Acute autoimmune hepatitis presenting with centrizonal liver disease: case report and review of the literature

Relatively little is known about the histological appearance of autoimmune hepatitis during the early stage of disease. We describe a case of autoimmune hepatitis in a 20-yr-old woman in which the initial liver biopsy was characterized by a marked predominance of centrizonal injury. Over the course of several months, the histological appearance evolved to what is more commonly associated with chronic autoimmune hepatitis. A review of the literature on this interesting entity is presented.     

Correlation between portal/hepatic vein gradient and response to transjugular intrahepatic portosystemic shunt creation in refractory ascites

PURPOSE: Transjugular portosystemic shunt (TIPS) creation is widely used in the treatment of patients with refractory ascites caused by portal hypertension. Although it is well-established that an optimal portosystemic gradient (PSG) to prevent recurrent variceal bleeding should be lower than 12 mm Hg, there are no clear data on the correlation between the post-TIPS portal/hepatic vein gradient (PHG) and control of ascites. The purpose of the present study was to determine whether there was any correlation between PHG and control of ascites after TIPS creation. MATERIALS AND METHODS: Portal/hepatic vein gradients before and after TIPS creation were studied in 28 patients who underwent TIPS creation. A multivariate analysis was performed to determine whether the portal/hepatic vein gradient independently predicted response to TIPS. Patients were considered responders if ascites disappeared or there was no further need for paracentesis. Patients were considered nonresponders if they required repeat paracentesis one or more months after TIPS creation. RESULTS: Among patients who experienced a response, the mean pre-TIPS PHG was significantly higher than that in those who did not respond (20.9 mm Hg +/- 5.1 vs 15 mm Hg +/- 3.4; P = .002). A higher pre-TIPS PHG was predictive of better response independent of severity of liver disease and serum creatinine level (odds ratio, 2.45; 95% CI, 1.23-4.9; P = 0.011). CONCLUSION: If the findings established in this study are confirmed in prospective long-term studies, a pre-TIPS PHG measurement can be a useful tool in helping clinicians assess the potential benefit of TIPS in refractory ascites.     

A New Approach of Canopy Temperature based Irrigation Scheduling of Wheat in Humid Subtropical Climate of India

Proceedings of the National Academy of Sciences, India Section B: Biological Sciences - The aim of the study is to develop a new canopy temperature based index named plant stress index (PSI) as an...     

Short Bowel Syndrome: An Uncommon Clinical Entity and a Therapeutic Challenge—Our Experience and Review of Literature

Short bowel syndrome (SBS), one of the commonest types of intestinal failure, usually secondary to extensive bowel resection, traditionally has been associated with a high mortality rate and hence a big challenge for the treating surgeons. It requires comprehensive clinical care to minimise the morbidities and mortality associated with the condition. We report a retrospective review of a series of seven patients with SBS, who presented at our surgical emergency within a period of 1 year and their outcome so as to encourage others in managing such a challenge with more positive mindsets. A retrospective analysis of seven patients with SBS admitted from January 2014 to January 2015 with a follow-up of 1 year has been done in terms of their demographic characteristics, underlying pathology and clinical outcome. A rising incidence of SBS in the younger age group (71.4%) has been observed in this analysis. Majority of patients (57.1%) had mesenteric ischemia as the underlying cause followed by each case of small bowel volvulus, internal herniation and blunt trauma abdomen. A discharge rate of 71.4% and mortality rate of 28.5% were observed. With this analysis, we believe that SBS is no more an uncommon condition. A structured clinical approach, timely surgical intervention and multidisciplinary postoperative management are essential for managing such frail patients to achieve best possible results. This will encourage others in managing such a critically challenged condition with a more positive approach and thus beneficial for both the patients and the treating surgeon.     

Effect of Repeated Freezing and Thawing on 18 Clinical Chemistry Analytes in Rat Serum

In a preclinical research laboratory, using serum samples that have been frozen and thawed repeatedly is sometimes unavoidable when needing to confirm previous results or perform additional analysis. Here we determined the effects of multiple cycles of refrigeration or freezing and thawing of rat serum at 3 temperature conditions for different storage times on clinical chemistry analytes. Serum samples obtained from adult Wistar rats were stored at 2 to 8 °C and −10 to −20 °C for as long as 72 h and at −70 °C for as long as 30 d. At different time points (24, 48, and 72 h for samples stored at 2 to 8 °C or −10 to −20 °C and 1, 7, and 30 d for samples stored at −70 °C), the samples were brought to room temperature, analyzed, and then stored again at the designated temperature. The results obtained after each storage cycle were compared with those obtained from the initial analysis of fresh samples. Of the 18 serum analytes evaluated, 14 were stable without significant changes, even after 3 freeze–thaw cycles at the tested temperature ranges. Results from this study will help researchers working with rat serum to interpret the biochemical data obtained from serum samples that have been frozen and thawed repeatedly.Repeated cooling or freezing and thawing has long been assumed to affect the biochemical analytes of serum samples. However sometimes the use of such samples is unavoidable, as when needing to confirm the previous results or analyze additional analytes or at the time of instrument failure. The stability of biochemical analytes in human,^1,7 canine,¹⁰ and rat serum³ that has been stored and thawed only once for analysis has been addressed. In addition, the effect of repeated freezing and thawing on selected analytes in the serum and plasma of humans,^2,4 baboons,⁵ and canines⁹ has been reported previously. However similar information is unavailable for rats (Rattus norvegicus), a common laboratory animal used in various in vivo pharmacology and toxicity studies of drugs and pesticides.Typically serum is used to assess the effects of drugs on clinical chemistry analytes in these studies. Often, researchers need to reanalyze a few or all of the serum analytes to confirm conclusions or previous results. In addition, in the case of instrument failure, serum samples may need to be stored for future analysis. Under such circumstances, serum samples may need to be frozen and thawed repeatedly. Generally, serum samples for clinical chemistry analysis are refrigerated (2 to 8 °C) or frozen (−10 to −20 °C) for short-term durations and stored at −70 °C for long periods. In view of these practical situations, we investigated the effect of 3 freeze–thaw cycles on 18 serum clinical chemistry analytes that are evaluated routinely during nonclinical studies of drugs or chemicals in rodents.¹¹     

Antileishmanial amides and lignans from <Emphasis Type="Italic">Piper cubeba</Emphasis> and <Emphasis Type="Italic">Piper retrofractum</Emphasis>

The n-hexane, ethyl acetate, methanol, and acetone extracts of Piper cubeba Linn. and P. retrofractum Vahl. (Piperaceae) were evaluated in vitro against promastigotes of Leishmania donovani, and all exhibited significant in vitro activity at 100 μg/ml. Two lignans, cubebin and hinokinin, were isolated from the hexane extract of P. cubeba; and one bis-epoxy lignan, (−)-sesamin, and two amides, pellitorine and piplartine, were isolated from the hexane and methanol extracts of P. retrofractum. Cubebin and piplartine showed significant antileishmanial activity in vitro at 100 μM and were further tested in vivo in a hamster model of visceral leishmaniasis. Piplartine showed activity at 30 mg/kg dose. This is the first report of antileishmanial activity of these two plants and their isolated constituents. NIPER Communication No. 395.     

Dual PPARα/γ agonist saroglitazar improves liver histopathology and biochemistry in experimental NASH models

Background & Aims

Non‐alcoholic fatty liver disease (NAFLD) and non‐alcoholic steatohepatitis (NASH) are common clinico‐pathological conditions that affect millions of patients worldwide. In this study, the efficacy of saroglitazar, a novel PPARα/γ agonist, was assessed in models of NAFLD/NASH.

Methods & Results

HepG2 cells treated with palmitic acid (PA;0.75 mM) showed decreased expression of various antioxidant biomarkers (SOD1, SOD2, glutathione peroxidase and catalase) and increased expression of inflammatory markers (TNFα, IL1β and IL6). These effects were blocked by saroglitazar, pioglitazone and fenofibrate (all tested at 10μM concentration). Furthermore, these agents reversed PA‐mediated changes in mitochondrial dysfunction, ATP production, NFkB phosphorylation and stellate cell activation in HepG2 and HepG2‐LX2 Coculture studies. In mice with choline‐deficient high‐fat diet‐induced NASH, saroglitazar reduced hepatic steatosis, inflammation, ballooning and prevented development of fibrosis. It also reduced serum alanine aminotransferase, aspartate aminotransferase and expression of inflammatory and fibrosis biomarkers. In this model, the reduction in the overall NAFLD activity score by saroglitazar (3 mg/kg) was significantly more prominent than pioglitazone (25 mg/kg) and fenofibrate (100 mg/kg). Pioglitazone and fenofibrate did not show any improvement in steatosis, but partially improved inflammation and liver function. Antifibrotic effect of saroglitazar (4 mg/kg) was also observed in carbon tetrachloride‐induced fibrosis model.

Conclusions

Saroglitazar, a dual PPARα/γ agonist with predominant PPARα activity, shows an overall improvement in NASH. The effects of saroglitazar appear better than pure PPARα agonist, fenofibrate and PPARγ agonist pioglitazone.     

An unusual presentation of a hypopharyngeal mass

Benign swellings of the pharynx such as papilloma and retention cyst commonly arise from the soft palate, uvula, pillars and tonsils. Benign tumours arising from the hypopharynx are rare. We are reporting a case of fibrolipoma arising from the hypopharynx and protruding through the oral cavity as a ‘double tongue’.