We conclude that SHE is common in cirrhosis. The natural history of SHE is worse in patients with advanced cirrhosis and SHE probably predisposes the cirrhotic patient to overt hepatic encephalopathy.

DNA Polymerase (Bangalore Genei Pvt. Ltd., Bangalore, India) overlaid with two drops of mineral oil. Reaction mixture was denatured for 7 min at 95°C and subjected to 28 cycles each with a profile of 60 s at 92°C, 80 s at 52°C and 105 s at 72°C in a DNA Thermal Cycler (Perkin-Elmer, Norwalk, CT, USA). The electrophoresis of the PCR product was performed on a 1.5% agarose gel. Figure 2 shows the banding pattern of the PCR products.Thus, we have demonstrated that using degenerate primers for viral sequence of HBV, designed from the known protein sequence, it was possible to successfully amplify the virus DNA from both plasmid and clinical serum samples. This technique will allow design of primers with a high probability of successful amplification by reducing both the degeneracy and secondary structures of the primer. The technique can also be used for the design of primers for PCR sequencing or hybridization from a known protein sequence of even small regions. Information on Primer Premier is available at www.PremierBiosoft.com, by calling 415-856-2703 or from the author's address. Address correspondence to Dr. Sita Naik, Head, Department of Immunology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road, Lucknow-226 014, India. Vol. 24, No. 2 (1998) BioTechniques 319

No abstract

In the Indian population, the prevalence of resistance of H. pylori is very high to metronidazole, moderate to clarithromycin and amoxycillin and low to ciprofloxacin and tetracycline. The rate of resistance was higher in southern India than in northern India. The E-test emerges as a reliable quantitative antibiotic susceptibility test. A change in antibiotic policy to provide scope for rotation of antibiotics in the treatment of H. pylori in India is a public health emergency.

These results show the existence of a Th2 bias in pregnant women with acute hepatitis E. The role of this Th2 bias in the greater severity of hepatitis E among pregnant women needs further investigation.

Aerobic bacterial contamination of the small bowel is common in patients with TS. Prolonged OCTT in TS correlated with fecal fat and normalized in a subset of patients after treatment.

Hepatitis E virus (HEV) is a major cause of acute hepatitis in many developing countries. Based on data from nonendemic regions, an animal reservoir of HEV has been proposed; however, data from HEV-endemic regions are limited. We tested sera from 200 pigs, 98 chickens, 86 goats, 58 sheep and 30 buffaloes for anti-HEV IgG using two different enzyme immunoassays. Specificity of the detected antibodies was confirmed using inhibition assays. Stool specimens from 210 pigs, 94 piglets and 37 sheep were tested for HEV-RNA using nested amplification methods; the polymerase chain reaction products were sequenced and compared with known human and swine HEV sequences. Of the 200 swine sera, 193 and 195, respectively, tested positive in the two assays. All goat sera showed anti-HEV reactivity in both the assays. Inhibition studies confirmed the HEV specificity of antibodies detected in swine and goat sera using both the assays. Sera from sheep, buffalo and chickens also showed high rates of apparent reactivity, but inhibition studies were unable to confirm the specificity of reactions in these species. One faecal specimen showed amplification using Indian swine HEV-specific primers. The genomic sequence of the amplicon from this isolate had only 76-79% nucleotide and 93% amino acid homology with human HEV isolates reported from India and other parts of the world, and most closely resembled swine HEV isolates from other parts of India. Infection with HEV or a related agent is widespread among animals in northern India. However, the swine HEV in India differs genetically from human HEV isolates, indicating that pigs may not play an important role in the spread of human hepatitis E in endemic regions.

The number connection test (NCT), which assesses the extent of organic brain damage, has been used extensively to evaluate mental state in portasystemic encephalopathy, but has certain inherent limitations. It cannot be performed by illiterates and those unfamiliar with Roman alphanumeric notations. We, therefore, devised a figure connection test (FCT) based on the subject's identification of figures rather than alphabets or numerals. Four variations each of FCT-A (A1-A4) and FCT-B (B1-B4) employing different motifs were developed and compared with four variations each of NCT-A (A1-A4) and NCT-B (B1-B4) in groups of healthy volunteers with differing educational status. These volunteer groups were as follows: postgraduates 64; graduates 66; subgraduates 75; and illiterates 45. Significant differences in mean scores of various tests were observed between these normal groups. Control values of the tests for these groups have been standardized and can serve as nomograms. The effect of educational attainments on performance of FCT and other psychometric tests was analysed and trail-making tests were validated for serial use. The FCT was then prospectively validated on 70 patients (classified for comparison with controls according to educational status as follows: postgraduates 7; graduates 21; subgraduates 32; and illiterates 10) with cirrhosis of liver without over encephalopathy, to detect subclinical hepatic encephalopathy. NCT-A was abnormal in 31.7%, NCT-B in 38.3%, FCT-A in 42.9% and FCT-B in 28.6% of patients. Taken together these tests diagnosed subclinical hepatic encephalopathy in 34 (48.5%) patients. We conclude that FCT is as useful as NCT in detecting psychomotor performance defects in cirrhotic patients without overt encephalopathy.