biomarker.
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Affiliation(s)
- Dipu Bharali
- Department of Medicine, Maulana Azad Medical College, New Delhi, 02, India
| | - Basu D. Banerjee
- Department of Biochemistry, University College of Medical Sciences, Dilshad Graden, Delhi, 65, India
| | - Mausumi Bharadwaj
- Division of Molecular Genetics, National Institute Cancer Prevention and Research, Noida, UP, India
| | - Syed A. Husain
- Department of Biosciences, Jamia Millia Islamia University, New Delhi, India
| | - Premashis Kar
- Department of Medicine, Maulana Azad Medical College, New Delhi, 02, India
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Singh S, Daga MK, Kumar A, Husain SA, Kar P. Role of oestrogen and its receptors in HEV-associated feto-maternal outcomes. Liver Int 2019; 39:633-639. [PMID: 29979823 DOI: 10.1111/liv.13928] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 06/15/2018] [Accepted: 07/02/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pregnant women infected with HEV develops adverse pregnancy outcomes like, abortions, intrauterine fetal death, still births, neonatal deaths, preterm delivery and maternal mortality. AIM To correlate oestrogen and its receptors ESR1α and ESR2β levels with HEV-associated feto-maternal outcomes. MATERIAL & METHODS A total of 142 pregnant women with HEV infection and 142 pregnant controls were included in study from Department of Obstetrics & Gynaecology and Department of Medicine, Maulana Azad Medical College (MAMC) and associated Lok Nayak Hospital (LNH), New Delhi. Three millilitre of blood sample was collected in plain for quantification of oestrogen, and its receptors ESR1α and ESR2β using commercially available third-generation ELISA kits. RESULTS The levels of oestrogen, ESR1α and ESR2β were considerably higher in HEV-infected pregnant women (20.11 ± 18.19 ng/mL, 10.58 ± 3.27 ng/mL, 10.42 ± 4.71 ng/mL respectively) than pregnant controls (11.74 ± 6.42 ng/mL, 9.11 ± 1.63 ng/mL, 9.01 ± 1.18 ng/mL respectively)(P < 0.0001). It was found that oestrogen levels were significantly higher in pregnant women infected with HEV who had preterm delivery, low birth weight babies and fetal loss (19.64 ± 17.60 ng/mL, 19.71 ± 17.63 ng/mL, 33.62 ± 23.20 ng/mL respectively) than who had full term delivery, average birth weight babies and live babies (11.71 ± 8.77 ng/mL, 11.99 ± 9.44 ng/mL, 16.58 ± 14.98 ng/mL respectively)(P < 0.05). A significant negative correlation was observed between baby birth weight and oestrogen levels in HEV-infected pregnant women. CONCLUSION The high level of oestrogen plays an important role in preterm delivery, low birth weight babies and fetal mortality in pregnant women with HEV infection through placental dysfunction. Moreover, oestrogen level is a significant predictor for preterm delivery and maternal mortality and ESR2β levels is a significant predictor for maternal mortality in pregnant women infected with HEV.
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Affiliation(s)
- Swati Singh
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
| | - Mradul K Daga
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
| | - Ashok Kumar
- Department of Obstetrics & Gynaecology, Maulana Azad Medical College, New Delhi, India
| | - Syed A Husain
- Department of Biosciences, Jamia Millia Islamia, New Delhi, India
| | - Premashis Kar
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
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Abstract
Hepatitis E virus (HEV) infection has distinct features, depending upon the genotype and geographical area. HEV genotypes 1 and 2 are endemic to various developing countries causing epidemics of acute viral hepatitis with human to human transmission. On the other hand, HEV genotypes 3 and 4 prevalent in developed countries commonly lead to subclinical infection and are transmitted zoonotically. HEV infection typically causes acute self-limiting illness associated with low morbidity and mortality. Infection with HEV genotype 1 or 2 in pregnancy, especially in the third trimester may lead to severe illness and fulminant liver failure. Poor maternal and fetal outcomes have been reported. Areas covered: This review highlights the various aspects of HEV infection in pregnancy including diagnosis, management, and prevention. Expert commentary: Treatment is mainly supportive with diligent monitoring and intensive care. Therapeutic termination of pregnancy cannot be recommended based to the available literature. Early liver transplantation (LT) should be considered in these patients although the indications and timing of LT are still controversial. Prevention of HEV infection or illness by improved sanitation and active/passive immunization needs further research.
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Affiliation(s)
- Premashis Kar
- a Department of Gastroenterology and Hepatology , Max Super Speciality Hospital , Ghaziabad , India
| | - Anando Sengupta
- a Department of Gastroenterology and Hepatology , Max Super Speciality Hospital , Ghaziabad , India
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Kar P, Karna R, Ruttala R, Arora S, Chakravarty A, Kumar S. Clinical and Molecular Risk Factors of Anti-tubercular Therapy Induced Hepatitis. J Clin Exp Hepatol 2019; 9:200-206. [PMID: 31024202 PMCID: PMC6477131 DOI: 10.1016/j.jceh.2018.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 06/10/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This is a case-control study aimed at evaluating clinical as well as molecular risk factors for occurrence of ATT induced hepatitis in Northern Indian population. METHODS 100 patients of tuberculosis were recruited from both Outdoor patient department and wards of Lok Nayak Hospital, New Delhi. 40 out of 100 patients who developed ATT induced hepatitis were taken as test group and 60 out of 100 patients who didn't develop liver dysfunction on ATT were taken as controls and studied and compared for clinical factors such as age, gender, nutritional status, HBsAg carrier, chronic hepatitis C and HIV infection. Molecular factors i.e. NAT2 acetylator status, GSTT1 and M1 null mutations were also determined in all of the patients in each group and compared. RESULTS Mean body weight and serum albumin were significantly lower in the ATT induced hepatitis patients as compared to the control group. No preferential association was observed between age and gender with ATT induced hepatitis. HBsAg carrier (OR-6.5; P = 0.03), HIV infection (OR-5.1; P = 0.01), slow acetylator phenotype (OR-3.85; P = 0.02), GSTM1 null mutation (OR-2.72; P = 0.02) and GSTT1 null mutation (OR-3.12; P = 0.02) were found to be positively co-related to ATT induced hepatitis according to the univariate analysis. HBsAg carrier (OR-23.18; P = 0.01), HIV infection (OR-16.92; P = 0.02), Slow acetylator phenotype (OR-70.90; P = 0.001), GSTM1 null mutation (OR-37.03; P = 0.002) and GSTT1 null mutation (OR-8.19; P = 0.014) were also found to be independently increasing the risk of ATT induced hepatitis using multivariate analysis. CONCLUSION The present study established a positive co-relation between malnutrition, HBsAg carrier, HIV infection, NAT2 slow acetylators, GSTM1 null mutation, GSTT1 null mutation and ATT induced hepatitis.
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Key Words
- ALT, Alanine Aminotransferase
- AST, Aspartate Aminotransferase
- ATD, Anti-tubercular Drugs
- ATT induced hepatitis
- ATT, Anti-tubercular Therapy
- GST, Glutathione-S-transferase
- GSTT1
- HAV, Hepatitis A Virus
- HBV, Hepatitis B Virus
- HBsAg, Hepatitis B Surface Antigen
- HCV, Hepatitis C Virus
- HEV, Hepatitis E Virus
- HIV, Human Immunodeficiency Virus
- NAT2
- pulmonary tuberculosis
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Affiliation(s)
- Premashis Kar
- Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi-02, India,Premashis Kar, Former Director Professor, Department of Medicine, Maulana Azad Medical College, University of Delhi, E23 Nivedeta Kunj, Sector 10 R.K. Puram, New Delhi 110022, India. Tel.: +91 011 23230132.
| | - Rahul Karna
- Maulana Azad Medical College, University of Delhi, New Delhi-02, India
| | - Rajesh Ruttala
- Maulana Azad Medical College, University of Delhi, New Delhi-02, India
| | - Shilpa Arora
- Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi-02, India
| | - Anita Chakravarty
- Department of Medical Microbiology, Maulana Azad Medical College, University of Delhi, New Delhi-02, India
| | - Suresh Kumar
- Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi-02, India
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Bharali D, Banerjee BD, Bharadwaj M, Husain SA, Kar P. Expression analysis of apolipoproteins AI & AIV in hepatocellular carcinoma: A protein-based hepatocellular carcinoma-associated study. Indian J Med Res 2018; 147:361-368. [PMID: 29998871 PMCID: PMC6057253 DOI: 10.4103/ijmr.ijmr_1358_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background & objectives: Hepatocellular carcinoma (HCC) is one of the leading causes of cancer mortality. The objective of this study was to find out the differential expression of apolipoproteins (ApoAI and ApoAIV) in HCC and cases of liver cirrhosis and chronic hepatitis (controls) without HCC and to compare ApoAI and ApoAIV expression with alpha-foetoprotein (AFP), the conventional marker in HCC. Methods: Fifty patients with HCC and 50 controls comprising patients with liver cirrhosis (n=25) and chronic hepatitis (n=25) without HCC were included in this study. Total proteins were precipitated using acetone precipitation method followed by albumin and IgG depletion of precipitated protein using depletion kit. Proteins were separated by sodium dodecyl sulphate-polyacrylamide gel electrophoresis. The expression changes of ApoAI and ApoAIV were confirmed by western blotting using specific primary and secondary polyclonal antibodies followed by densitometric protein semi-quantitative estimation. ApoAI, ApoAIV and AFP were measured in the plasma samples by ELISA method. Results: Semi-quantitative densitometric image analysis of the western blot images and the comparison between HCC patients with those without HCC (control) revealed differential expression of ApoAI and ApoAIV. Levels of ApoAI were significantly higher in patients with HCC compared to controls without HCC (0.279±0.216 vs 0.171±0.091 and 0.199±0.014; P <0.001). Levels of ApoAIV were significantly lower in patients of HCC compared to controls without HCC (0.119±0.061 vs 0.208±0.07 and 0.171±0.16; P <0.01). ELISA assays of apolipoproteins (ApoAI and ApoAIV) revealed similar results of expression of ApoAI and ApoAIV as detected in western blotting densitometric image analysis. Interpretation & conclusions: Increased expression of ApoAI and decreased expression of ApoAIV in HCC patients compared to controls without HCC revealed the abnormalities in HCC. These molecules need to be studied further for their use as potential biomarkers in the future diagnostic tools along with other conventional biomarkers for screening of HCC cases. It needs further analysis in higher number of patient population.
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Affiliation(s)
- Dipu Bharali
- Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi, India
| | - Basu Dev Banerjee
- Department of Biochemistry, University College of Medical Sciences, Delhi, India
| | - Mausumi Bharadwaj
- Division of Molecular Genetics & Biochemistry, ICMR-National Institute of Cancer Prevention & Research, Noida, India
| | - Syed Akhtar Husain
- Department of Biosciences, Jamia Milia Islamia University, New Delhi, India
| | - Premashis Kar
- Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi, India
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Karra VK, Chowdhury SJ, Ruttala R, Gumma PK, Polipalli SK, Chakravarti A, Kar P. HLA-DQA1 & DQB1 variants associated with hepatitis B virus-related chronic hepatitis, cirrhosis & hepatocellular carcinoma. Indian J Med Res 2018; 147:573-580. [PMID: 30168489 PMCID: PMC6118146 DOI: 10.4103/ijmr.ijmr_1644_15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background & objectives: Clinical outcome after hepatitis B virus (HBV) exposure varies extremely from spontaneous clearance to chronic hepatitis B and often progresses to liver cirrhosis (LC) and hepatocellular carcinoma (HCC). Host genetic factor plays an important role in the regulation of immune response. This study was aimed to investigate whether HLA class II DQA1 and DQB1 gene polymorphism were associated with chronic hepatitis B infection and in the development of HBV-related LC and HCC. Methods: DQA1 and DQB1 allele polymorphism were studied in 187 patients with HBV-related liver diseases (which included 73 chronic hepatitis B, 84 LC and 30 HCC patients) and 109 controls who had spontaneously recovered from HBV infection using polymerase chain reaction amplification with sequence-specific primers. Results: Our data suggested that DQA1*0101/2/4 [odds ratio (OR)=2.78; Pc=0.003], DQA1*0103 (OR=2.64; Pc=0.0007) and DQB1*0302/3 (OR=2.15; Pc=0.01) were associated with the protection from chronic HBV infection, whereas DQB1*0402 (OR=0.25; Pc=0.001) showed susceptible effect on chronic HBV infection. DQB1*0601 (OR=3.73; Pc=0.006) conferred protective effect from developing LC; similarly, DQB1*0302/3 (OR=5.53; Pc=0.05) and DQB1*0402 (OR=0.00; Pc=0.001) conferred protective effect from developing HCC. However, DQA1*0601 and DQB1*0503 showed susceptible effect on chronic HBV infection; these associations were no longer significant after Bonferroni correction. Interpretation & conclusions: Our results revealed HLA-DQA1*0101/2/4 - DQA1*0103 - DQB1*0302/3 and DQB1*0601 as protective and DQB1*0402 as risk alleles. The study suggests that various subtypes of HLA-DQA1 and DQB1 are associated with both HBV clearance and development of chronic HBV infections.
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Affiliation(s)
- Vijay Kumar Karra
- Department of Medicine, PCR Hepatitis Laboratory, Maulana Azad Medical College, University of Delhi, New Delhi, India
| | - Soumya Jyoti Chowdhury
- Department of Medicine, PCR Hepatitis Laboratory, Maulana Azad Medical College, University of Delhi, New Delhi, India
| | - Rajesh Ruttala
- Department of Medicine, PCR Hepatitis Laboratory, Maulana Azad Medical College, University of Delhi, New Delhi, India
| | - Phani Kumar Gumma
- Department of Medicine, PCR Hepatitis Laboratory, Maulana Azad Medical College, University of Delhi, New Delhi, India
| | - Sunil Kumar Polipalli
- Department of Medicine, PCR Hepatitis Laboratory, Maulana Azad Medical College, University of Delhi, New Delhi, India
| | - Anita Chakravarti
- Department of Medical Microbiology, Maulana Azad Medical College, University of Delhi, New Delhi, India
| | - Premashis Kar
- Department of Medicine, PCR Hepatitis Laboratory, Maulana Azad Medical College, University of Delhi, New Delhi, India
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Cooper A, Kanumilli N, Hill J, Holt RIG, Howarth D, Lloyd CE, Kar P, Nagi D, Naik S, Nash J, Nelson H, Owen K, Swindell B, Walker R, Whicher C, Wilmot E. Language matters. Addressing the use of language in the care of people with diabetes: position statement of the English Advisory Group. Diabet Med 2018; 35:1630-1634. [PMID: 29888553 DOI: 10.1111/dme.13705] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2018] [Indexed: 10/14/2022]
Abstract
The language used by healthcare professionals can have a profound impact on how people living with diabetes, and those who care for them, experience their condition and feel about living with it day-to-day. At its best, good use of language, both verbal and written, can lower anxiety, build confidence, educate and help to improve self-care. Conversely, poor communication can be stigmatizing, hurtful and undermining of self-care and can have a detrimental effect on clinical outcomes. The language used in the care of those with diabetes has the power to reinforce negative stereotypes, but it also has the power to promote positive ones. The use of language is controversial and has many perspectives. The development of this position statement aimed to take account of these as well as the current evidence base. A working group, representing people with diabetes and key organizations with an interest in the care of people with diabetes, was established to review the use of language. The work of this group has culminated in this position statement for England. It follows the contribution of Australia and the USA to this important international debate. The group has set out practical examples of language that will encourage positive interactions with those living with diabetes and subsequently promote positive outcomes. These examples are based on a review of the evidence and are supported by a simple set of principles.
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Affiliation(s)
| | - N Kanumilli
- Greater Manchester Strategic Clinical Network, UK
| | | | | | | | | | | | - D Nagi
- Association of British Clinical Diabetologists, UK
| | - S Naik
- University College Hospital, UK
| | | | - H Nelson
- JDRF, the Type 1 diabetes Charity, UK
| | - K Owen
- Oxford Centre for Diabetes, Endocrinology and Metabolism, UK
| | - B Swindell
- Diabetes UK and Parkrun Outreach (Diabetes), UK
| | | | - C Whicher
- Young Diabetes and Endocrinologists Forum representative, UK
| | - E Wilmot
- Diabetes Technology Network UK, Derby Teaching Hospitals NHS Foundation Trust, UK
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Abeysekara AU, Albert A, Alfaro R, Alvarez C, Álvarez JD, Arceo R, Arteaga-Velázquez JC, Avila Rojas D, Ayala Solares HA, Belmont-Moreno E, BenZvi SY, Brisbois C, Caballero-Mora KS, Capistrán T, Carramiñana A, Casanova S, Castillo M, Cotti U, Cotzomi J, Coutiño de León S, De León C, De la Fuente E, Díaz-Vélez JC, Dichiara S, Dingus BL, DuVernois MA, Ellsworth RW, Engel K, Espinoza C, Fang K, Fleischhack H, Fraija N, Galván-Gámez A, García-González JA, Garfias F, González-Muñoz A, González MM, Goodman JA, Hampel-Arias Z, Harding JP, Hernandez S, Hinton J, Hona B, Hueyotl-Zahuantitla F, Hui CM, Hüntemeyer P, Iriarte A, Jardin-Blicq A, Joshi V, Kaufmann S, Kar P, Kunde GJ, Lauer RJ, Lee WH, León Vargas H, Li H, Linnemann JT, Longinotti AL, Luis-Raya G, López-Coto R, Malone K, Marinelli SS, Martinez O, Martinez-Castellanos I, Martínez-Castro J, Matthews JA, Miranda-Romagnoli P, Moreno E, Mostafá M, Nayerhoda A, Nellen L, Newbold M, Nisa MU, Noriega-Papaqui R, Pretz J, Pérez-Pérez EG, Ren Z, Rho CD, Rivière C, Rosa-González D, Rosenberg M, Ruiz-Velasco E, Salesa Greus F, Sandoval A, Schneider M, Schoorlemmer H, Seglar Arroyo M, Sinnis G, Smith AJ, Springer RW, Surajbali P, Taboada I, Tibolla O, Tollefson K, Torres I, Vianello G, Villaseñor L, Weisgarber T, Werner F, Westerhoff S, Wood J, Yapici T, Yodh G, Zepeda A, Zhang H, Zhou H. Publisher Correction: Very-high-energy particle acceleration powered by the jets of the microquasar SS 433. Nature 2018; 564:E38. [PMID: 30482938 DOI: 10.1038/s41586-018-0688-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this Letter, owing to a production error, the penultimate version of the PDF was published. The HTML version was always correct. The PDF has been corrected online.
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Affiliation(s)
- A U Abeysekara
- Department of Physics and Astronomy, University of Utah, Salt Lake City, UT, USA
| | - A Albert
- Physics and Theoretical Divisions, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - R Alfaro
- Instituto de Física, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - C Alvarez
- Universidad Autónoma de Chiapas, Tuxtla Gutiérrez, Mexico
| | - J D Álvarez
- Universidad Michoacana de San Nicolás de Hidalgo, Morelia, Mexico
| | - R Arceo
- Universidad Autónoma de Chiapas, Tuxtla Gutiérrez, Mexico
| | | | - D Avila Rojas
- Instituto de Física, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - H A Ayala Solares
- Department of Physics, Pennsylvania State University, University Park, PA, USA
| | - E Belmont-Moreno
- Instituto de Física, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - S Y BenZvi
- Department of Physics and Astronomy, University of Rochester, Rochester, NY, USA
| | - C Brisbois
- Department of Physics, Michigan Technological University, Houghton, MI, USA
| | | | - T Capistrán
- Instituto Nacional de Astrofísica, Óptica y Electrónica, Puebla, Mexico
| | - A Carramiñana
- Instituto Nacional de Astrofísica, Óptica y Electrónica, Puebla, Mexico
| | - S Casanova
- Institute of Nuclear Physics Polish Academy of Sciences, IFJ-PAN, Krakow, Poland.,Max-Planck Institute for Nuclear Physics, Heidelberg, Germany
| | - M Castillo
- Universidad Michoacana de San Nicolás de Hidalgo, Morelia, Mexico
| | - U Cotti
- Universidad Michoacana de San Nicolás de Hidalgo, Morelia, Mexico
| | - J Cotzomi
- Facultad de Ciencias Físico Matemáticas, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - S Coutiño de León
- Instituto Nacional de Astrofísica, Óptica y Electrónica, Puebla, Mexico
| | - C De León
- Facultad de Ciencias Físico Matemáticas, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - E De la Fuente
- Departamento de Física, Centro Universitario de Ciencias Exactas e Ingenierías, Universidad de Guadalajara, Guadalajara, Mexico
| | - J C Díaz-Vélez
- Departamento de Física, Centro Universitario de Ciencias Exactas e Ingenierías, Universidad de Guadalajara, Guadalajara, Mexico.,Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, WI, USA
| | - S Dichiara
- Instituto de Astronomía, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - B L Dingus
- Physics and Theoretical Divisions, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - M A DuVernois
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, WI, USA
| | - R W Ellsworth
- School of Physics, Astronomy, and Computational Sciences, George Mason University, Fairfax, VA, USA
| | - K Engel
- Department of Physics, University of Maryland, College Park, MD, USA
| | - C Espinoza
- Instituto de Física, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - K Fang
- Department of Astronomy, University of Maryland, College Park, MD, USA.,Joint Space-Science Institute, University of Maryland, College Park, MD, USA
| | - H Fleischhack
- Department of Physics, Michigan Technological University, Houghton, MI, USA
| | - N Fraija
- Instituto de Astronomía, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - A Galván-Gámez
- Instituto de Astronomía, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - J A García-González
- Instituto de Física, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - F Garfias
- Instituto de Astronomía, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - A González-Muñoz
- Departamento de Física, Centro Universitario de Ciencias Exactas e Ingenierías, Universidad de Guadalajara, Guadalajara, Mexico
| | - M M González
- Instituto de Astronomía, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - J A Goodman
- Department of Physics, University of Maryland, College Park, MD, USA
| | - Z Hampel-Arias
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, WI, USA.,Inter-university Institute for High Energies, Université Libre de Bruxelles, Brussels, Belgium
| | - J P Harding
- Physics and Theoretical Divisions, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - S Hernandez
- Instituto de Física, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - J Hinton
- Max-Planck Institute for Nuclear Physics, Heidelberg, Germany
| | - B Hona
- Department of Physics, Michigan Technological University, Houghton, MI, USA
| | | | - C M Hui
- NASA Marshall Space Flight Center, Astrophysics Office, Huntsville, AL, USA
| | - P Hüntemeyer
- Department of Physics, Michigan Technological University, Houghton, MI, USA
| | - A Iriarte
- Instituto de Astronomía, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - A Jardin-Blicq
- Max-Planck Institute for Nuclear Physics, Heidelberg, Germany
| | - V Joshi
- Max-Planck Institute for Nuclear Physics, Heidelberg, Germany
| | - S Kaufmann
- Universidad Autónoma de Chiapas, Tuxtla Gutiérrez, Mexico
| | - P Kar
- Department of Physics and Astronomy, University of Utah, Salt Lake City, UT, USA
| | - G J Kunde
- Physics and Theoretical Divisions, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - R J Lauer
- Department of Physics and Astronomy, University of New Mexico, Albuquerque, NM, USA
| | - W H Lee
- Instituto de Astronomía, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - H León Vargas
- Instituto de Física, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - H Li
- Physics and Theoretical Divisions, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - J T Linnemann
- Department of Physics and Astronomy, Michigan State University, East Lansing, MI, USA
| | - A L Longinotti
- Instituto Nacional de Astrofísica, Óptica y Electrónica, Puebla, Mexico
| | - G Luis-Raya
- Universidad Politecnica de Pachuca, Pachuca, Mexico
| | | | - K Malone
- Department of Physics, Pennsylvania State University, University Park, PA, USA
| | - S S Marinelli
- Department of Physics and Astronomy, Michigan State University, East Lansing, MI, USA
| | - O Martinez
- Facultad de Ciencias Físico Matemáticas, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | | | - J Martínez-Castro
- Centro de Investigación en Computación, Instituto Politécnico Nacional, Mexico City, Mexico
| | - J A Matthews
- Department of Physics and Astronomy, University of New Mexico, Albuquerque, NM, USA
| | | | - E Moreno
- Facultad de Ciencias Físico Matemáticas, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - M Mostafá
- Department of Physics, Pennsylvania State University, University Park, PA, USA
| | - A Nayerhoda
- Institute of Nuclear Physics Polish Academy of Sciences, IFJ-PAN, Krakow, Poland
| | - L Nellen
- Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de Mexico, Mexico City, Mexico
| | - M Newbold
- Department of Physics and Astronomy, University of Utah, Salt Lake City, UT, USA
| | - M U Nisa
- Department of Physics and Astronomy, University of Rochester, Rochester, NY, USA
| | | | - J Pretz
- Department of Physics, Pennsylvania State University, University Park, PA, USA
| | | | - Z Ren
- Department of Physics and Astronomy, University of New Mexico, Albuquerque, NM, USA
| | - C D Rho
- Department of Physics and Astronomy, University of Rochester, Rochester, NY, USA.
| | - C Rivière
- Department of Physics, University of Maryland, College Park, MD, USA
| | - D Rosa-González
- Instituto Nacional de Astrofísica, Óptica y Electrónica, Puebla, Mexico
| | - M Rosenberg
- Department of Physics, Pennsylvania State University, University Park, PA, USA
| | - E Ruiz-Velasco
- Max-Planck Institute for Nuclear Physics, Heidelberg, Germany
| | - F Salesa Greus
- Institute of Nuclear Physics Polish Academy of Sciences, IFJ-PAN, Krakow, Poland
| | - A Sandoval
- Instituto de Física, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - M Schneider
- Santa Cruz Institute for Particle Physics, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - H Schoorlemmer
- Max-Planck Institute for Nuclear Physics, Heidelberg, Germany
| | - M Seglar Arroyo
- Department of Physics, Pennsylvania State University, University Park, PA, USA
| | - G Sinnis
- Physics and Theoretical Divisions, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - A J Smith
- Department of Physics, University of Maryland, College Park, MD, USA
| | - R W Springer
- Department of Physics and Astronomy, University of Utah, Salt Lake City, UT, USA
| | - P Surajbali
- Max-Planck Institute for Nuclear Physics, Heidelberg, Germany
| | - I Taboada
- School of Physics and Center for Relativistic Astrophysics, Georgia Institute of Technology, Atlanta, GA, USA
| | - O Tibolla
- Universidad Autónoma de Chiapas, Tuxtla Gutiérrez, Mexico
| | - K Tollefson
- Department of Physics and Astronomy, Michigan State University, East Lansing, MI, USA
| | - I Torres
- Instituto Nacional de Astrofísica, Óptica y Electrónica, Puebla, Mexico
| | - G Vianello
- Department of Physics, Stanford University, Stanford, CA, USA
| | - L Villaseñor
- Facultad de Ciencias Físico Matemáticas, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - T Weisgarber
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, WI, USA
| | - F Werner
- Max-Planck Institute for Nuclear Physics, Heidelberg, Germany
| | - S Westerhoff
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, WI, USA
| | - J Wood
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, WI, USA
| | - T Yapici
- Department of Physics and Astronomy, University of Rochester, Rochester, NY, USA
| | - G Yodh
- Department of Physics and Astronomy, University of California, Irvine, Irvine, CA, USA
| | - A Zepeda
- Universidad Autónoma de Chiapas, Tuxtla Gutiérrez, Mexico.,Physics Department, Centro de Investigación y de Estudios Avanzados del IPN, Mexico City, Mexico
| | - H Zhang
- Department of Physics and Astronomy, Purdue University, West Lafayette, IN, USA
| | - H Zhou
- Physics and Theoretical Divisions, Los Alamos National Laboratory, Los Alamos, NM, USA.
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Abstract
AIM To review the existing evidence regarding the use of language in clinical encounters. BACKGROUND Awareness of the importance of language in clinical encounters is mostly lacking or located within broader discussions on communication. METHODS A scoping study was conducted to review existing research that could increase our understanding of the role language plays as well as identify gaps in knowledge and inform the development of a position statement on language in diabetes care. RESULTS Evidence shows that, although carefully chosen language can have a positive effect, there is a potential negative impact of language on people's experiences of diabetes care. The use of stigmatizing and discriminatory words during communication between healthcare practitioners and people with diabetes can lead to disengagement with health services as well as sub-optimal diabetes self-management. Clinical encounters can be compromised where language barriers exist or where there is limited understanding of cultural differences that may have an impact on diabetes self-management. What little empirical evidence there is shows that training can improve language and communication skills. CONCLUSION This review raises a number of questions that are being addressed by the NHS England Language Matters Group, which has developed a set of recommendations to support the use of appropriate language in clinical encounters.
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Affiliation(s)
- C E Lloyd
- School of Health, Wellbeing and Social Care, Open University, Milton Keynes
| | - A Wilson
- School of Health, Wellbeing and Social Care, Open University, Milton Keynes
| | - R I G Holt
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton
| | - C Whicher
- Southern Health NHS Foundation Trust, Southampton
| | - P Kar
- NHS Trust, NHS England, London, UK
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Kar P, Sengupta A. Synthetic therapeutics for the treatment of hepatitis B during pregnancy. Expert Opin Pharmacother 2018; 19:1771-1778. [PMID: 30273073 DOI: 10.1080/14656566.2018.1527313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Hepatitis B infection in pregnancy mandates careful monitoring and specialized management according to the phase of hepatitis B infection. Perinatal transmission may be prevented by antiviral therapy in mothers with high viral load and timely immunoprophylaxis of the infant. AREAS COVERED This review focuses on the current first-line therapies for treating hepatitis B in pregnancy, timing of therapy, and prevention of perinatal transmission. Strategies to manage disease at the various phases and potential emerging therapies in phase III of development are also covered. Medline/PubMed and Cochrane databases were searched systematically from 1990 to April 2018 with the relevant articles selected for the review. EXPERT OPINION Universal antenatal screening for hepatitis B and strict immunoprophylaxis for infants form the cornerstones to prevent hepatitis B virus (HBV) perinatal transmission. Tenofovir is the preferred drug for treatment in pregnancy in view of its good efficacy and high barrier to resistance. Most of the data on antivirals are from cohort studies which are prone to bias and more randomized controlled trials (RCTs) are needed to establish the benefits and safety of these drugs in pregnancy. Various novel drugs are in the pipeline which may pave the way for a cure in the near future.
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Affiliation(s)
- Premashis Kar
- a Department of Gastroenterology and Hepatology , Max Super Speciality Hospital, Vaishali , Ghaziabad , India
| | - Anando Sengupta
- a Department of Gastroenterology and Hepatology , Max Super Speciality Hospital, Vaishali , Ghaziabad , India
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Bharali D, Jebur HB, Baishya D, Kumar S, Sarma MP, Masroor M, Akhter J, Husain SA, Kar P. Expression Analysis of Serum microRNA-34a and microRNA-183 in Hepatocellular Carcinoma. Asian Pac J Cancer Prev 2018; 19:2561-2568. [PMID: 30256056 PMCID: PMC6249442 DOI: 10.22034/apjcp.2018.19.9.2561] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background/objective:: HCC is a multistep process starting from chronic hepatitis that progress through cirrhosis to HCC. MicroRNA expression level was found to be deregulated in HCC. To find out whether the expression level of miR-34a and miR-183 was deregulated in HCC compared to controls without HCC. Methods: Real time quantitative PCR was done to find out the miRNA expression level in terms of Ct value followed by statistical analysis. Results: Over-expression of miR-183 and under-expression of miR-34a in HCC was detected. All changes in expression level of miR-34a and miR-183 were found to be due to HCC compared to controls without HCC. So both miR-34a and miR-183 were suitable to differentiate HCC from Cirrhosis and chronic hepatitis with an efficient diagnostic power of sensitivity, specificity and expression level. But they might not have any role in patients’ survival. Conclusion: miR-34a and miR-183 might be considered as potential markers of HCC screening molecule in addition to other approved panel of marker. Our study warrants further expression level study.
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Affiliation(s)
- Dipu Bharali
- Department of Medicine, Maulana Azad Medical College, New Delhi, India.
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38
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Archer A, Benbow W, Bird R, Brose R, Buchovecky M, Buckley J, Bugaev V, Connolly M, Cui W, Daniel M, Feng Q, Finley J, Fortson L, Furniss A, Gillanders G, Hütten M, Hanna D, Hervet O, Holder J, Hughes G, Humensky T, Johnson C, Kaaret P, Kar P, Kelley-Hoskins N, Kertzman M, Kieda D, Krause M, Krennrich F, Kumar S, Lang M, Lin T, Maier G, McArthur S, Moriarty P, Mukherjee R, O’Brien S, Ong R, Otte A, Petrashyk A, Pohl M, Pueschel E, Quinn J, Ragan K, Reynolds P, Richards G, Roache E, Rulten C, Sadeh I, Santander M, Sembroski G, Staszak D, Sushch I, Wakely S, Wells R, Wilcox P, Wilhelm A, Williams D, Williamson T, Zitzer B. Measurement of cosmic-ray electrons at TeV energies by VERITAS. Int J Clin Exp Med 2018. [DOI: 10.1103/physrevd.98.062004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Karna R, Ruttala R, Kar P. Do medical college students living in hostel in India need hepatitis A vaccine? Indian J Med Res 2018; 148:235-237. [PMID: 30381548 PMCID: PMC6206773 DOI: 10.4103/ijmr.ijmr_636_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Rahul Karna
- Department of Medicine, Maulana Azad Medical College, New Delhi 110 002, India
| | - Rajesh Ruttala
- Department of Medicine, Maulana Azad Medical College, New Delhi 110 002, India
| | - Premashis Kar
- Department of Medicine, Maulana Azad Medical College, New Delhi 110 002, India,For correspondence:
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Sarma MP, Bhattacharjee M, Kar P, Medhi S. Detection of HBV Genotype C in Hepatocellular Carcinoma Patients from North East India: a Brief Report. Asian Pac J Cancer Prev 2018; 19:1741-1746. [PMID: 30049181 PMCID: PMC6165653 DOI: 10.22034/apjcp.2018.19.7.1741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background and Objectives: Newer genotypes of HBV have been reported from India. This study was aimed to
determine the circulating genotypes of HBV in hepatocellular carcinoma patients from three different geographical
locations of India. Methods: 141 HBV related HCC cases were included from three different hospitals across the country.
Genotyping of HBV was performed by PCR using type specific primers specially designed in 70 cases. Samples of
interest were confirmed by direct sequencing of the precore/core region of HBV genome. Results: Genotypes could
be detected in 40 (57.14%) out of the 70 HBV DNA positive HCC cases by type specific primers. HBV genotype D
was documented in 20 (50%), genotype A in 10 (25.0%) and genotype C in 10 (25.0%) of these HCC cases. Genotype
C of HBV was detected only in the samples from North East India. No significant difference was observed for the
biochemical profile. Conclusion: Although Genotype D is the major HBV genotype in India followed by A, detection
of HBV genotypes C in HCC patients indicates a changing epidemiology of the virus in India that may require region
based management of the virus.
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Affiliation(s)
- Manash P Sarma
- PCR Hepatitis Laboratory, Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi, India.,Department of Biotechnology, Assam down town University, Panikhaiti, Assam, India.
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Maurya G, Hazam RK, Ruttala R, Karna R, Das BC, Kar P. A study of association between regulatory polymorphism in the IL-10 gene promoter region and acute viral hepatitis, and acute liver failure. Indian J Gastroenterol 2018; 37:293-298. [PMID: 30109600 DOI: 10.1007/s12664-018-0858-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/20/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND The level of inflammatory cytokine Interleukin (IL)-10 is increased in patients infected with hepatitis-related acute liver failure (ALF), and this was thought to be because of the regulatory polymorphism in the IL-10 gene promoter region. The present study was designed to analyze the possible association between IL-10 gene promoter polymorphism and acute viral hepatitis (AVH), and ALF. An attempt was made to quantify IL-10 levels at admission, during the hospital stay, and at the final outcome to study its relationship with liver injury among patients with AVH, ALF, and controls. METHODS The study included 40 patients each with ALF and AVH. IL-10 gene promoter polymorphism was detected by the PCR-RFLP method. Quantification of IL-10 was done using commercially available ELISA kits. RESULTS The individuals with -592 AC, -819 TC, -1082 AA genotypes were found to have a significantly higher risk of ALF whereas those with -592 AA and - 819 CC polymorphism were found to be less susceptible. Individuals with - 819 CC were found to be more susceptible to AVH while those with -592 AA and -819 TT were less susceptible as compared to controls. Mean serum IL-10 at admission was significantly elevated in patients with ALF (38.4±11.3 pg/mL) as compared to patients with AVH (16.7±5.4 pg/mL) and control population (8.3±3.6 pg/mL, p < 0.05). CONCLUSION Regulatory polymorphism in the IL-10 gene promoter has a possible and significant association with severity and outcome in patients with AVH and ALF. Raised levels of IL-10 could be predictive of prognosis in patients with ALF.
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Affiliation(s)
- Gaurav Maurya
- Department of Medicine, Maulana Azad Medical College, University of Delhi, E23 Nivedita Kunj, Sector 10, R.K. Puram, New Delhi, 110 002, India
| | - Rajib Kishore Hazam
- Department of Medicine, Maulana Azad Medical College, University of Delhi, E23 Nivedita Kunj, Sector 10, R.K. Puram, New Delhi, 110 002, India
| | - Rajesh Ruttala
- Department of Medicine, Maulana Azad Medical College, University of Delhi, E23 Nivedita Kunj, Sector 10, R.K. Puram, New Delhi, 110 002, India
| | - Rahul Karna
- Department of Medicine, Maulana Azad Medical College, University of Delhi, E23 Nivedita Kunj, Sector 10, R.K. Puram, New Delhi, 110 002, India
| | - Bhudev C Das
- Center for Biomedical Research, University of Delhi, New Delhi, 110 002, India
| | - Premashis Kar
- Department of Medicine, Maulana Azad Medical College, University of Delhi, E23 Nivedita Kunj, Sector 10, R.K. Puram, New Delhi, 110 002, India.
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Strain WD, Hope SV, Green A, Kar P, Valabhji J, Sinclair AJ. Type 2 diabetes mellitus in older people: a brief statement of key principles of modern day management including the assessment of frailty. A national collaborative stakeholder initiative. Diabet Med 2018; 35:838-845. [PMID: 29633351 DOI: 10.1111/dme.13644] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2018] [Indexed: 12/25/2022]
Abstract
Rates of population ageing are unprecedented and this, combined with the progressive urbanization of lifestyles, has led to a dramatic shift in the epidemiology of diabetes towards old age, particularly to those aged 60-79 years. Both ageing and diabetes are recognized as important risk factors for the development of functional decline and disability. In addition, diabetes is associated with a high economic, social and health burden. Traditional macrovascular and microvascular complications of diabetes appear to account for less than half of the diabetes-related disability observed in older people. Despite this, older adults are under-represented in clinical trials. Guidelines from organizations such as the National Institute for Health and Care Excellence (NICE), the European Association for the Study of Diabetes, and the American Diabetes Association acknowledge the need for individualized care, but the glycaemic targets that are suggested to constitute good control [HbA1c 53-59 mmol/mol (7-7.5%)] are too tight for frail older individuals. We present a framework for the assessment of older adults and guidelines for the management of this population according to their frailty status, with the intention of reducing complications and improving quality of life for these people.
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Affiliation(s)
- W D Strain
- Diabetes and Vascular Research Centre, University of Exeter Medical School, Medical Academic Staff Committee, Lead Physician, Academic Department of Healthcare for the Older Person, Royal Devon and Exeter Hospital Trust, and British Medical Association Medical Academic Staff Committee
| | - S V Hope
- Secretary, British Geriatrics Society Special Interest Group in Diabetes, and University of Exeter Medical School
| | - A Green
- General Practitioner, Hedon Group Practice, East Yorkshire, and Clinical and Prescribing Policy Lead, British Medical Association GP Committee
| | - P Kar
- National Clinical Deputy Director for Diabetes, NHS England
| | - J Valabhji
- National Clinical Director for Obesity & Diabetes, NHS England and Imperial College London
| | - A J Sinclair
- Association of British Clinical Diabetologists and Director, Foundation for Diabetes Research in Older People, Diabetes Frail Ltd
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Kapahtia S, Hazam RK, Asim M, Karra VK, Chowdhury SJ, Das BC, Kar P. Role of Glutathione S Transferase M1 and T1 Gene Polymorphism in Hepatitis B Related Liver Diseases and Cryptogenic Cirrhosis. J Clin Exp Hepatol 2018; 8:169-172. [PMID: 29892180 PMCID: PMC5992258 DOI: 10.1016/j.jceh.2017.05.208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 05/24/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND AIM Progression of hepatitis B virus infection (HBV) might be affected by host genetic factors. The present study was undertaken to study the role of glutathione S-transferases (GST)-M1 and T1 gene polymorphisms in different stages of HBV infection: HBV inactive carrier, chronic hepatitis B and cirrhosis, and cryptogenic cirrhosis. METHODS The study population comprised of 170 subjects; 120 cases (HBV inactive carrier, n = 30; HBV related chronic hepatitis, n = 30; HBV related cirrhosis, n = 30; cryptogenic cirrhosis, n = 30) and 50 unrelated healthy adults without liver disease as controls. Analysis of GSTM1 and GSTT1 gene polymorphisms was done by multiplex polymerase chain reaction. RESULTS The GSTM1 null genotype was seen more commonly in hepatitis B cirrhosis (n = 21; 70%), chronic hepatitis B (n = 19; 63.33%) and cryptogenic cirrhosis (n = 17; 56.67%) as compared with inactive carrier (n = 9; 30%) and controls (n = 13; 26%). The GSTT1 null genotype was seen less frequently in all the groups, the observed frequencies were controls (n = 7; 14%), inactive carrier (n = 5; 16.67%), chronic hepatitis B (n = 8; 26.67%) and hepatitis B cirrhosis (n = 7; 23.33%). The difference of GSTM1 null genotype frequencies was statistically significant for hepatitis B cirrhosis vs. controls (P = 0.0002), chronic hepatitis B vs. controls (P = 0.002) and cryptogenic cirrhosis vs. controls (P = 0.01). The GSTT1 null genotype was not found to vary significantly between the groups. CONCLUSION The patients with GSTM1 null genotype are at risk of progression of liver disease as the frequency of GSTM1 null genotype was found to be significantly higher in chronic hepatitis B, hepatitis B cirrhosis and cryptogenic cirrhosis as compared with controls.
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Affiliation(s)
- Siddharth Kapahtia
- Department of Medicine, Maulana Azad Medical College, University of Delhi, India
| | - Rajib K. Hazam
- Department of Medicine, Maulana Azad Medical College, University of Delhi, India
| | - Mohammad Asim
- Department of Medicine, Maulana Azad Medical College, University of Delhi, India
| | - Vijay K. Karra
- Department of Medicine, Maulana Azad Medical College, University of Delhi, India
| | - Soumya J. Chowdhury
- Department of Medicine, Maulana Azad Medical College, University of Delhi, India
| | - Bhudev C. Das
- Dr B.R.Ambedkar Center for Biomedical Research, University of Delhi, India
| | - Premashis Kar
- Department of Medicine, Maulana Azad Medical College, University of Delhi, India,Address for correspondence: Premashis Kar, Department of Medicine, B.L.Taneja Block, R/N-127, New Delhi 110002, India. Tel.: +91 011 23230132; fax: +91 011 23230132.
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44
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Kar P. HEV-related Liver Disease in India : Why is the Disease Stormy? Annals of the National Academy of Medical Sciences (India) 2018. [DOI: 10.1055/s-0040-1712822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
ABSTRACTHepatitis E virus (HEV) is an important cause of epidemic and sporadic acute viral hepatitis (AVH) in many developing countries, including India. Hepatitis E, a positive-sense single-stranded RNA virus approximately 7.2 kb in length had been classified provisionally into the Caliciviridae family from 1988 to 1998 but HEV is currently placed in the genus Hepevirus and is the only member of the family Hepeviridae. Pregnant women with jaundice and AVH caused by HEV infection have worse fetal and obstetric outcome and higher maternal mortality compared to other types of viral hepatitis. Studies from various developing countries have shown that the incidence of HEV infection in pregnancy is high and a significant proportion of pregnant women can progress to fulminant hepatitis with a mortality rate varying from 30% to 100%. The incidence of hepatitis B virus (HBV) related acute liver failure is known widely in comparison to hepatitis C virus (HCV) infection in which acute liver failure (ALF) is rare. But the severe course of HEV infection causing ALF during pregnancy is unique to this virus with chronicity occurring in recipients of solid organ transplants.Various factors have been suggested to be associated with the mortality rate of the HEV in pregnant women along with the abortion of the fetus. Steroid hormones play a significant role in the viral replication through their effects on viral regulatory elements. The NF-κB signaling pathway regulating at the transcriptional level through p50 subunits has been suggested to correlate with the severe liver damage, leading to multiple organ failure and the death of both the mother and the fetus. Pregnant women in Asia suffer from folate deficiency reducing the immunocompetence to greater risk of multiple viral infections and higher viral load. The viral load of HEV was found to be significantly higher (P < 0.05) in pregnant patients compared to the non-pregnant and the viral copies of HEV with fulminant hepatic failure (FHF) in pregnant women were comparatively higher when compared to the pregnant women with AVH, which may be related to the severity of the disease in these patients. Besides, reduced expression of progesterone and progesterone induced-blocking factor and the high viral load of HEV have been regarded as a cause of poor pregnancy outcome in hepatitis E infection. Vertical transmission of the HEV infection has been reported. There are published reports of abortion, death of the fetus in utero, premature delivery or death of the baby soon after birth in patients with icteric hepatitis or with ALF caused by HEV. However, studies in Europe and United States have shown the course of viral hepatitis during pregnancy resembling with the non-pregnant women. In contrast, various reports carried out in India, Iran, Africa, and Middle East have reported the incidence of ALF to be higher during pregnancy.Data on the viral load of HEV during pregnancy are limited. The study was designed to determine the viral load of HEV and its association with the disease severity in patients with ALF. A total HEV related 163 patients with ALF which included 105 pregnant, 46 non-pregnant women and girls, 12 men, and 730 patients with AVH which comprised of 220 pregnant women; 282 non-pregnant women and girls, and 228 men were included. Viral load was measured by real-time PCR. Comparison was made between the pregnant and non-pregnant women. HEV RNA was detectable in 265 patients (142 pregnant; 75 non-pregnant and 48 men) and 104 patients with ALF (64 pregnant, 34 non-pregnant and 6 men). The viral load of HEV in pregnant women with ALF and AVH was significantly higher 129,984.0±103,104.17 and 768.92±1,105.40 copies/ml, respectively compared to the non-pregnant women which was 189.2±225 and 12.73±7.8 copies/ml (P < 0.0001). The viral load of HEV was also significantly higher in the pregnant patients with ALF compared to the pregnant women with AVH and also men (P < 0.0001). High viral load of HEV during pregnancy could be one of the factors responsible for the severity of the infection during pregnancy.
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Affiliation(s)
- Premashis Kar
- Department of Gastroenterology and Hepatology, Max Super Specialty Hospital, Ghaziabad
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Sharma S, Kumar A, Kar P, Agarwal S, Ramji S, Husain SA, Prasad S, Sharma S. Risk factors for vertical transmission of hepatitis E virus infection. J Viral Hepat 2017; 24:1067-1075. [PMID: 28570034 DOI: 10.1111/jvh.12730] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 04/24/2017] [Indexed: 01/10/2023]
Abstract
Hepatitis E virus (HEV) infection can be vertically transmitted, but the factors that transmit the disease to foetuses are still unclear. We studied a total of 144 pregnant women with HEV infection. Cord blood and newborn samples were taken for analysis. Nutritional factors were evaluated on the basis of anthropometric parameters and biochemical factors, and HEV viral load was quantified by real-time PCR. Sequencing of HEV-positive samples was performed. Approximately 14.63% (6/41) of pregnant patients with acute liver failure (ALF) died before delivery. Vertical transmission was observed in 46.09% (59/128) of HEV-IgM-positive mothers. Approximately 23.80% (10/42) of newborns in the acute viral hepatitis group and 29.41% (5/17) in the ALF group were positive for HEV-RNA. No significant difference was observed in the occurrence of vertical transmission in HEV groups. Viral load was found to be a significant predictor for vertical transmission of HEV infection adjusted with haemoglobin and folate in derivation cohort group. Incorporating these variables, a new score predicting vertical transmission of HEV was derived. Using these significant predictors, the probability for vertical transmission of HEV was well stratified in the validation group (P>.05). In conclusion, viral load was associated with vertical transmission of HEV infection. A valid prediction score model was generated that was verified in a validation cohort group.
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Affiliation(s)
- S Sharma
- Department of Obstetrics and Gynecology, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - A Kumar
- Department of Obstetrics and Gynecology, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - P Kar
- Department of Medicine, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - S Agarwal
- Department of Biochemistry, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - S Ramji
- Department of Neonatology, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - S A Husain
- Department of Biosciences, Jamia Millia Islamia, New Delhi, India
| | - S Prasad
- Department of Obstetrics and Gynecology, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - S Sharma
- National Institute of Cancer Prevention and Research (NICPR), Noida, India
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Kar P, Kumar D, Gumma PK, Chowdhury SJ, Karra VK. Down regulation of TRIF, TLR3, and MAVS in HCV infected liver correlates with the outcome of infection. J Med Virol 2017; 89:2165-2172. [PMID: 28480979 DOI: 10.1002/jmv.24849] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 04/18/2017] [Indexed: 12/19/2022]
Abstract
In virus-infected cells, pattern recognition receptors (PRRs) recruits their specific adaptor molecules, mitochondrial antiviral signaling protein (MAVS), TIR-domain-containing adapter-inducing interferon-β (TRIF), and TNF receptor associated factor (TRAF6) which induces interferon. Toll-like receptor 3 (TLR3) induces activation of the NF-kappa B (NF-κB) for interferon production. The study has been designed to assess the correlation of TLR3, MAVS, TRIF, and TRAF6 outcome of HCV infection. The 46 chronic hepatitis C (CHC) patients were screened for LFT (Liver function test), HBsAg, Anti HCV, viral load, histology, and expression of TLR3, MAVS, TRIF, and TRAF6 genes. Out of 46 CHC patients, 7 were on therapy. The 12 healthy controls were screened for LFT, HBsAg, Anti HCV and gene expressions. The gene expressions were studied in liver tissue and measured using semi-quantitative analysis of Western blots. It has been observed that the expression of TRAF6 was independent of HCV infection. The expression of TRIF, TLR3, and MAVS were significantly (P < 0.05) down regulated in CHC (N = 46) compared to healthy controls (N = 12), in high viral load (N = 21) compared to low viral load (N = 25), in HAI (Histology activity index) 1-4 (N = 12), 5-8 (N = 16), 9-12 (N = 8), 13-18 (N = 5) compared to HAI 0 (N = 5) cases. The significant reduction in the expression of TRIF, TLR3, and MAVS was observed in non-responder (N = 3) compared to responder (N = 4) after treatment (P < 0.05). The HCV viral load was positively correlated with the disease severity. The down regulation of TRIF, TLR3, and MAVS expressions in CHC correlates with the disease severity and the outcome of HCV infection.
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Affiliation(s)
- Premashis Kar
- Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi, India
| | - Deepak Kumar
- Department of Biotechnology and Molecular Medicine, Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana
| | - Phani Kumar Gumma
- Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi, India
| | - Soumya Jyoti Chowdhury
- Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi, India
| | - Vijay Kumar Karra
- Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi, India
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Chapple L, Weinel L, Ali Abdelhamid Y, Summers M, Nguyen T, Kar P, Chapman M, Deane A. MON-P003: Critical Illness Reduces Self-Reported Appetite and Oral Intake but Notactual Intake at a weighed Meal 3- Months Post-Discharge. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)31080-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mohammadpour A, Wiltshire BD, Zhang Y, Farsinezhad S, Askar AM, Kisslinger R, Ren Y, Kar P, Shankar K. 100-fold improvement in carrier drift mobilities in alkanephosphonate-passivated monocrystalline TiO 2 nanowire arrays. Nanotechnology 2017; 28:144001. [PMID: 28273048 DOI: 10.1088/1361-6528/aa628e] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Single crystal rutile titania nanowires grown by solvothermal synthesis are actively being researched for use as electron transporting scaffolds in perovskite solar cells, in low detection limit ultraviolet photodetectors, in photoelectrochemical water-splitting, and in chemiresistive and electrochemical sensing. The electron drift mobility (μ n ) in solution-grown TiO2 nanowires is very low due to a high density of deep traps, and reduces performance in optoelectronic devices. In this study, the effects of molecular passivation of the nanowire surface by octadecylphosphonic acid (ODPA), on carrier transport in TiO2 nanowire ensembles, were investigated using transient space charge limited current measurements. Infrared spectroscopy indicated the formation of a highly ordered phosphonate monolayer with a high likelihood of bidentate binding of ODPA to the rutile surface. We report the hole drift mobility (μ p ) for the first time in unpassivated solvothermal rutile nanowires to be 8.2 × 10-5 cm2 V-1 s-1 and the use of ODPA passivation resulted in μ p improving by nearly two orders of magnitude to 7.1 × 10-3 cm2 V-1 s-1. Likewise, ODPA passivation produced between a 2 and 3 order of magnitude improvement in μ n from ∼10-5-10-6 cm2 V-1 s-1 to ∼10-3 cm2 V-1 s-1. The bias dependence of the post-transit photocurrent decays in ODPA-passivated nanowires indicated that minority carriers were lost to trapping and/or monomolecular recombination for small values of bias (<5 V). Bimolecular recombination was indicated to be the dominant recombination mechanism at higher bias values.
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Affiliation(s)
- A Mohammadpour
- Department of Electrical and Computer Engineering, University of Alberta, 9211-116 St, Edmonton, AB T6G 1H9, Canada
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Archambault S, Archer A, Benbow W, Bird R, Bourbeau E, Brantseg T, Buchovecky M, Buckley J, Bugaev V, Byrum K, Cerruti M, Christiansen J, Connolly M, Cui W, Daniel M, Feng Q, Finley J, Fleischhack H, Fortson L, Furniss A, Geringer-Sameth A, Griffin S, Grube J, Hütten M, Håkansson N, Hanna D, Hervet O, Holder J, Hughes G, Hummensky B, Johnson C, Kaaret P, Kar P, Kelley-Hoskins N, Kertzman M, Kieda D, Koushiappas S, Krause M, Krennrich F, Lang M, Lin T, McArthur S, Moriarty P, Mukherjee R, Nieto D, O’Brien S, Ong R, Otte A, Park N, Pohl M, Popkow A, Pueschel E, Quinn J, Ragan K, Reynolds P, Richards G, Roache E, Rulten C, Sadeh I, Santander M, Sembroski G, Shahinyan K, Smith A, Staszak D, Telezhinsky I, Trepanier S, Tucci J, Tyler J, Wakely S, Weinstein A, Wilcox P, Williams D, Zitzer B. Dark matter constraints from a joint analysis of dwarf Spheroidal galaxy observations with VERITAS. Int J Clin Exp Med 2017. [DOI: 10.1103/physrevd.95.082001] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Borkakoti J, Ahmed G, Rai A, Kar P. Report of novel H105R, D29N, V27A mutations in the methyltransferase region of the HEV genome in patients with acute liver failure. J Clin Virol 2017; 91:1-4. [PMID: 28359977 DOI: 10.1016/j.jcv.2017.03.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/17/2017] [Accepted: 03/18/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The Hepatitis E virus (HEV) has been responsible for major outbreaks in the developing countries affecting millions of people and acute sporadic hepatitis worldwide. The HEV methyltransferase is important for capping the 5'-end of the viral pregenomic RNA which is critical for viral infection. OBJECTIVES We aimed to assess the substitutional profile in the HEV methyltransferase region in patients with acute liver failure (ALF) and acute viral hepatitis (AVH) from North Indian population and associate the substitutions with the poor outcome of the disease. STUDY DESIGN HEV RNA was detected and partial region encoding the Methyltransferase domain in the HEV genome was amplified by Reverse Transcriptase(RT-PCR). Viral load of HEV was quantified utilizing Real time PCR.32 representative samples consisting of 16 AVH and 16 ALF were directly sequenced and amino acid changes were compared using Fischer's exact (two-tailed) test. RESULTS Novel mutations Valine27Alanine (V27A), Aspartate29Asparagine (D29N) and Histidine105Arginine (H105R) mutation corresponding to 107T>C, 115G>A and 341 A>G substitutions respectively were significantly (p<0.0001) obtained in 16/16(100%) ALF patients compared to none (0/16) of the AVH patients. HEV viral load and disease severity parameters corresponding to the samples with D29N and V27A mutations were significantly higher compared to the isolates lacking these mutations while the H105R mutation was associated with decreased viremia. CONCLUSION The D29N and V27A mutations had significant association with the poor outcome in ALF patients suggesting key role in enhancing HEV replication while the association of H105R mutation with decreased viremia creates interest on its antiviral aspects.
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Affiliation(s)
- Jayanta Borkakoti
- PCR Hepatitis Laboratory, Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi, India; Department of Biotechnology, Gauhati University, Assam, India
| | - Giasuddin Ahmed
- Department of Biotechnology, Gauhati University, Assam, India
| | - Arvind Rai
- Department of Biochemistry, National Centre for Disease Control, New Delhi, India
| | - Premashis Kar
- PCR Hepatitis Laboratory, Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi, India.
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