Background: Diarrhea is one of the common gastrointestinal (GI) adverse events after solid organ transplantation. Diarrhea may be caused by infectious or non-infectious etiology. The infectious etiology of diarrhea varies according to the location and duration of diarrhea. Non-infectious etiologies include drugs, inflammatory bowel disease, neoplasia. The objective of this study was to evaluate the etiological profile of diarrhea in solid organ transplant recipients presenting to a tertiary care center in Southern India.Methods: This was a retrospective analysis of prospectively collected data of all solid organ transplantation recipients referred to the Department of Medical Gastroenterology for evaluation of diarrhea from April 2012 till May 2014. All patients had stool evaluated by wet mount examination, modified acid fast (AFB) stain, trichrome stain, culture, and Clostridium difficile toxin assay. EDTA plasma was collected for quantitative Cytomegalovirus (CMV) detection by real-time PCR. If the diarrhea was acute (<2 wk), and no etiological agent was identified, empirical antibiotic therapy was instituted and followed up. If persistent or chronic diarrhea (>2-4 wk), endoscopic evaluation (upper GI endoscopy and/or colonoscopy with biopsies), depending on the clinical type of diarrhea was done. If no specific etiological diagnosis was established after endoscopic evaluation, breath test for SIBO and celiac serology were done. If no specific etiology was identified after the above investigations, dose of immunosuppressive drugs was reduced. If diarrhea responded to dose reduction, it was considered to be drug related.Results: Fifty-eight episodes of diarrhea occurred in 55 solid organ transplant recipients during the study period. Renal transplant recipients constituted the majority (70%). Most (79%) of patients included in the study had their transplant > 6 mo ago.Infective diarrhea was the etiology in 46%, drug-related diarrhea in 29.3%. No specific etiology was identified in 22.4% of patients. Parasites accounted for 69% of all

Managing chronic hepatitis B (CHB) during pregnancy remains a challenging task as there is no information on the consequences to the fetus. Telbivudine, an oral nucleoside analog (NA), is a potential therapeutic option during pregnancy, but clinical experience is lacking. We report on the safety and efficacy of telbivudine 600 mg/day administered to a 20-year-old Indian woman with hepatitis B e antigen negative CHB, who became pregnant during treatment. Telbivudine was continued with monitoring of maternal hepatitis B virus (HBV) DNA and alanine aminotransferase (ALT) levels during pregnancy and after delivery. The patient maintained polymerase chain reaction (PCR) undetectable HBV DNA and normal ALT levels with telbivudine throughout pregnancy. At birth, HBV DNA was undetectable by PCR in the newborn. No congenital abnormalities were noted. In conclusion, telbivudine therapy during pregnancy was effective in maintaining undetectable viremia, and no safety concerns were noted in the mother and child. Additional clinical studies are warranted.

Background: The existing scores for predicting severity of acute pancreatitis (AP) underperform in sensitivity. The existing scores do not predict moderately severe pancreatitis. Methods: We performed a prospective observational study from August 2014 to April 2016 on patients hospitalized at Apollo Hospitals, Chennai, with a clinical diagnosis of AP (as per Atlanta 2012 classification). Three established scoring systems – Complete Ranson's (at 48 h), Acute Physiology and Chronic Health Evaluation (APACHE-II), Bedside Index of Severity in AP (BISAP) and new score BISAP + saturation of oxygen, hematocrit (BISAP + SHO) (packed cell volume [PCV]) and overweight by body mass index [BMI]) were calculated at admission. In BISAP + SHO score 5 points were given as in BISAP and 3 points were added 1 each for low oxygen saturation ≤92%, PCV ≥47% and BMI of ≥23 making BISAP + SHO an 8-point score. The prediction by scores was validated against the actual clinical outcome of severity. Results: Of 102 patients with AP, 34 (33%) patients had organ failure (OF) and in 17 patients (16.5%) it lasted >48 h, classified as severe AP. Remaining 17 were moderately severe AP as OF resolved within <48 h. Cut-off values to predict severe pancreatitis were - Ranson's score - ≥3, APACHE-II - ≥8, BISAP - ≥3, and BISAP + SHO - ≥5. Area under receiver operator curve (AUC) for Ranson's, APACHE-II, BISAP and BISAP + SHO were 0.958, 0.953, 0.899 and 0.989, respectively. With a score 3 or 4, BISAP + SHO predicted moderately severe AP with a sensitivity of 94.12%, specificity 97.6%. Conclusions: The BISAP + SHO (rephrased as BISSHOAP) stratifies AP with better AUC than existing scores and is also able to predict moderately severe pancreatitis in the ER.