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Background and aim As a distinguished system, the cytochrome P450 (CYP) enzyme superfamily is involved in the biotransformation of several endogenous and exogenous substances including drugs, toxins, and carcinogens. Reports on the role of CYP enzyme in gastric cancer (GC) from the Eastern region of India are scarce. The present study aimed to evaluate the effect of single nucleotide polymorphisms (SNP) in cytochrome P450 family 2 subfamily C member 9 (CYP2C9*3) among cases with gastric malignancy. Material and methods The current study is a cross-sectional observational study carried out among 113 GC cases attending the Institute of Medical Sciences and SUM Hospital, Bhubaneswar, India, and Srirama Chandra Bhanja Medical College and Hospital, Cuttack, India. Two ml of venous blood was collected from the confirmed cases of GC. The samples were subjected to genomic DNA isolation followed by polymerase chain reaction (PCR) and restriction fragment length polymorphism (PCR-RFLP). Results The prevalence of both homozygous and heterozygous mutation in GC cases is 4% and 8%, respectively. The overall association of cytochrome P450 family 2 subfamily C member 9 (CYP2C9) mutation in GC cases is 12% whereas 88% were detected as wild/standard type. The mutation CYP2C9 SNP has been seen in

BACKGROUND AND AIM: Chronic Hepatitis B (CHB) is a global health problem affecting around 400 million of people worldwide. Two available first-line antiviral drugs are tenofovir disoproxil fumarate (TDF) and Entecavir (ETV). Till date,there are few published reports from India comparing efficacy of TDF and ETV in CHB cases. Therefore, this present study was carried out with an aim to compare the efficacy of ETV and TDF in patients with nucleos(t)ide naïve CHB. MATERIALS AND METHODS: This retrospective cohort study was carried out in 192 treatment naïve CHB cases, who completed 24 months of treatment with either TDF or ETV between March 2015 and August 2017. The primary end point of the study was undetectable hepatitis B virus DNA after 24 months of therapy. RESULTS: Of total 192 patients with CHB, 38 hepatitis B e-antigen (HBeAg)–positive and 53 HBeAg-negative patients were treated with tenofovir, whereas 40 HBeAg-positive and 61 HBeAg-negative patients were treated with ETV. Pretreatment characteristics at baseline were not statistically different between the TDF and ETV groups. Patients treated with TDF achieved significantly higher complete viral suppression as compared with ETV-treated patients (Log rank: 7.04, P = 0.008) in HBeAg-positive CHB during the 24 months follow-up time; whereas no significant difference in viral suppression rate could be noticed in HBeAg-negative patients (Log rank: 0.98, P = 0.38). Both univariate and multivariate analysis by cox proportional hazard model confirmed that tenofovir had significant rate of complete viral suppression in comparison with ETV in HBeAg-positive patients (P < 0.05); whereas complete viral suppression rates were similar in HBeAg-negative patients. CONCLUSION: In our study, tenofovir had more effective antiviral suppressive effect compared with ETV in HBeAg-positive, nucleos(t)ide-naïve CHB cases.

Backgrounds and aims Hepatocellular Carcinoma (HCC) is the leading cause of cancer-related mortality across the world. Non-viral etiological factors including obesity and metabolic syndrome have now become prevalent cause of hepatocellular carcinoma. Sonic Hedgehog (SHH) pathway is activated in hepatocellular carcinoma but its role in regulation of lipogenic molecules during the hepatocarcinogenesis is not known. The aim of present study is to explore the role of SHH pathway in fatty changes associated with hepatocarcinogenesis at different stages and to further correlate the expression of SHH with lipogenic pathways. Results Our results demonstrated significant increase in lipidosis and fibrosis in DEN+CCl4 treated animals. It was simultaneously associated with the enhanced expression level of SHH, E2F1, adiponectin, and lipogenic molecules in DEN+CCl4 treated animals. These results were also corroborated with the similar findings in higher stage patients' biospecimens. Methods N-Nitrosodiethylamine (DEN) and Carbon TetraChloride (CCl4) induced hepatocellular acrcinoma model in male Wistar rats were established to study the expression level of SHH pathway and associated fatty changes during different stages of hepatocarcinogenesis. The expression levels of SHH, E2F1, and lipogenic molecules were checked at different stages of hepatocellular carcinoma. These results were further compared with biospecimens of hepatocellular carcinoma patients of different stages. Conclusions Our results revealed an unknown aspect of SHH pathway in hepatocarcinogenesis via its control over lipogenesis. It gives insight into the lipogenic properties of DEN+CCl4 induced rodent hepatocarcinogenesis model and how SHH pathway operate to arbitrate this response.

The Gastric cancer (GC) is the problem seen more frequently in tropical countries. The expressivity of cyclooxygenase-2 (COX-2) and inherent individual susceptibility to oncogenicity are due to over-expression of and single nucleotide polymorphisms (SNPs). The present experimental case-control study aims to evaluate the role of over-expression of COX-2 polymorphisms in the development of gastric cancer (GC) in the region at Eastern India. The genomic DNA was isolated from the peripheral blood samples of 124 GC patients and 176 controls attending the hospital, during February 2017 to December 2020. GC with or without infection of halophile, Helicobacter pylori was diagnosed by the histo-pathological assessment. DNA was isolated of GC-cases and controls by the salting-out method. Three SNPs of COX-2 gene such as, -1195GA, -765GC, and − 1290AG were arbitrarily chosen to identify the genetic polymorphisms. Genotypes were analyzed by undertaking ‘polymerase chain reaction restriction fragment length polymorphism’ (PCR-RFLP). A total of 124 GC cases with 176 healthy individuals were enrolled in the study. A fraction of 10.5% cases had GG homozygous mutation alleles at -1195GA, while the 5% fraction had GG homozygous mutant alleles at -765GC, and an 8.9% fraction had GG homozygous mutant alleles at -1290AG, amongst all the GC cases. COX-2 polymorphisms were crucially associated with the risk of development of GC, compared to controls with p = 0.003, both in 1195 GA and 1290AG. COX-2 polymorphisms could play a crucial role in the development of GC in the coastal Eastern Indian region.

Introduction Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, with a global prevalence of 20%-40%. Approximately 40%-60% of patients with type 2 diabetes mellitus (DM2) experience NAFLD; out of which 20%-40% cases may have higher severity. Due to the scarcity of available reports from the eastern part of India, we aimed to evaluate the effects of dapagliflozin, a sodium-glucose cotransporter-2 inhibitor used in these types of cases. Material and methods The study included consecutive patients with DM2 and NAFLD, treated with dapagliflozin at 10 mg daily for six months. All patients underwent detailed anthropometric, biochemical, abdominal ultrasonography, and transient elastography studies at baseline and after therapy as well as a comparative analysis. Results In the 100 patients included in our study, the male patients outnumbered the female patients (male-to-female ratio, 4.27:-1) and the mean age at presentation was 44.11 ± 8.24 years. The mean body mass index significantly decreased over the course of the therapy, from 27.31± 1.87 kg/m2 at baseline to 26.21 ± 1.51 kg/m2 after the therapy. The patients’ transaminitis, dyslipidemia, and glycemic status significantly improved over the course of the therapy. We also observed significant (p < 0.05) improvement in hepatic steatosis by the end of the treatment. Although transient elastography by FibroScan-measured hepatic fibrosis score (Echosens, Paris, France) significantly decreased from 6.95 ± 1.42 to 6 ± 1.44 kPa, hepatic fibrosis did not improve significantly (p ≥ 0.05) following therapy. Conclusion Although dapagliflozin improved body mass index, transaminitis, dyslipidemia, glycemic status, and hepatic steatosis, it had a minimal effect on hepatic fibrosis.

Background and aim Idiopathic chronic pancreatitis (ICP) is said to be present when no identifiable etiology can be identified. Robust evidence suggested that the serine protease inhibitor nucleus Kazol type 1 (SPINK1) N34S mutation was frequently associated with ICP. As there is a paucity of data on genetic studies in ICP cases from the coastal eastern region of India, we performed this study with an aim to evaluate the SPINK1 genetic mutations and other associated clinical correlates in ICP cases. Material and methods Consecutive ICP cases attending the department of gastroenterology, Institute of Medical Sciences (IMS) and SUM Hospital, were enrolled and evaluated for the pertinent clinical history and undergone detailed biochemical and radiological evaluations. Two ml of venous blood in ethylenediaminetetraacetic acid (EDTA) vials were collected from each case and subjected to a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) test for genetic analysis. Result In this study, the mean age of the cases at the time of the first consultation with us and the age of the first clinical presentation were 34.52±6.44 and 28.73±5.52 years, respectively. Males outnumbered females (Male:Female - 2.12:1). Out of the total of 200 cases, 50% had no SPINK1 mutation, whereas 40% and 10% cases had SPINK1 N34S heterozygous and homozygous mutations, respectively. The mean age of clinical presentation, severe abdominal pain, exocrine and endocrine insufficiency, and parenchymal atrophy were significantly more common in mutants as compared to non-mutants (p-value

Introduction Irritable bowel syndrome (IBS) is a common gastrointestinal (GI) disorder. Female patients with bowel disease commonly report worsening of symptoms in the menstrual cycle. However, there is a paucity of data regarding IBS presentations' variation during different phases of the menstrual cycle. The current study aimed to evaluate the same in female IBS patients. Materials and methods Consecutive premenopausal female patients with the diagnosis of IBS attending the outdoor (OPD) of Department of Gastroenterology and Gynaecology; IMS and SUM Hospital, Bhubaneswar, Odisha from June 2019 to December 2019 were included in the study and evaluated by a set of questionnaires regarding various presentations during all the three phases of the menstrual cycle. Results Consecutive 102 cases with the diagnosis of IBS were included in the study and evaluated. The mean age of presentation was in mid-30s. Most of the subjects suffered from IBS mixed (IBS-M) type. More patients significantly suffered from constipation (27.27%) during the luteal phase of their menstrual cycles than the menstrual period of their cycles (p - 0.009). More than 50% of all the cases suffered from abdominal bloating during all phases of the menstrual cycle, which was quite disturbing and affected the quality of life. These IBS patients were more symptomatic with more significant limitation of daily activities, suffered from low quality of life, and obtained physician consultation during the menstrual phase as compared to other cycle stages. Conclusion Premenopausal female patients with IBS become much more symptomatic during the menstrual phase of the cycle than other stages of the cycle.

Background: Globally out of 200 crore population who are getting exposed to the hepatitis B virus (HBV),about 350 million are chronically carrying it resulting in 0.5 to 1.2 million deaths each year . These mortalitiesare due to chronic hepatitis, cirrhosis, and hepatocellular carcinoma (HCC). Horizontal transmission in earlychildhood and parental transmission at any age are the important routes of transmission. This study wasconducted with following objectives.(a) To assess the prevalence of adherence to Hepatitis vaccination.(b) To associate this adherence with demographic factors.Methodology: After receiving approval from the Institutional Ethics Committee a record based retrospectivecohort study was conducted at Gastroenterology and Hepatology OPD of IMS and SUM Hospital,Bhubaneswar. Data regarding all the patients who have received First dose of Hepatitis Vaccine from January2019 to December 2019 were followed up till June 2020 to find out how many of them have revisited toobtain second dose as well as third dose of vaccine. Their demographic characteristics collected from theimmunisation register. Data was entered and analysed using SPSS vs 21 using appropriate statistics.Results and conclusion: Total 1134 subjects have received the first dose of Hepatitis B vaccine. Meanage of the participants is 36±15yrs. First dose taken by 453(39.9%) people, 324(28.6%) had completed theschedule by taking the final dose of vaccine. Hardly one third of the patients adheres to the schedule andcompletes it. Inadequate vaccination makes the patients vulnerable to risks of Hepatitis B and its morbidities.

BACKGROUND Left ventricular diastolic dysfunction (LVDD) is the earliest cardiac dysfunction noted in patients with liver cirrhosis, which increases the morbidity and mortality in such patients. There are sparse studies from India evaluating the predictive factors of LVDD in patients with cirrhosis. Hence we undertook this prospective study with an aim to evaluate the factors predicting the development of LVDD in liver cirrhosis. METHODS 104 patients with cirrhosis were enrolled in this prospective study. A detailed cardiac evaluation was done by 2 D echocardiography with tissue Doppler imaging by an experienced senior cardiologist. The severity of liver disease was defined by Model For End-Stage Liver Disease (MELD) and Child-Pugh score. RESULTS The prevalence of LVDD was 46% in our study. Multivariate logistic regression analysis revealed that serum albumin, MELD score, and presence of ascites (OR = 0.1, 95%CI 0.03-0.3, p < 0.001; Or = 1.12, 95%CI 1.03-1.22, p < 0.001; OR = 4.19, 95%CI 1.38-12.65, p < 0.01, respectively) were independent predictors of LVDD in patients with cirrhosis. Diastolic dysfunction was unrelated to age, sex, and etiology of cirrhosis. The patients with cirrhosis and LVDD had significantly higher child Pugh score, MELD score, and lower serum albumin than patients without LVDD. The echocardiographic parameters like E/e’ ratio, Deceleration time (DT), and Left atrial volume index (LAVI) were significantly different in cirrhotic patients with higher MELD and child Pugh score than lower. CONCLUSION The present study showed a significant correlation of diastolic dysfunction with the severity of the liver disease. Low serum albumin, high MELD score, and presence of ascites significantly predict the development of LVDD in patients with cirrhosis.

Introduction Tuberculosis is a disease that has been affecting mankind since time immemorial and it still continues to be a global health concern. Objective of the study was to evaluate the burden, clinical profile, diagnosis and diagnostic difficulties and outcome of abdominal tuberculosis (AbT) in non human immunodeficiency virus (HIV) infected adults in the department of gastroenterology at a tertiary care hospital over a period of two years. Material & methods It was an observational study and the study period was from January 2016 till January 2018. The patients who were sero positive for HIV virus were excluded from the study. Results The number of patients hospitalized during the period of 2016–2018 with abdominal tuberculosis was 58. The burden of tuberculosis of indoor patients was 1.3 cases per every 100 patients admitted. Presenting complaint of most of these patients [61%] was abdominal pain. Constitutional symptoms like fever; weight loss and loss of appetite were present in only 40% of the patients. Ascites was the presenting sign in around 45% of the patients. Peritoneum was the most common site of involvement [27 out of 58]. Almost all of these patients [25 out of 27] presented with abdominal pain and abdominal distension. Intestine was the second most common site. Ileocaecal involvement was present in fourteen patients, while other areas of colon were involved in five patients. All the 58 patients were given anti tubercular therapy. There was complete resolution of tuberculosis in 91% of cases [53 out of 58 patients]. Six patients developed drug induced liver injury. Death occurred in two patients who had disseminated tuberculosis. Conclusion Although the burden of the disease remains the same, availability of newer investigations has aided in its early diagnosis and availability of good drugs has reduced the mortality and morbidity.

Fasciolopsis is one of the rarest parasitic infestations in our locality. The usual definitive host is the sheep; humans are accidental hosts in the life cycle of a liver fluke – Fasciola. In the chronic phage of Fasciolopsis, the patient presents with cholestasis and cholangitis. Yet, there is no proof of association of this parasite with carcinoma of the gallbladder. We here present such a case of Fasciolopsis in association with Stage IV gallbladder malignancy. Fasciola worms were extracted on endoscopic retrograde cholangiopancreatography done as a palliative measure for associated obstructive jaundice. The chronic phase of this zoonotic infection can be easily misdiagnosed as any other cause of obstructive jaundice if not properly investigated. The importance of repeated stool examination for parasitic ova and cysts should never be understated as it may help in early diagnosis of such treatable conditions as well as preventing the complications.

Hepatocellular carcinoma (HCC) is one of the major causes of cancer-related mortality and is particularly refractory to the available chemotherapeutic drugs. Among various etiologies of HCC, viral etiology is the most common, and, along with alcoholic liver disease and nonalcoholic steatohepatitis, accounts for almost 90% of all HCC cases. HCC is a heterogeneous tumor associated with multiple signaling pathway alterations and its complex patho-physiology has made the treatment decision challenging. The potential curative treatment options are effective only in small group of patients, while palliative treatments are associated with improved survival and quality of life for intermediate/advanced stage HCC patients. This review article focuses on the currently available treatment strategies and hurdles encountered for HCC therapy. The curative treatment options discussed are surgical resection, liver transplantation, and local ablative therapies which are effective for early stage HCC patients. The palliative treatment options discussed are embolizing therapies, systemic therapies, and molecular targeted therapies. Besides, the review also focuses on hurdles to be conquered for successful treatment of HCC and specifies the future prospects for HCC treatment. It also discusses the multi-modal approach for HCC management which maximizes the chances of better clinical outcome after treatment and identifies that selection of a particular treatment regimen based on patients’ disease stage, patients’ ages, and other underlying factors will certainly lead to a better prognosis.