Cancer is characterized by mutagenic events that lead to disrupted cell signaling and cellular functions. It is one of the leading causes of death worldwide. Literature suggests that pathogens, mainly Helicobacter pylori and Epstein–Barr virus (EBV), have been associated with the etiology of human cancer. Notably, their co-infection may lead to gastric cancer. Pathogen-mediated DNA damage could be the first and crucial step in the carcinogenesis process that modulates numerous cellular signaling pathways. Altogether, it dysregulates the metabolic pathways linked with cell growth, apoptosis, and DNA repair. Modulation in these pathways leads to abnormal growth and proliferation. Several signaling pathways such RTK, RAS/MAPK, PI3K/Akt, NFκB, JAK/STAT, HIF1α, and Wnt/β-catenin are known to be altered in cancer. Therefore, this review focuses on the oncogenic roles of H. pylori, EBV, and its associated signaling cascades in various cancers. Scrutinizing these signaling pathways is crucial and may provide new insights and targets for preventing and treating H. pylori and EBV-associated cancers.

In the last three decades, the use of herbal medications has been increasing for the treatment of various chronic disorders. Studies in the past have shown that many of these medicines could contain high levels of heavy metals, including lead. Therefore, we planned this study to evaluate the possibility of lead toxicity as the underlying cause in patients consuming these unnamed herbal medicines among patients presenting with significant abdominal pain. (Unexplained abdominal pain means pain in abdomen in which no etiology could be ascertained after all possible routine and specialized investigations including computerized axial tomography [CT] of the abdomen and upper gastrointestinal [UGI] endoscopy/colonoscopy). This is an observational case series of prospectively maintained data of all patients having unexplained abdominal pain and found to have an elevated blood lead level from 2011 to 2019. Lead toxicity was diagnosed when its blood lead level was >25 μg/dL. Total sixty-six patients with unexplained abdominal pain from 2011 to 2019 were recruited. Out of the sixty-six patients, seventeen had elevated blood lead levels. All seventeen patients had a history of ingestion of herbal medicines for more than 6 months. Among the seventeen patients, eight were taking it for infertility and sexual dysfunction, six for diabetes, two for arthritis and one for hypertension. Basophilic stippling was seen in one patient. Fourteen patients had low hemoglobin with a median value of 9.7 g/dL. Mean serum blood lead level was 87.1 μg/dL. None of them required anti-chelating agent. Lead toxicity owing to herbal medicine is not uncommon cause of unexplained abdominal pain. Most of these patients do not require a chelating agent for treatment. There is a need to bring these herbal medicines under strict regulations for displaying its constituents and their concentrations.

Background: Acute kidney injury (AKI) constitutes an important cause of morbidity and mortality among patient with chronic liver disease (CLD). Its etiologies are varied and if diagnosed early, outcome may be good in majority. Hence we aimed this study. Aim: To study the prevalence of AKI at presentation amongst all patients with CLD and to study etiologies of AKI and its outcome. A prospective study. Methods: All consecutive patients who presented at liver clinic from 1st October 2015 to 30th September 2016 with diagnosis of CLD with AKI formed the study group. All patients were evaluated for presence of AKI. Etiological work up was done in all patients for CLD. Similarly work up was done to find out etiologies of AKI among patients who had it. Among AKI patients, presenting symptoms were analyzed along with CTP score. Treatment outcome was also measured among AKI patients. Results: Total 116 patients were seenat liver clinic during study period. Out of 116, 36 patients (31.03%). Etiology of AKI was -HRS in 22 (61%) patients out of which 3 patients also had UTI; Prerenal failure in 9 (25%) patients out of which two also had UTI and one had LRTI; Sepsis in 10 (27%) patients (5 had SBP, 4 had LRTI, one had lower limb cellulitis) out of which 6 patients also had HRS, 2 patients had only UTI. One patient had underlying CKD. Symptoms at presentation were Abdominal distension 16 (44%), fever 10 (27%), abdominal pain 8 (22.2%), jaundice 9(25%), decreased appetite 10 (27.7%), decreased urine output 13 (36.1), loose stools 9 (25%), GI bleed 4 (11.1%). CTP class of AKI patients was - CTP B -10 patient (27.7%) and CTP C 26 patient (72.3%). Hyponatremia (serum sodium -130 mEq/L or less) was present in 21(58.3%) patients out of which 4(11.1%) had sodium < 120.Of 36 AKI patients, 12 patients were treated with both albumin and Terlipressin(34.2%), while additional 5 patients were treated with Terlipressin alone. 32 patients (89%) received antibiotics. Out of 36 patients with CLD with AKI, 8 patients (22.2%) expired in hospital and additional 3 patients left against medical advice in view of poor prognosis suggesting an overall mortality of 30.5%, while25 patients were discharged. All 8 patients who expired in hospital had HRS out of which 4 patients also had SBP with alcoholic hepatitis along with HRS. Overall out of 22 patients with HRS, 8 patients (36.36%) expired in same admission. Conclusion: Almost one third of patients with CLD present with AKI. Among AKI patients with CLD, HRS has worst prognosis with more than one third dying in same admission The authors have none to declare.