Hepatitis: Gupta S

Parsad D, Gupta S, Anonymous00015. · Department of Dermatology, Postgraduate Institute of Medical Education & Research, Chandigarh, India. · Indian J Dermatol Venereol Leprol. · Pubmed #18688102 links to  free full text

Abstract: Vitiligo surgery is an effective method of treatment for selected, resistant vitiligo patches in patients with vitiligo. PHYSICIAN'S QUALIFICATIONS: The physician performing vitiligo surgery should have completed postgraduate training in dermatology which included training in vitiligo surgery. If the center for postgraduation does not provide education and training in cutaneous surgery, the training may be obtained at the surgical table (hands-on) under the supervision of an appropriately trained and experienced dermatosurgeon at a center that routinely performs the procedure. Training may also be obtained in dedicated workshops. In addition to the surgical techniques, training should include local anesthesia and emergency resuscitation and care. FACILITY: Vitiligo surgery can be performed safely in an outpatient day care dermatosurgical facility. The day care theater should be equipped with facilities for monitoring and handling emergencies. A plan for handling emergencies should be in place, with which all nursing staff should be familiar. Vitiligo grafting for extensive areas may need general anesthesia and full operation theater facility in a hospital setting and the presence of an anesthetist is recommended in such cases. INDICATIONS FOR VITILIGO SURGERY: Surgery is indicated for stable vitiligo that does not respond to medical treatment. While there is no consensus on definitive parameters for stability, the Task Force suggests the absence of progression of disease for the past one year as a definition of stability. Test grafting may be performed in doubtful cases to detect stability. PREOPERATIVE COUNSELING AND INFORMED CONSENT: A detailed consent form elaborating the procedure and possible complications should be signed by the patient. The patient should be informed of the nature of the disease and that the determination of stability is only a vague guide. The consent form should specifically state the limitations of the procedure, about the possible future progression of disease and whether more procedures will be needed for proper results. The patient should be provided with adequate opportunity to seek information through brochures and one-to-one discussions. The need for concomitant medical therapy should be emphasized and the patient should understand that proper results take time (a few months to a year). Preoperative laboratory studies include hemogram including platelet counts, bleeding and clotting time (or prothrombin and activated partial thromboplastin time), and blood chemistry profile. Screening for antibodies for hepatitis B surface antigen and HIV is recommended depending on individual requirements. ANESTHESIA: Lignocaine (2%) with or without adrenaline is generally used for anesthesia; infiltration and nerve block anesthesia are adequate in most cases. General anesthesia may be needed in patients with extensive lesions. POSTOPERATIVE CARE: Proper postoperative immobilization and care are very important to obtain satisfactory results.

Gupta S, Altice FL. · Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, CT 06510-2283, USA. · J Urban Health. · Pubmed #19184447 No free full text.

Abstract: Among the blood-borne chronic viral infections, hepatitis B virus (HBV) infection is one that is not only treatable but also preventable by provision of vaccination. Despite the availability of HBV vaccine for the last 15 years, more than 1.25 million individuals in the USA have chronic HBV infection, and about 5,000 die each year from HBV-related complications. From a societal perspective, access to treatment of chronic viral infections, like HIV and viral hepatitis, is highly cost-effective and has lasting benefits by reducing risk behaviors, morbidity, mortality, as well as disease transmission in the community. Individuals in correctional facilities are specially predisposed to such chronic viral infections because of their high-risk behaviors. The explosion of incarceration in the USA over the last few decades and the disproportionate burden of morbidity and mortality from chronic infections among the incarcerated have put incredible strains on an overcrowded system that was not originally designed to provide comprehensive medical care for chronic illnesses. Recently, there has been a call to address medical care for individuals with chronic medical conditions in correctional settings, including those with infectious diseases. The economic and public health burden of chronic hepatitis B and its sequelae, including cirrhosis and hepatocellular carcinoma, is felt most prominently in managed care settings with limited budgets, like correctional facilities. Prevalence of HBV infection among the incarcerated in the USA is fivefold that of the general population. We present a review of diagnosis, prevention, and the recently streamlined treatment guidelines for management of HBV infection in correctional settings, and discuss the implications and public health impact of these measures.

Agarwal SK, Kalra V, Dinda A, Gupta S, Dash SC, Bhowmik D, Tiwari SC. · Department of Nephrology, All India Institute of Medical Sciences, New Delhi 110029, India. · Int Urol Nephrol. · Pubmed #15783120 No free full text.

Abstract: Fibrosing cholestatic hepatitis (FCH) is an uncommon complication of renal transplantation. It is usually associated with hepatitis B and C viral infection. It is further rare in renal transplantation in absence of HBV and HCV infection. To the best of our knowledge, only three cases of FCH in renal transplantation, which were both HBV and HCV negative, have been reported to date. Out of these, two cases were diagnosed to have CMV infection and the third was attributed to azathioprin. We are presenting another case of FCH in a renal transplant recipient with CMV infection.

Gupta S, Bent S, Kohlwes J. · University of California, San Francisco, USA. · Ann Intern Med. · Pubmed #12834318 links to  free full text

Abstract: BACKGROUND: Patients with hepatitis C virus (HCV) are at increased risk for hepatocellular carcinoma. Although serum alpha-fetoprotein (AFP) is often used to detect hepatocellular carcinoma in HCV-infected individuals, its utility is unclear. PURPOSE: To define the test characteristics of AFP for the diagnosis of hepatocellular carcinoma in patients with HCV. DATA SOURCES: MEDLINE search from 1966 to December 2002 for English- and non-English-language articles examining the test characteristics of AFP for identifying hepatocellular carcinoma. STUDY SELECTION: Articles were included if they reported the sensitivity and specificity of AFP for detecting hepatocellular carcinoma in patients with HCV. Articles were excluded if the cause of hepatitis was ambiguous or if 50% or more of the study patients did not have HCV. DATA EXTRACTION: Relevant articles were evaluated for quality of evidence; test characteristics were abstracted and calculated. DATA SYNTHESIS: Five studies met all inclusion criteria and were analyzed. The overall quality of evidence was limited; only one study universally applied an acceptable gold standard test, and three of five studies used a case-control design that potentially overestimates diagnostic accuracy. By using the most commonly reported cutoff value of a positive test result for hepatocellular carcinoma (AFP level > 20 microg/L), the ranges of test characteristics were as follows: sensitivity, 41% to 65%; specificity, 80% to 94%; positive likelihood ratios, 3.1 to 6.8; and negative likelihood ratios, 0.4 to 0.6. CONCLUSIONS: The paucity of high-quality data calls for more rigorous study of AFP and other diagnostic tests for detecting hepatocellular carcinoma in HCV-infected patients with an accepted gold standard applied to the entire cohort. Even if the "best-case" estimates of AFP sensitivity and specificity are accurate, AFP has limited utility for detecting hepatocellular carcinoma.

Gupta S. · Marion Bessin Liver Research Center, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York 10461, USA. · J Gastroenterol Hepatol. · Pubmed #12472951 No free full text.

Abstract: Repopulation of the liver with transplanted cells holds significant promise for developing novel therapies. The liver is a most suitable target for treating a variety of genetic, metabolic and acquired diseases. Liver disease, such as chronic viral hepatitis, constitutes an enormous burden worldwide. Advancing liver cell therapy requires insights into mechanisms of cell engraftment and proliferation, as well as unique requirements of specific diseases for correction by cell transplantation. This review highlights recent developments in the area of hepatocyte transplantation. Aspects concerning modulation of cell engraftment, regulation of gene expression and proliferation of transplanted cells are discussed. Other issues concern the current status of clinical applications of hepatocyte transplantation, as well as novel sources of cells that could benefit cell therapy in the future. The general conclusion is that cell therapy has become more practical in recent years and insights into how the normal liver and the diseased liver can be repopulated will offer effective ways to treat many disorders in the near future.

Gupta S, Rogler CE. · Marion Bessin Liver Research Center, Albert Einstein College of Medicine, Bronx, New York 10461, USA. · Am J Physiol. · Pubmed #10600807 links to  free full text

Abstract: The ability to localize transplanted hepatocytes in the liver offers exciting new opportunities. Transplanted hepatocytes enter liver plates, form hybrid plasma membrane structures with adjacent hepatocytes, express liver genes correctly, and survive indefinitely. The transplanted cell mass is regulated, such that cell proliferation is limited in the normal adult liver, whereas the liver is repopulated extensively when proliferation rates in transplanted and host hepatocytes become dissociated or host hepatocytes are ablated selectively. Transplanted hepatocytes are susceptible to hepatitis viruses. These aspects of transplanted hepatocyte biology indicate that liver repopulation systems can help address questions concerning pathophysiological mechanisms.

Gupta S, Anderson RM. · Wellcome Trust Centre for the Epidemiology of Infectious Disease in the Department of Zoology, University of Oxford, South Parks Road, Oxford, UK OX1 3PS. · Parasitol Today. · Pubmed #10557151 No free full text.

Abstract: Sunetra Gupta and Roy Anderson discuss how the balance between host immune responses against conserved and variable antigens shapes the population structure of pathogens. At one extreme, immune selection against polymorphic determinants can cause pathogen populations to self-organize spontaneously into discrete antigenic types that may either be maintained over long periods or undergo cyclical or chaotic fluctuations. At the other extreme, diversity may be drastically reduced by competition induced by a strong immune response against a conserved determinant. Where does each pathogen lie along this continuum? How would this knowledge influence our attempts to control an infectious disease?

Gandhoke I, Gupta S, Lal S, Khare S. · National Institute of Communicable Diseases, 22 Shamnath Marg, Delhi-110054. · J Commun Dis. · Pubmed #15909752 No free full text.

Abstract: The present study was conducted to find out the seroconversion following Recombinant Hepatitis B vaccination in healthy adults. Eighty healthy adults (males and females) of age group 18 yrs to 60 yrs were chosen for the study. Their prevaccination blood samples tested negative for HBsAg and Anti HBs antibodies by ELISA test. The subjects were administered 3 doses of recombinant Hepatitis B-(Engerix B) vaccine at 0, 1 and 6 months duration using 20 micrograms of vaccine per dose. Seropositivity (anti HBs titre > or = 10 mIU) after 2 doses was 48.75% and was 91.25% after 3 doses of the vaccine. 8.75% of the vaccinees did not seroconvert. The non responders when further scrutinized did not show evidence of HIV or Hepatitis C infection and they had a normal haemogram and normal immunoglobulins (IgA,IgM,IgG) levels. However 2 such subjects were found to be positive for anti HBc IgG antibodies indicating chances of Hepatitis B infection from a mutant strain of HBV where it is not possible to detect presence of HBs Ag using currently available diagnostic kits.

Agarwal SK, Gupta S, Dash SC, Bhowmik D, Tiwari SC. · Department of Nephrology, AIIMS, New Delhi 110029, India. · Int Urol Nephrol. · Pubmed #15783119 No free full text.

Abstract: Renal transplantation (RT) recipients are at a high risk of developing tuberculosis (TB) following transplantation. Effectiveness of isoniazid (INH) in preventing TB is well documented in immunocompetent as well as immunocompromised persons. There is paucity of data on role of INH prophylaxis in RT recipients. Thus, a prospective randomised trial of INH in RT recipients was carried out to determine the efficacy of daily INH monotherapy in the prevention of TB in these patients. Patients of end stage renal disease (ESRD) taken for RT formed the subjects of study. Patients with active TB and active hepatitis at the time of RT were excluded from the study. Patients were randomised to receive INH 300 mg with pyridoxine 20 mg daily from the day of RT. The duration of the treatment was planned for 1 year or till the development of TB, which ever was earlier. Between October 1998 and September 2000, 114 RT were done at our hospital. Of these, 24 (21%) patients had active TB at the time of RT and thus were excluded. Patients included were randomised with 1:2 ratio of treatment and control group. Of the 90 patients thus enrolled, 30 were randomised in treatment group and 60 in control group. Of the included patients five patients had very early graft loss (three in treatment and two in control group) within days and thus excluded from the analysis. Three of the 27 (11.1%) patients in treatment group and 15 (25.8%) in control group developed TB (P = 0.10). The risk ratio of (RR) of INH versus control group of TB was 0.36 (95% CI, 0.10-1.32) but the difference was not statistically significant (P = 0.12). Only one patient developed INH induced hepatitis. In conclusion, with INH prophylaxis, there was a trend towards protection from TB, though it was not statistically significant. Further, all patients tolerated INH and hepatotoxicity was not a major problem in this group of patients.

Gupta S, Handa S, Kanwar AJ, Radotra BD, Minz RW. · Department of Dermatology, Venereology, Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. · Indian J Dermatol Venereol Leprol. · Pubmed #19584459 links to  free full text

Abstract: BACKGROUND: Cutaneous vasculitis presents as a mosaic of clinical and histological findings. Its pathogenic mechanisms and clinical manifestations are varied. AIMS: To study the epidemiological spectrum of cutaneous vasculitides as seen in a dermatologic clinic and to determine the clinico-pathological correlation. METHODS: A cohort study was conducted on 50 consecutive patients clinically diagnosed as cutaneous vasculitis in the dermatology outdoor; irrespective of age, sex and duration of the disease. Based on the clinical presentation, vasculitis was classified according to modified Gilliam's classification. All patients were subjected to a baseline workup consisting of complete hemogram, serum-creatinine levels, serum-urea, liver function tests, chest X-ray, urine (routine and microscopic) examination besides antistreptolysin O titer, Mantoux test, cryoglobulin levels, antineutrophilic cytoplasmic antibodies and hepatitis B and C. Histopathological examination was done in all patients while immunofluorescence was done in 23 patients. RESULTS: Out of a total of 50 patients diagnosed clinically as cutaneous vasculitis, 41 were classified as leukocytoclastic vasculitis, 2 as Heinoch-Schonlein purpura, 2 as urticarial vasculitis and one each as nodular vasculitis, polyarteritis nodosa and pityriasis lichenoid et varioliforme acuta. Approximately 50% of the patients had a significant drug history, 10% were attributed to infection and 10% had positive collagen workup without any overt manifestations, while 2% each had Wegener granulomatosis and cryoglobulinemia. No cause was found in 26% cases. Histopathology showed features of vasculitis in 42 patients. Only 23 patients could undergo direct immunofluorescence (DIF), out of which 17 (73.9%) were positive for vasculitis. CONCLUSIONS: Leukocytoclastic vasculitis was the commonest type of vaculitis presenting to the dermatology outpatient department. The workup of patients with cutaneous vasculitis includes detailed history, clinical examination and investigations to rule out multisystem involvement followed by skin biopsy and DIF at appropriate stage of evolution of lesions. Follow up of these patients is very essential as cutaneous manifestations may be the forme fruste of serious systemic involvement.

Krohn N, Kapoor S, Enami Y, Follenzi A, Bandi S, Joseph B, Gupta S. · Department of Medicine, Marion Bessin Liver Research Center, Diabetes Research Center and Cancer Research Center, Albert Einstein College of Medicine, Bronx, New York 10461, USA. · Gastroenterology. · Pubmed #19422086 No free full text.

Abstract: BACKGROUND & AIMS: Hepatocyte transplantation-induced liver inflammation impairs cell engraftment. We defined whether proinflammatory cytokines and chemokines played roles in regulation of hepatocyte engraftment in the liver. METHODS: We performed studies over up to 3 weeks in rat hepatocyte transplantation systems. Expression of 84 cytokine-chemokine genes was studied by quantitative real-time polymerase chain reactions. Expression of selected up-regulated genes was verified by immunohistochemistry. Hepatic recruitment of neutrophils was demonstrated by myeloperoxidase activity assays, and Kupffer cell activation was established by carbon phagocytosis assays. The role of neutrophils and Kupffer cells in regulating expression of cytokine-chemokine genes as well as cell engraftment was determined by cell depletion studies. RESULTS: Within 6 hours after syngeneic cell transplantation, expression of 25 cytokine-chemokine genes increased by 2- to 123-fold, P < .05. These genes were largely associated with activated neutrophils and macrophages, including chemokine ligands, CXCL1, CXCL2, CCL3, CCL4; chemokine receptors, CXCR1 or CXCR2, CCR1, CCR2; and regulatory cytokines tumor necrosis factor alpha and interleukin-6. Inflammatory cells in the liver immunostained for CCR1, CCR2, CXCR1, and CXCR2, which indicated that up-regulated messenger RNA was appropriately translated. When neutrophils and Kupffer cells were depleted with neutrophil antiserum and gadolinium chloride, respectively, before transplanting cells, cell transplantation-induced cytokine-chemokine responses were attenuated. Virtually all abnormalities subsided in animals treated with neutrophil antiserum plus gadolinium chloride. Moreover, depletion of neutrophils or Kupffer cells improved engraftment of transplanted cells. CONCLUSIONS: Cell transplantation-induced liver inflammation involves proinflammatory cytokine-chemokine systems capable of modulation by neutrophils and Kupffer cells. This offers new directions for optimizing cell therapy strategies.

Marks DH, Adineh M, Wang B, Gupta S. · Department of Medicine, Cooper Green Mercy Hospital, Birmingham, Alabama, USA. · Neuropsychiatr Dis Treat. · Pubmed #19300595 links to  free full text

Abstract: Interferon alfa2 (IFN-alpha2) is a parenterally administered cytokine used to treat patients with Hepatitis C and B, and malignancy. Interferon (INF) has a relatively high rate of central nervous system (CNS) adverse effects, including agitation, depression, fatigue, cognitive dysfunction, suicidal thought and drug craving. Using functional magnetic resonance imaging (fMRI) we studied patients with Hepatitis C virus (HCV) infection who were not more than mildly clinically depressed at baseline for their CNS reaction to IFN-alpha2. During fMRI, patients underwent visual stimulation with pictures designed to induce feelings of depression. In the two patients who became clinically depressed or markedly anxious while on treatment with interferon, but not in patients who did not experience these effects, there was a significant activation in specific areas of the brain known to be involved with depression, along with an increase above baseline in the Beck Depression Scale for the patient who developed INF-induced depression. The activation pattern differed from that previously observed for endogenous depression, indicating that INF-induced depression may differ in its underlying neuropathology. Functional magnetic resonance imaging can be an important tool in understanding and monitoring for (INF and other) medication-induced CNS effects, and response to treatment.

Agarwal SK, Dash SC, Gupta S, Pandey RM. · Department of Nephrology, All-India Institute of Medical Sciences, New Delhi, India. · Nephron Clin Pract. · Pubmed #19147995 No free full text.

Abstract: Hepatitis C virus (HCV) infection is the most common blood-borne viral infection in haemodialysis. It causes significant morbidity and long-term mortality. Practice of universal precautions has been reported to be sufficient to prevent HCV seroconversion in dialysis units. However, the seroconversion rate remains very high in many dialysis units. A previous study from 1995 to 1998 at our own hospital without isolation showed that nosocomial transmission is the major cause of HCV seroconversion. The present study was therefore conducted with the aim to study the impact of isolation on HCV seroconversion. In this prospective cohort study, with non-probability consecutive sampling, patients with HCV infection were dialysed in an isolated room. In addition, standard universal precautions were practiced. HCV seroconversion rate was compared with the previous study. All patients with end-stage kidney disease (ESKD) admitted to our hospital for renal replacement therapy were included in the present study. At the time of admission, HCV screening was done. All anti-HCV-positive patients were dialysed in an isolated room. While on maintenance haemodialysis, all patients were monthly tested for anti-HCV, aspartate aminotransferase and alanine aminotransferase. Any patient who had HCV seroconversion was transferred to an isolated room for maintenance haemodialysis. Patients with HCV infection were managed by further testing for HCV-RNA and liver biopsy. Every patient who ultimately received renal transplantation at our hospital was also tested for HCV just prior to renal transplantation as well as 3 months after renal transplantation. HCV infection was diagnosed by detecting anti-HCV antibodies using an ELISA-based third-generation diagnostic test kit. Serum bilirubin, aspartate aminotransferase and alanine aminotransferase were assayed using standard laboratory techniques. From March 2003 to February 2006, 1,417 patients were admitted for haemodialysis in our unit. Of these 1,077 (76%) had ESKD. Mean age of patients was 42.47 +/- 16.2 (14-94) and 70.39% were males. Patients with ESKD had had more dialysis sessions (10.9 +/- 39.5 vs. 4.4 +/- 5.95, p = 0.009), more blood transfusions and more pre-existing HCV infections (4.72 vs. 1.5%, p = 0.009) than patients with acute renal failure. Of the ESKD patients, 65.7% were discharged, 9.47% died, 1.85% were shifted to chronic ambulatory peritoneal dialysis and 22.46% patients received renal transplantation. Of the patients who received renal transplantation, HCV seroconversion was detected in 2.75%. In the previous study without isolation practices, the HCV seroconversion rate in transplanted patients was 36.2%. The hazard of HCV seroconversion was 0.97 (95% CI 0.93-1.02, p = 0.2) for each additional dialysis and 1.09 (95% CI 0.88-1.36, p = 0.37) for each additional blood transfusion. The study concludes that isolation of HCV-infected patients during haemodialysis significantly decreases the HCV seroconversion rate.

Guleria S, Kamboj M, Chatterjee A, Sharma M, Awasthy V, Dinda A, Mahajan S, Bhowmik D, Gupta S, Agarwal SK, Tiwari SC. · Department of Surgery, Nephrology and Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. · Transplant Proc. · Pubmed #18790202 No free full text.

Abstract: BACKGROUND: The safety and efficacy of tacrolimus in transplantation are well established. However, tacrolimus (Pan Graf) has only been available in India for the last 2 years. We conducted this study to assess the safety and efficacy of tacrolimus in living related kidney transplantation. Herein we have reported our experience with tacrolimus as de novo therapy in a living related renal transplant program. MATERIALS AND METHODS: One hundred fifty-five consecutive recipients of living donor renal allografts were included in this study after consent and ethical clearance. Immunosuppression consisted of tacrolimus, mycophenolate mofetil or azathioprine, and steroids. The dose of tacrolimus was adjusted according to levels done on a regular basis. All patients were followed for periods ranging from 3 to 33 months. All episodes of graft dysfunction were evaluated by a graft biopsy. We evaluated the effects of this regimen on the incidence of graft rejection, graft survival, patient survival, and new onset diabetes mellitus. Six patients were diabetic prior to transplantation and 9 patients were hepatitis C virus (HCV) positive. RESULTS: There were 137 male and 18 female patients. The incidence of acute rejection was 3.87%; 17.93% developed new onset diabetes mellitus; and 77.7% of HCV-positive patients and 14.07% of HCV-negative patients developed posttransplantation diabetes mellitus. The patient survival at the current follow-up was 94.19%. CONCLUSION: This generic form of tacrolimus is a safe, effective immunosuppressant in living related renal transplantation.

Chaudhary A, Kukreti H, Pasha ST, Gupta S, Kumari M, Khare S, Lal S, Rai A. · Division of Biochemistry & Biotechnology, National Institute of Communicable Diseases, Delhi, India. · Intervirology. · Pubmed #18781077 No free full text.

Abstract: BACKGROUND: The impact of HIV on hepatitis C virus (HCV) genome during HCV/HIV co-infection is poorly understood. The present study was intended to unveil nucleotide sequence variability in the 5'-untranslated region (5'UTR) of HCV in co-infected cases. METHODS: Automated nucleotide sequencing of the 5'UTR of HCV from both mono- and co-infected cases was performed. RESULTS: Data analysis revealed deletion of a continuous stretch of 12 nucleotides (nt 240-251) from domain IIIc in 20% co-infected cases, but no long-stretch deletion was observed in HCV from mono-infected cases. On the contrary, there was no insertion in the 5'UTR of HCV from co-infectedcases, but there were insertions in domain II and III (3 mononucleotides and 2 dinucleotides) of the 5'UTR in mono-infected cases. CONCLUSION: Since domain III is known to be important for binding of 40S ribosomal subunit, deletion of a single stretch of 12 nucleotides in HCV from co-infected cases observed in the present study may have implications during HCV replication with or without HIV infection. Although this is the first report on genomic heterogeneity in the 5'UTR of HCV from HCV/HIV co-infected Indian patients, it would be worthwhile to study if similar changes are observed in other genes of HCV during co-infection.

Tandon VR, Khajuria V, Kapoor B, Kour D, Gupta S. · Post-Graduate Department of Pharmacology and Therapeutics, Govt. Medical College Jammu (J and K), 180001 India. · Fitoterapia. · Pubmed #18621114 No free full text.

Abstract: Hepatoprotective (HP) activity of Vitex negundo (VN) leaf ethanolic extract was investigated against hepatotoxicity (HT) produced by administering a combination of three anti-tubercular drugs isoniazid (INH)-7.5 mg/kg, rifampin (RMP)-10 mg/kg and pyrazinamide (PZA)-35 mg/kg for 35 35 days by oral route in rats. V. negundo leaf ethanolic extract was administered in three graded doses of 100, 250 and 500 mg/kg orally, 45 min prior to anti-tubercular challenge for 35 days. HP effect of V. negundo leaf ethanolic extract was evident in the doses of 250 and 500 mg/kg as there was a significant decrease in TB, AST, ALT and ALP levels in comparison to control. Histology of the liver section of the animals treated with the V. negundo leaf ethanolic extract in the doses of 250 and 500 mg/kg further confirms the HP activity.

Gupta S, Gupta R, Joshi YK, Singh S. · Department of Laboratory Medicine, Division of Clinical Microbiology, All India Institute of Medical Sciences, New Delhi, India. · Intervirology. · Pubmed #18309243 No free full text.

Abstract: OBJECTIVES: Familial clustering of HBV provides epidemiological evidence for the different modes of spread of the virus. Though the majority of the studies have addressed the issue of perinatal transmission in India, only a few reports have dealt with other modes of transmission. METHODS: The study was prospectively designed and data were collected from a total of 265 household contacts of 91 index patients with HBV-related chronic liver disease between January 2006 and July 2007. The prevalences of HBsAg and various antibodies; anti-HBs, anti-HBc and anti-HBe, were estimated in all household contacts using ELISA and VIDAS. RESULTS: Among the various household contacts, the highest prevalence of HBsAg was seen in the pediatric age group (kids 1-15 years: 37.0%) and especially in siblings (48.3%), with statistical significance (p < 0.001). Hepatitis B virus (HBV) serological markers were found more commonly in contacts of female (68.8%) index patients as compared to males (p > 0.05). The development of anti-HBV antibodies showed an increasing trend with age (p < 0.001), with the highest prevalence in parents. CONCLUSION: Horizontal transmission plays an important role in contributing to the high prevalence of HBsAg especially in young children. Hence, this age group needs to be targeted for primary prevention and effective vaccine.

Singh AK, Jiang Y, Benlhabib E, Gupta S. · Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, Twin Cities Campus, St. Paul, MN 55108, USA. · J Med Food. · Pubmed #17887948 No free full text.

Abstract: Chronic alcohol drinking has been associated with the development of a number of abnormalities, including neuron-behavioral disorders, liver, pancreas, and heart-related diseases and inflammation and immune disorders. Because diverse mechanisms are involved in the development of these disorders, the commonly used receptor- or enzyme-specific drugs do not provide comprehensive protection against the adverse effects of alcoholism. This study describes possible therapeutic potency of puerarin (PU) from kudzu root, polyenylphosphatidylcholine from soy (SPCh), and curcumin (CU) from turmeric against alcohol's addiction-related and inflammatory-related abnormalities in alcohol-preferring P rats receiving free choice water and 15% ethanol in water. P-rats were fed once daily either the vehicle (for control) or different doses of PU, SPCh, CU, PU + SPCh, or PU + CU. The rats were divided in two groups: one received water alone, and the other free choice water and ethanol. Four rats from each group were fitted with electroencephalogram (EEG) electrodes for EEG recording. After 70 days of alcohol drinking, alcohol was withdrawn for 2 weeks, and the withdrawal symptoms were assessed. This study showed that alcohol drinking for 70 days (1) caused liver inflammation characterized by elevated tumor necrosis factor-alpha, interleukin-1beta, and matrix metalloproteinase-9 expression and (2) dysregulated lipopolysaccharide (LPS)-induced pleurisy. Alcohol withdrawal after 70 days of drinking generated severe withdrawal symptoms including seizure-type EEG activity. PU suppressed the addiction-mediated abnormalities but did not affect the inflammation-related abnormalities, while SPCh or CU suppressed only the inflammation-related abnormalities in alcohol-drinking rats subjected to LPS-induced pleurisy. A combination of PU with SPCh or CU suppressed both the addiction-related and inflammation-related abnormalities of alcohol drinking. Therefore, a mixture consisting of PU and either SPCh or CU may provide alternative therapy for alcohol-related disorders.

Irshad M, Dhar I, Gupta S, Khushboo, Joshi YK. · Clinical Biochemistry Division, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India. · Hepatogastroenterology. · Pubmed #17591087 No free full text.

Abstract: BACKGROUND/AIMS: The present study was designed to investigate the effect of hepatitis C virus (HCV) core protein expression on the blood level of lipids, lipoproteins and apolipoprotein in various forms of liver diseases. At the same time, effect of HCV core protein was also studied on the level of antioxidants in these patient groups. The aim behind this study was to explore the possibility of HCV core induced lipid changes and ensuing oxidative liver damage in these liver diseases. METHODOLOGY: We studied a total number of 130 patients including 50 patients with acute viral hepatitis (AVH), 30 with chronic hepatitis (CH), 30 with hepatic cirrhosis and 20 patients with fulminant hepatic failure (FHF). Sera from all these patients were analyzed for hepatitis viral markers and HCV core protein using EIA assays. Sera/plasma from them were simultaneously analyzed for total cholesterol, triglyceride, low density lipoprotein (LDL), high density lipoprotein (HDL), apolipoprotein A-1 and B, and also for antioxidants. RESULTS: Analysis of data demonstrated the presence of viral hepatitis B, C and E infections in these cases. Hepatitis A and D infections were absent in all the patients. When data on lipid and lipoprotein were analyzed in relation to HCV core expression, we could not observe a significant change in the serum level of total cholesterol, triglyceride, LDL, HDL, apolipoprotein A-1 and apoprotein B in core positive patients as compared to core negative cases. However, lipoprotein (a) [Lp(a)] level was significantly reduced in core positive patients as compared to core negative cases. Furthermore, analysis of Superoxide dismutase (SOD), Total antioxidant (TAO) and Uric Acid in these patients demonstrated only a minor change in SOD and TAO levels in relation to HCV core, though at the same time, Uric Acid was found raised in all the groups. CONCLUSIONS: These observations clearly indicate that core expression does not bring a significant change in serum level of lipids, lipoprotein and apoproteins. Similarly, HCV core expression also does not show a major change in SOD and TAO levels suggesting an insignificant impact of core on oxidative stress during liver diseases.

Guleria S, Kamboj M, Sharma M, Chatterjee A, Dinda A, Chaudhary A, Mahajan S, Gupta S, Bhowmik D, Agarwal SK, Tiwari SC, Dash SC. · Department of Surgery and Nephrology and Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India, and Panacea Biotec India Ltd. · Transplant Proc. · Pubmed #17445588 No free full text.

Abstract: BACKGROUND: Success of modern transplantation is in large part due to the successful development of effective immunosuppressive agents. The safety and efficacy of tacrolimus in transplantation is well established. However, tacrolimus (Pan Graf, Panacea Biotec Ltd, India) has only been available in India for the last 2 years. This study was conducted to assess the safety and efficacy of tacrolimus in live related kidney transplantation. We report an initial experience of tacrolimus as de novo therapy in a live related renal transplantation program. MATERIALS AND METHODS: One hundred one consecutive recipients of a live renal allograft were commenced on triple immunosuppression consisting of tacrolimus, mycophenolate mofetil or azathioprine, and steroids. The dose of tacrolimus was adjusted to keep trough levels at 10-12 ng/mL in the first 3 months, 8-10 ng/mL in the next 3 months, and 5-8 ng/mL thereafter. All patients were followed up for a period ranging from 4 weeks to 24 months. The effect of this regimen on the incidence of graft rejection, graft survival, patient survival, and new-onset diabetes mellitus was evaluated. Any evidence of graft dysfunction was evaluated using a graft biopsy. RESULTS: There were 89 male and 12 female patients with mean age of 32.08 years. The incidence of acute rejection was 3.96%; 21.05% developed new-onset diabetes mellitus. Six patients were diabetic prior to transplantation and 9 patients were hepatitis C virus (HCV)-positive; 77.7% of HCV-positive patients and 15.1% of HCV-negative patients developed posttransplantation diabetes mellitus. The patient survival rate at the current follow-up was 92.07%. No graft was lost due to rejection. CONCLUSION: Tacrolimus is a safe and effective immunosuppressant in live related renal transplantation.

Gupta S, Boojh R. · Administrative Staff College, Centre for Energy, Environment & Technology, Hyderabad, India. · Waste Manag Res. · Pubmed #17253005 No free full text.

Abstract: Biomedical waste has become a serious health hazard in many countries, including India. Careless and indiscriminate disposal of this waste by healthcare establishments and research institutions can contribute to the spread of serious diseases such as hepatitis and AIDS (HIV) among those who handle it and also among the general public. The present study pertains to the biomedical waste management practices at Balrampur Hospital, a premier healthcare establishment in Lucknow, in North India. The study shows that infectious and non-infectious wastes are dumped together within the hospital premises, resulting in a mixing of the two, which are then disposed of with municipal waste at the dumping sites in the city. All types of wastes are collected in common bins placed outside the patients wards. For disposal of this waste the hospital depends on the generosity of the Lucknow Municipal Corporation, whose employees generally collect it every 2 or 3 days. The hospital does not have any treatment facility for infectious waste. The laboratory waste materials, which are disposed of directly into the municipal sewer without proper disinfection of pathogens, ultimately reach the Gomti River. All disposable plastic items are segregated by the rag pickers from the hospital as well as municipal bins and dumps. The waste is deposited either inside the hospital grounds, or outside in the community bin for further transportation and disposal along with municipal solid waste. The open dumping of the waste makes it freely accessible to rag pickers who become exposed to serious health hazards due to injuries from sharps, needles and other types of material used when giving injections. The results of the study demonstrate the need for strict enforcement of legal provisions and a better environmental management system for the disposal of biomedical waste in the Balrampur Hospital, as well as other healthcare establishments in Lucknow.

Gupta S, Singh S. · Division of Clinical Microbiology, Department of Laboratory Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. · World J Gastroenterol. · Pubmed #17106941 links to  free full text

Abstract: AIM: To determine the prevalence of hepatitis B and C virus infections in human immunodeficiency virus (HIV) -positive patients at a tertiary care hospital in New Delhi, India. METHODS: Serum samples from 451 HIV positive patients were analyzed for HBsAg and HCV antibodies during three years (Jan 2003-Dec 2005). The control group comprised of apparently healthy bone-marrow and renal donors. RESULTS: The study population comprised essentially of heterosexually transmitted HIV infection. The prevalence rate of HBsAg in this population was 5.3% as compared to 1.4% in apparently healthy donors (P < 0.001). Though prevalence of HCV co-infection (2.43%) was lower than HBV in this group of HIV positive patients, the prevalence was significantly higher (P < 0.05) than controls (0.7%). Triple infection of HIV, HBV and HCV was not detected in any patient. CONCLUSION: Our study shows a significantly high prevalence of hepatitis virus infections in HIV infected patients. Hepatitis viruses in HIV may lead to faster progression to liver cirrhosis and a higher risk of antiretroviral therapy induced hepatotoxicity. Therefore, it would be advisable to detect hepatitis virus co-infections in these patients at the earliest.

Gupta S, Mathur P, Singh S. · Department of Clinical Microbiology, All India Institute of Medical Sciences, New Delhi-l10 029, India. · Trop Gastroenterol. · Pubmed #17089623 No free full text.

This publication has no abstract.

Gupta S, Jen J, Kolz K, Cutler D. · Schering-Plough Research Institute, Kenilworth, NJ, USA. · Br J Clin Pharmacol. · Pubmed #16939523 links to  free full text

Abstract: AIMS: To assess the dose selection using population pharmacokinetics of Pegylated Intron-alpha2b (PEG-Intron) in patients with chronic myelogenous leukaemia (CML). METHODS: PEG-Intron 3-6 microg kg(-1) was administered subcutaneously once a week and blood samples were collected up to 48 weeks of treatment. A total of 624 samples collected from 137 patients were included in the analysis. Nonlinear mixed-effects modelling was used to analyse the sparsely sampled concentration data from a clinical efficacy trial. Covariates in the analysis included weight, sex, age, race, serum creatinine and estimated creatinine clearance (CLcr). RESULTS: The apparent clearance of PEG-Intron decreased after repeated dosing. The clearance at treatment week 4 was 42.3 l day(-1) (patients with CLcr 120 ml min(-1)) with interpatient variability 30%. At treatment week 48, the clearance value was reduced to 69% of its week 4 value. CLcr, a composite variable calculated from body weight, sex, age and serum creatinine, had a small but statistically significant influence on the clearance of PEG-Intron. The clearance of PEG-Intron in patients with CML was 40% higher than that of hepatitis C virus-infected patients. CONCLUSION: The dose of PEG-Intron 6.0 microg kg(-1) week(-1) appeared appropriate in the treatment of patients with CML.

Vikrant S, Agarwal SK, Gupta S, Bhowmik D, Tiwari SC, Dash SC, Guleria S, Mehta SN. · Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India. · Transpl Infect Dis. · Pubmed #16390397 No free full text.

Abstract: BACKGROUND: Infectious diseases remain among the major morbid events in patients with end-stage renal disease (ESRD) on renal replacement therapy (RRT). In developing countries, tuberculosis (TB) has been found to occur more frequently in these patients than in the general population. Efficacy of isoniazid (INH) chemoprophylaxis has been seen in other situations, such as human immunodeficiency virus infection. However, studies on INH prophylaxis in ESRD patients on RRT are limited. METHODS: In this prospective randomized controlled trial, from April 2000 to June 2001, a total of 109 ESRD patients registered for renal transplant and accepted for maintenance hemodialysis in our hospital were included and followed up until June 2004 to assess the role of INH prophylaxis in preventing development of TB. At the time of acceptance for hemodialysis, 54 patients were assigned to receive daily INH for 1 year and 55 patients were assigned to the control group. Primary outcome was development of TB. Secondary outcome was INH hepatotoxicity. To evaluate the effect of INH prophylaxis on the development of TB, a Kaplan-Meier survival estimate was used to plot TB-free survival curve and log-rank test was used for comparison. RESULTS: Overall, TB was diagnosed in 27 patients during RRT, with an incidence of 24.8%. TB developed in 9 (16.7%) patients in the INH group and in 18 (32.7%) patients in the control group. There was a significantly lower incidence of TB in the INH group as compared with the control group. The risk ratio of INH vs. control group for development of TB was 0.40 (95% confidence index [CI], 0.17-0.92; P=0.032). In the INH group 27 (50%) patients and in the control group 17 (30.9%) patients developed some hepatic dysfunction. However, significant hepatitis that required discontinuation of INH developed in only 9 (16.7%) patients in the INH group. Furthermore, significant hepatitis also developed in 6 (10.9%) patients in the control group. The majority of patients with significant hepatitis in both groups (INH as well as control) were subsequently found to be positive for hepatitis B and/or hepatitis C viral infection. Mild hepatitis (which did not require discontinuation of INH) was seen in 18 (33.3%) patients in the INH group and 11 (20%) patients in the control group. Viral hepatitis infection was not found in any of the milder cases of hepatitis in either group. CONCLUSION: This study shows significant efficacy of INH chemoprophylaxis during RRT in preventing development of TB, when the INH was started during dialysis itself. INH chemoprophylaxis was safe and well tolerated in the majority of patients. However, mild hepatic dysfunction was common, both in the treatment as well as in the control group. As the incidence of viral hepatitis overall was high in our patients on RRT, it is difficult to identify INH-induced hepatitis in this clinical setting.