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Koshy A, Devadas K, Panackel C, Philip M, Premaletha N, Zacharias P, Ramachandran TM, Gopalakrishna R, Mukkada RJ, Philips CA, Augustine P, Krishnakumar R, Sebastian B, Chettupuzha AP, Sadasivan S, Thomas GK, Siyad I, Sandesh K, Abhilash VB, Antony R, Kandathil JC, Pratap T, Mahadevan P. Multi-center prospective survey of hepatocellular carcinoma in Kerala: More than 1,200 cases. Indian J Gastroenterol 2023; 42:233-240. [PMID: 37154853 DOI: 10.1007/s12664-022-01314-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 11/22/2022] [Indexed: 05/10/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is considered uncommon in India. The aim of this study was to document the demographic characteristics and clinical aspects of HCC in Kerala, India. METHODS A survey of HCC in Kerala was performed. All gastroenterologists in the region were invited. From May 2018 to April 2020, data was collected in a standardized questionnaire. RESULTS Forty-three doctors from 15 centers contributed the data. Total 1217 patients were analyzed. This is the largest state-wide survey of HCC in India. HCC was more common in men (90%) than in women (p < 0.01). The etiology of liver disease was hepatitis B virus (7%), hepatitis C virus (4%) and alcohol (40%). Diabetes mellitus was present in 64%, hypercholesterolemia in 17% and hypertension in 38%. Obesity was present in 33% and 15% were overweight. Non-alcoholic fatty liver disease (NAFLD) with or without metabolic syndrome was present in 44%. Serum alpha-fetoprotein was > 400 ng/mL in 24%, total tumor diameter was > 5 cm in 59%, portal vein invasion was seen in 35% and distant metastasis was seen in 15%. Specific therapy was given to 52%. Treatments given included liver transplantation (n = 24), liver resection (n = 39) and transarterial chemoembolization (TACE, n = 184). Although the study was not designed to compare survival, patients who had liver transplantation had longer survival (median 69 months) compared to matched patients given only TACE (median 18 months) (p = 0.03). CONCLUSION HCC is common in Kerala, India. NAFLD has a predominant association with HCC in Kerala. Most of the patients report late when curative treatment is not possible.
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Affiliation(s)
- Abraham Koshy
- Department of Gastroenterology, VPS Lakeshore Hospital, Kochi, 682 040, India.
| | - Krishnadas Devadas
- Department of Gastroenterology, Trivandrum Medical College, Trivandrum, 695 011, India
| | - Charles Panackel
- Department of Gastroenterology, Aster Medcity, Kochi, 682 027, India
| | - Mathew Philip
- Department of Gastroenterology, PVS Memorial Hospital, Kochi, 682 017, India
| | - N Premaletha
- Department of Gastroenterology, Kottayam Medical College, Kottayam, 686 008, India
| | - Prakash Zacharias
- Department of Gastroenterology, PVS Memorial Hospital, Kochi, 682 017, India
| | - T M Ramachandran
- Department of Gastroenterology, Calicut Medical College, Calicut, 673 008, India
| | - Rajesh Gopalakrishna
- Department of Gastroenterology, Amrita Institute of Medical Sciences, Kochi, 682 041, India
| | - Roy J Mukkada
- Department of Gastroenterology, VPS Lakeshore Hospital, Kochi, 682 040, India
| | | | - Philip Augustine
- Department of Gastroenterology, Rajagiri Hospital, Aluva, 683 112, India
| | - Rema Krishnakumar
- Department of Gastroenterology, Moulana Hospital, Perinthalmanna, 679 322, India
| | - Benoy Sebastian
- Department of Gastroenterology, Medical Trust Hospital, Kochi, 682 016, India
| | | | - Shine Sadasivan
- Department of Gastroenterology, Amrita Institute of Medical Sciences, Kochi, 682 041, India
| | - George K Thomas
- Department of Gastroenterology, Pushpagiri Medical College Hospital, Thiruvalla, 689 101, India
| | - Ismail Siyad
- Department of Gastroenterology, Aster Medcity, Kochi, 682 027, India
| | - K Sandesh
- Department of Gastroenterology, Calicut Medical College, Calicut, 673 008, India
| | - V B Abhilash
- Department of Gastroenterology, ESIC Hospital, Kollam, 691 002, India
| | - Rajesh Antony
- Department of Radiology, VPS Lakeshore Hospital, Kochi, 682 040, India
| | - Julio C Kandathil
- Department of Radiology, VPS Lakeshore Hospital, Kochi, 682 040, India
| | - Thara Pratap
- Department of Radiology, VPS Lakeshore Hospital, Kochi, 682 040, India
| | - Pushpa Mahadevan
- Department of Pathology, VPS Lakeshore Hospital, Kochi, 682 040, India
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Koshy A, Mukkada RJ, Chettupuzha AP, Francis JV, Kandathil JC, Mahadevan P. Hemochromatosis in India: First Report of Whole Exome Sequencing With Review of the Literature. J Clin Exp Hepatol 2020; 10:163-169. [PMID: 32189932 PMCID: PMC7067988 DOI: 10.1016/j.jceh.2019.04.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/17/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Primary hemochromatosis is unusual in India. The homeostatic iron regulator (HFE) gene C282Y mutation, a common cause for hemochromatosis in Europe, is considered almost nonexistent in India. We are reporting a case of hemochromatosis with the HFE gene C282Y mutation and two other adult cases with a novel hemojuvelin (HJV) mutation from Kerala. METHODS Of 434 cases with chronic liver disease, 3 cases were identified with the serum ferritin level of more than 1000 ng/mL and primary hemochromatosis after excluding secondary causes. Whole exome sequencing, including genes HFE, HJV, SLC40A1, TFR2, FTH1, HAMP, SKIV2L, TTC37, and BMP2, was performed for blood samples in all 3 cases. RESULTS One patient with hemochromatosis had a homozygous HFE gene C282Y mutation, and two other adult cases had a novel homozygous HJV D355Y mutation. This is the first report of hemochromatosis associated with the HFE C282Y mutation from Kerala and the second report in India. This is the second report of hemochromatosis associated with an HJV mutation from India. CONCLUSION HJV mutations may explain some of the adult onset primary hemochromatosis in India.
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Affiliation(s)
- Abraham Koshy
- Departments of Gastroenterology, VPS Lakeshore Hospital, Kochi, India
- Address for correspondence: Professor Abraham Koshy, Department of Gastroenterology Lakeshore Hospital, Kochi 682304, India. Tel: +91 484 701032; fax: +91 484 701996.
| | - Roy J. Mukkada
- Departments of Gastroenterology, VPS Lakeshore Hospital, Kochi, India
| | | | - Jose V. Francis
- Departments of Gastroenterology, VPS Lakeshore Hospital, Kochi, India
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Mukkada RJ, Antony R, Chooracken MJ, Francis JV, Chettupuzha AP, Mathew PG, Augustine P, Koshy A. Endoscopic ultrasound-guided coil or glue injection in post-cyanoacrylate gastric variceal re-bleed. Indian J Gastroenterol 2018; 37:153-159. [PMID: 29629510 DOI: 10.1007/s12664-018-0844-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/10/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS N-butyl-cyanoacrylate injection is recommended in bleeding/recently bled gastric varices. However, cyanoacrylate injection is associated with re-bleed in 25% to 50% of patients. Endoscopic ultrasound (EUS)-guided coil application is an emerging treatment modality for bleeding gastric varices. The aim of this study was to compare EUS-guided coil application combined with or without cyanoacrylate glue injection to injection alone in post-glue gastric variceal re-bleed. METHODS A retrospective analysis of a prospectively maintained database was performed. Thirty patients who re-bled after cyanoacrylate injection and who had EUS-guided coil application to gastric varices were included. The comparison was done with data of 51 patients who had only repeat cyanoacrylate injection. Both groups had a follow up for 12 months. EUS-guided coil application was done under endosonographic guidance. A single coil was placed in 7, two coils in each of 13 patients, three in 5, four in 3, five in one, and 6 coils in one patient. In addition, cyanoacrylate glue injection was given in 15 patients. Eight patients had repeat EUS-guided coil application 1 month later. Re-bleed and mortality were assessed. RESULTS Coilng: Six out of 30 (20%) patients re-bled during follow up of 9 to 365 days. Three out of 30 (10%) died. One patient died 9 days after the procedure due to acute respiratory distress syndrome, one died 4 months after the procedure due to a re-bleed and one 5 months after the procedure due to spontaneous bacterial peritonitis. Glue only: 26/51 (51%) re-bled during follow up of 45 to 365 days. EUS-guided coil application resulted in significantly less re-bleed than glue-only (Kaplan-Meir survival analysis with log-rank test, z = 5.4, p < 0.001). Two out of 51 (4%) died 59 and 186 days after the procedure. CONCLUSION EUS-guided coil application with/without cyanoacrylate injection for the obliteration of gastric varices is effective for post-cyanoacrylate gastric variceal re-bleed.
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Affiliation(s)
- Roy J Mukkada
- Departments of Gastroenterology and Radiology, VPS Lakeshore Hospital and Research Centre, Kochi, 682 304, India
| | - Rajesh Antony
- Departments of Gastroenterology and Radiology, VPS Lakeshore Hospital and Research Centre, Kochi, 682 304, India
| | - Mathew J Chooracken
- Departments of Gastroenterology and Radiology, VPS Lakeshore Hospital and Research Centre, Kochi, 682 304, India
| | - Jose V Francis
- Departments of Gastroenterology and Radiology, VPS Lakeshore Hospital and Research Centre, Kochi, 682 304, India
| | - Antony P Chettupuzha
- Departments of Gastroenterology and Radiology, VPS Lakeshore Hospital and Research Centre, Kochi, 682 304, India
| | - Pradeep G Mathew
- Departments of Gastroenterology and Radiology, VPS Lakeshore Hospital and Research Centre, Kochi, 682 304, India
| | - Philip Augustine
- Departments of Gastroenterology and Radiology, VPS Lakeshore Hospital and Research Centre, Kochi, 682 304, India
| | - Abraham Koshy
- Departments of Gastroenterology and Radiology, VPS Lakeshore Hospital and Research Centre, Kochi, 682 304, India.
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Philip M, Augustine P, Thomas V, Ramesh GN, Vinayakumar KR, Ramachandran TM, Siyad I, Mukkada RJ, Devi RS, Chettupuzha AP, Jaison VA, Ramesh M, Mahadevan P, Koshy A. Multi-center prospective survey of inflammatory bowel diseases in Kerala: More than 2000 cases. Indian J Gastroenterol 2017; 36:459-467. [PMID: 29368189 DOI: 10.1007/s12664-017-0809-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 12/19/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is considered uncommon in Asia. The aim of this study was to document the demographic characteristics and clinical aspects of ulcerative colitis (UC) and Crohn's disease (CD) in Kerala, India. METHODS A survey of IBD in Kerala was performed. All gastroenterologists in the region were invited. From May 2013 to October 2015, data were collected in a standardized pro-forma. RESULTS Forty-seven doctors in 34 centers contributed data. A total of 2142 patients were analyzed. This is the largest state-wide survey of IBD in India. Ulcerative colitis was diagnosed in 1112 (38 new), Crohn's disease in 980 (53 new), and 50 were unclassified (5 new). The district-wise distribution of IBD cases correlated with the District-wise Gross State Domestic Product (r = 0.69, p < 0.01). Three percent was below the age of 18. Patients with UC had more diarrhea (73% vs. 51%), bleeding PR (79% vs. 34%), and intermittent flares (35% vs. 13%) (all p < 0.01). Patients with CD had more abdominal pain (62% vs. 46%), weight loss (53% vs. 40%), fever (28% vs. 18%), and history of antituberculosis treatment (21% vs. 5%) (all p < 0.01). Compared to adults, children (below 18 years) were more likely to have extensive UC (58% vs. 34%, p < 0.01) and unclassified IBD (15% vs. 2%, p < 0.01). CONCLUSION Inflammatory bowel disease is common in Kerala, India. The disease characteristics of patients with IBD are almost similar to those from other parts of the country. Both UC and CD were seen in equal proportion in Kerala.
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Affiliation(s)
- Mathew Philip
- Department of Gastroenterology, PVS Memorial Hospital, Banerji Road, Kaloor, Ernakulam, 682 017, India
| | - Philip Augustine
- Department of Gastroenterology, PVS Memorial Hospital, Banerji Road, Kaloor, Ernakulam, 682 017, India
| | - Varghese Thomas
- Calicut Medical College, Medical College Road, Kozhikode, 673 008, India
| | - G N Ramesh
- Department of Gastroenterology, PVS Memorial Hospital, Banerji Road, Kaloor, Ernakulam, 682 017, India
| | - K R Vinayakumar
- Trivandrum Medical College, Ulloor Road, Thiruvananthapuram, 695 011, India
| | - T M Ramachandran
- Calicut Medical College, Medical College Road, Kozhikode, 673 008, India
| | - Ismail Siyad
- Amrita Institute of Medical Sciences, Ponekkara, P. O, Kochi, 682 026, India
| | - Roy J Mukkada
- VPS Lakeshore Hospital, Nettoor, Maradu, Ernakulam, 682 040, India
| | - R Sobhana Devi
- Kottayam Medical College, Gandhi Nagar, Kottayam, 686 008, India
| | | | - Varghese A Jaison
- Elite Hospital, Koorkenchery Road, Koorkenchery, Thrissur, 680 007, India
| | - M Ramesh
- MES Medical College, Valanchery-Nilambur Road, Palachode Post, Malaparamba, Perinthalmanna, Kolathur, Malappuram, 679 321, India
| | - P Mahadevan
- Department of Pathology, VPS Lakeshore Hospital, Nettoor, Maradu, Ernakulam, 682 040, India
| | - Abraham Koshy
- VPS Lakeshore Hospital, Nettoor, Maradu, Ernakulam, 682 040, India.
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Mukkada RJ, Antony R, Francis JV, Chettupuzha AP, Augustine P, Venugopal B, Koshy A. Bronchobiliary Fistula Treated Successfully With Endoscopic Microcoils and Glue. Ann Thorac Surg 2014; 98:e33-4. [DOI: 10.1016/j.athoracsur.2014.04.052] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/19/2014] [Accepted: 04/04/2014] [Indexed: 10/25/2022]
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Mukkada RJ, Chettupuzha AP, Francis VJ, Mathew PG, Chirayath SP, Koshy A, Augustine P. Endoscopic removal of chicken bone that caused gastric perforation and liver abscess. Indian J Gastroenterol 2008; 26:246-7. [PMID: 18227580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A 40-yr-old gentleman presented with abdominal pain, nausea and vomiting since 3 weeks. CT scan of the abdomen showed a liver abscess but also a bone penetrating the left lobe of the liver. A 5-cm-long chicken bone was removed endoscopically. He was discharged on day 8 and was asymptomatic 12 months later. Endoscopic retrieval of an extraluminal foreign body causing liver abscess has not been reported previously.
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Affiliation(s)
- R J Mukkada
- Department of Gastroenterology, Lakeshore Hospital, Kochi 682 304, India
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Raman RV, Vasuchembukkara, Harikumar R, Chettupuzha AP, Thomas V. Radiological quiz - chest. Indian J Radiol Imaging 2005. [DOI: 10.4103/0971-3026.29189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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