Ashish Goel1, Pamela Christudoss2, Renu George3, Banumathi Ramakrishna4, G Jayakumar Amirtharaj5, Shyamkumar N Keshava6, Anup Ramachandran5, K A Balasubramanian5, Ian Mackie7, Jude J Fleming2, Elwyn Elias1,8, Chundamannil E Eapen9. 1. Department of Hepatology, Christian Medical College, Vellore, 632 004, India. 2. Department of Clinical Biochemistry, Christian Medical College, Vellore, 632 004, India. 3. Department of Dermatology, Christian Medical College, Vellore, 632 004, India. 4. Department of Pathology, Christian Medical College, Vellore, 632 004, India. 5. Wellcome Trust Research Laboratory, Christian Medical College, Vellore, 632 004, India. 6. Department of Radiology, Christian Medical College, Vellore, 632 004, India. 7. Haemostasis Research Unit, Haematology Department, University College London, London, UK. 8. University Hospital Birmingham, Birmingham, UK. 9. Department of Hepatology, Christian Medical College, Vellore, 632 004, India. eapen@cmcvellore.ac.in.
Abstract
BACKGROUND AND AIMS: Idiopathic noncirrhotic intrahepatic portal hypertension (NCIPH), a chronic microangiopathy of the liver caused by arsenicosis from use of contaminated groundwater, was reported from Asia. This study aimed to see, if in the twenty-first century, arsenicosis was present in NCIPH patients at our hospital and, if present, to look for groundwater contamination by arsenic in their residential locality. METHODS: Twenty-seven liver biopsy proven NCIPH patients, 25 portal hypertensive controls with hepatitis B or C related cirrhosis and 25 healthy controls, matched for residential locality, were studied. Eighty-four percent to 96 % of study subjects belonged to middle or lower socioeconomic category. Arsenicosis was looked for by estimation of arsenic levels in finger/toe nails and by skin examination. Arsenic levels in nails and in ground water (in NCIPH patients with arsenicosis) was estimated by mass spectrometry. RESULTS: Nail arsenic levels were raised in five (10 %) portal hypertensive study subjects [two NCIPH patients (both had skin arsenicosis) and three portal hypertensive controls]. All of these five patients were residents of West Bengal or Bangladesh. Skin arsenicosis was noted in three NCIPH patients (11 %) compared to none of disease/healthy controls. Ground water from residential locality of one NCIPH patient with arsenicosis (from Bangladesh) showed extremely high level of arsenic (79.5 μg/L). CONCLUSIONS: Arsenicosis and microangiopathy of liver, possibly caused by environmental contamination continues in parts of Asia. Further studies are needed to understand the mechanisms of such 'poverty-linked thrombophilia'.
BACKGROUND AND AIMS: Idiopathic noncirrhotic intrahepatic portal hypertension (NCIPH), a chronic microangiopathy of the liver caused by arsenicosis from use of contaminated groundwater, was reported from Asia. This study aimed to see, if in the twenty-first century, arsenicosis was present in NCIPH patients at our hospital and, if present, to look for groundwater contamination by arsenic in their residential locality. METHODS: Twenty-seven liver biopsy proven NCIPH patients, 25 portal hypertensive controls with hepatitis B or C related cirrhosis and 25 healthy controls, matched for residential locality, were studied. Eighty-four percent to 96 % of study subjects belonged to middle or lower socioeconomic category. Arsenicosis was looked for by estimation of arsenic levels in finger/toe nails and by skin examination. Arsenic levels in nails and in ground water (in NCIPH patients with arsenicosis) was estimated by mass spectrometry. RESULTS: Nail arsenic levels were raised in five (10 %) portal hypertensive study subjects [two NCIPH patients (both had skin arsenicosis) and three portal hypertensive controls]. All of these five patients were residents of West Bengal or Bangladesh. Skin arsenicosis was noted in three NCIPH patients (11 %) compared to none of disease/healthy controls. Ground water from residential locality of one NCIPH patient with arsenicosis (from Bangladesh) showed extremely high level of arsenic (79.5 μg/L). CONCLUSIONS:Arsenicosis and microangiopathy of liver, possibly caused by environmental contamination continues in parts of Asia. Further studies are needed to understand the mechanisms of such 'poverty-linked thrombophilia'.
Authors: Ashish Goel; P L Alagammai; Sukesh C Nair; Ian Mackie; Banumathi Ramakrishna; Jayaprakash Muliyil; Shyamkumar N Keshava; C E Eapen; Elwyn Elias Journal: Indian J Gastroenterol Date: 2014-04-24
Authors: D N Guha Mazumder; A K Chakraborty; A Ghose; J D Gupta; D P Chakraborty; S B Dey; N Chattopadhyay Journal: Bull World Health Organ Date: 1988 Impact factor: 9.408
Authors: Ashish Goel; V Raghupathy; G J Amirtharaj; Aaron Chapla; Aparna Venkatraman; Banumathi Ramakrishna; Anup Ramachandran; Nihal Thomas; K A Balasubramanian; Ian Mackie; Elwyn Elias; Chundamannil E Eapen Journal: Indian J Gastroenterol Date: 2017-10-05
Authors: Ashish Goel; Banumathi Ramakrishna; Uday Zachariah; K G Sajith; Deepak K Burad; Thomas A Kodiatte; Shyamkumar N Keshava; K A Balasubramanian; Elwyn Elias; C E Eapen Journal: Indian J Med Res Date: 2019-04 Impact factor: 2.375