1
|
Yewale RV, Ramakrishna BS, Doraisamy BV, Basumani P, Venkataraman J, Jayaraman K, Murali A, Premkumar K, Kumar AS. Long-term safety and effectiveness of azathioprine in the management of inflammatory bowel disease: A real-world experience. JGH Open 2023; 7:599-609. [PMID: 37744710 PMCID: PMC10517446 DOI: 10.1002/jgh3.12955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 06/15/2023] [Accepted: 07/22/2023] [Indexed: 09/26/2023]
Abstract
Background and Aim Azathioprine (AZA) forms the cornerstone for maintenance of sustained remission in inflammatory bowel disease (IBD). There is apprehension regarding the long-term effectiveness and safety of AZA in IBD. We present our experience with AZA use and outcomes in a cohort of IBD patients followed up over a long period of time. Methods Records of 507 IBD patients under treatment at a single, tertiary care center in south India between 2013 and 2022 were evaluated retrospectively. Long-term compliance, tolerance, clinical outcome at the point of last follow-up, type and duration to the onset of adverse events, and subsequent amendment to treatment with regard to AZA were analyzed. Results Of 507 patients with IBD, 320 patients (207 Crohn's disease [CD], 113 ulcerative colitis [UC]) who received AZA were included. The median follow-up was 41 months (interquartile range 15.5-77.5). Total duration of exposure was 1359 patient-years with median usage of 33 months. Of the patients, 26.9% received AZA for >5 years. Mean initiation and maximum doses of AZA were 0.97 and 1.72 mg/kg/day. Among the participants, 20.6% experienced side effects, including myelotoxicity (7.2%) and gastrointestinal intolerance (5.6%). Six patients developed malignancy. Among the side effects, 39.4% of side effects were dose-dependent. Among the patients, 38.1% had relapses requiring pulse corticosteroid therapy, and 16.2% had more than one relapse after commencement of AZA. AZA was continued till the last follow-up in 76.5%. Among the patients, 49.7% (UC 51.3, CD 48.8) attained durable remission without biologics, and 5.3% continued to have active disease. Conclusion AZA is safe and effective in the long-term in IBD. Effectiveness, tolerance, and compliance with AZA are well sustained beyond 5 years of usage and comparable between UC and CD.
Collapse
Affiliation(s)
- Rohan V Yewale
- Institute of Gastroenterology, SRM Institutes for Medical ScienceChennaiTamil NaduIndia
| | | | - Babu Vinish Doraisamy
- Institute of Gastroenterology, SRM Institutes for Medical ScienceChennaiTamil NaduIndia
| | - Pandurangan Basumani
- Department of GastroenterologyApollo Hospitals Greams RoadChennaiTamil NaduIndia
| | - Jayanthi Venkataraman
- Department of HepatologySri Ramachandra Institute of Higher Education and ResearchChennaiTamil NaduIndia
| | - Kayalvizhi Jayaraman
- Institute of Gastroenterology, SRM Institutes for Medical ScienceChennaiTamil NaduIndia
| | | | | | | |
Collapse
|
2
|
Ghoshal UC, Sachdeva S, Pratap N, Karyampudi A, Mustafa U, Abraham P, Bhatt CB, Chakravartty K, Chaudhuri S, Goyal O, Makharia GK, Panigrahi MK, Parida PK, Patwari S, Sainani R, Sadasivan S, Srinivas M, Upadhyay R, Venkataraman J. Indian consensus statements on irritable bowel syndrome in adults: A guideline by the Indian Neurogastroenterology and Motility Association and jointly supported by the Indian Society of Gastroenterology. Indian J Gastroenterol 2023; 42:249-273. [PMID: 36961659 PMCID: PMC10036984 DOI: 10.1007/s12664-022-01333-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 12/20/2022] [Indexed: 03/25/2023]
Abstract
The Indian Neurogastroenterology and Motility Association (INMA), earlier named the Indian Motility and Functional Diseases Association developed this evidence-based practice guidelines for the management of irritable bowel syndrome (IBS). A modified Delphi process was used to develop this consensus containing 28 statements, which were concerning diagnostic criteria, epidemiology, etiopathogenesis and comorbidities, investigations, lifestyle modifications and treatments. Owing to the Coronavirus disease-19 (COVID-19) pandemic, lockdowns and mobility restrictions, web-based meetings and electronic voting were the major tools used to develop this consensus. A statement was regarded as accepted when the sum of "completely accepted" and "accepted with minor reservation" voted responses were 80% or higher. Finally, the consensus was achieved on all 28 statements. The consensus team members are of the view that this work may find use in teaching, patient care, and research on IBS in India and other nations.
Collapse
Affiliation(s)
- Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India.
| | - Sanjeev Sachdeva
- Department of Gastroenterology, GB Pant Hospital, New Delhi, 110 002, India
| | - Nitesh Pratap
- Department of Gastroenterology, KIMS Hospital, Secunderabad, 500 003, India
| | - Arun Karyampudi
- Department of Gastroenterology, GSL Medical College and General Hospital, Rajahmundry , 533 296, India
| | - Uzma Mustafa
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Philip Abraham
- Department of Gastroenterology, P. D. Hinduja Hospital, Mumbai, 400 016, India
| | - Chetan B Bhatt
- Sir HN Reliance Foundation Hospital, Mumbai, 400 004, India
| | - Karmabir Chakravartty
- Department of Gastroenterology, Woodland Multispeciality Hospital, Kolkata, 700 027, India
| | - Sujit Chaudhuri
- Department of Gastroenterology, AMRI Hospitals, Salt Lake, Kolkata, 700 098, India
| | - Omesh Goyal
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | - Govind K Makharia
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Manas Kumar Panigrahi
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, 751 019, India
| | - Prasanta Kumar Parida
- Department of Gastroenterology, SCB Medical College and Hospital, Cuttack, 753 001, India
| | | | - Rajesh Sainani
- Department of Gastroenterology, Jaslok Hospital, Mumbai, 400 026, India
| | - Shine Sadasivan
- Department of Gastroenterology, Amrita Institute of Medical Sciences, Kochi, 682 041, India
| | - M Srinivas
- Department of Gastroenterology, Gleneagles Global Health City, Chennai, 600 100, India
| | - Rajesh Upadhyay
- Department of Gastroenterology, Max Superspeciality Hospital, New Delhi, 110 017, India
| | - Jayanthi Venkataraman
- Department of Gastroenterology, Sri Ramachandra Institute of Higher Education and Research, Chennai, 600 116, India
| |
Collapse
|
3
|
Dixit VK, Sahu MK, Venkatesh V, Bhargav VY, Kumar V, Pateriya MB, Venkataraman J. Gastrointestinal Emergencies and the Role of Endoscopy. Journal of Digestive Endoscopy 2022. [DOI: 10.1055/s-0042-1755303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AbstractMany gastrointestinal (GI) disorders present to the emergency room with acute clinical presentations, some even life threatening. Common emergencies encountered that require urgent endoscopic interventions include GI hemorrhage (variceal and nonvariceal), foreign body ingestion, obstructive jaundice, postprocedure-related complications such as postpolypectomy bleed or perforation, etc. A major advantage of emergency endoscopy is that it is cost effective and, on many occasions, can be life-saving. The present review will highlight a practical approach on various endoscopic modalities and their use in the GI emergencies.
Collapse
Affiliation(s)
- Vinod Kumar Dixit
- Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Manoj Kumar Sahu
- Department of Gastroenterology and Hepatobiliary Sciences, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan (SOA) University, Bhubaneswar, Odisha, India
| | - Vybhav Venkatesh
- Department of Gastroenterology and Hepatobiliary Sciences, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan (SOA) University, Bhubaneswar, Odisha, India
| | - Varanasi Yugandhar Bhargav
- Department of Hepatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Vinod Kumar
- Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Mayank Bhushan Pateriya
- Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Jayanthi Venkataraman
- Department of Hepatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| |
Collapse
|
4
|
Duseja A, Singh SP, Mehta M, Shalimar, Venkataraman J, Mehta V, Devadas K, Kar SK, Goyal O, Nagral A, Saigal S, Nijhawan S, Praharaj D, Shukla A, Sharma B, Narayanasamy K, Kumar P, Rao PN, Arora A, Mehta R, Asati P, Ranjan P, Koshy A, Alam S, Mukewar S, Mukewar S, Mohan Prasad VG, Rastogi M, Sanyal AJ. Clinicopathological Profile and Outcome of a Large Cohort of Patients with Nonalcoholic Fatty Liver Disease from South Asia: Interim Results of the Indian Consortium on Nonalcoholic Fatty Liver Disease. Metab Syndr Relat Disord 2022; 20:166-173. [PMID: 35085026 DOI: 10.1089/met.2021.0104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background: Previous data from South Asia and India had shown that patients with nonalcoholic fatty liver disease (NAFLD) have mild liver disease severity. There are no data regarding long-term clinical outcomes in patients with NAFLD from South Asia. The aim of the study was to evaluate the clinicopathological profile, severity of NAFLD, and clinical outcomes in a large cohort of patients with NAFLD from South Asia. Methods: In an ongoing real-life study [Indian Consortium on nonalcoholic fatty liver disease (ICON-D)], interim data captured across 23 centers in India over 18 months was analyzed for clinicopathological profile, severity of NAFLD, and hepatic/extrahepatic events on follow-up. Results: Of 4313 patients (mean age 45 ± 12.2 years, males 52%), data on metabolic risk factors in 3553 (82.3%) patients revealed that 378 (10.6%) were lean, 575 (16.2%) overweight, 2584 (72.7%) obese; metabolic syndrome in 1518 (42.7%) and at least one metabolic risk factor in 3292 (92.6%) patients. Evidence of significant or advanced fibrosis assessed with [aspartate transaminase to platelet ratio index (APRI), n = 3196 (74%)], [fibrosis-4 (FIB-4), n = 3554 (82.4%)], [NAFLD fibrosis score (NFS), n = 1924 (44.6%)], [Fibroscan, n = 2475, (57.3%)], and histology [n = 267 (6.2%)] was present in 682 (21.3%), 676 (19%), 397 (20.6%), 715 (29%), and 41 (15.4%) patients, respectively; 246 (10%) patients on Fibroscan and 22 (8.2%) on histology had evidence of cirrhosis. On a mean follow-up 43.5 months, hepatic and extrahepatic events recorded in 1353 (31.3%) patients showed that patients with compensated cirrhosis [71 (5.2%)] had more hepatic [26 (36.7%)] and extrahepatic events [8 (11.3%)] in comparison with those without cirrhosis (P < 0.0001). Conclusion: Around one fifth of patients with NAFLD in South Asia have significant liver disease. Both hepatic and extrahepatic events on follow-up are observed more commonly in patients with nonalcoholic steatohepatitis-related compensated cirrhosis.
Collapse
Affiliation(s)
- Ajay Duseja
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shivaram P Singh
- Department of Gastroenterology, SCB Medical College, Cuttack, India
| | - Manu Mehta
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shalimar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Jayanthi Venkataraman
- Department of Hepatology, Sri Ramachandra Institute of Higher Education & Research, Chennai, India
| | - Varun Mehta
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, India
| | - Krishnadas Devadas
- Department of Gastroenterology, Government Medical College, Trivandrum, India
| | | | - Omesh Goyal
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, India
| | | | | | | | - Dibyalochan Praharaj
- Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneshwar, India
| | - Akash Shukla
- Department of Gastroenterology, Seth GSMC & KEM Hospital, Mumbai, India
| | - Brij Sharma
- Department of Gastroenterology, Indira Gandhi Medical College & Hospital, Shimla, India
| | - K Narayanasamy
- Department of Hepatology, Madras Medical College, Chennai, India
| | - Pramod Kumar
- Centre of Liver Sciences, AIG Hospitals, Hyderabad, India
| | | | - Anil Arora
- Department of Gastroenterology and Hepatology, Sir Gangaram Hospital, New Delhi, India
| | - Rajiv Mehta
- Department of Gastroenterology, Surat Institute of Digestive Sciences, Surat, India
| | - Pankaj Asati
- NSC Bose Medical College and Hospital, Jabalpur, India
| | - Piyush Ranjan
- Department of Gastroenterology and Hepatology, Sir Gangaram Hospital, New Delhi, India
| | - Abraham Koshy
- Department of Hepatology, VPS Lakeshore, Kochi, India
| | - Seema Alam
- Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | | | | | | | - Mukul Rastogi
- Department of Hepatology, Gastroenterology and Liver Transplant, Fortis Hospital, Noida, India
| | - Arun J Sanyal
- Division of Gastroenterology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| |
Collapse
|
5
|
Jain M, Kumar GSS, Gowrishankar R, Srinivas M, Joshi V, Venkataraman J. Defaecation disorders among information technology personnel: A cross-sectional study. Natl Med J India 2021; 34:333-336. [PMID: 35818093 DOI: 10.25259/nmji_157_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background Individuals working in the information technology (IT) industry are likely to develop lifestyle disorders. We aimed to determine the presence of defaecation-related disorders in IT personnel in Chennai. Methods This cross-sectional, questionnaire-based study was done from June to December 2018. We included employees between 18 and 60 years of age and excluded those with <1 year stay in Chennai, pregnancy and those who sent incomplete responses. The cohort was classified as normal, irritable bowel syndrome (IBS), faecal evacuation disorder (FED) and a combination of the latter two. Results The overall response rate was 95.6%. The study included 54.7% of men, and the median age was 31 years. The majority of respondents used an Indian toilet (554; 58%). Almost all (96.2%) passed stools daily, and stool consistency was soft in 59%. Based on the study criteria, 180 (18.8%) had FED, 56 (5.9%) had IBS and a small group had a combination of symptoms of IBS and FED (20; 2.1%). Respondents with symptoms of IBS had a higher proportion of comorbid states (p<0.0001), lesser stool frequency (p<0.0001) and required more toilet time (p<0.00001). Conclusion Over one-fourth (26.7%) of the respondents had defaecation-related issues, 18.8% had symptoms suggestive of FED and 5.6% that of IBS, often above 30 years of age.
Collapse
Affiliation(s)
- Mayank Jain
- Department of Gastroenterology, Gleneagles Global Health City, Chennai 600100, Tamil Nadu, India
| | - G S Sameer Kumar
- Department of Gastroenterology, Gleneagles Global Health City, Chennai 600100, Tamil Nadu, India
| | | | - Melpakkam Srinivas
- Department of Gastroenterology, Gleneagles Global Health City, Chennai 600100, Tamil Nadu, India
| | - Vivek Joshi
- Department of Gastroenterology, Gleneagles Global Health City, Chennai 600100, Tamil Nadu, India
| | - Jayanthi Venkataraman
- Department of Hepatology, Institute Hospital Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| |
Collapse
|
6
|
Singh SP, Ahuja V, Ghoshal UC, Makharia G, Dutta U, Zargar SA, Venkataraman J, Dutta AK, Mukhopadhyay AK, Singh A, Thapa BR, Vaiphei K, Sathiyasekaran M, Sahu MK, Rout N, Abraham P, Dalai PC, Rathi P, Sinha SK, Bhatia S, Patra S, Ghoshal U, Poddar U, Mouli VP, Kate V. Management of Helicobacter pylori infection: The Bhubaneswar Consensus Report of the Indian Society of Gastroenterology. Indian J Gastroenterol 2021; 40:420-444. [PMID: 34219211 DOI: 10.1007/s12664-021-01186-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/20/2021] [Accepted: 04/20/2021] [Indexed: 02/04/2023]
Abstract
The Indian Society of Gastroenterology (ISG) felt the need to organize a consensus on Helicobacter pylori (H. pylori) infection and to update the current management of H. pylori infection; hence, ISG constituted the ISG's Task Force on Helicobacter pylori. The Task Force on H. pylori undertook an exercise to produce consensus statements on H. pylori infection. Twenty-five experts from different parts of India, including gastroenterologists, pathologists, surgeons, epidemiologists, pediatricians, and microbiologists participated in the meeting. The participants were allocated to one of following sections for the meeting: Epidemiology of H. pylori infection in India and H. pylori associated conditions; diagnosis; treatment and retreatment; H. pylori and gastric cancer, and H. pylori prevention/public health. Each group reviewed all published literature on H. pylori infection with special reference to the Indian scenario and prepared appropriate statements on different aspects for voting and consensus development. This consensus, which was produced through a modified Delphi process including two rounds of face-to-face meetings, reflects our current understanding and recommendations for the diagnosis and management of H. pylori infection. These consensus should serve as a reference for not only guiding treatment of H. pylori infection but also to guide future research on the subject.
Collapse
Affiliation(s)
- Shivaram Prasad Singh
- Department of Gastroenterology, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, 753 007, India.
| | - Vineet Ahuja
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Govind Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Showkat Ali Zargar
- Department of Gastroenterology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, 190 011, India
| | - Jayanthi Venkataraman
- Department of Hepatology, Sri Ramachandra Medical Centre, No. 1 Ramachandra Nagar, Porur, Chennai, 600 116, India
| | - Amit Kumar Dutta
- Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore, 632 004, India
| | - Asish K Mukhopadhyay
- Division of Bacteriology, National Institute of Cholera and Enteric Diseases, Kolkata, 700 010, India
| | - Ayaskanta Singh
- Department of Gastroenterology, IMS and Sum Hospital, Bhubaneswar, 756 001, India
| | - Babu Ram Thapa
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Superspeciality of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Kim Vaiphei
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160 012, India
| | - Malathi Sathiyasekaran
- Department of Pediatric Gastroenterology, Kanchi Kamakoti Childs Trust Hospital, Chennai, 600 034, India
| | - Manoj K Sahu
- Department of Gastroenterology, IMS and Sum Hospital, Bhubaneswar, 756 001, India
| | - Niranjan Rout
- Department of Pathology, Acharya Harihar Post Graduate Institute of Cancer, Manglabag, Cuttack, 753 007, India
| | - Philip Abraham
- P D Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Cadel Road, Mahim, Mumbai, 400 016, India
| | - Prakash Chandra Dalai
- Gastro and Kidney Care Hospital, IRC Village, Nayapalli, Bhubaneswar, 751 015, India
| | - Pravin Rathi
- Department of Gastroenterology, Topiwala National Medical College and B Y L Nair Charitable Hospital, Dr Anandrao Laxman Nair Marg, Mumbai, 400 008, India
| | - Saroj K Sinha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Shobna Bhatia
- Department of Gastroenterology and Hepatobiliary Sciences, Sir HN Reliance Foundation Hospital and Research Centre, Raja Rammohan Roy Road, Prarthana Samaj, Girgaon, Mumbai, 400 004, India
| | - Susama Patra
- Department of Pathology, All India Institute of Medical Sciences, Patrapada, Bhubaneswar, 751 019, India
| | - Ujjala Ghoshal
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Ujjal Poddar
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | | | - Vikram Kate
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, 605 006, India
| |
Collapse
|
7
|
Govindarajan R, Ramamoorthy G, Shanmugam RM, Bavanandam S, Murugesan M, Shanmugam C, Arumugam A, Chellamuthu VP, Venkatraj RK, Sampathkumar K, Rejoice P, Kumar KA, Adamali S, Mariappan K, Rathnavel R, Manivasagam VSC, Velusamy A, Arumugam S, Elikkottil TT, Dev AV, Sen M, Palaniappan A, Dorairaj AJ, Kedarisetty CK, Venkataraman J, Karthikeyan M, Somasundaram A, Ramakrishnan A, Madesh VP, Varghese J, Anupa DK, Leelakrishnan V, Swaminathan M, Kantamaneni R, Dhus JU, Murugan N, Natarajan K, Selvi C, Saithanyamurthi HV, Nadaraj A, Jeyaseelan L, Eapen CE. Rodenticide ingestion is an important cause of acute hepatotoxicity in Tamil Nadu, southern India. Indian J Gastroenterol 2021; 40:373-379. [PMID: 34189713 DOI: 10.1007/s12664-021-01178-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 06/25/2020] [Accepted: 03/29/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM Though rodenticidal hepatotoxicity is reported from India, there is no systematic study to assess its magnitude. This study aimed to assess exposure to rodenticide as a risk factor for acute hepatotoxicity in Tamil Nadu, India. METHODS We retrospectively analyzed acute hepatotoxicity caused by ingestion of hepatotoxin or potentially hepatotoxic drug overdose across 15 hospitals in 6 districts of Tamil Nadu from 1 January 2019 to 30 June 2019. Study exclusion criteria were idiosyncratic drug-induced liver injury and chronic liver diseases. RESULTS Of the 702 patients, 685 gave history of consuming rodenticide; hepatotoxicity in the other patients resulted from paracetamol overdose (n=10) and due to other drugs (n=7); 97% patients had a suicidal intent. Of 671 patients with complete data, ratio of number of patients with hepatotoxicity due to rodenticide to paracetamol overdose was 450:6 (i.e. 75:1). The 451 rodenticidal hepatotoxicity patients (255 males, 75% were 15-34 years old) underwent conservative management (n=396), plasma exchange (n=54) and plasma exchange followed by liver transplant (n=1); 159 patients (35%) had poor outcome (131 died, 28 discharged in moribund state). Based on our observations, we estimate a case burden of 1584 rodenticidal hepatotoxicity patients (95% CI: 265-6119) with poor outcome in 554 patients in Tamil Nadu from January 2019 to June 2019. Population attributable risk for rodenticide as cause of hepatotoxicity was 22.7%. CONCLUSION Rodenticide ingestion was an important cause of acute hepatotoxicity in Tamil Nadu. Most patients were young and one-third had poor outcome. Public health interventions are needed to address this.
Collapse
Affiliation(s)
- Ramkumar Govindarajan
- Department of Medical Gastroenterology, Thanjavur Medical College, Thanjavur, 613 004, India
| | - Ganesan Ramamoorthy
- Department of Medical Gastroenterology, Thanjavur Medical College, Thanjavur, 613 004, India
| | | | - Sumathi Bavanandam
- Department of Medical Gastroenterology, Stanley Medical College, Chennai, 600 001, India
| | - Manimaran Murugesan
- Department of Medical Gastroenterology, Stanley Medical College, Chennai, 600 001, India
| | - Chitra Shanmugam
- Department of Medical Gastroenterology, Stanley Medical College, Chennai, 600 001, India
| | - Aravind Arumugam
- Department of Medical Gastroenterology, Government Kilpauk Medical College, Chennai, 600 010, India.,Department of Digestive Health and Diseases, Government Kilpauk Medical College, Chennai, 600 010, India
| | - Vaishnavi Priyaa Chellamuthu
- Department of Medical Gastroenterology, Government Kilpauk Medical College, Chennai, 600 010, India.,Department of Digestive Health and Diseases, Government Kilpauk Medical College, Chennai, 600 010, India
| | | | - Kavitha Sampathkumar
- Department of Medical Gastroenterology, Government Kilpauk Medical College, Chennai, 600 010, India.,Department of Digestive Health and Diseases, Government Kilpauk Medical College, Chennai, 600 010, India
| | - Poppy Rejoice
- Department of Medical Gastroenterology, Tirunelveli Medical College, Tirunelveli, 627 011, India
| | - Kandasamy Alias Kumar
- Department of Medical Gastroenterology, Tirunelveli Medical College, Tirunelveli, 627 011, India
| | - Shafique Adamali
- Department of Medical Gastroenterology, Tirunelveli Medical College, Tirunelveli, 627 011, India
| | - Kannan Mariappan
- Department of Medical Gastroenterology, Government Rajaji Hospital, Madurai Medical College, Madurai, 625 020, India
| | - Ramani Rathnavel
- Department of Medical Gastroenterology, Government Rajaji Hospital, Madurai Medical College, Madurai, 625 020, India
| | | | - Arulselvan Velusamy
- Department of Medical Gastroenterology, Government Medical College, Coimbatore, 641 018, India
| | - Senthilvadivu Arumugam
- Department of Medical Gastroenterology, Government Medical College, Coimbatore, 641 018, India
| | - Thasneem Taj Elikkottil
- Department of Medical Gastroenterology, Government Medical College, Coimbatore, 641 018, India
| | - Anand Vimal Dev
- Department of Hepatology, Christian Medical College, Vellore, 632 004, India
| | - Mousumi Sen
- Department of Forensic Medicine, Christian Medical College, Vellore, 632 004, India
| | - Alagammai Palaniappan
- Department of Gastroenterology, Meenakshi Mission Hospital and Research Centre, Madurai, 625 107, India
| | - Allwin James Dorairaj
- Department of Gastroenterology, Meenakshi Mission Hospital and Research Centre, Madurai, 625 107, India
| | - Chandan Kumar Kedarisetty
- Department of Hepatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, 600 116, India
| | - Jayanthi Venkataraman
- Department of Hepatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, 600 116, India
| | - Mugilan Karthikeyan
- Department of Hepatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, 600 116, India
| | - Aravindh Somasundaram
- Department of Gastroenterology, Kovai Medical Center Hospital, Coimbatore, 641 014, India
| | - Arulraj Ramakrishnan
- Department of Gastroenterology, Kovai Medical Center Hospital, Coimbatore, 641 014, India
| | - Vijaya Prakash Madesh
- Department of Gastroenterology, Kovai Medical Center Hospital, Coimbatore, 641 014, India
| | - Joy Varghese
- Department of Hepatology and Transplant Hepatology, Gleneagles Global Health City Hospital, Chennai, 600 100, India
| | - Dheeraj Kumar Anupa
- Department of Hepatology and Transplant Hepatology, Gleneagles Global Health City Hospital, Chennai, 600 100, India
| | - Venkatakrishnan Leelakrishnan
- Department of Gastroenterology and Hepatology, PSG Institute of Medical Sciences and Research, Coimbatore, 641 004, India
| | - Mukundan Swaminathan
- Department of Gastroenterology and Hepatology, PSG Institute of Medical Sciences and Research, Coimbatore, 641 004, India
| | - Ravindra Kantamaneni
- Department of Gastroenterology and Hepatology, PSG Institute of Medical Sciences and Research, Coimbatore, 641 004, India
| | - Jeyaraj Ubal Dhus
- Department of Medical Gastroenterology and Hepatology, Apollo Hospitals, Chennai, 600 006, India
| | - Natarajan Murugan
- Department of Medical Gastroenterology and Hepatology, Apollo Hospitals, Chennai, 600 006, India
| | - Kartik Natarajan
- Department of Medical Gastroenterology and Hepatology, Apollo Hospitals, Chennai, 600 006, India
| | - Caroline Selvi
- Department of Medical Gastroenterology, Government Royapettah Hospital, Kilpauk Medical College, Chennai, 600 010, India
| | | | - Ambily Nadaraj
- Clinical Epidemiology Unit, Christian Medical College, Vellore, 632 004, India
| | | | | |
Collapse
|
8
|
Key Words
- ALF, Acute Liver Failure
- ALI, Acute Liver Injury
- HDU, High Dependency Unit
- ICU, Intensive Care Unit
- INASL, Indian National Association for the study of Liver
- KCH, King's College Hospital
- LT, Liver transplantation
- MELD, Model for End-Stage Liver Disease
- PLEX, Plasma Exchange
- TN, Tamil Nadu
- YPP, Yellow Phosphorus Poison
- vWF, von Willebrand Factor
Collapse
Affiliation(s)
| | - Jayanthi Venkataraman
- Department of Hepatology, Sri Ramachandra Institute of Higher Education & Research, Chennai, India
| |
Collapse
|
9
|
Tapadia A, Jain M, Reddy MS, Mahadevan B, Varghese J, Venkataraman J. Serum C-reactive protein and neutrophil-to-lymphocyte ratio as predictors of survival in cirrhotic patients with systemic inflammatory response syndrome and bacterial infection. Indian J Gastroenterol 2021; 40:265-271. [PMID: 33974227 DOI: 10.1007/s12664-020-01134-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/04/2019] [Accepted: 11/29/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cirrhotic patients are prone to infections due to underlying immune dysfunction in them. We aimed to study the role of inflammatory markers, serum C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR), in predicting infection, blood culture positivity, and short-term (1 month) mortality in hospitalized cirrhotic patients. METHODS This prospective study was done over a period of 14 months (October 2017 to November 2018). Patient data included age, gender, etiology of cirrhosis, reason for admission, and comorbidity. Laboratory tests included blood chemistry and blood cell counts, and blood and urine culture. The specific tests included were CRP and NLR. Survival of patients in the following 1 month was noted. Area under receiver operating characteristic curve (AUROC), sensitivity, specificity, predictive values, diagnostic accuracy were calculated and logistic regression analysis performed. A p-value < 0.05 was considered significant. RESULTS Two hundred and eight patients formed the study cohort. The median age was 51.5 years and male predominance was noted. Alcohol-related liver disease (49%) was the commonest etiology. The infection rate was 62%, culture positivity was 58.5%, and mortality was 30.8%. NLR and CRP were significantly higher in those with documented infection (culture positive or negative) and among nonsurvivors. Optimal cutoffs for NLR and CRP to predict infection were 5.86 and 33.7, respectively. The risk of having an infection was 7.5 times and about 15 times if NLR and CRP were above the cutoffs. The risk of 1-month mortality was 2-3 times higher if patients had NLR and CRP above the cutoffs. The combination of NLR and CRP (≥ 5.86 and ≥ 33.7, respectively) increased specificity and diagnostic accuracy for infection. CONCLUSION NLR and CRP were independently good predictors of infection and 1-month survival among the patients with cirrhosis of liver included in this study.
Collapse
Affiliation(s)
- Ashishkumar Tapadia
- Department of Gastroenterology and Hepatology, Gleneagles Global Health City, Chennai 600, 100, India
| | - Mayank Jain
- Department of Gastroenterology and Hepatology, Gleneagles Global Health City, Chennai 600, 100, India.
- Department of Gastroenterology, Arihant Hospital and Research Centre, Indore, 452 009, India.
| | - Mettu Srinivas Reddy
- Institute of Liver Disease and Transplantation, Dr. Rela's Institute of Medical Sciences, Chennai 600 044, India
| | - B Mahadevan
- Department of Gastroenterology and Hepatology, Gleneagles Global Health City, Chennai 600, 100, India
| | - Joy Varghese
- Department of Gastroenterology and Hepatology, Gleneagles Global Health City, Chennai 600, 100, India
| | - Jayanthi Venkataraman
- Department of Gastroenterology and Hepatology, Gleneagles Global Health City, Chennai 600, 100, India
- Department of Hepatology, Sri Ramachandra Medical College, Porur, Chennai 600 116, India
| |
Collapse
|
10
|
Abstract
Inflammatory bowel disease (IBD) in recent times is causing a significant healthcare burden as both ulcerative colitis and Crohn's disease (CD) require lifelong therapy and constant monitoring. The current review highlights the concerns in a country like India with special reference to the changing trends of IBD, risk attribution and the financial issues. Indian immigrants behave like residential Indians, whereas their children show IBD prevalence similar to the West, highlighting the role of environmental triggers. However, the environmental and genetic factors in Indians with IBD are not well understood. Men appear to be more frequently affected than women in India. The disease severity is milder in the patients, both males and females, but the risk for colorectal cancer (CRC) is similar to the West. The incidence of paediatric IBD is on the rise. The major burden of IBD in the Indian subcontinent at present is in children, adolescents and teens. Cost towards the management of complications, non-adherence to treatment, differentiating tuberculosis from CD and finally screening for CRC in patients with IBD are the points to ponder in the Indian scenario.
Collapse
Affiliation(s)
- Mayank Jain
- Department of Medical Gastroenterology, Gleneagles Global Health City, Chennai, India
| | - Jayanthi Venkataraman
- Department of Medical Gastroenterology, Gleneagles Global Health City, Chennai, India
| |
Collapse
|
11
|
Tapadia A, Mahadevan B, Jain M, Sameer Kumar GS, Venkataraman J. Hereditary haemorrhagic telangiectasia. Natl Med J India 2021; 33:60. [PMID: 33565494 DOI: 10.4103/0970-258x.308260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Ashishkumar Tapadia
- Institute of GI Sciences and Research, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - B Mahadevan
- Institute of GI Sciences and Research, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - Mayank Jain
- Institute of GI Sciences and Research, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - G S Sameer Kumar
- Institute of GI Sciences and Research, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - Jayanthi Venkataraman
- Institute of GI Sciences and Research, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| |
Collapse
|
12
|
Devarbhavi H, Joseph T, Sunil Kumar N, Rathi C, Thomas V, Prasad Singh S, Sawant P, Goel A, Eapen CE, Rai P, Arora A, Leelakrishnan V, Gopalakrishnan G, Vardhan Reddy V, Singh R, Goswami B, Venkataraman J, Balaraju G, Patil M, Patel R, Taneja S, Koshy A, Nagaraja Rao P, Kumar Sarin S, Rathi P, Dhiman R, Duseja AK, Vargese J, Kumar Jain A, Wadhawan M, Ranjan P, Karanth D, Ganesh P, Nijhawan S, Krishna Dhali G, Adarsh CK, Jhaveri A, Nagral A, Rao P, Shalimar. The Indian Network of Drug-Induced Liver Injury: Etiology, Clinical Features, Outcome and Prognostic Markers in 1288 Patients. J Clin Exp Hepatol 2021; 11:288-298. [PMID: 33994711 PMCID: PMC8103312 DOI: 10.1016/j.jceh.2020.11.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [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: 06/21/2020] [Accepted: 11/09/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Etiology of and outcomes following idiosyncratic drug-induced liver injury (DILI) vary geographically. We conducted a prospective study of DILI in India, from 2013 to 2018 and summarize the causes, clinical features, outcomes and predictors of mortality. METHODS We enrolled patients with DILI using international DILI expert working group criteria and Roussel Uclaf causality assessment method. Follow-up was up to 3 months from onset of DILI or until death. Multivariate logistics regression was carried out to determine predictors of non-survival. RESULTS Among 1288 patients with idiosyncratic DILI, 51.4% were male, 68% developed jaundice, 68% required hospitalization and 8.2% had co-existing HIV infection. Concomitant features of skin reaction, ascites, and encephalopathy (HE) were seen in 19.5%, 16.4%, and 10% respectively. 32.4% had severe disease. Mean MELD score at presentation was 18.8 ± 8.8. Overall mortality was 12.3%; 65% in those with HE, 17.6% in patients who fulfilled Hy's law, and 16.6% in those that developed jaundice. Combination anti-TB drugs (ATD) 46.4%, complementary and alternative medicines (CAM) 13.9%, anti-epileptic drugs (AED) 8.1%, non-ATD antimicrobials 6.5%, anti-metabolites 3.8%, anti-retroviral drugs (ART)3.5%, NSAID2.6%, hormones 2.5%, and statins 1.4% were the top 9 causes. Univariate analysis identified, ascites, HE, serum albumin, bilirubin, creatinine, INR, MELD score (p < 0.001), transaminases (p < 0.04), and anti-TB drugs (p = 0.02) as predictors of non-survival. Only serum creatinine (p = 0.017), INR (p < 0.001), HE (p < 0.001), and ascites (p = 0.008), were significantly associated with mortality on multivariate analysis. ROC yielded a C-statistic of 0.811 for MELD and 0.892 for combination of serum creatinine, INR, ascites and HE. More than 50 different agents were associated with DILI. Mortality varied by drug class: 15% with ATD, 13.6% with CAM, 15.5% with AED, 5.8% with antibiotics. CONCLUSION In India, ATD, CAM, AED, anti-metabolites and ART account for the majority of cases of DILI. The 3-month mortality was approximately 12%. Hy's law, presence of jaundice or MELD were predictors of mortality.
Collapse
Key Words
- AED, Anti-epileptic drugs
- ALF, Acute liver failure
- ALT, Alanine aminotransferase
- ART, Anti-retroviral drugs
- AST, Aspartate aminotransferase
- ATD, Anti- tuberculosis drugs
- Anti-tuberculosis drugs
- C.I, Confidence interval
- CAM, Complementary and alternative medicine
- Complimentary medicines
- DILI, Drug-induced liver injury
- DILIN, Drug induced liver injury network
- HE, Hepatic encephalopathy
- HIV, Human immunodeficiency virus
- INR, International normalised ratio
- Isoniazid
- Jaundice
- MELD, Model for end stage liver disease
- Mortality
- NSAID, Nonsteroidal anti-inflammatory drugs
- OR, Odds ratio
- Prognosis
- Pyrazinamide
- ROC, Receiver operating characteristic
- RUCAM, Roussel uclaf causality assessment method
- Rifampicin
- TB, Tuberculosis.
- TCM, Traditional chinese medicines.
- Traditional medicines
- ULN, Upper limit of normal
- USA, United states of america
Collapse
Affiliation(s)
- Harshad Devarbhavi
- Department of Gastroenterology, St. John's Medical College Hospital, Bangalore, India,Address for correspondence. Harshad Devarbhavi, Department of Gastroenterology and Hepatology, St. John's Medical College Hospital, Bangalore, India.
| | - Tarun Joseph
- Department of Gastroenterology, St. John's Medical College Hospital, Bangalore, India
| | | | - Chetan Rathi
- Department of Gastroenterology, LTM Medical College Hospital, Mumbai, India
| | - Varghese Thomas
- Department of Gastroenterology, Government Medical College, Kozhikode, India
| | | | - Prabha Sawant
- Department of Gastroenterology, LTM Medical College Hospital, Mumbai, India
| | - Ashish Goel
- Department of Gastroenterology, Christian Medical College, Vellore, India
| | | | - Prakash Rai
- Department of General Medicine, Holy Spirit Hospital, Mumbai, India
| | - Anil Arora
- Department of Gastroenterology, Sir Ganga Ram Hospital, New Delhi, India
| | | | | | - Vishnu Vardhan Reddy
- Department of Gastroenterology, St. John's Medical College Hospital, Bangalore, India
| | - Rajvir Singh
- Acute Care Surgery, HGH, Hamad Medical Corporation, Doha, Qatar
| | - Bhabadev Goswami
- Department of Gastroenterology, Dispur Hospitals, Guwahati, India
| | | | - Girisha Balaraju
- Department of Gastroenterology, Kasturba Medical College Hospital, Manipal, India
| | - Mallikarjun Patil
- Department of Gastroenterology, St. John's Medical College Hospital, Bangalore, India
| | - Rakesh Patel
- Department of Gastroenterology, Suyash Endoscopy Centre, Thane, India
| | - Sunil Taneja
- Department of Hepatology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Abraham Koshy
- Department of Gastroenterology, Lakeshore Hospital, Kochi, India
| | - Padaki Nagaraja Rao
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Pravin Rathi
- Department of Gastroenterology, B.Y.L. Nair Hospital, Mumbai, India
| | - Radhakrishna Dhiman
- Department of Hepatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ajay K. Duseja
- Department of Hepatology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Joy Vargese
- Department of Hepatology, Gleneagles Global Health City, Chennai, India
| | - Ajay Kumar Jain
- Department of Gastroenterology, Choithram Hospital and Research Centre, Indore, India
| | - Manav Wadhawan
- Department of Gastroenterology, BLK Super Speciality Hospital, New Delhi, India
| | - Piyush Ranjan
- Department of Gastroenterology, Sir Ganga Ram Hospital, New Delhi, India
| | - Dheeraj Karanth
- Department of Gastroenterology, Vikram Hospital, Bangalore, India
| | | | - Sandeep Nijhawan
- Department of Gastroenterology, Sawai Man Singh Medical College, Jaipur, India
| | - Gopal Krishna Dhali
- School of Digestive and Liver Diseases, Institute of Post Graduate Medical Education & Research, Kolkata, India
| | - Channagiri K. Adarsh
- Department of Gastroenterology, BGS Gleneagles Global Hospitals, Bangalore, India
| | - Ajay Jhaveri
- Department of Gastroenterology, Jaslok Hospital and Research Center, Mumbai, India
| | - Aabha Nagral
- Department of Gastroenterology, Jaslok Hospital and Research Center, Mumbai, India
| | - Prasanna Rao
- Department of Gastroenterology, Apollo Hospitals, Bangalore, India
| | - Shalimar
- Department of Gastroenterology and Hepatology, AIIMS, New Delhi, India
| |
Collapse
|
13
|
Bhargav V, Jain M, Alen T, Kedarisetty C, Arthur P, Karthikeyan M, Selvan T, Venkataraman J. Clusters and components of metabolic syndrome (MeS) as a predictor for fatty liver: A cross-sectional study. J Diabetol 2021. [DOI: 10.4103/jod.jod_17_21] [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: 03/19/2023] Open
|
14
|
|
15
|
Sood A, Ahuja V, Kedia S, Midha V, Mahajan R, Mehta V, Sudhakar R, Singh A, Kumar A, Puri AS, Tantry BV, Thapa BR, Goswami B, Behera BN, Ye BD, Bansal D, Desai D, Pai G, Yattoo GN, Makharia G, Wijewantha HS, Venkataraman J, Shenoy KT, Dwivedi M, Sahu MK, Bajaj M, Abdullah M, Singh N, Singh N, Abraham P, Khosla R, Tandon R, Misra SP, Nijhawan S, Sinha SK, Bopana S, Krishnaswamy S, Joshi S, Singh SP, Bhatia S, Gupta S, Bhatia S, Ghoshal UC. Second correction to: Diet and inflammatory bowel disease: The Asian Working Group guidelines. Indian J Gastroenterol 2020; 39:627-628. [PMID: 33219987 DOI: 10.1007/s12664-020-01112-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Ajit Sood
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, 141 001, India.
| | - Vineet Ahuja
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110 023, India
| | - Saurabh Kedia
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110 023, India
| | - Vandana Midha
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | - Ramit Mahajan
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | - Varun Mehta
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | - Ritu Sudhakar
- Department of Dietetics, Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | - Arshdeep Singh
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | - Ajay Kumar
- BLK Super Speciality Hospital, New Delhi, 110 005, India
| | | | | | - Babu Ram Thapa
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Bhabhadev Goswami
- Department of Gastroenterology, Gauhati Medical College, Guwahati, 781 032, India
| | - Banchha Nidhi Behera
- Department of Dietetics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Byong Duk Ye
- Department of Gastroenterology, Asan Medical Center, Seoul, South Korea
| | - Deepak Bansal
- Consultant Gastroenterology, Max Hospital, Bathinda, 151 001, India
| | - Devendra Desai
- Hinduja Hospital and Medical Research Centre, Mumbai, 400 016, India
| | - Ganesh Pai
- Department of Gastroenterology, Kasturba Medical College, Manipal, 576 104, India
| | | | - Govind Makharia
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110 023, India
| | | | | | - K T Shenoy
- Department of Gastroenterology, Sree Gokulam Medical College and Research Foundation, Trivandrum, 695 011, India
| | - Manisha Dwivedi
- Department of Gastroenterology, Moti Lal Nehru Medical College, Allahabad, 211 001, India
| | - Manoj Kumar Sahu
- Department of Gastroenterology, IMS and Sum Hospital, Bhubaneswar, 756 001, India
| | - Meenakshi Bajaj
- Dietician, Tamil Nadu Govt. Multi Super Speciality Hospital, Chennai, 600 010, India
| | - Murdani Abdullah
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Namrata Singh
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110 023, India
| | - Neelanjana Singh
- Pushpawati Singhania Research Institute, New Delhi, 110 001, India
| | - Philip Abraham
- P D Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Cadel Road, Mahim, Mumbai, 400 016, India
| | - Rajiv Khosla
- Max Super Speciality Hospital, Saket, New Delhi, 110 017, India
| | - Rakesh Tandon
- Pushpawati Singhania Research Institute, New Delhi, 110 001, India
| | - S P Misra
- Department of Gastroenterology, Moti Lal Nehru Medical College, Allahabad, 211 001, India
| | - Sandeep Nijhawan
- Department of Gastroenterology, SMS Medical College, Jaipur, 302 004, India
| | - Saroj Kant Sinha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Sawan Bopana
- Fortis Hospital, Vasant Kunj, New Delhi, 110 070, India
| | | | - Shilpa Joshi
- Mumbai Diet and Health Centre, Mumbai, 400 001, India
| | - Shivram Prasad Singh
- Department of Gastroenterology, Sriram Chandra Bhanj Medical College and Hospital, Cuttack, 753 001, India
| | - Shobna Bhatia
- Department of Gastroenterology, King Edward Memorial Hospital, Mumbai, 400 012, India
| | - Sudhir Gupta
- Shubham Gastroenterology Centre, Nagpur, 440 001, India
| | | | - Uday Chand Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| |
Collapse
|
16
|
Jain M, Venkataraman J. Identification of demographic and environmental factors predisposing to ulcerative colitis in southern India. Indian J Gastroenterol 2020; 39:619-620. [PMID: 33058002 DOI: 10.1007/s12664-020-01036-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Mayank Jain
- Department of Gastroenterology, Gleneagles Global Health City, Chennai, 600 100, India.
| | - Jayanthi Venkataraman
- Department of Gastroenterology, Gleneagles Global Health City, Chennai, 600 100, India
| |
Collapse
|
17
|
Kedarisetty CK, Samaga BL, Vidyasagar S, Venkataraman J. Oral melatonin improves the detection of parasitemia in malaria. J Infect Dev Ctries 2020; 14:1327-1331. [PMID: 33296347 DOI: 10.3855/jidc.12518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/11/2020] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Malaria is a growing global threat and a major cause of mortality in the tropics. The gold standard diagnosis is peripheral blood smear examination. It has been demonstrated that melatonin acts as messenger molecule in malaria pathophysiology. This concept was used to evolve a clinical study wherein use of exogenous melatonin could improve the chance of detection of the parasite. METHODOLOGY In a prospective study, 80 consecutive patients seen in the Department of Medicine at Kasturba Hospital, Manipal, suspected to have malarial fever were enrolled with proper informed consent, and randomly assigned to the groups given oral melatonin 3mg (melatonin group, n = 40) or placebo (control group, n = 40). Blood samples were collected for peripheral smear examination at baseline and then at two, three, four and five hours after drug administration. The primary end point was the parasite detection index. RESULTS Baseline characteristics of patients were comparable. In the melatonin group, there was a significant increase of 0.0943 ± 0.22 in the mean parasite index from 0.217 ± 0.42 pre-melatonin to 0.3114 ± 0.5 post-melatonin (p = 0.001), compared to a difference of 0.0025 ± 0.22 in mean parasite index before and after placebo in the control group (p = 0.95). The maximum rise in parasite detection was seen at five hours after melatonin. CONCLUSIONS In a single centre study, for the first time, it has been shown that a significantly higher proportion of patients was diagnosed with malaria on peripheral smear after oral melatonin administration, maximal at five hours after administration of melatonin.
Collapse
Affiliation(s)
| | | | - Sudha Vidyasagar
- Department of Medicine, Kasturba Medical College, Manipal, India.
| | - Jayanthi Venkataraman
- Department of Hepatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.
| |
Collapse
|
18
|
Jain M, Baijal N, Srinivas M, Baijal R, Pratap N, Bachkaniwala V, Ganesh P, Venkataraman J. Retrospective study on symptoms and treatment modalities used and short-term follow up of achalasia cardia in Indian setting. JGH Open 2020; 4:856-859. [PMID: 33102755 PMCID: PMC7578270 DOI: 10.1002/jgh3.12328] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/06/2020] [Accepted: 03/13/2020] [Indexed: 12/20/2022]
Abstract
Background Achalasia cardia is a rare esophageal motor disorder that is frequently diagnosed late. Aim The aim of this study was to study the symptoms, treatment given, and response to treatment in patients with achalasia cardia in an Indian setting. Materials and methods This retrospective study included all patients diagnosed with achalasia cardia on high‐resolution esophageal manometry, using Chicago Classification v 3.0. On follow up, patients were contacted by telephone, and details of the treatment given and response were recorded in a predesigned pro forma. We excluded overseas patients, postoperative cases of achalasia, and those in whom the manometry catheter could not be passed across the gastroesophageal junction. Results A total of 452 patients (260 males, median age 44.5 years) were included in the study cohort. The major symptoms included dysphagia for solids and liquids (428, 94.7%), regurgitation (360, 79.6%), naso‐oral regurgitation (182, 40.3%), weight loss (322, 71.3%), and chest pain (158, 35%). Type 2 achalasia (229, 50.6%) was the most common subtype, followed by type 3 (154, 34.1%). Chest pain was more common in type 3, and weight loss and naso‐oral regurgitation were more common in type 2 achalasia. A majority of patients underwent Heller's myotomy and pneumatic dilatation. Of 280 patients for whom treatment details were available, 98% reported good response to endoscopic/surgical management. Conclusion The predominant symptoms of achalasia cardia vary per the manometric subtype. Heller's myotomy and pneumatic dilatation are the most commonly used treatment options. Response to treatment is good. The choice of treatment modality was likely influenced by financial reasons and availability of local expertise.
Collapse
Affiliation(s)
- Mayank Jain
- Arihant Hospital and Research Centre Indore India
| | - Neha Baijal
- Maulana Azad Medical College New Delhi India
| | | | - Rajiv Baijal
- Pushpavati Singhania Hospital and Research Centre New Delhi India
| | - Nitesh Pratap
- Krishna Institute of Medical Sciences Secunderabad India
| | | | - P Ganesh
- Sri Ramachandra Medical College Chennai India
| | - Jayanthi Venkataraman
- Gleneagles Global Health City Chennai India.,Sri Ramachandra Medical College Chennai India
| |
Collapse
|
19
|
Bokarvadia RK, Mahadevan B, Jain M, Ravi R, Paghadar S, Chenduran SNK, Venkataraman J. Tuberculosis masquerading as a retroperitoneal pseudotumour. Natl Med J India 2020; 32:317. [PMID: 32985455 DOI: 10.4103/0970-258x.295961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - B Mahadevan
- Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - Mayank Jain
- Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - R Ravi
- Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | | | | | | |
Collapse
|
20
|
Sanglodkar U, Jain M, Venkataraman J. Predictors of immediate and short-term mortality in spontaneous bacterial peritonitis. Indian J Gastroenterol 2020; 39:331-337. [PMID: 32770323 DOI: 10.1007/s12664-020-01040-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 08/31/2018] [Accepted: 04/13/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is scarce data from the Indian subcontinent on the outcomes following spontaneous bacterial peritonitis (SBP). AIM To study the immediate (within 30 days) and short-term mortality (31-90 days) associated with SBP and to determine the predictors of the same. METHODS This prospective observational study was done among patients with liver cirrhosis who underwent paracentesis. Patient data included age, gender, co-morbidity, cirrhosis-related complications, model of end-stage liver disease (MELD), and Child-Turcotte-Pugh (CTP) scores. SBP was diagnosed based on ascitic fluid polymorphonuclear leukocyte count > 250/mm3 with or without ascitic fluid culture positivity. RESULTS Of the 870 patients with cirrhosis and ascites registered during the study period, 610 fulfilled the criteria for inclusion. Altogether, 122 patients with SBP were identified: 52 (42.6%) died, 40 (32.8%) survived without liver transplant, and 30 (24.6%) underwent liver transplantation within 3 months. Thirty-two patients (26.2%) were blood culture posi tive for bacteria and 7 (5.7%) demonstrable bacterial growth in ascitic fluid. Blood culture positivity was significantly higher in the group with immediate mortality (p < 0.0001) and was also significantly associated (p 0.005) with mortality at 3 months. CONCLUSION Nearly two-fifths (42.6%) of the study cohort died within 3 months of an episode of SBP. Four-fifths of these patients died within 30 days. Blood culture positivity was significantly associated with immediate and short-term mortality.
Collapse
Affiliation(s)
- Uday Sanglodkar
- Department of Gastroenterology, Gleneagles Global Health City, Chennai, 600 100, India
| | - Mayank Jain
- Department of Gastroenterology, Gleneagles Global Health City, Chennai, 600 100, India.
| | - Jayanthi Venkataraman
- Department of Gastroenterology, Gleneagles Global Health City, Chennai, 600 100, India
| |
Collapse
|
21
|
Abstract
AbstractThe major drawback of conventional white light endoscopy (WLE) is that it lacks accuracy in diagnosis and differentiation of various benign and premalignant mucosal gastrointestinal lesions. To overcome this, image-enhanced endoscopy techniques, which provide high-definition images with good resolution and contrast enhancement, have been developed. One such technique is narrow-band imaging (NBI). NBI functions by filtering the illumination light. The red component of the standard red, green, and blue filters is rejected and the selected bandwidth of the blue and green light is transmitted. The present review highlights the role of NBI in diagnosis of benign gastric lesions like atrophic gastritis, Helicobacter pylori–related gastritis, intestinal metaplasia, and other rarer conditions. NBI is a simple procedure which does not require any additional equipment and does not have a long learning curve. Use of NBI in daily practice is likely to improve detection of mucosal abnormalities.
Collapse
Affiliation(s)
- Sameer Paghadhar
- Department of Gastroenterology, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - Mayank Jain
- Department of Gastroenterology, Arihant Hospital and Research Centre, Indore, Madhya Pradesh, India
| | - B. Mahadevan
- Department of Gastroenterology, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - Jayanthi Venkataraman
- Department of Gastroenterology, Sri Ramachandra Medical College, Porur, Chennai, Tamil Nadu, India
| |
Collapse
|
22
|
Varghese J, Joshi V, Bollipalli MK, Malleeswaran S, Patcha R, Nair H, Vij V, Sachan D, Subramanian P, Jain M, Venkataraman J. Role of therapeutic plasma exchange in acute liver failure due to yellow phosphorus poisoning. Indian J Gastroenterol 2020; 39:544-549. [PMID: 33409946 PMCID: PMC7787244 DOI: 10.1007/s12664-020-01095-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 09/14/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Therapeutic plasma exchange (TPE) has been utilized in various liver disorders. There is limited data on the efficacy of TPE in patients with acute liver failure (ALF). METHODS Study group consisted of patients who underwent TPE for ALF due to yellow phosphorous poisoning (YPP) between 2015 and 2019. Demographic data and biochemical parameters were recorded before and after TPE. Overall survival and transplant-free survival (based on King's College Hospital Criteria [KCHC]) were analyzed. RESULTS Forty-three patients underwent TPE for ALF due to YPP. Most of them were young males. Overall survival was 34 (79.06%). In our study population, 20 patients fulfilled KCHC (Group A) and 23 did not fulfill KCHC (Group B). Both the groups showed significant improvement in alanine aminotransferase, aspartate aminotransferase, and international normalized ratio (INR) after TPE (p < 0.05). In Group B, there was significant improvement in ammonia after TPE (p < 0.05) and all 23 patients (100%) survived after TPE. In Group A, 4 underwent liver transplantation (LT), 7 survived without LT, and the remaining 9 died without LT. Mean survival after completing TPE was 41.2 ± 44.5 days in Group A and 90 days in Group B. This difference was statistically significant (p = 0.001). There was statistically significant difference in post-TPE values of INR (p = 0.012) and ammonia (p = 0.011) between non-survivors and survivors. Adverse events such as hypotension (11.62%) and minor allergic reaction (4.65%) were managed conservatively. CONCLUSION TPE is an effective procedure in ALF due to YPP, not fulfilling KCHC for LT. In KCHC fulfilled group, though it shows LT-free survival benefit, there is requirement of prospective, large volume, multi-center study to assess its efficacy.
Collapse
Affiliation(s)
- Joy Varghese
- Department of Hepatology and Transplant Hepatology, Institute of Liver Diseases and Transplantation, Gleneagles Global Health City, Chennai 600 100, India
| | - Vivek Joshi
- Department of Hepatology and Transplant Hepatology, Institute of Liver Diseases and Transplantation, Gleneagles Global Health City, Chennai 600 100, India
| | | | - Selvakumar Malleeswaran
- Department of Liver Anesthesia and ICU, Gleneagles Global Health City, Chennai 600 100, India
| | - Rajinikanth Patcha
- Department of HPB and Transplantation, Gleneagles Global Health City, Chennai 600 100, India
| | - Harikumar Nair
- Department of Hepatology and Transplant Hepatology, Institute of Liver Diseases and Transplantation, Gleneagles Global Health City, Chennai 600 100, India
| | - Vivek Vij
- Department of HPB and Transplantation, Gleneagles Global Health City, Chennai 600 100, India
| | - Deepti Sachan
- Department of Transfusion Medicine, Dr. Rela Institute and Medical Centre, Chennai 600 044, India
| | - Pushkala Subramanian
- Department of Immunology, The Tamil Nadu Dr. MGR University, Chennai 600 032, India
| | - Mayank Jain
- Department of Hepatology and Transplant Hepatology, Institute of Liver Diseases and Transplantation, Gleneagles Global Health City, Chennai 600 100, India
| | - Jayanthi Venkataraman
- Department of Hepatology, Sri Ramachandra Institute for Higher Education and Research, Chennai 600 116, India
| |
Collapse
|
23
|
Kedarisetty CK, Bhargav VY, Karthikeyan M, Sathiyasekaran BW, Venkataraman J. The Predicament of the PREDICT Study!! J Clin Exp Hepatol 2020; 10:271. [PMID: 32405184 PMCID: PMC7212285 DOI: 10.1016/j.jceh.2019.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 11/14/2019] [Indexed: 12/12/2022] Open
Affiliation(s)
- Chandan K. Kedarisetty
- Address for correspondence. Chandan K. Kedarisetty, DM (Hepatology), Department of Hepatology, Sri Ramachandra Institute of Higher Education and Research, No.1, Ramachandra Nagar, Porur, Chennai 600116.
| | | | | | | | - Jayanthi Venkataraman
- Departments of Hepatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| |
Collapse
|
24
|
Jain M, Venkataraman J, Reddy MS, Rela M. Determinants of Medication Adherence in Liver Transplant Recipients. J Clin Exp Hepatol 2019; 9:676-683. [PMID: 31889747 PMCID: PMC6926177 DOI: 10.1016/j.jceh.2019.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 08/22/2018] [Accepted: 03/07/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aim of this study was to study the determinants of nonadherence to immunosuppressant drugs in liver transplant (LT) recipients using personalised interview and questionnaire methods. METHODS The study was conducted on adult LT recipients (deceased donor liver transplant [DDLT] and living donor liver transplant [LDLT]) from the Indian subcontinent, at post-LT clinic visit between July and December 2016. Recipient details included baseline demography, comorbidity, psychological status, details of addiction, indication and type of transplant. Details on financial support for transplantation, admissions for rejection, infection and posttransplant complications were obtained from the hospital records. An adherence questionnaire was completed by direct interview and using a questionnaire. RESULTS Sixty-seven LT recipients (56 males, median age 48.17 years) constituted the study group. Overall, 11 patients (16.47%) were nonadherent to treatment. LDLT recipients were more adherent than DDLT recipients. Nonadherent recipients were believers in alternative systems of medicine. Medication-related factors such as improper dosing, meagre drug knowledge difficulty in remembering drug dose and timings and economic constraints in continuing medical treatment were statistically significant in nonadherent recipients. Although variation in the tacrolimus levels were significantly more common in the nonadherent group, acute cellular rejection and infection were not statistically different. CONCLUSIONS The prevalence of nonadherence was 16.5%. Determinants of nonadherence were DDLT, belief in alternative medications, high regimen complexity, poor knowledge about medications and cost issues with long-term medications.
Collapse
Affiliation(s)
- Mayank Jain
- Institute of Liver Disease and Transplantation, Gleneagles Global Health City, Chennai 100, India
| | | | | | | |
Collapse
|
25
|
Bakthavatchalam M, Venkataraman J, Ramana RJ, Jain M, Singh B, Thanigai AK, Velyoudam V, Manickam Neethirajan S, Tiwari MK, Agarwal AK, Kalkura NS. Morphological and elemental mapping of gallstones using synchrotron microtomography and synchrotron X-ray fluorescence spectroscopy. JGH Open 2019; 3:381-387. [PMID: 31633042 PMCID: PMC6788379 DOI: 10.1002/jgh3.12171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/05/2019] [Accepted: 02/06/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND AIM Regional differences in gallstone (GS) composition are well documented in the Indian subcontinent. The reasons for the same are unknown. Etiopathogenesis of GS remains elusive despite advances in instrumentation. This was an in-depth analysis of the chemical, structural, and elemental composition of GS with special reference to synchroton studies. METHODS We used high-end sensitive analytical complementary microscopic and spectroscopic methods techniques, such as X-ray diffraction, scanning electron microscopy, Fourier transform infrared, synchrotron X-ray fluorescence spectroscopy (SR-XRF), and 2D and 3D synchrotron microtomography (SR-μCT), to study the ultra structure and trace element composition of three major types of GS (cholesterol, mixed, and pigment). SR-XRF quantified the trace elements in GS. RESULTS The cholesterol GS (monohydrate and anhydrate) were crystalline, with high calcium content. The pigment GS were amorphous, featureless, black, and fragile, with high calcium bilirubinate and carbonate salts. They had the highest concentration of iron (average 31.50 ppm) and copper (average 92.73 ppm), with bacterial inclusion. The mixed stones had features of both cholesterol and pigment GS with intermediate levels of copper (average 20.8 ppm) and iron (average 17.78 ppm). CONCLUSION SR-μCT has, for the first time, provided cross-sectional computed imaging delineating the framework of GS and mineral distribution. It provided excellent mapping of cholesterol GS. SR-XRF confirmed that pigment GS had high concentrations of copper and iron with bacterial inclusions, the latter possibly serving as a nidus to the formation of these stones.
Collapse
Affiliation(s)
| | | | | | - Mayank Jain
- Institute of GI Sciences, Gleneagles Global Hospitals and Health CityChennaiIndia
| | - Balwant Singh
- Indus 2Raja Ramanna Centre for Advance TechnologyIndoreIndia
| | - Arul K Thanigai
- Department of Physics, Energy and Biophotonics LabAMETChennaiIndia
| | | | | | - Manoj K Tiwari
- Indus 2Raja Ramanna Centre for Advance TechnologyIndoreIndia
| | | | | |
Collapse
|
26
|
Bhatia SJ, Makharia GK, Abraham P, Bhat N, Kumar A, Reddy DN, Ghoshal UC, Ahuja V, Rao GV, Devadas K, Dutta AK, Jain A, Kedia S, Dama R, Kalapala R, Alvares JF, Dadhich S, Dixit VK, Goenka MK, Goswami BD, Issar SK, Leelakrishnan V, Mallath MK, Mathew P, Mathew P, Nandwani S, Pai CG, Peter L, Prasad AVS, Singh D, Sodhi JS, Sud R, Venkataraman J, Midha V, Bapaye A, Dutta U, Jain AK, Kochhar R, Puri AS, Singh SP, Shimpi L, Sood A, Wadhwa RT. Indian consensus on gastroesophageal reflux disease in adults: A position statement of the Indian Society of Gastroenterology. Indian J Gastroenterol 2019; 38:411-440. [PMID: 31802441 DOI: 10.1007/s12664-019-00979-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 03/10/2019] [Accepted: 07/17/2019] [Indexed: 02/06/2023]
Abstract
The Indian Society of Gastroenterology developed this evidence-based practice guideline for management of gastroesophageal reflux disease (GERD) in adults. A modified Delphi process was used to develop this consensus containing 58 statements, which were generated by electronic voting iteration as well as face-to-face meeting and review of the supporting literature primarily from India. These statements include 10 on epidemiology, 8 on clinical presentation, 10 on investigations, 23 on treatment (including medical, endoscopic, and surgical modalities), and 7 on complications of GERD. When the proportion of those who voted either to accept completely or with minor reservation was 80% or higher, the statement was regarded as accepted. The prevalence of GERD in India ranges from 7.6% to 30%, being < 10% in most population studies, and higher in cohort studies. The dietary factors associated with GERD include use of spices and non-vegetarian food. Helicobacter pylori is thought to have a negative relation with GERD; H. pylori negative patients have higher grade of symptoms of GERD and esophagitis. Less than 10% of GERD patients in India have erosive esophagitis. In patients with occasional or mild symptoms, antacids and histamine H2 receptor blockers (H2RAs) may be used, and proton pump inhibitors (PPI) should be used in patients with frequent or severe symptoms. Prokinetics have limited proven role in management of GERD.
Collapse
Affiliation(s)
- Shobna J Bhatia
- Seth GS Medical College and KEM Hospital, Mumbai, 400 012, India.
| | | | - Philip Abraham
- P D Hinduja Hospital and MRC, and Hinduja Heathcare Surgical, Mumbai, 400 016, India
| | - Naresh Bhat
- Aster CMI Hospital, Bengaluru, 560 092, India
| | - Ajay Kumar
- Fortis Escorts Liver and Digestive Diseases Institute, Delhi, 110 025, India
| | | | - Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Vineet Ahuja
- All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - G Venkat Rao
- Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | | | - Amit K Dutta
- Christian Medical College, Vellore, 632 004, India
| | - Abhinav Jain
- Seth GS Medical College and KEM Hospital, Mumbai, 400 012, India
| | - Saurabh Kedia
- All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Rohit Dama
- Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | - Rakesh Kalapala
- Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | | | | | - Vinod Kumar Dixit
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221 005, India
| | | | - B D Goswami
- Gauhati Medical College, Dispur Hospitals, Guwahati, 781 032, India
| | - Sanjeev K Issar
- JLN Hospital and Research Center, Bhilai Steel Plant, Bhilai, 490 009, India
| | | | | | | | - Praveen Mathew
- Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, 560 066, India
| | | | - Cannanore Ganesh Pai
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576 104, India
| | | | - A V Siva Prasad
- Institute of Gastroenterology, Visakhapatnam, 530 002, India
| | | | | | - Randhir Sud
- Medanta - The Medicity, Gurugram, 122 001, India
| | | | - Vandana Midha
- Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | - Amol Bapaye
- Deenanath Mangeshkar Hospital and Research Center, Pune, 411 004, India
| | - Usha Dutta
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Ajay K Jain
- Choithram Hospital and Research Centre, Indore, 452 014, India
| | - Rakesh Kochhar
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | | | | | | | - Ajit Sood
- Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | | |
Collapse
|
27
|
Mangla N, Bokarvadia R, Jain M, Varghese J, Venkataraman J. Scoring Systems that Predict Mortality at Admission in End-stage Liver Disease. Indian J Crit Care Med 2019; 23:445-448. [PMID: 31749551 PMCID: PMC6842835 DOI: 10.5005/jp-journals-10071-23261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Various scoring systems have been developed to assess the severity and survival in end-stage liver disease. Aim of the study Prospective study to compare and analyze the efficacy of scoring systems in predicting mortality in ESLD patients who present with cirrhosis specific complications to the emergency room. Materials and methods This prospective, single point study was conducted over a two year period from September 2014 to August 2016 among 162 ESLD patients seeking admission to the emergency unit of Gleneagles Global Health City, Chennai. Baseline investigations incorporated hemogram, liver biochemical parameters, coagulation parameters (PT/INR), serum creatinine, serum electrolytes and blood gas analysis, to calculate the CTP score, MELD, MELD-Na, MESO, iMELD, Updated MELD, UKELD, SOFA and APACHE II. Comparison of MELD snd non MELD scores were done between survivors and nonsurvivors. The mortality rate for the same admission was calculated. Results Of the 162 patients requiring emergency admision, 148 were men (91.4%). The median age of patients was 56 years (range 25–75 years). The cause for liver cirrhosis was alcohol followed by nonalcoholic steatohepatitis and hepatitis B. The indications for emergency admissions were fever, tense ascites, reduced urine output and altered sensorium. Thirty patients (18.5%) expired during the same admission. The predictive accuracy of all scores for predicting mortality by ROC curves was between 0.7 and 0.8 (p < 0.05). Conclusion Although, all scores appear to be equally good, simple scores like CTP and MELD is all that is required to ascertain the prognosis of patients seeking emergency admission. How to cite this article Mangla N, Bokarvadia R, Jain M, Varghese J, Venkataraman J. Scoring Systems that Predict Mortality at Admission in End-stage Liver Disease. Indian J Crit Care Med 2019;23(10):445–448.
Collapse
Affiliation(s)
- Neeraj Mangla
- Department of Emergency Medicine and Hepatology, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - Ravi Bokarvadia
- Department of Emergency Medicine and Hepatology, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - Mayank Jain
- Department of Emergency Medicine and Hepatology, Gleneagles Global Health City, Chennai, Tamil Nadu, India
- Mayank Jain, Department of Emergency Medicine and Hepatology, Gleneagles Global Health City, Chennai, Tamil Nadu, India, e-mail:
| | - Joy Varghese
- Department of Emergency Medicine and Hepatology, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - Jayanthi Venkataraman
- Department of Emergency Medicine and Hepatology, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| |
Collapse
|
28
|
Palaniappan S, Arvind MA, Dinesh J, Melpakam S, Vijaya S, Venkataraman J, Rela M. Role of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of space occupying lesions of the pancreas. Journal of Digestive Endoscopy 2019. [DOI: 10.4103/0976-5042.147509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Introduction: Space occupying lesions (SOLs) of the pancreas are commonly encountered in day to day practice either as an incidental finding or during evaluation of symptomatic patients. The aim of the present study was to compare the final diagnosis at follow-up with diagnosis made at computed tomography (CT)/magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS). Materials and Methods: Retrospective analysis of EUS data of 131 patients referred for tissue diagnosis of SOL in pancreas was done. The lesions were classified as malignant, benign, and nonneoplastic by both CT/MRI and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in conjunction with clinical presentation, biochemical parameters, and tumor markers. Follow-up cases with a final diagnosis alone were included for the comparative analysis. Statistical Analysis: Chi-square test, sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) for CT/MRI and EUS-FNA were computed against the follow-up data. Results: Of the 131, there were 78 males (59.5%). The median age of presentation was 48 years (range: 11–82 years. Follow-up information on the final diagnosis was available for 54 patients. Confirmed diagnosis at follow-up was malignant lesion in 18, benign in 13 and 23 with a nonneoplastic lesion. When EUS-FNA outcome was compared with the definitive diagnosis of the 54 patients, it had a higher sensitivity for malignant (66.7% vs. 61.1%) and nonneoplastic lesions (78.3% vs. 73.9%) and was similar to CT/MRI for benign lesions (76.9% for both). EUS-FNA had a higher specificity (87.8% vs. 80.5%) with a good PPV for benign lesions (66.7% vs. 55.6%). CT/MRI was less accurate than EUS-FNA in predicting benign (79.6% vs. 85.2%) and nonneoplastic lesions (79.6% vs. 81.5%) compared to malignant lesions wherein it was similar at 81.5%. The high NPV with a lower PPV for both EUS/FNA and CT/MRI suggests that follow-up definitive diagnosis was superior to both –. Conclusions: Endoscopic ultrasound-guided fine-needle aspiration had a higher specificity, but low sensitivity for the both neoplastic and nonneoplastic lesion of the pancreas compared to the world literature. The overall EUS-FNA yield was low when compared to the follow-up definitive diagnosis.
Collapse
Affiliation(s)
- S. Palaniappan
- Department of Gastroenterology and Institute of Hepatobiliary and Pancreatic and Liver Transplantation, Global Health City, Chennai, Tamil Nadu, India
| | - M. A. Arvind
- Department of Gastroenterology and Institute of Hepatobiliary and Pancreatic and Liver Transplantation, Global Health City, Chennai, Tamil Nadu, India
| | - Jothimani Dinesh
- Department of Gastroenterology and Institute of Hepatobiliary and Pancreatic and Liver Transplantation, Global Health City, Chennai, Tamil Nadu, India
| | - Srinivas Melpakam
- Department of Gastroenterology and Institute of Hepatobiliary and Pancreatic and Liver Transplantation, Global Health City, Chennai, Tamil Nadu, India
| | - Srinivasan Vijaya
- Department of Gastroenterology and Institute of Hepatobiliary and Pancreatic and Liver Transplantation, Global Health City, Chennai, Tamil Nadu, India
| | - Jayanthi Venkataraman
- Department of Gastroenterology and Institute of Hepatobiliary and Pancreatic and Liver Transplantation, Global Health City, Chennai, Tamil Nadu, India
| | - Mohamed Rela
- Department of Gastroenterology and Institute of Hepatobiliary and Pancreatic and Liver Transplantation, Global Health City, Chennai, Tamil Nadu, India
| |
Collapse
|
29
|
Abstract
ABSTRACT
Background: The histological nature of polyps by site prevalence and size is unclear. Aim: To determine the prevalence of polyps in patients undergoing routine lower gastrointestinal (LGI) endoscopy and identify the histological types and their characteristics by age, location and size. Materials and Methods: For this retrospective study, patients undergoing ileocolonoscopy or sigmoidoscopy between 2014 and 2016 were included. Data on age, gender, test indication, site and size of polyps and histology type were collected. Results: Two hundred and ninety (12.7%) of 2303 patients who underwent LGI endoscopy had colonic polyps (n= 317; single in 272 patients). The median age was 61.1 years (range 5-99 years) and 223 (76.4%) were men. Polyps were rare <40 years age (7.3%). By site, the polyp frequency in right colon was 6.9%, 3.9% in left colon and 4.6% in the rectum. Two thirds of polyps (64%) were <1cm size. The 3 common polyp types were adenomatous (48.9%), hyperplastic (23.7%), and inflammatory (22.4%). Adenomatous polyps were common above 60 years (p <0.0002), located often in right (35.5%) or left colon (42.6%), large in size (54.2%) and showed low grade dysplasia (89.7%). Hyperplastic polyps were most common in the middle aged and in the rectum (p <0.00001). Inflammatory polyps were the most common type below 40 years age. Almost all hyperplastic and inflammatory polyps were <1cm size (93.3% and 87.3%). Conclusions: Adenomatous polyps were the commonest type; especially >60 years age. High grade dysplasia and carcinoma were rare (10.3%). While two-thirds of polyps <1cm size were inflammatory or hyperplastic, 86% of large polyps were adenomatous.
Collapse
Affiliation(s)
- Mayank Jain
- Departments of Gastroenterology, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - Mukul Vij
- Departments of Pathology, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - M. Srinivas
- Departments of Gastroenterology, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - Tom Michael
- Departments of Gastroenterology, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - Jayanthi Venkataraman
- Departments of Gastroenterology, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| |
Collapse
|
30
|
Jayanth R, Devaraj H, Surendran R, Jain M, Venkataraman J. MUC2 and MUC5AC Expression in Colon Cancer: A Preliminary Report from South India. Indian J Med Paediatr Oncol 2019. [DOI: 10.4103/ijmpo.ijmpo_33_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Background: There is scanty data from India regarding MUC protein expression from colorectal cancers (CRC) among Indian patients. Aim of the Study: The aim of this study is to assess the alterations in the expression of MUC2 and MUC5AC in 25 patients with CRC by site of the tumor location and differentiation at histology. Materials and Methods: Patients with proven adenocarcinoma of the colon alone were included for the study. Biopsy specimens obtained from tumorous lesions in the colon were classified based on histopathology as well differentiated, moderately, and poorly differentiated adenocarcinoma. Immunohistochemistry was done in the 4 μm thick sections to identify the expression of MUC2 and MUC5AC mucins. Results: MUC2 was uniformly expressed with near similar intensity while MUC5 was moderately (56%) to highly expressed (36%) in mucinous tumors. In nonmucinous tumors, MUC2 was least expressed (68%) with a significant expression on MUC5AC (88%). Except for rectosigmoid growth which had greater expression of MUC5AC (31%), both proximal and distal carcinomas had significant MUC2 and MUC5AC expression. Conclusion: MUC2 and MUC5AC are expressed in colonic cancers, the former showing mildtomoderate expression and the latter moderatetointense expression. The expression is more in mucinous adenocarcinoma.
Collapse
Affiliation(s)
- R Jayanth
- Department of Medical and Surgical Gastroenterology, Stanley Medical College and Hospital, Chennai, Tamil Nadu, India
| | - H Devaraj
- Glycotechnology Centre, AC Tech, University of Madras, Chennai, Tamil Nadu, India
| | - R Surendran
- Department of Medical and Surgical Gastroenterology, Stanley Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Mayank Jain
- Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - Jayanthi Venkataraman
- Department of Medical and Surgical Gastroenterology, Stanley Medical College and Hospital, Chennai, Tamil Nadu, India
- Gleneagles Global Health City, Chennai, Tamil Nadu, India
| |
Collapse
|
31
|
Jain M, Venkataraman J, Varghese J, Vij M, Reddy MS, Rela M. Explant liver evaluation decodes the mystery of cryptogenic cirrhosis! JGH Open 2019; 4:39-43. [PMID: 32055695 PMCID: PMC7008160 DOI: 10.1002/jgh3.12200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/30/2019] [Accepted: 05/04/2019] [Indexed: 12/16/2022]
Abstract
Background and Aim To determine the concordance of liver explants with the pretransplant diagnosis. Methods This was a retrospective analysis of 251 liver explants. Patient information included demography, comorbidity, and etiological diagnosis. Final diagnosis was based on morphological and histological findings. For non‐alcoholic steatohepatitis (NASH) and cryptogenic cirrhosis, we investigated comorbid states such as obesity, hypertension, and diabetes. Chi square test and Cohen's Kappa value were used. A P value of <0.05 was considered significant. Results A total of 192 patients (76.5%) were males. A significant concordance of explant diagnosis with pretransplant diagnosis was present in 225 (89.6%) patients. It was 100% for alcohol‐related disease, hepatitis B, hepatitis C, autoimmune (AI) liver disease, biliary cirrhosis, and Budd–Chiari syndrome. Of 37 patients with a pretransplant diagnosis of cryptogenic cirrhosis, major discordance was observed in 23 (62.1%). On explant, seven patients each had hemochromatosis 5 (13.5%), AI hepatitis, and NASH (18.9%); two had noncirrhotic fibrosis (5.4%); and one each had Wilson's disease and congenital hepatic fibrosis (2.7%). Of the 20 explants, 3 with pretransplant diagnosis of NASH had a diagnosis of cryptogenic cirrhosis on explant specimens. Cohen's Kappa for the concordance of pretransplant diagnosis and explant diagnosis in NASH and cryptogenic cirrhosis patients was 0.75 and 0.47, respectively. An incidental hepatocellular carcinoma was picked up in 16 explants, and 18 had granulomas. Conclusion Concordance between pretransplant and explant diagnosis is lower for NASH and cryptogenic cirrhosis. The true prevalence of cryptogenic cirrhosis in our study was 5.6%.
Collapse
Affiliation(s)
- Mayank Jain
- Institute of GI Sciences and Liver Transplantation Gleneagles Global Health City Chennai India
| | - Jayanthi Venkataraman
- Institute of GI Sciences and Liver Transplantation Gleneagles Global Health City Chennai India
| | - Joy Varghese
- Institute of GI Sciences and Liver Transplantation Gleneagles Global Health City Chennai India
| | - Mukul Vij
- Institute of GI Sciences and Liver Transplantation Gleneagles Global Health City Chennai India
| | - Mettu S Reddy
- Institute of GI Sciences and Liver Transplantation Gleneagles Global Health City Chennai India
| | - Mohamed Rela
- Institute of GI Sciences and Liver Transplantation Gleneagles Global Health City Chennai India
| |
Collapse
|
32
|
Bokarvadia R, Jain M, Kedarisetty C, Varghese J, Venkataraman J. Prevalence and clinical presentation of cirrhotic cardiomyopathy: A single centre experience from southern India. Indian J Gastroenterol 2019; 38:150-157. [PMID: 31115783 DOI: 10.1007/s12664-019-00946-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/10/2018] [Accepted: 02/13/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND There are scanty data from India on the prevalence and clinical profile of cirrhotic cardiomyopathy (CCM). AIM To identify the prevalence and clinical presentation of CCM in patients with liver cirrhosis. METHODS Five hundred and eighty-six patients with liver cirrhosis were recruited based on inclusion criteria and evaluated for cardiac parameters using electrocardiography, 2-dimensional echocardiography, dobutamine stress test and coronary angiography as needed. Baseline demographic data, liver biochemistry, endoscopic and radiological findings were recorded in all the patients. Appropriate statistical analyses were performed. RESULTS: Four thousand eight hundred and seventy-seven patients with liver disease were registered during the study period. Five hundred and eighty-six cirrhotic patients had cardiac evaluation as per the study protocol. One hundred fifty-nine had coronary artery disease and were excluded. One hundred and ninety-eight of 427 remaining patients (46.4%) had CCM. The median age of patients with CCM was higher compared with those without CCM (52 years vs. 46 years; p-value < 0.00001). Likewise, cirrhosis-related complications ([isolated or in combination], lower pulse rate [< 60/min] and prolonged corrected QT interval [QTc]; p<0.00001) were more frequent in patients with CCM. After excluding known risk factors for CCM such as alcohol, diabetes, hypothyroidism, hypertension, the true prevalence of CCM was 8.2% (48 out of 586). Hepatotropic viral infections (p 0.03) and prolonged QTc (p 0.0004) were commoner in CCM. CONCLUSION Prevalence of CCM in our setting is 33.8%. CCM is commoner in males and is independent of the etiology of cirrhosis, comorbidity and severity of liver disease. Diastolic dysfunction and prolonged QTc interval are common in CCM.
Collapse
Affiliation(s)
- Ravi Bokarvadia
- Department of Gastroenterology and Hepatology, Gleneagles Global Health City, Chennai, 600 100, India
| | - Mayank Jain
- Department of Gastroenterology and Hepatology, Gleneagles Global Health City, Chennai, 600 100, India.
| | - Chandankumar Kedarisetty
- Department of Gastroenterology and Hepatology, Gleneagles Global Health City, Chennai, 600 100, India
| | - Joy Varghese
- Department of Gastroenterology and Hepatology, Gleneagles Global Health City, Chennai, 600 100, India
| | - Jayanthi Venkataraman
- Department of Gastroenterology and Hepatology, Gleneagles Global Health City, Chennai, 600 100, India
| |
Collapse
|
33
|
Jain M, Baijal R, Srinivas M, Venkataraman J. Fecal evacuation disorders in anal fissure, hemorrhoids, and solitary rectal ulcer syndrome. Indian J Gastroenterol 2019; 38:173-177. [PMID: 30707420 DOI: 10.1007/s12664-018-0927-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 08/10/2018] [Accepted: 12/15/2018] [Indexed: 02/04/2023]
Abstract
The causative factors for hemorrhoids, anal fissure, and solitary rectal ulcer syndrome (SRUS) are poorly understood. The study was done to identify the prevalence of fecal evacuation disorders in patients with anal fissure, hemorrhoids, and SRUS using anorectal manometry (ARM). Retrospective analysis of ARM data from three centers across India was done. Baseline demographic details and symptoms pertaining to bowel movements were noted. Limited colonoscopy details pertaining to hemorrhoids, fissure-in-ano, and SRUS were noted. The patients were divided into two groups-group I (those with fissure, hemorrhoids, or solitary rectal ulcer) and group II (normal study). ARM parameters of resting anal pressure, squeeze pressure, dyssynergic defecation, and abnormal balloon expulsion were compared between the two groups. Sub-analysis was done for ARM metric differences between those with hemorrhoids, chronic fissure, and SRUS. Appropriate statistical tests were used. A p-value of < 0.05 was considered significant. There were more men in group I (87%; p-value 0.01) with a higher resting anal pressure (80 vs. 69 mmHg, p-value 0.03). Functional evacuation disorders (p < 0.0001), dyssynergic defecation (77.2% vs. 46.8%, p < 0.0001) and abnormal balloon expulsion (66.7% vs. 20.3%, p < 0.0001) were significantly higher in group I. These were significantly more common in patients with anal fissure and SRUS compared to those with hemorrhoids (p-value 0.028). Functional evacuation disorders are frequently noted in patients with hemorrhoids, anal fissure, and SRUS.
Collapse
Affiliation(s)
- Mayank Jain
- Department of Gastroenterology, Gleneagles Global Health City, 439, Cheran Nagar, Chennai, 600 100, India. .,Choithram Hospital and Research Centre, 14, Manik Bagh Road, Indore, 452 014, India.
| | - Rajiv Baijal
- Pushpavati Singhania Hospital and Research Centre, Press Enclave Marg, J Pocket, Phase II, Sheikh Sarai, New Delhi, 110 017, India
| | - M Srinivas
- Department of Gastroenterology, Gleneagles Global Health City, 439, Cheran Nagar, Chennai, 600 100, India
| | - Jayanthi Venkataraman
- Department of Gastroenterology, Gleneagles Global Health City, 439, Cheran Nagar, Chennai, 600 100, India
| |
Collapse
|
34
|
Patil V, Jain M, Venkataraman J. Paracentesis-induced acute kidney injury in decompensated cirrhosis - prevalence and predictors. Clin Exp Hepatol 2019; 5:55-59. [PMID: 30915407 PMCID: PMC6431093 DOI: 10.5114/ceh.2019.83157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 09/13/2018] [Indexed: 12/22/2022] Open
Abstract
AIM OF THE STUDY A subgroup of cirrhotic patients undergoing therapeutic paracentesis develop acute kidney injury (AKI) despite adequate colloidal replacement.The aim of the study was to determine the prevalence and predictors of paracentesis-induced AKI in cirrhotic patients with normal baseline renal parameters and adequate colloidal replacement. MATERIAL AND METHODS This prospective, observational analytical study was undertaken between April 2015 and April 2017. All patients undergoing therapeutic paracentesis were enrolled as per inclusion and exclusion criteria. Based on Acute Kidney Injury Network (AKIN) criteria for AKI, comparative analysis was performed between those developing and not developing AKI for demography, renal parameters, frequency and quantity of paracentesis per session. Univariate and multivariate regression analyses were performed to determine the predictors of AKI. RESULTS Altogether, 177 patients underwent 859 therapeutic paracenteses. Ninety-four paracentesis sessions resulted in an AKI (10.9%). The median number of paracenteses was 10 (range 1-25) and the median volume of fluid drained per paracentesis was 6 l (1-20 l). In univariate analysis, younger age (p < 0.02), higher MELD (Model For End-Stage Liver Disease) score (p < 0.0001), CTP (Child-Turcotte-Pugh) class C (p < 0.017) and prior history of renal dysfunction (p < 0.0001) were significantly associated with AKI. For each liter of fluid drained, the risk of AKI increased by 1.24 times. Frequency of paracentesis did not influence the AKI. In multivariate logistic regression, the significant predictors of AKI were past renal dysfunction, a higher MELD and volume of fluid tapped at paracentesis. CONCLUSIONS Post-paracentesis AKI occurs in 10.9% of cases, despite adequate colloid replacement. For each 1 l of fluid drained during paracentesis, the risk of AKI increased by 1.24 times.
Collapse
|
35
|
Sanglodkar U, Jain M, Alexander M, Venkataraman J. Gastroesophageal Reflux-Is It Uncommon in Indian Patients With Decompensated Liver Cirrhosis? J Clin Exp Hepatol 2019; 9:418-419. [PMID: 31360035 PMCID: PMC6637082 DOI: 10.1016/j.jceh.2018.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 09/26/2018] [Indexed: 12/12/2022] Open
Affiliation(s)
- Uday Sanglodkar
- Department of Gastroenterology, Gleneagles Global Health City, Chennai, India
| | - Mayank Jain
- Department of Gastroenterology, Gleneagles Global Health City, Chennai, India,Address for correspondence: Mayank Jain, Consultant, Department of Gastroenterology, Gleneagles Global Health City, Chennai, India.
| | - M.J. Alexander
- Department of Gastroenterology, Stanley Medical College, Chennai, India
| | - Jayanthi Venkataraman
- Department of Gastroenterology, Gleneagles Global Health City, Chennai, India,Department of Gastroenterology, Stanley Medical College, Chennai, India
| |
Collapse
|
36
|
Joshi V, Jain M, Srinivas M, Mahadevan B, Kumar GSS, Ganesh P, Reddy AS, Venkataraman J. Bowel Cleansing Agents in Clinical Practice: A Cross-Sectional Study on Safety, Efficacy, and Predictor of Good Bowel Preparation. Journal of Digestive Endoscopy 2019. [DOI: 10.4103/jde.jde_71_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
ABSTRACT
Background: A good bowel preparation for colonoscopy is the most important factor that has an impact on visualization and outcome of the procedure. Aim: The primary aim of the study was to assess the quality of bowel preparation as reported by the Boston Bowel Preparation Score (BBPS). The secondary aim of the study was to analyze the patient feedback on ease of administration, palatability, and side effects with the bowel preparation. Materials and Methods: Patients undergoing colonoscopy between March 2018 and September 2018 were enrolled in the study. Patients <18 years of age, those with the previous history of colorectal surgery, emergency procedures in an unprepared colon, and those not willing to participate were excluded from the study. Colon preparation of the patient was decided by senior consultants. A predesigned pro forma that included demography, indication for the procedure, preparation details, dietary recommendations the previous day if any, side effects, and patient’s comfort to preparation was completed by two-independent observers. The BBPS was used to assess the bowel preparation. A score of <5 was deemed inadequate. P < 0.05 was considered statistically significant. Results: The study cohort consisted of 141 patients, of which 78 were male (55.3%). Eighty (56.7%) patients received oral sulfate-based preparation and 61(43.4%) polyethylene glycol-based preparation. Nearly one third of cases reported the solution to be non palatable. 15.4% respondents reported nausea, vomiting and bloating as the major side effects of the preparation. The median duration of colonoscopy was 25 min (8–45 min). One hundred and eighteen patients (83.6%) had a BBPS score of ≥5. Sulfate preparation resulted in better bowel cleansing (P = 0.01). Age, gender, and dosing schedule of preparation, including bedtime dosing of stimulant laxative, did not alter the BBPS score. Conclusion: Sulfate- and polyethylene glycol-based preparations are commonly used for cleansing the colon. Bowel cleansing was adequate in most patients and sulfate-based yielded better bowel cleansing. Nearly 15.4% of patients reported side effects to these preparations.
Collapse
Affiliation(s)
- Vivek Joshi
- Department of Gastroenterology, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - Mayank Jain
- Department of Gastroenterology, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - M. Srinivas
- Department of Gastroenterology, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - B. Mahadevan
- Department of Gastroenterology, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - G. S. Sameer Kumar
- Department of Gastroenterology, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - P. Ganesh
- Department of Gastroenterology, Ramchandra Medical College, Chennai, Tamil Nadu, India
| | - Alla Siddharth Reddy
- Department of Gastroenterology, Ramchandra Medical College, Chennai, Tamil Nadu, India
| | - Jayanthi Venkataraman
- Department of Gastroenterology, Ramchandra Medical College, Chennai, Tamil Nadu, India
| |
Collapse
|
37
|
Jain M, Varghese J, Kedarishetty C, Srinivasan V, Venkataraman J. Incidence and risk factors for mortality in patients with cirrhosis awaiting liver transplantation. Indian J Transplant 2019. [DOI: 10.4103/ijot.ijot_27_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
|
38
|
Jain M, K B, Kumar SS, Joshi V, Reddy M, Rela M, Venkataraman J. Diabetes mellitus as a risk factor for hepatocellular carcinoma: A single-centre experience from South India. J Diabetol 2019. [DOI: 10.4103/jod.jod_40_18] [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
|
39
|
Jain M, Bokarvadia R, Varghese J, Venkataraman J. Cirrhotic cardiomyopathy- Survival at 3 months after liver transplantation. Indian J Transplant 2019. [DOI: 10.4103/ijot.ijot_60_18] [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
|
40
|
Sood A, Ahuja V, Kedia S, Midha V, Mahajan R, Mehta V, Sudhakar R, Singh A, Kumar A, Puri AS, Tantry BV, Thapa BR, Goswami B, Behera BN, Ye BD, Bansal D, Desai D, Pai G, Yattoo GN, Makharia G, Wijewantha HS, Venkataraman J, Shenoy KT, Dwivedi M, Sahu MK, Bajaj M, Abdullah M, Singh N, Singh N, Abraham P, Khosla R, Tandon R, Misra SP, Nijhawan S, Sinha SK, Bopana S, Krishnaswamy S, Joshi S, Singh SP, Bhatia S, Gupta S, Bhatia S, Ghoshal UC. Correction to: Diet and inflammatory bowel disease: The Asian Working Group guidelines. Indian J Gastroenterol 2019; 38:558-559. [PMID: 31993918 PMCID: PMC7645533 DOI: 10.1007/s12664-019-01013-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The recommendations 31 which recommend "VSL#3®", refer only to the product used in the cited literature and equivalent products independent from the present product labelings. This product is now known by the generic name "De Simone Formulation".
Collapse
Affiliation(s)
- Ajit Sood
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, 141 001 India
| | - Vineet Ahuja
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110 023 India
| | - Saurabh Kedia
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110 023 India
| | - Vandana Midha
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, 141 001 India
| | - Ramit Mahajan
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, 141 001 India
| | - Varun Mehta
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, 141 001 India
| | - Ritu Sudhakar
- Department of Dietetics, Dayanand Medical College and Hospital, Ludhiana, 141 001 India
| | - Arshdeep Singh
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, 141 001 India
| | - Ajay Kumar
- BLK Super Speciality Hospital, New Delhi, 110 005 India
| | | | | | - Babu Ram Thapa
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012 India
| | - Bhabhadev Goswami
- Department of Gastroenterology, Gauhati Medical College, Guwahati, 781 032 India
| | - Banchha Nidhi Behera
- Department of Dietetics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012 India
| | - Byong Duk Ye
- Department of Gastroenterology, Asan Medical Center, Seoul, South Korea
| | - Deepak Bansal
- Consultant Gastroenterology, Bathinda, 151 001 India
| | - Devendra Desai
- P. D. Hinduja Hospital and Medical Research Centre, Mumbai, 400 016 India
| | - Ganesh Pai
- Department of Gastroenterology, Kasturba Medical College, Manipal, 576 104 India
| | | | - Govind Makharia
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110 023 India
| | | | | | - K. T. Shenoy
- Department of Gastroenterology, Sree Gokulum Medical College and Research Foundation, Trivandrum, 695 011 India
| | - Manisha Dwivedi
- Department of Gastroenterology, Moti Lal Nehru Medical College, Allahabad, 211 001 India
| | - Manoj Kumar Sahu
- Department of Gastroenterology, IMS and Sum Hospital, Bhubaneswar, 756 001 India
| | | | - Murdani Abdullah
- Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Namrata Singh
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110 023 India
| | - Neelanjana Singh
- Dietician, Pushpawati Singhania Research Institute, New Delhi, 110 001 India
| | - Philip Abraham
- P D Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Cadel Road, Mahim, Mumbai, 400 016 India
| | - Rajiv Khosla
- Max Super Speciality Hospital, Saket, New Delhi, 110 017 India
| | - Rakesh Tandon
- Pushpawati Singhania Research Institute, New Delhi, 110 001 India
| | - S. P. Misra
- Department of Gastroenterology, Moti Lal Nehru Medical College, Allahabad, 211 001 India
| | - Sandeep Nijhawan
- Department of Gastroenterology, SMS Medical College, Jaipur, 302 004 India
| | - Saroj Kant Sinha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012 India
| | - Sawan Bopana
- Fortis Hospital, Vasant Kunj, New Delhi, 110 070 India
| | | | - Shilpa Joshi
- Dietician, Mumbai Diet and Health Centre, Mumbai, 400 001 India
| | - Shivram Prasad Singh
- Department of Gastroenterology, Sriram Chandra Bhanj Medical College and Hospital, Cuttack, 753 001 India
| | - Shobna Bhatia
- Department of Gastroenterology, King Edward Memorial Hospital, Mumbai, 400 012 India
| | - Sudhir Gupta
- Shubham Gastroenterology Centre, Nagpur, 440 001 India
| | - Sumit Bhatia
- Consultant Gastroenterology, Medanta The Medicity, Gurgaon, 122 001 India
| | - Uday Chand Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014 India
| |
Collapse
|
41
|
Jain M, Srinivas M, Bawane P, Venkataraman J. Multiple rapid swallow testing in patients with gastroesophageal reflux disease. Indian J Gastroenterol 2018; 37:555-558. [PMID: 30617918 DOI: 10.1007/s12664-018-0919-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 08/23/2018] [Accepted: 11/07/2018] [Indexed: 02/04/2023]
Abstract
Patients with gastroesophageal reflux disease are commonly referred to a gastrointestinal motility unit for assessment of esophageal physiology tests prior to an anti-reflux procedure. On esophageal manometry, most patients have normal peristalsis; however, minor disorders of motility such as ineffective esophageal motility and fragmented peristalsis are not uncommon. Multiple rapid swallow (MRS) test is a provocative method for assessing peristaltic reserve in such patients. We report our single-center experience on MRS testing. ᅟ ᅟ.
Collapse
Affiliation(s)
- Mayank Jain
- Department of Gastroenterology, Gleneagles Global Health City, 439, Cheran Nagar, Chennai, 600 100, India.
| | - Melpakkam Srinivas
- Department of Gastroenterology, Gleneagles Global Health City, 439, Cheran Nagar, Chennai, 600 100, India
| | - Piyush Bawane
- Department of Gastroenterology, Gleneagles Global Health City, 439, Cheran Nagar, Chennai, 600 100, India
| | - Jayanthi Venkataraman
- Department of Gastroenterology, Gleneagles Global Health City, 439, Cheran Nagar, Chennai, 600 100, India
| |
Collapse
|
42
|
Jain M, Varghese J, Muruganandham KM, Venkataraman J. Stauffer’s Syndrome: A Rare Paraneoplastic Syndrome with Renal Cell Carcinoma. Indian J Med Paediatr Oncol 2018. [DOI: 10.4103/ijmpo.ijmpo_97_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AbstractAn elderly male patient presented with cholestatic jaundice and weight loss. On evaluation, he was found to have left renal mass and hepatomegaly. Diagnosis of Stauffer’s syndrome was confirmed based on his clinical history, biochemical evaluation, and liver biopsy. Resolution of jaundice was noted after removal of the renal mass.
Collapse
Affiliation(s)
- Mayank Jain
- Departments of Gastroenterology, Gleneagles global Health City, Chennai, Tamil Nadu, India
| | - Joy Varghese
- Departments of Hepatology, Gleneagles global Health City, Chennai, Tamil Nadu, India
| | - K M Muruganandham
- Departments of Urology, Gleneagles global Health City, Chennai, Tamil Nadu, India
| | - Jayanthi Venkataraman
- Departments of Gastroenterology, Gleneagles global Health City, Chennai, Tamil Nadu, India
| |
Collapse
|
43
|
Jain M, Srinivas M, Bawane P, Venkataraman J. Basal lower esophageal sphincter pressure in gastroesophageal reflux disease: An ignored metric in high-resolution esophageal manometry. Indian J Gastroenterol 2018; 37:446-451. [PMID: 30402679 DOI: 10.1007/s12664-018-0898-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 12/28/2017] [Accepted: 09/20/2018] [Indexed: 02/04/2023]
Abstract
Manometry and 24-h pH interpretation have seldom been studied. Our aim was to study these parameters as gold standard in reflux disease and to identify predictors of pathological acid reflux. Retrospective case record review of all patients with reflux disease evaluated using endoscopy, manometry, and 24-h pH testing from 2010 to 2016. Patients were categorized using Johnson-DeMeester score into two groups-group I (score > 14.7, normal study) and group II (< 14.7, normal study). These groups were compared for the above-mentioned parameters. Appropriate statistical tests were applied. P-value < 0.05 was considered significant. The study group includes 94 patients (median age 44 years, 63.8% males). Sixty (63.8%) and 34 patients belonged to groups I and II, respectively, 76.6% patients had normal endoscopy while the remaining had mild esophagitis. Peristalsis was normal in 66%, followed by ineffective esophageal motility (19.1%) and fragmented peristalsis (14.9%). Demography, symptoms, endoscopy findings, and peristalsis characteristics were similar between the two groups. Group II patients had significantly lower basal lower esophageal sphincter (LES) pressure (11.9 vs. 16.6; p < 0.02), lower integrated relaxation pressure (5.7 vs. 7.4; p < 0.01), and larger separation between LES and crural diaphragm (1.7 vs. 1.4 cm; p < 0.003). Basal LES pressure < 10 mmHg had the highest likelihood ratio (2.2) to predict an abnormal pH study. Basal LES pressure, integrated relaxation pressure, and hiatus size correlated with pathological acid reflux. Hypotensive basal lower esophageal sphincter pressure was the best predictor of an abnormal pH study but with negative linear correlation.
Collapse
Affiliation(s)
- Mayank Jain
- Department of Gastroenterology, Gleneagles Global Health City, 439, Medavakkam Road, Perumbakkam, Cheran Nagar, Chennai, 600 100, India.
| | - M Srinivas
- Department of Gastroenterology, Gleneagles Global Health City, 439, Medavakkam Road, Perumbakkam, Cheran Nagar, Chennai, 600 100, India
| | - Piyush Bawane
- Department of Gastroenterology, Gleneagles Global Health City, 439, Medavakkam Road, Perumbakkam, Cheran Nagar, Chennai, 600 100, India
| | - Jayanthi Venkataraman
- Department of Gastroenterology, Gleneagles Global Health City, 439, Medavakkam Road, Perumbakkam, Cheran Nagar, Chennai, 600 100, India
| |
Collapse
|
44
|
Jain M, Vargese J, Sachan D, Venkataraman J. von Willebrand Factor: A Tool to Predict Severity and Prognosis in Liver Disease. J Assoc Physicians India 2018; 66:70-71. [PMID: 31324089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Von Willebrand factor (vWF) is an adhesive and multimeric glycoprotein that has a central role in primary hemostasis. v W F levels correlate with thrombosis risk and inversely with bleeding risk within the apparently healthy population. Recently, numerous publications in Indian and western literature have focussed to its role in liver diseases like acute liver failure, chronic liver disease, non cirrhotic portal hypertension and tropical infections eg. dengue. The present review encapsulates the recent advances in this aspect.
Collapse
Affiliation(s)
- Mayank Jain
- Consultant, Institute of Liver Disease and Transplantation, Gleneagles Global Health City,Chennai, Tami Nadu
| | - Joy Vargese
- Consultant, Institute of Liver Disease and Transplantation, Gleneagles Global Health City,Chennai, Tami Nadu
| | - Deepti Sachan
- Consultant, Institute of Liver Disease and Transplantation, Gleneagles Global Health City,Chennai, Tami Nadu
| | - Jayanthi Venkataraman
- Consultant, Institute of Liver Disease and Transplantation, Gleneagles Global Health City,Chennai, Tami Nadu
| |
Collapse
|
45
|
Jain M, Baijal R, Srinivas M, Venkataraman J. Clinical predictors and gender-wise variations in dyssynergic defecation disorders. Indian J Gastroenterol 2018; 37:255-260. [PMID: 29948991 DOI: 10.1007/s12664-018-0856-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 03/22/2018] [Accepted: 05/14/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is insufficient data from India regarding clinical predictors of dyssynergic defecation. AIM To identify demography, symptom, and colonoscopic parameters that can predict dyssynergic defecation (DD) among patients with chronic constipation (CC) and to compare the profile among male and female patients with DD. METHODS Data collected from three centers during June 2014 to May 2017 included age, gender, symptom duration, form and consistency of stools, digital examination, colonoscopy, and anorectal manometry (ARM). Patients were grouped based on ARM diagnosis: group I (normal study) and group II (DD). The two groups were compared for demography, symptom profile, and colonoscopy findings. Gender-wise subset analysis was done for those with the normal and abnormal ARM using chi-square and unpaired t tests. RESULTS Of 236 patients with CC evaluated, 130 (55%) had normal ARM and 106 (45%) had DD. Male sex, straining during defecation, bleeding per rectum, and abnormal colonoscopic diagnosis were significantly more common in group II. While bleeding per rectum and absence of urge to defecate were more common in males (p < 0.02), straining, digital evacuation, and hard stools were commoner in females with DD. CONCLUSION Straining during defecation, bleeding per rectum, and abnormal colonoscopy findings were more common in patients with DD. Symptoms of bleeding per rectum and absence of urge to defecate in men and straining during defecation in female patients were significantly associated with DD. Symptoms differ in males and females with DD.
Collapse
Affiliation(s)
- Mayank Jain
- Choithram Hospital and Research Centre, 14, Manik Bagh Road, Indore, 452 014, India. .,Gleneagles Global Health City, 439, Medavakkam Road, Perumbakkam, Cheran Nagar, Chennai, 600 100, India.
| | - Rajiv Baijal
- Pushpavati Singhania Hospital and Research Centre, Press Enclave Marg, Sheikh Sarai II, New Delhi, 110 017, India
| | - Melpakkam Srinivas
- Gleneagles Global Health City, 439, Medavakkam Road, Perumbakkam, Cheran Nagar, Chennai, 600 100, India
| | - Jayanthi Venkataraman
- Gleneagles Global Health City, 439, Medavakkam Road, Perumbakkam, Cheran Nagar, Chennai, 600 100, India
| |
Collapse
|
46
|
Jain M, Venkataraman J. Vitamin D levels in ulcerative colitis at first diagnosis: Does it "bell the cat"? Indian J Gastroenterol 2018; 37:276-277. [PMID: 29855855 DOI: 10.1007/s12664-018-0853-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Mayank Jain
- Department of Gastroenterology, Gleneagles Global Health City, 439, Cheran Nagar, Chennai, 600 100, India.
| | - Jayanthi Venkataraman
- Department of Gastroenterology, Gleneagles Global Health City, 439, Cheran Nagar, Chennai, 600 100, India
| |
Collapse
|
47
|
Servarayan Murugesan C, Manickavasagam K, Chandramohan A, Jebaraj A, Jameel ARA, Jain MS, Venkataraman J. Gastric cancer in India: epidemiology and standard of treatment. Updates Surg 2018; 70:233-239. [PMID: 29611052 DOI: 10.1007/s13304-018-0527-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 03/14/2018] [Indexed: 02/07/2023]
Abstract
India has a low incidence of gastric cancer. It ranks among the top five most common cancers. Regional diversity of incidence is of importance. It is the second most common cause of cancer related deaths among Indian men and women in the age between 15 and 44. Helicobacter pylori carcinogenesis is low in India. Advanced stage at presentation is a cause of concern. Basic and clinical research in India reveals a globally comparable standard of care and outcome. The large population, sociodemographic profile and challenges in health expenditure, however, remain a major challenge for health care policy managers. The newer formation of National Cancer Grid, integration of national databases and the creation of social identification database Aadhaar by The Unique Identification Authority of India are set to enhance the health care provision and optimal outcome.
Collapse
Affiliation(s)
- Chandramohan Servarayan Murugesan
- Center for Gastroesophageal Disorders, ESOINDIA, Chennai, India. .,Department of General, GI and Minimal Access Surgery, St. Isabel's Hospital, Chennai, 600010, India.
| | - Kanagavel Manickavasagam
- Center for Gastroesophageal Disorders, ESOINDIA, Chennai, India.,Department of General, GI and Minimal Access Surgery, St. Isabel's Hospital, Chennai, 600010, India
| | | | - Abishai Jebaraj
- Center for Gastroesophageal Disorders, ESOINDIA, Chennai, India.,Department of General, GI and Minimal Access Surgery, St. Isabel's Hospital, Chennai, 600010, India
| | - Abdul Rehman Abdul Jameel
- Department of Gastrointestinal Surgery, Saveetha Medical College, Saveetha University, Thandalam, Chennai, 602105, India
| | - Mayank Shikar Jain
- Institute of Gastroenterology, Gleneagles Global Hospital, Chennai, 600100, India
| | | |
Collapse
|
48
|
Bawane P, Mahadevan B, Jain M, Chenduran SNK, Sridhar CG, Ravi R, Venkataraman J. Double‑Scope Peroral Endoscopic Myotomy Technique: Light at the End of the Tunnel! Journal of Digestive Endoscopy 2018. [DOI: 10.4103/jde.jde_51_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
ABSTRACT
Peroral Endoscopic Myotomy has become the preferred therapy for achalasia cardia.An important predictor of the success and safety of this technique remains the correct identification of the Esophago gastric junction and the extent of myotomy. However, this key step may be difficult in a subset of patients. The present case highlights the use of double scope technique to manage such technical issues.
Collapse
Affiliation(s)
- Piyush Bawane
- Department of Gastroenterology and Interventional Endoscopy, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - B. Mahadevan
- Department of Gastroenterology and Interventional Endoscopy, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - Mayank Jain
- Department of Gastroenterology and Interventional Endoscopy, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - S. N. K. Chenduran
- Department of Gastroenterology and Interventional Endoscopy, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - C. G. Sridhar
- Department of Gastroenterology and Interventional Endoscopy, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - R. Ravi
- Department of Gastroenterology and Interventional Endoscopy, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - Jayanthi Venkataraman
- Department of Gastroenterology and Interventional Endoscopy, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| |
Collapse
|
49
|
Jain M, Srinivas M, Ravi R, Mahadevan B, Michael T, Venkataraman J. Isolated Terminal Ileal Mucosal Changes: When is the Bite Indicated? Journal of Digestive Endoscopy 2018. [DOI: 10.4103/jde.jde_68_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
ABSTRACT
Aim: This study aims to determine the clinical presentation, and ileal mucosal changes during colonoscopy for which terminal ileal (TI) biopsies were taken at our center and to determine the specific histopathology which had the best yield for specific colonoscopy findings. Materials and Methods: Retrospective audit of all patients who underwent colonoscopy with ileoscopy between 2012 and 2016. All patients with TI mucosal changes and normal colonic mucosa, who underwent ileal biopsy, were included in this study. Patient data regarding age, gender, indication for ileocolonoscopy (screening for colorectal cancers, inflammatory bowel disease [IBD], or irritable bowel syndrome [IBS]) and histopathology changes were collected. Appropriate statistical tests were used and P < 0.05 was considered statistically significant. Results: One hundred and nine patients had isolated ileal lesions. The median age was 44.1 years (range 8–80
years). Men outnumbered women in a ratio of 82:27. The major clinical indications for ileocolonoscopy were IBS (64.2%), followed by IBD (22%). Ulcers (aphthoid) were the most frequent finding followed by mucosal nodularity and nonspecific findings. Ulcers in ileum were most often reported as chronic ileitis (46.2%), followed by nonspecific changes (35.2%) Biopsy from nodular ileal lesions, were predominantly nonspecific (74.4%), followed by acute (15.4%) and chronic ileitis (10.2%). About 50% of specimens with nonspecific ileal changes had nonspecific histological changes. Ileal ulcers had the highest sensitivity, PPV, and NPV for significant histological findings. Conclusion: Ileal ulcers are the significant colonoscopy findings where tissue biopsy is likely to yield a definitive diagnosis and justify specific management. Biopsies from nonspecific ileal changes and nodularity should be discouraged as it is unlikely to pick up
any major abnormality.
Collapse
Affiliation(s)
- Mayank Jain
- Department of Gastroenterology, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - M. Srinivas
- Department of Gastroenterology, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - R. Ravi
- Department of Gastroenterology, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - B. Mahadevan
- Department of Gastroenterology, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - Tom Michael
- Department of Gastroenterology, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| | - Jayanthi Venkataraman
- Department of Gastroenterology, Gleneagles Global Health City, Chennai, Tamil Nadu, India
| |
Collapse
|
50
|
Ghoshal UC, Sachdeva S, Pratap N, Verma A, Karyampudi A, Misra A, Abraham P, Bhatia SJ, Bhat N, Chandra A, Chakravartty K, Chaudhuri S, Chandrasekar TS, Gupta A, Goenka M, Goyal O, Makharia G, Mohan Prasad VG, Anupama NK, Paliwal M, Ramakrishna BS, Reddy DN, Ray G, Shukla A, Sainani R, Sadasivan S, Singh SP, Upadhyay R, Venkataraman J. Indian consensus on chronic constipation in adults: A joint position statement of the Indian Motility and Functional Diseases Association and the Indian Society of Gastroenterology. Indian J Gastroenterol 2018; 37:526-544. [PMID: 30617919 PMCID: PMC6339668 DOI: 10.1007/s12664-018-0894-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 09/18/2018] [Indexed: 02/06/2023]
Abstract
The Indian Motility and Functional Diseases Association and the Indian Society of Gastroenterology developed this evidence-based practice guideline for management of chronic constipation. A modified Delphi process was used to develop this consensus containing 29 statements, which were generated by electronic voting iteration as well as face to face meeting and review of the supporting literature primarily from India. These statements include 9 on epidemiology, clinical presentation, and diagnostic criteria; 8 on pathophysiology; and the remaining 12 on investigations and treatment. When the proportion of those who voted either to accept completely or with minor reservation was 80% or higher, the statement was regarded as accepted. The members of the consensus team believe that this would be useful for teaching, clinical practice, and research on chronic constipation in India and in other countries with similar spectrum of the disorders.
Collapse
Affiliation(s)
- Uday C. Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014 India
| | | | | | - Abhai Verma
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014 India
| | - Arun Karyampudi
- Asian Institute of Gastroenterology, Hyderabad, 500 082 India
| | - Asha Misra
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014 India
| | - Philip Abraham
- P D Hinduja Hospital and MRC, and Hinduja Heathcare Surgical, Mumbai, 400 016 India
| | | | - Naresh Bhat
- Aster CMI Hospital, Bangalore, 560 092 India
| | | | | | - Sujit Chaudhuri
- Advanced Medicare Research Institute, Salt Lake, Kolkata, 700 091 India
| | - T. S. Chandrasekar
- Department of Gastroenterology, Medindia Hospitals, Nungambakkam, Chennai, 600 034 India
| | - Ashok Gupta
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014 India
| | - Mahesh Goenka
- Appollo Gleneagles Hospitals, Kolkata, 700 054 India
| | - Omesh Goyal
- Dayanand Medical College, Ludhiana, 141 001 India
| | - Govind Makharia
- All India Institute of Medical Sciences, New Delhi, 110 029 India
| | | | | | | | | | - D. N. Reddy
- Asian Institute of Gastroenterology, Hyderabad, 500 082 India
| | - Gautam Ray
- B R Singh Railway Hospital, Kolkata, 700 014 India
| | - Akash Shukla
- Lokmanya Tilak Municipal General Hospital and Medical College, Sion, Mumbai, 400 022 India
| | | | | | | | | | | |
Collapse
|