B.N. Tandon

Prevalence and clinical features of chronic pancreatitis in southern india

SummaryWe have conducted a field study in India in the state of Kerala involving 28,567 inhabitants to determine the prevalence and clinical features of chronic pancreatitis of the tropics (CPT), an illness that is endemic in several regions of India. Selection criteria for the present study included:1.Characteristic abdominal pain;2.Evidence of diabetes mellitus; and3.Evidence of malnutrition/malabsorption.A diagnosis of chronic calcific pancreatitis (CCP) was established by evidence of either 1, 2, or 3 plus X-ray evidence of pancreatic calculi. Diagnosis of noncalcifying chronic pancreatitis (NCCP) was established by 1, 2, or 3 plus an abnormal ultrasound of the pancreas and an abnormal bentiromide test. CPT was discovered among 36 individuals (prevalence 1:793). Strict entry criteria may have excluded additional cases. CPT was far advanced at the time of diagnosis in that 28 had evidence of calcification, 19 had diabetes mellitus, and 27 had an abnormal bentiromide test. The major differences from previous hospital-based studies were female predominance (male/female ratio, 1:1.8), onset of disease at an older age (mean 23.9 yr), and evidence of milder disease. We conclude that previous hospital-based reports that CPT is a severe illness with a male predominance may reflect greater access of seriously ill individuals in general and males in particular to medical care.

Recovery of Exocrine Pancreatic Function in Adult Protein-calorie Malnutrition

Nine adult patients with protein-calorie malnutrition underwent a pancreozymin-secretin test of exocrine pancreatic function and then were treated with a high protein diet. Studies of pancreatic function were repeated at 2 weeks and again at 6 weeks following institution of a high protein diet. There was substantial recovery in exocrine pancreatic function after only 2 weeks of dietary therapy.

Exocrine Pancreatic Function in Calcific Pancreatitis in India

Fifteen young patients from southern India with calcific pancreatitis underwent a pancreozymin-secretin test of exocrine pancreatic function. Volume output and enzyme concentration of pancreatic juice were markedly reduced. Protease and lipase secretion were impaired more than amylase secretion. Bicarbonate concentration was well preserved. This profile supports pathological information that both ductular obstruction and acinar damage are important features of this disorder. The less severe reduction in amylase secretion may represent an adaptive response of the pancreas to the high carbohydrate content of the diet. The results of this study suggest that calcific pancreatitis in India differs considerably from the disease as reported elsewhere.

Serodiagnosis of intestinal tuberculosis by enzyme immunoassay and soluble antigen fluorescent antibody tests using a saline extracted antigen

The efficacy of enzyme-linked immunosorbent assay (ELISA) and soluble antigen fluorescent antibody (SAFA) tests in the diagnosis of intestinal tuberculosis was compared using saline extracted surface antigen of M. tuberculosis H37Ra. Of the 24 proved cases of intestinal tuberculosis ELISA detected positivity in 92% compared with 83% detected by the SAFA test. The 2 tests showed a strong correlation with each other and yielded a clear cut difference between patients and controls, although there was some degree of overlap.

Enzyme linked protein-A: an ELISA for detection of IgG antibodies against Mycobacterium tuberculosis in intestinal tuberculosis.

Enzyme linked protein-A has been used to develop an enzyme-linked immunosorbent assay (ELISA) to detect circulating IgG antibodies to Mycobacterium tuberculosis. The specific binding of protein-A to IgG fractions through Fc receptors, makes the test more specific for detection of total IgG antibodies. The ELISA system has been used for detection of circulating antibodies to M. tuberculosis H37Ra in 22 patients with histologically proven intestinal tuberculosis and 88 healthy controls, in addition to 7 diseased controls. The ELISA has been found to be a sensitive test as it was positive in all 22 patients with intestinal tuberculosis. Its specificity was 85% in Indian controls and 97% in Norwegian controls. The test is easy to perform and may be recommended for the serological diagnosis of intestinal tuberculosis.

Epidemiology of HBsAg carriers in India. A holistic approach to control of hepatitis-B reservoir

Abstract Morbidity and mortality due to hepatitis B virus (HBV) infection is a matter of concern all over the world. The incidence of HBV infection depends upon the human reservoir particularly located in Asian Pacific and some of the African countries. Knowledge of the epidemiology of HBV infection is essential to formulate a strategy for its control. Six thousand and twenty‐four persons of different categories which included urban, rural, pregnant, non‐pregnant, diabetic, alcoholic and occupational high‐risk groups were tested for HBsAg. Personal and environmental factors contributing to the development of the HBsAg carrier state were studied. It was found that hospital environment, blood transfusion, perinatal transmission and urbanization were the major factors responsible for the spread of the HBV infection. A holistic approach for the control of HBV infection, which should include an improvement of the hospital and urban environment, complete exclusion of commercial blood donors and HBsAg screening of the voluntary blood donors is recommended, while immunoprophylaxis should be reserved for the protection of high‐risk groups and to prevent perinatal transmission.

Localization of a new enteric non-A, non-B [HEV] virus in target organ liver.

SummaryThirteenMacaca mulatta monkeys were used for transmission of enteric non-A, non-B hepatitis virus (HEV) by the portal vein (PV) route. All these animals developed changes which are found in selflimiting acute viral hepatitis e.g. rise in liver enzymes, the presence of HEV specific viral particles in the stool and histological changes in the liver from 21 to 45 days after HEV inoculation. All the animals recovered completely as reflected by normalization of liver enzymes, and regenerative changes in the liver. The present report highlights the ultrastructural changes in the livers of these experimental monkeys. The histopathological changes included infiltration of lymphocytes and polymorphonucleocytes around the necrotic area, swelling of mitochondria, dilation of smooth endoplasmic reticulum (ER), and presence of 27–34 nm virus particles during the acute phase of the disease. In comparison, 9 control monkeys did not show any such histological changes.

Hepatitis C virus antibody in acute and chronic liver diseases in India

Non-A, non-B hepatitis (NANBH) is the major cause of acute and chronic active hepatitis in India (1). This infection leads to severe liver damage when associated with hepatitis B virus (HBV) infection (2). The etiological agents responsible for NANBH are 2 recently characterised major groups of viruses, i.e. hepatitis-E virus, HEV (3) and hepatitis-C virus, HCV (4). HEV is associated with waterborne hepatitis, HCV is the causative agent of bloodborne hepatitis. It is already established that HEV is the foremost cause of waterborne epidemics of viral hepatitis in different parts of the world. However, the relative roles of HEV and HCV in the causation of acute sporadic hepatitis is not known. The present study was designed to evaluate the prevalence of anti-HCV in sporadic acute and chronic viral hepatitis patients in India. Using Ortho-ELISA kits for anti-HCV, the antibody was tested by the courtesy of Dr T. Uchida (Nihon University, School of Medicine, Tokyo, Japan) in serum samples collected from patients of fulminant hepatitis (n=28), subacute hepatic failure (a= 12) and chronic active hepatitis (n=7). All these patients were positive for HBsAg but negative for IgM anti-HBc and IgM anti-HAV, thus forming a group of HBV carriers without active HBV or hepatitis A virus (HAV) infections. The results of this study demonstrated that antiHCV was present in 45% of fulminant hepatitis, 58% of subacute hepatitis and 43% of chronic active hepatitis patients. These data indicate that HCV infection is quite frequent in India. However, at present, it appears difficult to explain such a high prevalence of anti-HCV in fulminant and subacute hepatitis patients, which is in contrast to the earlier reports that anti-HCV is present only in 15-25 Yo (5) of cases with acute infection. Presumably presence of HBsAg helps in aggravating the situation by enhancing host immune response vs. HCV leading to high anti-HCV positivity in acute infections. These antibodies may be involved in the pathogenesis of liver causing a massive liver damage. This is also supported by our earlier findings of high morbidity and mortality in the patients with superimposed NANB infection in HBV carriers (2).