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Ghoshal UC, Sachdeva S, Ghoshal U, Misra A, Puri AS, Pratap N, Shah A, Rahman MM, Gwee KA, Tan VPY, Ahmed T, Lee YY, Ramakrishna BS, Talukdar R, Rana SV, Sinha SK, Chen M, Kim N, Holtmann G. Asian-Pacific consensus on small intestinal bacterial overgrowth in gastrointestinal disorders: An initiative of the Indian Neurogastroenterology and Motility Association. Indian J Gastroenterol 2022; 41:483-507. [PMID: 36214973 PMCID: PMC9549446 DOI: 10.1007/s12664-022-01292-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 06/20/2022] [Accepted: 08/02/2022] [Indexed: 02/04/2023]
Abstract
In the clinical setting, small intestinal bacterial overgrowth (SIBO) is a frequent, but under-diagnosed entity. SIBO is linked to various gastrointestinal (GI) and non-GI disorders with potentially significant morbidity. The optimal management of SIBO is undefined while there is a lack of published consensus guidelines. Against this background, under the auspices of the Indian Neurogastroenterology and Motility Association (INMA), formerly known as the Indian Motility and Functional Diseases Association (IMFDA), experts from the Asian-Pacific region with extensive research and clinical experience in the field of gut dysbiosis including SIBO developed this evidence-based practice guideline for the management of SIBO utilizing a modified Delphi process based upon 37 consensus statements, involving an electronic voting process as well as face-to-face meetings and review of relevant supporting literature. These statements include 6 statements on definition and epidemiology; 11 on etiopathogenesis and pathophysiology; 5 on clinical manifestations, differential diagnosis, and predictors; and 15 on investigations and treatment. When the proportion of those who voted either to accept completely or with minor reservations was 80% or higher, the statement was regarded as accepted. The members of the consensus team consider that this guideline would be valuable to inform clinical practice, teaching, and research on SIBO in the Asian-Pacific region as well as in other countries.
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Affiliation(s)
- Uday C. Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014 India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, G B Pant Hospital, New Delhi, 110 002 India
| | - Ujjala Ghoshal
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014 India
| | - Asha Misra
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014 India
| | | | | | - Ayesha Shah
- University of Queensland, Faculty of Medicine, and Princess Alexandra Hospital, Department of Gastroenterology and Hepatology, Brisbane, Queensland, Australia
| | - M. Masudur Rahman
- Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh
| | - Kok Ann Gwee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore ,Stomach, Liver and Bowel Centre, Gleneagles Hospital, Singapore, Singapore
| | - Victoria P Y Tan
- Faculty of Medicine, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia ,GI Function and Motility Unit, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - B S Ramakrishna
- SIMS Institute of Gastroenterology, Hepatology, and Transplantation, SRM Institutes for Medical Science, Chennai, 600 026 India
| | - Rupjyoti Talukdar
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 500 082 India
| | - S V Rana
- Department of Biochemistry, All India Institute of Medical Sciences, Rishikesh, 249 203 India
| | - Saroj K Sinha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012 India
| | - Minhu Chen
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Gerald Holtmann
- University of Queensland, Faculty of Medicine, and Princess Alexandra Hospital, Department of Gastroenterology and Hepatology, Brisbane, Queensland, Australia
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Malik A, Saha S, Morya RK, Bhadada SK, Rana SV. Impact of serotonin transporter gene polymorphism on gut motility in patients with type 2 Diabetes mellitus. J Neurogastroenterol Motil 2021; 27:240-247. [PMID: 33526751 PMCID: PMC8026373 DOI: 10.5056/jnm20211] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/29/2020] [Accepted: 11/29/2020] [Indexed: 11/20/2022] Open
Abstract
Background/Aims The pathogenesis of gastrointestinal (GI) symptoms in patients with type 2 diabetes mellitus (T2DM) is yet to be delineated clearly. Serotonin, a monoamine neurotransmitter, resides primarily in the gut and plays a vital role in GI system. However, no study has been documented the role of serotonin and serotonin transporter gene (SLC6A4) polymorphism in the development of GI symptoms in T2DM patients. Methods Three hundred diabetes patients attending diabetes clinic at Postgraduate Institute of Medical Education and Research, Chandigarh, and matched healthy controls were enrolled for this study. Plasma from collected blood sample was used for serotonin measurement by enzyme-linked immunosorbent assay method and buffy coat was used for isolation of DNA by phenol chloroform method. Serotonin transporter gene polymorphism was analyzed by polymerase chain reaction method. Results The frequency of short allele (S) and SS genotype was significantly higher in patients with T2DM than controls and was associated with increased risk of T2DM. The frequency of LS genotype showed an association with protection from the disease. Regarding GI symptoms, 78.2% of patients with constipation showed LL and LS genotypes, and 97.7% of patients with diarrhea had SS genotype. The patients without GI symptoms did not show any association of gut motility with genotype. Furthermore, serotonin was significantly higher in diabetic patients who belonged to SS genotype compared to LS or LL genotype and who presented with diarrhea. Conclusion SS genotypes are prone to develop diarrhea because of faster gut motility resulting from higher serotonin levels as compared to LS and LL genotype in T2DM patients.
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Affiliation(s)
- Aastha Malik
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sarama Saha
- Department of Biochemistry, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India
| | - Rajesh K Morya
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay K Bhadada
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Satya V Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.,Department of Biochemistry, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India
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Puttaiah Kadyada S, Thapa BR, Kaushal K, Walia R, Rana SV, Dhaka N, Lal SB, Prasad R, Das S, Thakur R, Kamal K. Incomplete functional and morphological recovery after acute and acute recurrent pancreatitis in children. J Gastroenterol Hepatol 2019; 34:293-301. [PMID: 29791723 DOI: 10.1111/jgh.14288] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/29/2018] [Accepted: 05/01/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIM There is lack of data on functional and morphological recovery after an attack of acute pancreatitis (AP) or acute recurrent pancreatitis (ARP) in children. This study aims to evaluate the functional impairment and morphological changes in the pancreas after recovery. METHODS All consecutive patients presenting with AP (n = 61) or ARP (n = 35), as per standard diagnostic criteria, were enrolled. After 2 months of pancreatitis, fecal elastase-1 (FE-1) (μg/g) and 2-h oral glucose tolerance test to calculate oral disposition index (DIo ) (mmol/L) (β-cell function) were performed. Morphological changes were assessed by endoscopic ultrasound and transabdominal ultrasound. Patients with chronic pancreatitis (CP) (n = 27) and healthy children (HC) (n = 26) were included as controls for functional parameters. RESULTS At a median follow up of 12 (4-44) and 11 (2-108) months, 66.7% and 75.9% (P = 0.57) of AP and ARP demonstrated exocrine insufficiency (FE-1 < 200), respectively. Mean (SD) FE-1 was 183.64 ± 150.94 (AP), 135.70 ± 103.80 (ARP), 46.56 ± 30.20 (CP), and 240.00 ± 181.83 (HC) (P < 0.001; anova) (AP vs CP, ARP vs CP, and CP vs HC; P < 0.001). Prediabetes due to insulin resistance was seen in 16.6% and 22.6% (P = 0.56) of AP and ARP. Median (interquartile range) DIo (mmol/L) was comparable between AP (4.20 [2.36, 8.3]) and HC (5.20 [2.89, 8.68]), but was low in ARP (2.97 [1.80, 5.12]), which was comparable with CP (1.91 [1.20, 2.83]). Endoscopic ultrasound demonstrated morphological changes in 25% and 37% (P = 0.34) of AP and ARP, respectively. CONCLUSION There was high frequency of biochemical evidence of exocrine insufficiency. β-Cell function (DIo ) was preserved among AP but was poor in ARP. Nearly one-third showed morphological changes in imaging.
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Affiliation(s)
- Srikanth Puttaiah Kadyada
- Division of Pediatric Gastroenterology, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Babu Ram Thapa
- Division of Pediatric Gastroenterology, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Karanvir Kaushal
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rama Walia
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S V Rana
- Division of Biochemistry, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Narendra Dhaka
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sadhna B Lal
- Division of Pediatric Gastroenterology, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajendra Prasad
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhamoy Das
- Division of Pediatric Gastroenterology, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajini Thakur
- Division of Biochemistry, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kishore Kamal
- Department of Biostatistics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Rana SV, Malik A, Bhadada SK, Sachdeva N, Morya RK, Sharma G. Malabsorption, Orocecal Transit Time and Small Intestinal Bacterial Overgrowth in Type 2 Diabetic Patients: A Connection. Indian J Clin Biochem 2016; 32:84-89. [PMID: 28149017 DOI: 10.1007/s12291-016-0569-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 02/03/2016] [Accepted: 04/22/2016] [Indexed: 01/19/2023]
Abstract
Type 2 diabetes mellitus consists of dysfunctions characterized by hyperglycemia and resulting from combination of resistance to insulin action and inadequate insulin secretion. Most of diabetic patients report significant gastrointestinal symptoms. Entire GI tract can be affected by diabetes from oral cavity to large bowel and anorectal region. Proteins, carbohydrates, fats, and most fluids are absorbed in small intestine. Malabsorption may occurs when proper absorption of nutrients does not take place due to bacterial overgrowth or altered gut motility. The present study was planned to measure various malabsorption parameters in type 2 diabetic patients. 175 patients and 175 age and sex matched healthy controls attending Endocrinology Clinic in PGI, Chandigarh were enrolled. Lactose intolerance was measured by using non-invasive lactose hydrogen breath test. Urinary d-xylose and fecal fat were estimated using standard methods. Orocecal transit time and small intestinal bacterial overgrowth were measured using non-invasive lactulose and glucose breath test respectively. Out of 175 diabetic patients enrolled, 87 were males while among 175 healthy subjects 88 were males. SIBO was observed in 14.8 % type 2 diabetic patients and in 2.8 % of controls. There was statistically significant increase (p < 0.002) in OCTT in type 2 diabetic patients compared with controls. OCTT was observed to be more delayed (p < 0.003) in patients who were found to have SIBO than in patients without SIBO. Lactose intolerance was observed in 60 % diabetic patients and 39.4 % in controls. Urinary d-xylose levels were also lower in case of diabetic patients but no significant difference was found in 72 h fecal fat excretion among diabetic patients and controls. Urinary d-xylose and lactose intolerance in SIBO positive type 2 diabetic patients was more severe as compared to SIBO negative diabetic patients. From this study we can conclude that delayed OCTT may have led to SIBO which may have instigated the process of malabsorption among type 2 diabetic patients.
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Affiliation(s)
- S V Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Aastha Malik
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Sanjay K Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Naresh Sachdeva
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Rajesh Kumar Morya
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
| | - Gaurav Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 India
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Hallworth MJ, Epner PL, Ebert C, Fantz CR, Faye SA, Higgins TN, Kilpatrick ES, Li W, Rana SV, Vanstapel F. Current Evidence and Future Perspectives on the Effective Practice of Patient-Centered Laboratory Medicine. Clin Chem 2015; 61:589-99. [DOI: 10.1373/clinchem.2014.232629] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBACKGROUNDSystematic evidence of the contribution made by laboratory medicine to patient outcomes and the overall process of healthcare is difficult to find. An understanding of the value of laboratory medicine, how it can be determined, and the various factors that influence it is vital to ensuring that the service is provided and used optimally.CONTENTThis review summarizes existing evidence supporting the impact of laboratory medicine in healthcare and indicates the gaps in our understanding. It also identifies deficiencies in current utilization, suggests potential solutions, and offers a vision of a future in which laboratory medicine is used optimally to support patient care.SUMMARYTo maximize the value of laboratory medicine, work is required in 5 areas: (a) improved utilization of existing and new tests; (b) definition of new roles for laboratory professionals that are focused on optimizing patient outcomes by adding value at all points of the diagnostic brain-to-brain cycle; (c) development of standardized protocols for prospective patient-centered studies of biomarker clinical effectiveness or extraanalytical process effectiveness; (d) benchmarking of existing and new tests in specified situations with commonly accepted measures of effectiveness; (e) agreed definition and validation of effectiveness measures and use of checklists for articles submitted for publication. Progress in these areas is essential if we are to demonstrate and enhance the value of laboratory medicine and prevent valuable information being lost in meaningless data. This requires effective collaboration with clinicians, and a determination to accept patient outcome and patient experience as the primary measure of laboratory effectiveness.
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Affiliation(s)
- Mike J Hallworth
- Department of Clinical Biochemistry, Royal Shrewsbury Hospital, Shrewsbury, Shropshire, UK
| | | | | | | | | | | | | | | | - S V Rana
- Department of Gastroenterology, PGIMER, Chandigarh, India
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Rana SV, Sharma SK, Ola RP, Kamboj JK, Malik A, Morya RK, Sinha SK. N-acetyltransferase 2, cytochrome P4502E1 and glutathione S-transferase genotypes in antitubercular treatment-induced hepatotoxicity in North Indians. J Clin Pharm Ther 2013; 39:91-6. [PMID: 24188272 DOI: 10.1111/jcpt.12105] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [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: 06/13/2013] [Accepted: 09/30/2013] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Tuberculosis (TB) is a major cause of illness and death in developing countries. Hepatotoxicity is a serious side effect of antituberculosis treatment (ATT). NAT2, CYP2E1 and glutathione S-transferase (GST) gene polymorphisms may play an important role in ATT-induced hepatotoxicity. So, elucidating the genetics involved in anti-TB drug-induced hepatotoxicity in patients would be of utmost clinical significance. Therefore, the objective of the study was to elucidate the role of NAT2, CYP2E1 and GST gene polymorphisms in ATT-induced hepatotoxicity in North Indian patients. METHODS Three hundred patients with pulmonary and extra-pulmonary TB were enrolled. Total genomic DNA was isolated from each patient's peripheral lymphocytes using phenol-chloroform method, and genetic polymorphic analysis for N-acetyltransferase 2 (NAT2), cytochrome P4502E1 (CYP2E1) and GST was performed by polymerase chain reaction (PCR) with restriction fragment length polymorphism (RFLP). RESULTS AND DISCUSSION Of the 300 patients, 185 were males and 115 females. Among them, 33 males and 22 females developed ATT-induced hepatotoxicity. There were significant increases in alanine aminotransferase, aspartate aminotransferase and bilirubin levels in patients with ATT-induced hepatotoxicity at 1 month of treatment. NAT2 5/7 and 6/7 were significantly higher in hepatotoxicity patients as compared to the non-hepatotoxicity group. c1/c1 allele of CYP2E1 gene was lower (50·9%) in ATT-induced hepatotoxicity patients as compared to non-hepatotoxicity patients (61·2%), whereas c1/c2 and c2/c2 alleles were higher, but not statistically significant. GSTM1 was significantly higher in hepatotoxicity patients as compared to non-hepatotoxicity patients, whereas GSTT1 and GSTT1/M1 were lower, but not statistically significant. WHAT IS NEW AND CONCLUSION This study indicates that patients with slow-acetylator genotypes (NAT2 5/7, 6/7) and GSTM1 allele of GST enzyme were at higher risk of ATT-induced hepatotoxicity.
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Affiliation(s)
- S V Rana
- Department of Super Specialty Gastroenterology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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Rana SV, Sharma S, Sinha SK, Parsad KK, Malik A, Singh K. Pro-inflammatory and anti-inflammatory cytokine response in diarrhoea-predominant irritable bowel syndrome patients. ACTA ACUST UNITED AC 2013; 33:251-6. [PMID: 23923350 DOI: 10.7869/tg.2012.66] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM Irritable bowel syndrome (IBS) is referred to as a functional bowel disorder which is diagnosed by a number of characteristic symptoms (Rome II criteria) in the absence of detectable structural abnormalities. Low-grade inflammation of the intestine may be one of the reasons for development of diarrhoea-predominant IBS (IBS-D). We undertook this study to estimate the serum levels of pro-inflammatory (IL-6, TNF-alpha) and anti-inflammatory (IL-10) cytokines in IBS-D patients. METHODS A total of 108 diarrhoea patients were screened. Out of these only 63 adult IBS-D patients were enrolled. Age and sex matched 62 apparently healthy controls with no GI symptoms were also recruited. Out of 63 IBS-D patients, 37 were males while there were 32 males among the controls. The patients with IBS-D were diagnosed according to the Rome II criteria. Levels of serum IL-6, TNF-alpha and IL-10 were measured in all subjects using ELISA. RESULTS Mean (+/- SD) age of IBS-D patients (42.6 +/- 19.5 years) was comparable (p = 0.64) to that of controls (43.5 +/- 18.7 years). The mean (+/- SD) levels of IL-6 in IBS-D patients (32.2 +/- 12.01 pg/ml) was significantly higher (p < 0.001) than in controls (7.48 +/- 2.55 pg/ml). The levels of TNF-alpha in IBS-D patients (16.3 +/- 5.2 pg/ml) were also significantly higher (p < 0.05) than in controls (7.94 +/- 2.19 pg/ml). There was no significant difference in the serum levels of IL-10 (p = 0.23) between IBS-D patients (5.75 +/- 2.1 pg/ml) and controls (5.84 +/- 1.9 pg/ml). CONCLUSION Our results indicate that mild inflammation is involved in IBS-D patients as proinflammatory cytokines were increased although no difference in anti-inflammatory cytokine was observed.
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Affiliation(s)
- S V Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, India.
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Rana SV, Sharma S, Malik A, Kaur J, Prasad KK, Sinha SK, Singh K. Small intestinal bacterial overgrowth and orocecal transit time in patients of inflammatory bowel disease. Dig Dis Sci 2013; 58:2594-8. [PMID: 23649377 DOI: 10.1007/s10620-013-2694-x] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [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] [Received: 09/23/2012] [Accepted: 04/18/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) consists of Ulcerative colitis (UC) and Crohn's disease (CD). These two conditions share many common features-diarrhea, bloody stools, weight loss, abdominal pain, fever and fatigue. Small intestinal bacterial overgrowth (SIBO) is frequent in patients with CD but it has not been studied in UC Indian patients. AIM The study was planned to measure orocecal transit time (OCTT) and SIBO in UC and CD patients. METHODS One hundred thirty-seven patients of IBD (95 UC and 42 CD) and 115 healthy controls were enrolled. OCTT and SIBO were measured by lactulose and glucose hydrogen breath test respectively. Concentration of hydrogen and methane were measured by SC microlyser from Quintron, USA. RESULTS Mean±standard deviation (SD) of OCTT in patients of IBD was significantly higher as compared to controls. Furthermore, OCTT was significantly higher in CD patients as compared to UC patients. It was also observed that occurrence of SIBO was significantly higher in IBD patients as compared to controls. The occurrence of SIBO in CD (45.2%) was significantly higher as compared to patients in UC (17.8%) group. Percentage of methane positive IBD patients (2.9%) was significantly lower as compared to methane positive controls (24.4%). CONCLUSION OCTT was significantly delayed in IBD patients as compared to controls and in CD patients as compared to UC patients. OCTT was significantly higher in SIBO positive IBD patients as compared to SIBO negative patients. Thus, we can suggest that delayed OCTT would have been the cause of increased SIBO in these patients.
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Affiliation(s)
- S V Rana
- Department of Super Specialty Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India.
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Rana SV, Sharma S, Kaur J, Sinha SK, Singh K. Comparison of lactulose and glucose breath test for diagnosis of small intestinal bacterial overgrowth in patients with irritable bowel syndrome. Digestion 2012; 85:243-7. [PMID: 22472730 DOI: 10.1159/000336174] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [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] [Received: 10/25/2011] [Accepted: 01/03/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Validity of the lactulose breath test (LBT) to diagnose small intestinal bacterial overgrowth (SIBO) has been questioned. Therefore, a study was planned to compare LBT with glucose breath test (GBT) to diagnose SIBO in irritable bowel syndrome (IBS) patients and controls. METHODS 175 diarrhea-predominant IBS patients and 150 apparently healthy controls were enrolled. IBS was diagnosed according to Rome II criteria. Breath samples were collected every 10 min up to 180 min. Breath H₂ and CH₄ were measured using an SC MicroLyzer. SIBO was positive with a sustained increase in breath H₂ or CH₄ or both ≥10 ppm over a baseline value within <90 min in case of LBT and within <120 min in GBT. RESULTS SIBO was positive in 60/175 (34.3%) patients by lactulose and in 11/175 (6.2%) patients by GBT. In controls, LBT was positive for SIBO in 45/150 (30%) patients and in 1/150 (0.66%) patients by GBT. Positive LBT for SIBO was not significantly different in patients and controls; while using GBT, SIBO was significantly higher (p < 0.01) in patients as compared to controls. By using GBT as gold standard for SIBO, sensitivity, specificity, positive predictive value and negative predictive value of LBT in IBS patients was 63.6, 67.7, 11.7 and 96.6% respectively. CONCLUSION LBT is not a good test to discriminate SIBO in IBS patients from controls.
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Affiliation(s)
- S V Rana
- Department of Super Specialty of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Sahni N, Gupta KL, Rana SV, Prasad R, Bhalla AK. Intake of antioxidants and their status in chronic kidney disease patients. J Ren Nutr 2012; 22:389-99. [PMID: 22227184 DOI: 10.1053/j.jrn.2011.09.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 09/03/2011] [Accepted: 09/03/2011] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To evaluate the intake and status of antioxidants in chronic kidney disease (CKD) patients. DESIGN Randomized control trial. SETTING Hospital outpatient department. SUBJECTS One hundred eighty-five subjects (145 predialysis CKD patients and 40 apparently healthy controls) were enrolled for this study. The patients were divided into moderate and severe renal failure groups based on their creatinine and glomerular filtration rates. INTERVENTION All patients completed a food frequency questionnaire, 24-hour dietary recall form, and anthropometric measurements and underwent biochemical and antioxidant lab tests. MAIN OUTCOME MEASURES Dietary intake, anthropometry, biochemical measures of blood and antioxidant enzymes as well as oxidative stress. RESULTS Overall, the diet was significantly lower in antioxidant-rich food intake in all the CKD patients as compared with controls. The oxidative stress measured in blood was found to be in consonance with the intake from diet. CONCLUSION Micronutrients play a major role in the antioxidant status of the patients and must be monitored, as deficiency of these might elevate the oxidative stress of the body, especially in the chronic diseases.
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Affiliation(s)
- N Sahni
- Department of Dietetics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Rana SV, Ola RP, Sharma SK, Arora SK, Sinha SK, Pandhi P, Singh K. Comparison between acetylator phenotype and genotype polymorphism of n-acetyltransferase-2 in tuberculosis patients. Hepatol Int 2011; 6:397-402. [PMID: 22020825 DOI: 10.1007/s12072-011-9309-4] [Citation(s) in RCA: 15] [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: 03/28/2011] [Accepted: 08/03/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Isoniazid (INH) is one of the most important drugs of antitubercular treatment regime, and in some cases it causes hepatotoxicity. It is metabolized by hepatic N-acetyltransferase-2 (NAT2). AIM To compare whether both methods, i.e., genotype NAT2 and phenotype test of measuring serum INH levels, are useful to identify acetylator status of patients on antitubercular treatment (ATT). METHODS A total of 251 tuberculosis (TB) patients on standard treatment were followed up to 6 months for this study. NAT2 genotype was assessed by PCR with restriction fragment length polymorphism (RFLP) whereas serum INH levels were measured by fluorometry. RESULTS Of the 251 patients, 50 (19.9%) developed ATT-induced hepatotoxicity. By phenotypic estimation, in the hepatotoxicity group, 17/50 (34%) were slow acetylators whereas 33/50 (66%) were fast acetylators. Genotypically, 19/50 (38%) were slow acetylators and 31/50 (62%) fast acetylators. By phenotypic analysis, in non-hepatotoxicity group, 46/201 (22.9%) were slow acetylators and 155/201 (77.1%) fast acetylators. By genotypic analysis, 30/201 (14.9%) were slow acetylators and 171/201 (85%) fast acetylators. Overall, slow acetylators (25.1%) measured phenotypically were not significantly different from slow acetylators (19.5%) measured genotypically. CONCLUSION This study suggests that the acetylator status of TB patients can be detected by phenotypic method as efficaciously as by genotypic method. Therefore, phenotypic method can replace genotypic method to determine acetylating status as phenotypic method is simple and inexpensive.
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Affiliation(s)
- S V Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. .,, House # 137, Sector 15-A, Chandigarh, 160015, India.
| | - R P Ola
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjeev K Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S K Arora
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S K Sinha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - P Pandhi
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - K Singh
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Rana SV, Chacko F, Lal V, Arora SK, Parbhakar S, Sharma SK, Singh K. To compare CSF adenosine deaminase levels and CSF-PCR for tuberculous meningitis. Clin Neurol Neurosurg 2010; 112:424-30. [PMID: 20347212 DOI: 10.1016/j.clineuro.2010.02.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 02/13/2010] [Accepted: 02/20/2010] [Indexed: 10/19/2022]
Abstract
This study was planned to compare the adenosine deaminase (ADA) levels and polymerase chain reaction (PCR) in cerebrospinal fluid (CSF) as a rapid method to diagnose tuberculosis meningitis (TBM). Fifty-four adult patients with suspected TBM and 37 controls were included in this study. The median ADA level was 21U/L of most likely TBM, 14U/L of unconfirmed TBM and 5U/L of controls. PCR for Mycobacterium tuberculosis was positive in 12 out of 27 most likely TBM cases, 5 out of 27 unconfirmed TBM cases and 3 out of 37 controls. Using a cut off level of >10U/L, CSF-ADA had a sensitivity of 92.5% and specificity of 97% for the diagnosis of TBM. PCR for M. tuberculosis had a sensitivity of 44.5% and specificity 92% in the most likely TBM cases. This study shows that CSF-ADA is a more sensitive indicator than PCR for the diagnosis of M. tuberculosis.
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Affiliation(s)
- S V Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education And Research, Chandigarh, India.
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13
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Rana SV, Sinha SK, Sharma S, Kaur H, Bhasin DK, Singh K. Effect of predominant methanogenic flora on outcome of lactose hydrogen breath test in controls and irritable bowel syndrome patients of north India. Dig Dis Sci 2009; 54:1550-4. [PMID: 19003533 DOI: 10.1007/s10620-008-0532-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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] [Received: 05/07/2008] [Accepted: 09/11/2008] [Indexed: 12/12/2022]
Abstract
The relationship between methanogenic flora and hydrogen (H(2)) production is considered to be a possible confounding factor in the interpretation of hydrogen breath tests (H(2)BT). Therefore, the present study was conducted prospectively and included 154 IBS patients (fulfilling Rome II criteria) and 286 age-and-sex-matched apparently healthy controls. Each subject underwent H(2)BT after overnight fasting using 25 g lactose. Methane and H(2) were measured using an SC Microlyser from Quintron, USA, at baseline and every 30 min for a total of 4 h. Subjects with fasting methane concentration <10 ppm were labeled as low methane producers (LMP) and >10 ppm as predominant methane producers (PMP). A rise >20 ppm over base line in hydrogen concentration was taken as +ve hydrogen breath test. IBS and control groups included 66.78% and 67.53% males, respectively. Mean age in the two groups were 48.52 +/- 30.54 years (range 15-68 years) and 45.67 +/- 30.54 years (range 15-78 years), respectively. Hydrogen breath test was +ve in 77/154 (50%) IBS patients and in 142/286 (49.65%) in controls (P > 0.05). It was also observed that the hydrogen breath test was -ve due to PMP in 5/77 (6.49%) of IBS patients and in 29/154 (20.14%) in controls. PMP affected lactose hydrogen breath tests in 6.49-20.14% subjects. This effect is more apparent in apparently healthy subjects as compared to patients with IBS.
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Affiliation(s)
- S V Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Rana SV, Sharma S, Sinha SK, Kaur J, Prasad KK, Singh K. Influence of previously ingested wheat on fasting breath hydrogen in celiac patients. Dig Dis Sci 2009; 54:1276-9. [PMID: 18958623 DOI: 10.1007/s10620-008-0496-3] [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] [Received: 05/07/2008] [Accepted: 08/22/2008] [Indexed: 12/09/2022]
Abstract
The excretion of hydrogen in breath commonly persists, despite an overnight fast. Although the elevation of hydrogen concentration above the fasting value after the administration of a test sugar is evidence of malabsorption, the level of the fasting value itself in untreated celiac patients is unknown. Therefore, we studied the fasting breath hydrogen (FBH(2)) concentration in 40 healthy controls, 35 subjects with functional bowel disorders, and 30 patients of untreated celiac disease with and without bread or wheat diet one day before the test. The fasting level of hydrogen concentration in untreated celiac patients (28.7 +/- 19.5 ppm) was significantly higher than those in healthy volunteers (9.5 +/- 3.4 ppm) and subjects with functional bowel disorders (10.6 +/- 4.5 ppm). The percentage of patients with elevated H(2) fasting levels in untreated celiac disease (82.5%) was significantly higher than that in healthy controls (10%) and subjects with functional bowel disorders (17.1%). In 30 celiac patients, studied with and without wheat-free diet one day before the test, the fasting hydrogen levels decreased from 28.7 +/- 19.5 ppm to 10.6 +/- 3.5 ppm, and becoming normal in all patients of celiac disease. Our results show that the patients of untreated celiac disease should be instructed not to eat things made up of wheat one day before hydrogen breath testing so that the normal fasting hydrogen concentration can be obtained and false-negative hydrogen breath test results can be avoided.
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Affiliation(s)
- S V Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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15
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Abstract
Small intestinal bacterial overgrowth (SIBO) syndrome is characterized in its florid form by diarrhoea and weight loss. The most common underlying factors are dysmotility, small intestinal obstruction, blind or afferent loops. Small intestinal bacterial overgrowth can be diagnosed by: 1) culture of jejunum aspirate for bacterial counts, 2) 14C-D-xylose breath testing, 3) non-invasive hydrogen breath testing using glucose or lactulose or 4) 14C-glycocholic acid breath testing. The treatment usually consists of the eradication of bacterial overgrowth with repeated course of antimicrobials, correction of associated nutritional deficiencies and, when possible, correction of the underlying predisposing conditions.
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Affiliation(s)
- S V Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Rana SV, Kochhar R, Pal R, Nagi B, Singh K. Orocecal transit time in patients in the chronic phase of corrosive injury. Dig Dis Sci 2008; 53:1797-800. [PMID: 18095159 DOI: 10.1007/s10620-007-0096-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2007] [Accepted: 10/27/2007] [Indexed: 01/21/2023]
Abstract
UNLABELLED Accidental/suicidal ingestion of corrosive substances is common in North India. Decreased gastric secretion and delayed gastric emptying in the chronic phase of corrosive injury has been documented at our center. We hypothesize that patients in the chronic phase of corrosive injury may have delayed orocecal transit time (OCTT). OBJECTIVE To measure the orocecal transit time (using the noninvasive method of lactulose hydrogen breath test) in patients in the chronic phase of corrosive injury. METHODS Thirty patients with corrosive injury to their gastrointestinal tract with its sequelae and attending the gastroenterology services of PGIMER, Chandigarh for endoscopic dilatation of strictures were enrolled in this study. Patients with age >60 years, vagotomy, prior gastric surgery, peptic ulcer disease, systemic sclerosis, history of diabetes, hypothyroidism or intestinal pseudo-obstruction were excluded. Orocecal transit time was measured by using a 15 mL lactulose hydrogen breath test. End expiratory breath was taken every 10 min until there was a rise >10 ppm over the fasting value in two consecutive readings. RESULTS Thirty patients (11 females and 19 males) with a median age of 32 years, 27 with acid ingestion and 3 with alkali ingestion, were studied. None had symptoms of gastric outlet obstruction or gastroparesis. OCTT was significantly prolonged in the study group as compared to the control group (135.4 +/- 15.8 versus 90.6 +/- 10.4 min). No significant difference was observed between different age groups, gender, and type of caustic agent consumed. OCTT was maximally prolonged in patients with involvement of lower oesophagus, whereas patients without lower oesophagus involvement did not show significantly altered OCTT. CONCLUSION Our results show that patients with corrosive injury have prolonged OCTT even in the absence of any gastric symptoms. OCTT was prolonged maximally in patients with lower-third oesophageal cicatrization. This may a result of autovagotomy due to vagal entrapment in the cicatrization process involving the lower third of oesophagus.
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Affiliation(s)
- S V Rana
- Department of Gastroenterology, PGIMER, Chandigarh, India.
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Rana SV, Sharma S, Sinha SK, Prasad KK, Bhasin DK, Singh K. Orocecal transit time in patients with celiac disease from North India: a case control study. Trop Gastroenterol 2008; 29:98-100. [PMID: 18972770] [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: 05/27/2023]
Abstract
AIM The mechanisms responsible for bowel disturbances in celiac disease are still unknown. Small bowel motor abnormalities may be involved in this pathological condition; however, there is no study addressing small bowel transit in patients of celiac disease from Northern India. METHOD The mouth-to-cecum transit time was studied in 80 celiac patients and 80 age and sex matched apparently healthy controls. RESULTS Orocecal transit time in celiac patients was significantly delayed being 180+/-10.6 minutes (Mean+/-SE) as compared to 105+/-12.4 minutes in apparently healthy controls. CONCLUSION This prolonged orocecal transit time could be due to impaired small bowel function (deranged motility) in patients with celiac disease.
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Affiliation(s)
- S V Rana
- Department of Gastroentrology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
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18
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Rana SV, Sinha SK, Sikander A, Bhasin DK, Singh K. Study of small intestinal bacterial overgrowth in North Indian patients with irritable bowel syndrome: a case control study. Trop Gastroenterol 2008; 29:23-25. [PMID: 18564663] [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: 05/26/2023]
Abstract
BACKGROUND Approximately 20% of the general population has irritable bowel syndrome. Despite this high prevalence, the cause of irritable bowel syndrome is unknown. There is no data available concerning the prevalence of small intestinal bacterial overgrowth in North Indian patients with irritable bowel syndrome. AIM This study evaluated the prevalence of small intestinal bacterial overgrowth in patients with irritable bowel syndrome compared with healthy controls. METHODS This study included 225 consecutive patients of irritable bowel syndrome between the ages 20 and 65 years attending the gastroenterology clinics. Diagnosis of irritable bowel syndrome was made according to the Rome II criteria. Small intestinal bacterial overgrowth was estimated by using the non-invasive glucose hydrogen breath test. RESULTS Of 225 patients of irritable bowel syndrome, 160 (71.1%) were male and 65 (28.9%) were female. Of 100 controls, 65 (65%) were male and 35 (35%) female. The prevalence of small intestinal bacterial overgrowth was 25 of 225 (11.1%) patients with irritable bowel syndrome and 1 of 100 (1%) in apparently healthy controls. This difference was statistically significant. The prevalence of small intestinal bacterial overgrowth in male and female patients was not significantly different. CONCLUSION This study indicates that the prevalence of small intestinal bacterial overgrowth in irritable bowel syndrome patients from North India is approximately 11.1%, which is lower than the reported prevalence.
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Affiliation(s)
- S V Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Pal R, Rana SV, Vaiphei K, Singh K. Isoniazid-rifampicin induced lipid changes in rats. Clin Chim Acta 2007; 389:55-60. [PMID: 18157944 DOI: 10.1016/j.cca.2007.11.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Revised: 11/23/2007] [Accepted: 11/24/2007] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Isoniazid (INH) and rifampicine (RIF) continues to be highly effective drugs in the chemoprophylaxis and treatment of tuberculosis. It is associated with hepatotoxicity in some individuals. Change in liver and serum lipids may be one of the reasons of hepatotoxicity. We examined isoniazid-rifampicine induced lipid changes in liver and serum of rats. METHODS In a rat model of INH-RIF induced hepatotoxicity we evaluated the effect of oral administration of INH-RIF (50 mg/kg body weight /day each) on hepatic marker enzymes, total lipids, cholesterol, triglycerides and phospholipids in serum and liver of experimental rats after 28 days. Enzymes, total lipids and lipid fractions were measured according to standard methods. RESULTS Treatment with INH-RIF increased the hepatic marker enzymes after 28 days and altered the lipid levels in serum and liver. Administration of INH-RIF resulted in significantly increased liver and serum cholesterol and total Lipids as compared to control group, while triglycerides were significantly elevated in liver only. In contrast, phospholipids were significantly decreased in liver and no effect in serum was observed. CONCLUSION Changes in lipids (both in serum and liver) are likely involved in the pathogenesis of INH-RIF induced hepatoxicity in rats.
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Affiliation(s)
- R Pal
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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20
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Rana SV, Sinha SK, Lal S, Sikander A, Singh K. Small intestinal bacterial overgrowth in North Indian patients with celiac disease. Trop Gastroenterol 2007; 28:159-161. [PMID: 18416345] [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: 05/26/2023]
Abstract
BACKGROUND Occasionally celiac patients continue to experience gastro-intestinal symptoms even with a gluten free diet. In these cases, small intestinal bacterial overgrowth may be one of the causes of the lack of response. Therefore, this prospective study was planned to determine the prevalence of small intestinal bacterial overgrowth in celiac patients. MATERIALS AND METHODS We studied 87 confirmed cases of celiac disease from North India and 87 age and sex matched controls. Celiac disease was confirmed by positive IgA antitissue transglutaminase on ELISA. 80 g glucose hydrogen breath test (non-invasive test) was performed to establish small intestinal bacterial overgrowth. Rise of more than 10 ppm in hydrogen concentration over baseline value within two hours was considered suggestive of small intestinal bacterial overgrowth. RESULTS Out of 87 patients with celiac disease, 49 were male and 38 were female. The mean (+/-SD) age for male patients was 26.3 +/- 16.3 years (range 14-59 years) and for female patients was 28.4 +/- 15.6 years (range 16-58 years). Amongst the controls, 52 (59.8%) were male and 35 (40.2%) were female. The mean (+/- SD) age for male controls was 27.6 +/- 14.5 years (range 15-57 years) and for female controls was 29.3 +/- 16.5 years (range 18-59 years). Hydrogen breath test was suggestive of bacterial overgrowth in 18 of the 87 (20.7%) celiac disease patients but not in any of the apparently healthy controls. CONCLUSION This study indicates that a large number of celiac patients from North India suffer from bacterial overgrowth which can be accordingly treated with antibiotics.
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Affiliation(s)
- S V Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Rana SV, Thapa BR, Pal R. Comparison of D-xylose hydrogen breath test with urinary D-xylose test in Indian children with celiac disease. Dig Dis Sci 2007; 52:681-4. [PMID: 17237998 DOI: 10.1007/s10620-006-9459-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2006] [Accepted: 05/17/2006] [Indexed: 12/09/2022]
Abstract
D-xylose hydrogen breath test (H2BT) may be better parameter in screening for intestinal malabsorption in patients with celiac disease. This study sought to compare D-xylose H2BT with urinary D-xylose tests in screening for intestinal malabsorption in patients with celiac disease. A total of 68 children with confirmed celiac disease were enrolled for this study. Five-gram urine D-xylose test and D-xylose H2BT were performed simultaneously according to standard methods. Institute ethical clearance and informed consent was taken before starting this study. Of 68 children, 41 were boys and 27 girls of age range 5-14 years; 5-g urine D-xylose test was abnormal in 50% of cases and 5-g D-xylose H2BT in 69.9% of cases. D-xylose H2BT was able to pick up 19.9% more cases of malabsorption in Indian children with celiac disease. This study indicates that performance of 5-g D-xylose H2BT is a better test than 5-g urinary D-xylose test in screening for intestinal malabsorption in patients with celiac disease.
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Affiliation(s)
- S V Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, House # 137, Sector 15-A, Chandigarh 160015, India.
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Rana SV, Kashinath D, Singh G, Pal R, Singh R. Study on oxidative stress in patients with abdominal trauma. Mol Cell Biochem 2006; 291:161-6. [PMID: 16733803 DOI: 10.1007/s11010-006-9210-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2006] [Accepted: 04/07/2006] [Indexed: 11/28/2022]
Abstract
Reactive oxygen species have been implicated in the etiology of multiple organ dyspepsia syndrome and infection's complications in patients with trauma. But the oxidative stress and antioxidants levels in abdominal trauma have not yet been studied. Therefore, this study was planned to measure lipid peroxidation for oxidative stress and reduced glutathione, catalase and superoxide dismutase (SOD) for antioxidant levels in plasma & heamolysate of 30 patients with abdominal trauma and 30 controls. From this study we can summarize that there was an increase in oxidative stress and decrease in antioxidant levels (causing oxidative stress) on day zero in patients with abdominal trauma. This oxidative stress on day zero was not related to the development of complications. There was no significant difference in oxidative stress between patients with solitary and multiple abdominal organ injury and also between patients with hollow viscus injury and solid organ injury on day zero. From this study, we conclude that in patients with abdominal trauma there was increase in oxidative stress and decrease in antioxidant levels on day zero.
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Affiliation(s)
- S V Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Rana SV, Pal R, Vaiphie K, Singh K. Effect of different oral doses of isoniazid-rifampicin in rats. Mol Cell Biochem 2006; 289:39-47. [PMID: 16583132 DOI: 10.1007/s11010-006-9145-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2005] [Accepted: 01/26/2006] [Indexed: 10/24/2022]
Abstract
UNLABELLED Hepatotoxicity is one of the most serious adverse effects of antituberculosis drugs. The aim of this study was to produce a rat model of isoniazid-rifampicin (INH-RIF) induced hepatotoxicity. MATERIALS AND METHODS Wistar rats (100-150 g) were treated with different doses of INH i.e. 25, 50 and 75 mg/kg/day with a fixed dose of RIF i.e. 50 mg/kg/day intragastrically for a period of 28 days. Serum glutamate oxaloacetate aminotransferase (SGOT), glutamate pyruvate aminotransferase (SGPT), bilirubin (Bil) and alkaline phosphatase (ALP) were estimated at 0,14, 21 and 28 days in rats. Histological analysis was carried out to assess the liver. RESULTS Treatment of rats with INH-RIF (50 mg/kg/day each) induced hepatotoxicity as judged by elevated serum SGPT, SGOT, Bil and ALP as compared with their base line. Histological evaluation of INH-RIF induced hepatotoxicity also showed liver damage. CONCLUSION The present study suggests that 50 mg/kg/day each of INH-RIF was selected as hepatotoxic dose (i.e. minimum dose with maximum hepatotoxicity) in wistar rats.
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Affiliation(s)
- Satya V Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
AIM: To evaluate the hepatoprotective effect of garlic on liver injury induced by isoniazid (INH) and rifampicin (RIF).
METHODS: Wistar rats weighing 150-200 g were treated orally with 50 mg/kg of INH and RIF daily each for 28 d. For hepatoprotective studies, 0.25 g/kg per day of freshly prepared garlic homogenate was administered orally half an hour before the INH+RIF doses. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and bilirubin were estimated on d 0, 14, 21, and 28 in all the rats. Histological analysis was carried out to assess the injury to the liver. Lipid peroxidation (LPO) as a marker of oxidative stress and non-protein thiols (glutathione) for antioxidant levels were measured in liver homogenate.
RESULTS: The treatment of rats with INH+RIF (50 mg/kg per day each) induced hepatotoxicity in all the treated animals as judged by elevated serum ALT, AST, and bilirubin levels, presence of focal hepatocytic necrosis (6/8) and portal triaditis (8/8). Garlic simultaneously administered at a dose of 0.25 g/kg per day prevented the induction of histopathological injuries in INH+RIF co-treated animals, except in 4 animals, which showed only moderate portal triaditis. The histological changes correlated with oxidative stress in INH+RIF treated animals. The group which received 0.25 g/kg per day garlic homogenate along with INH+RIF showed higher levels of glutathione (P < 0.05) and low levels of LPO (P < 0.05) as compared to INH+RIF treated group.
CONCLUSION: Freshly prepared garlic homogenate protects against INH+RIF-induced liver injury in experimental animal model.
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Affiliation(s)
- Ravinder Pal
- Department of Gastor PGIMER, Chd, House No. 137, Sector 15-A, Chandigarh 160015, India
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Rana SV, Pal R, Vaiphei K, Singh K. Garlic hepatotoxicity: safe dose of garlic. Trop Gastroenterol 2006; 27:26-30. [PMID: 16910057] [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: 05/11/2023]
Abstract
Information on the effect of garlic on the liver and optimal dose of garlic to avoid liver damage is not known. This study was planned to determine the safe dose of garlic. Male wistar rats (110-170g) were fed fresh garlic homogenate (FSH) orally in three different doses (1.0, 2.5 and 5.0 g/kg body weight/day) daily for 28 days. Liver histology, serum transaminases, bilirubin and alkaline phosphatase were estimated at 0, 14, 21 and 28 days in control and experimental animals. 1.0, 2.5 and 5.0 g/kg body weight/day of garlic showed significant (P<0.001) deterioration in liver function tests (LFT's) after 21, 14 and 7 days respectively. A 1.0 g/kg body weight/day dose of garlic was associated with marked histological damage in liver after 21 days. Therefore, three lower doses of garlic (0.1, 0.25 and 0.5 g/kg body weight/day) were given orally to another group of similar rats to determine the safe dose of garlic. LFT's were serially measured and animals were sacrificed on the 29th day of experiment. All three lower doses showed significant deterioration in the LFT's values of animals after 28 days of feeding the freshly prepared garlic homogenate. Both doses of garlic i.e. 0.1 and 0.25 g/kg body weight/day were associated with normal histology of liver, but 0.5 g/kg body weight/day dose of garlic showed morphological changes in the liver of one animal. Therefore, the present study suggests that garlic with high dose has the potential ability to induce liver damage and low doses (0.1 or 0.25 g / kg body weight/day) are safe doses of garlic.
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Affiliation(s)
- S V Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh.
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Malhotra S, Rana SV, Sinha SK, Khurana S. Dietary fiber assessment of patients with irritable bowel syndrome from Northern India. Indian J Gastroenterol 2005; 23:217-8. [PMID: 15627661] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Data on the absolute fiber intake and the source of dietary fiber intake in patients with irritable bowel syndrome (IBS) have been lacking in northern Indians. OBJECTIVE To find out the absolute fiber intake from different sources of food items in patients with IBS and healthy subjects from northern India. METHODS Using the 72-hour recall method, dietary intake of macronutrients and fiber was determined in 33 consecutive adult patients with IBS and 33 age- and gender-matched healthy controls. RESULTS The patients consumed lower amounts of macronutrients (protein 60.4 g vs 79.3 g, fat 47.7 g vs 65.7 g, and carbohydrates 294.6 g vs 339.8 g) and dietary fiber (8.1 g vs 15.7 g) than the control subjects. Though the patients consumed similar amount of pulses as the controls (46.6 [25.0] vs 46 [19.6] g/day), their fiber intake from pulses was lower (0.8 [0.7] vs 1.4 [0.9] g/day). The intake of fiber from vegetables and fruits was also significantly lower in patients (2.1 and 0.5 g/day, respectively) than in control subjects (5.8 and 3.9 g/day, respectively; p< 0.001 each). CONCLUSION Total dietary fiber intake and intake of fiber from vegetables, fruits and pulses are lower in patients with IBS from northern India than in control subjects.
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Affiliation(s)
- Sunita Malhotra
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India
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Rana SV, Babu SGV, Kocchar R. Usefulness of ascitic fluid cholesterol as a marker for malignant ascites. Med Sci Monit 2005; 11:CR136-42. [PMID: 15735567] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2004] [Accepted: 06/22/2004] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND The differential diagnosis of ascites is a common clinical problem. However, the capability to distinguish malignant from non-malignant causes of ascites using available biochemical techniques would obviate many expensive and time-consuming diagnostic studies on patients presenting with ascites of unknown etiology. Therefore, this study was planned to evaluate the diagnostic efficacy of ascitic fluid cholesterol in comparison to the efficiency of ascitic/serum total protein, pH, glucose, total leukocyte count, and the serum/ascitic albumin gradient in differentiating "malignant" from non-malignant ascites. MATERIALS/METHODS A total of 50 patients (25 with malignant ascites and 25 with non-malignant) were evaluated for total ascitic protein, ascites/serum (A/S) total protein ratio, serum ascites albumin gradient (SAAG), ascitic pH, serum & ascitic cholesterol with glucose. RESULTS The mean ascitic cholesterol level was significantly higher in malignant ascites than in non-malignant ascites, with a cut off level of 70 mg/dl for ascitic fluid cholesterol; 22/25 (88%) patients with malignant ascites could be separated from the 25 patients with non-malignant ascites. The specificity (100%) and diagnostic efficiency (94%) of ascitic fluid cholesterol is better than the 84% specificity and 86% diagnostic efficiency of serum ascitic albumin gradient. CONCLUSIONS Total Ascitic protein (70%), Ascitic serum protein ratio (74%), ascitic leukocyte count (54%), and malignant cytology (82%) yielded much lower diagnostic efficiency than ascitic fluid cholesterol (94%) or SAAG (86%) in the diagnosis of malignant ascites.
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Affiliation(s)
- Satya V Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Abstract
The study was conducted in 54 adult patients with Giardia lamblia infection and 54 adult controls to detect lactose maldigestion employing the noninvasive lactose hydrogen breath test. Forty of 54 (74%) patients with Giardia lamblia and 24 of 54 (44.4%) controls showed lactose maldigestion (P < 0.01). In conclusion, this study shows that the frequency of lactose maldigestion is significantly higher in adult Indians suffering from Giardia lamblia infection compared to healthy individuals.
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Affiliation(s)
- S V Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh-160012, India.
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Rana SV, Rastogi N. Antioxidative enzymes in the liver and kidney of alloxan induced diabetic rats and their implications in cadmium toxicity. Physiol Chem Phys Med NMR 2004; 32:67-74. [PMID: 10970049] [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: 02/17/2023]
Abstract
The influence of insulin-dependent diabetes mellitus on the oxidative stress caused by cadmium in the liver and kidney of laboratory rats has been studied. The results suggest that cadmium and alloxan diabetes independently promote lipid peroxidation in both liver and kidney. However, lipid peroxidation diminished in the diabetic rats fed cadmium. Administration of cadmium to normal and diabetic rats depleted glutathione in liver only. No significant change was observed in the activity of glutathione peroxidase in kidney, whereas administration of cadmium to diabetic rats stimulated catalase activity when compared to cadmium-fed rats. The actual mechanism of these effects still remains to be confirmed, but an antagonistic relationship between cytotoxic mechanisms of diabetes mellitus and cadmium is speculated upon. The insulin-dependent activity of a unique form of cytochrome 450j may be involved.
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Affiliation(s)
- S V Rana
- Toxicological Laboratory, Department of Zoology, Ch. Charan Singh University, Meerut-250004, India
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Rana SV, Bhasin DK, Naik N. Lactose malabsorption in apparently healthy adults in northern India, assessed using lactose hydrogen breath test. Indian J Gastroenterol 2004; 23:78. [PMID: 15176547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Ramsey KH, Sigar IM, Rana SV, Gupta J, Holland SM, Byrne GI, Morrow JD. Inducible nitric oxide synthase regulates production of isoprostanes in vivo during chlamydial genital infection in mice. Infect Immun 2004; 71:7183-7. [PMID: 14638813 PMCID: PMC308939 DOI: 10.1128/iai.71.12.7183-7187.2003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Urinary nitrite and F(2)-isoprostanes, an index of oxidant stress, were elevated during chlamydial genital infection of mice. Enhancement of urinary nitrite and F(2)-isoprostanes was observed in phagocyte oxidase-deficient mice. Inhibition of inducible nitric oxide synthase reduced isoprostane excretion. We conclude that nitrogen radicals induce F(2)-isoprostane production and excretion during murine chlamydial genital infection.
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Affiliation(s)
- K H Ramsey
- Department of Microbiology, Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, Illinois 60515, USA.
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Rana SV, Bhasin DK, Naik N, Subhiah M, Ravinder P. Lactose maldigestion in different age groups of north Indians. Trop Gastroenterol 2004; 25:18-20. [PMID: 15303465] [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: 04/30/2023]
Abstract
Lactase activity with age has been reported in a wide variety of population globally. However, most of these studies in human have ignored to assess age stratified lactose maldigestion. Therefore, the present study was planned to determine lactose maldigestion in different age groups of north Indians adults. Two hundred apparently healthy north Indians (age rage 10-80 years) were subjected to a 50g lactose hydrogen breath test by standard method using a Model 12 Microlyzer from Quintron, USA. The percentage of lactose maldigestion was calculated for different age groups with an interval of 10 years. The results of this study revealed that the frequency of lactose maldigestion did not differ significantly among the age groups. Thus, this study suggests that lactose maldigestion is not associated with age stratification among north Indians.
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Affiliation(s)
- S V Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh.
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Ramsey KH, Sigar IM, Rana SV, Gupta J, Holland SM, Byrne GI. Role for inducible nitric oxide synthase in protection from chronic Chlamydia trachomatis urogenital disease in mice and its regulation by oxygen free radicals. Infect Immun 2001; 69:7374-9. [PMID: 11705910 PMCID: PMC98824 DOI: 10.1128/iai.69.12.7374-7379.2001] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
It has been previously reported that although inducible nitric oxide synthase (iNOS) gene knockout (NOS2(-/-)) mice resolve Chlamydia trachomatis genital infection, the production of reactive nitrogen species (RNS) via iNOS protects a significant proportion of mice from hydrosalpinx formation and infertility. We now report that higher in vivo RNS production correlates with mouse strain-related innate resistance to hydrosalpinx formation. We also show that mice with a deletion of a key component of phagocyte NADPH oxidase (p47(phox-/-)) resolve infection, produce greater amounts of RNS in vivo, and sustain lower rates of hydrosalpinx formation than both wild-type (WT) NOS2(+/+) and NOS2(-/-) controls. When we induced an in vivo chemical block in iNOS activity in p47(phox-/-) mice using N(G)-monomethyl-L-arginine (L-NMMA), a large proportion of these mice eventually succumbed to opportunistic infections, but not before they resolved their chlamydial infections. Interestingly, when compared to WT and untreated p47(phox-/-) controls, L-NMMA-treated p47(phox-/-) mice resolved their infections more rapidly. However, L-NMMA-treated p47(phox-/-) mice lost resistance to chronic chlamydial disease, as evidenced by an increased rate of hydrosalpinx formation that was comparable to that for NOS2(-/-) mice. We conclude that phagocyte oxidase-derived reactive oxygen species (ROS) regulate RNS during chlamydial urogenital infection in the mouse. We further conclude that while neither phagocyte oxidase-derived ROS nor iNOS-derived RNS are essential for resolution of infection, RNS protect from chronic chlamydial disease in this model.
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Affiliation(s)
- K H Ramsey
- Microbiology Department, Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, Illinois 60515, USA. kramse@.midwestern.edu
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Abstract
Exposure to benzene has been monitored in petrol-pump workers and dry cleaners of Meerut City (India) by measuring phenol content of their urine samples. Average values for phenol in urine were higher in petrol-pump workers than dry cleaners. Alcoholic subjects excreted more phenol than smokers and non-vegetarians. It is concluded that alcohol can alter the susceptibility of man to benzene toxicity by affecting its metabolism.
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Affiliation(s)
- Y Verma
- Toxicology Laboratory, Department of Zoology, Ch. Charan Singh University, Meerut, India
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Katyal R, Rana SV, Ojha S, Vaiphei K, Singh V, Singh K. Soybean trypsin inhibitor confers protection against rotavirus infection in infant mice. Trop Gastroenterol 2001; 22:207-10. [PMID: 11963327] [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: 02/24/2023]
Abstract
OBJECTIVE To study the effects of soybean trypsin inhibitor (TI) on glycine uptake, glutathione (GSH) levels and morphological changes of intestine in rotavirus (RV) infected infant mice. METHODS A total of 144 infant mice (7/8 days old) were divided in 3 groups (i.e. control, RV and RV + inhibitor). Infant mice were orally inoculated with the EB strain of RV and Trypsin protease inhibitor (TI) and 8 animals each were sacrificed on days 0,1,3,5,7 and 10 post infection (p.i). Glycine uptake (in vitro), GSH levels and histological changes were assessed in the jejunum, ileum and colon. RESULTS Glycine uptake and GSH levels were significantly reduced on days 3 and 5 p.i in jejunum and ileum of RV inoculated animals, compared to the controls. Glycine uptake and GSH levels were maintained as in controls in the RV + TI inoculated animals on days 3 and 5 p.i in jejunum and colon but not in ileum where lesser values were recorded. Histology showed vacuolar degeneration in ileum towards the apical portion whereas normal morphology was observed in jejunum, similar to controls. No histological changes were observed in colon in any of the groups. Electron microscopic study confirmed the viral infection. CONCLUSION Administration of Trypsin protease inhibitor along with RV reverted the effects of RV infection on amino acid uptake and GSH levels completely in the jejunum and partially in the ileum.
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Affiliation(s)
- R Katyal
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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Rana SV, Mandal AK, Kochhar R, Katyal R, Singh K. Lactose intolerance in different types of irritable bowel syndrome in north Indians. Trop Gastroenterol 2001; 22:202-4. [PMID: 11963325] [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: 02/24/2023]
Abstract
BACKGROUND Twenty-five patients of irritable bowel syndrome (IBS) and 25 normal healthy individuals serving as controls, were studied for lactose intolerance. METHODS Hydrogen breath test was used as an investigation after giving 50 g of oral lactose. Clinically, the patients were classified into 3 types of IBS. RESULTS Eleven (44%) out of 25 patients belonged to diarrhoeal type of IBS, 7 (28%) of 25 patients to spastic and rest 7 (28%) of 25 patients had features of both types of symptoms. Lactose hydrogen breath test was abnormal in 9 cases (82%) of 11 diarrhoeal type of IBS which was significantly higher (p < 0.02) than controls. However, the difference of abnormal hydrogen breath test between spastic type of IBS and patients with features of both types was not significant as compared to controls. CONCLUSIONS These results suggest that patients with diarrhoeal type of IBS have a higher incidence of lactose intolerance as compared to spastic type as well as patients with features of both types.
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Affiliation(s)
- S V Rana
- Department of Superspeciality of Gastroenterology, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India.
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Rana SV, Gupta D, Katyal R, Singh K. Mild-to-moderate malnutrition alters glutathione, gamma-glutamyl-transpeptidase and glycine uptake in small intestinal brush-border vesicles of rhesus monkeys. Ann Nutr Metab 2001; 45:143-7. [PMID: 11463996 DOI: 10.1159/000046721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In India about 85% of pre-school children show evidence of mild-to-moderate malnutrition. Consequences of severe malnutrition and protein deficiency are well reported by workers but little information is available on milder forms. METHODS Mild-to-moderate protein energy malnourished (PEM) state was induced in 12 monkeys by providing 2.42 g protein and 55 kcal kg(-1) day(-1) while 12 controls were fed 4.84 g protein and 110 kcal kg(-1). After a 30-40% reduction in body weight as compared with their controls, the animals were killed and brush border membrane vesicles (BBMV) were prepared from three parts of small intestine. Purified vesicles were assayed for gamma-glutamyl-transpeptidase (GGTP), glutathione (GSH) and U-(14)C-glycine uptake. RESULTS GGTP activity increased significantly while glutathione and uptake of glycine decreased significantly in all the three parts of small intestine. On nutritional rehabilitation of 9 weeks, the activity of GGTP, GSH and in vitro uptake of glycine amino acid recovered completely. CONCLUSION The results of the present study indicates that even mild-to-moderate malnutrition should not be ignored during the development state.
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Affiliation(s)
- S V Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Rana SV, Bhasin DK, Katyal R, Singh K. Comparison of duodenal and jejunal disaccharidase levels in patients with non ulcer dyspepsia. Trop Gastroenterol 2001; 22:135-6. [PMID: 11681105] [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: 02/22/2023]
Abstract
AIMS This study was conducted to compare the duodenal and jejunal disaccharidase levels in the same individual with duodenal ulcer or non ulcer dyspepsia. METHODS Thirty seven patients (duodenal ulcer--11, non-ulcer dyspepsia--26) were included in the study. Endoscopic biopsy samples were obtained from jejunum and duodenum using pediatric colonofibroscope. RESULTS Levels of jejunal disaccharidases were significantly higher than the duodenal disaccharidases. CONCLUSIONS An estimate of jejunal disaccharidases can be had by multiplication of duodenal disaccharidased by a factor 1.48 for lactase, 1.50 for sucrase and 1.56 for maltase.
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Affiliation(s)
- S V Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh-160 012, India.
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Dosoo DK, Rana SV, Offe-Amoyaw K, Tete-Donkor D, Maddy SQ. Total antioxidant status in non-insulin-dependent diabetes mellitus patients in Ghana. West Afr J Med 2001; 20:184-6. [PMID: 11922148] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Total antioxidant status (TAS) was measured in thirty-five (35) non-insulin-dependent diabetes mellitus (NIDDM) patients aged 40 to 65 (mean +/- SE 49.6 +/- 1.0) years. Patients were on diet and oral hypoglycaemic drug (Daonil) therapy with fasting plasma glucose (FPG) >7.8mmol/l. Similar measurements were carried out in thirty-four apparently healthy individuals within the same age range (mean + SE 46.3 +/- 1.1 years) and FPG <6.4 mmol/L. FPG was measured by glucose oxidase method and TAS by colorimetric method. Comparing the two groups, TAS was significantly reduced in the NIDDM patients (p<0.001). An inverse correlation between FPG and TAS suggests the existence of lower antioxidant defence in uncontrolled NIDDM. A good control of FPG accompanied with antioxidant therapy could help reduce free radical activity and minimise complications associated with increased free radical activity in diabetic patients.
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Affiliation(s)
- D K Dosoo
- Department of Chemical Pathology, University of Ghana Medical School, Accra, Ghana
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Rana SV, Kumar A. Effect of cadmium and zinc-metallothionein on methemoglobin and nitric oxide in dimethylnitrosamine treated rats. Indian J Exp Biol 2001; 39:487-9. [PMID: 11510137] [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: 02/21/2023]
Abstract
Protective effects of metallothionein (MT) have been studied against dimethylnitosamine (DMN) toxicity in laboratory rats. MT was induced by feeding rats on repeated sublethal doses of cadmium and zinc. These rats were subsequently administered DMN. Methemoglobin and nitric oxides, the established markers of DMN toxicity, were estimated in the blood samples of MT protected rats. Preinduction of MT decreased methemoglobin and ameliorated the generation of nitric oxides. Antioxidative effects of MT may have manifested these results, however, an effect on N-nitrosation is also speculated.
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Affiliation(s)
- S V Rana
- Toxicology Laboratory, Department of Zoology, Ch. C. S. University, Meerut 250004, India
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Attri S, Rana SV, Vaiphie K, Katyal R, Sodhi CP, Kanwar S, Singh K. Protective effect of N-acetylcysteine in isoniazid induced hepatic injury in growing rats. Indian J Exp Biol 2001; 39:436-40. [PMID: 11510126] [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: 02/21/2023]
Abstract
Status of oxidative/antioxidative profile was the mechanistic approach to inumerate the nature of protection by N-acetylcysteine (NAC) in isoniazid (INH) exposed experimental animals. Analysis of lipid peroxidation, thiol levels, cytochrome P450, superoxide dismutase (SOD), catalase, glutathione peroxidase, reductase and transferase were estimated in liver along with the body and liver weight of animals and histological observations. Isoniazid exposure to animals resulted in no change in body and liver weights. Thiols, lipid peroxidation, catalase, SOD glutathione peroxidase, reductase, transferase and cytochrome P450 levels were altered with INH exposure. Supplementation of NAC with INH protected the animals against hepatotoxic reactions by minimizing the free radical induced tissue injury and overall maintenance of the endogenous scavengers of free radicals.
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Affiliation(s)
- S Attri
- Department of Biochemistry, Govt. Medical College, Chandigarh 160 032, India
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Kaura D, Bhasin DK, Rana SV, Katyal R, Vaiphei K, Singh K. Alterations in duodenal disaccharidases in chronic smokers. Indian J Gastroenterol 2001; 20:62-3. [PMID: 11305493] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess the effect of smoking on activity of intestinal disaccharidases. METHODS The study was conducted on patients with non-ulcer dyspepsia who were smokers (n=20) or non-smokers (n=20). Smokers were classified according to smoking index into mild, moderate and heavy smokers. Biopsy specimens were taken from the second part of the duodenum at endoscopy and examined histologically, and for disaccharidase (lactase, sucrase, maltase and trehalase) activities. RESULTS Mean duration of symptoms was more in smokers than in non-smokers. None of the smokers had endoscopic evidence of duodenal inflammation. Lactase and trehalase levels were significantly decreased in smokers. There was no difference in enzyme levels between mild smokers and non-smokers. Decreased lactase, maltase and trehalase activities were observed in moderate smokers compared to mild smokers. Duration of symptoms had no relation to enzyme activities. CONCLUSIONS Intestinal disaccharidase levels are diminished by smoking.
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Affiliation(s)
- D Kaura
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh
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Katyal R, Singh V, Rana SV, Ojha S, Vaiphie K, Singh K. Protection against rotavirus challenge in mice orally inoculated with trypsin inhibitor. Indian J Med Res 2001; 113:40-7. [PMID: 21901906] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND AND OBJECTIVES the burden of rotavirus disease is significant in developed as well as developing countries and has not diminished with improved hygiene. In the present studies the protective efficacy of soyabean trypsin inhibitor (TI) was investigated on the gut following rotavirus (RV) infection in inbred mice. METHODS infant BALB/c mice of 7 days age (n=108) were divided into three equal groups (control, RV and RV+TI). Animals were orally inoculated either with normal saline, EB RV (serotype-3) or RV+TI and were sacrificed under light chloroform anesthesia on days 0, 1, 3, 5, 7 and 10 post inoculation (pi). Gamma-glutamyl transpeptidase (GGT), leucine aminopeptidase (LAP), and leucine amino acid uptake in the jejunum and ileum were assessed. RESULTS rotavirus inoculated animals showed significant reduction in body weights on days 3 and 5 pi as a result of diarrhoea which resolved by day 7 pi. In RV+TI inoculated animals diarrhoea jejunum and ileum in mice inoculated with RV as compared to controls. With the administration of TI the amino acid uptake, and GGT and LAP levels were higher in both segments of the small intestine and comparable to the controls. INTERPRETATION AND CONCLUSIONS on the administration of TI, leucine amino acid uptake, and levels of GGT and LAP were similar to the controls in the jejunum and ileum of infant mice showing its possible protective efficacy during rotavirus infection.
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Affiliation(s)
- R Katyal
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Lhatoo SD, Bhasin DK, Rana SV, Katyal R, Singh K. Effect of alcohol dependence on the levels of duodenal disaccharidases in human subjects. Indian J Physiol Pharmacol 2000; 44:495-9. [PMID: 11214508] [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: 02/19/2023]
Abstract
BACKGROUND The aim of the study was to detect the duodenal enzyme activity in patients of alcohol dependence and to compare with non-alcoholic patients of non-ulcer dyspepsia. METHODS Disaccharidases (lactase, sucrase, maltase) were estimated in 20 non alcoholic patients of non-ulcer dyspepsia and 20 alcoholics admitted to the drug de-addiction and treatment centre of PGIMER, Chandigarh, India. RESULTS No significant influence of alcohol on enzyme levels in patients of alcohol dependence when compared to patients of non-ulcer dyspepsia was observed. However, a significant decrease in lactase level was noted in patients consuming more than 125 gm/day of alcohol. CONCLUSION Amount of consumption of alcohol showed decrease in lactase enzyme, but not in maltase and sucrase. There was no effect of duration of alcohol consumption on dissacharidases in the two groups.
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Affiliation(s)
- S D Lhatoo
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh-160 012
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Katyal R, Rana SV, Singh K. Rotavirus infections. Acta Virol 2000; 44:283-8. [PMID: 11252673] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
In 1976, John Rohde, highlighting the importance of diarrhea as prime killer of children in the developing world, beckoned the scientific community to "take science where the diarrhea is". The World Health Organization estimates that one billion diarrheal episodes occur in infants annually resulting in 3.3 million deaths, making diarrheal disease a major contributor to infant mortality in developing world (Bern et al., 1992). The need for simple, effective and inexpensive intervention to treat diarrhea and to prevent its occurrence is urgent and abundantly clear. Among the etiological agents of acute infectious diarrhea rotaviruses account for nearly 25% of hospital admissions in India with vomitting and diarrhea followed by severe dehydration in very young children below 2 years of age (Broor et al., 1985). In developing countries, it has been estimated that more than 870,000 children die from rotavirus infection every year (Perez-Schael, 1996). The discovery of rotavirus by Bishop and colleagues in 1973 initiated a line of research that has progressed rapidly towards the goal of prevention of rotavirus diarrhea (Bishop et al., 1973).
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Affiliation(s)
- R Katyal
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. pgi.chd.nic.in!medinst
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Singh KD, Bhasin DK, Rana SV, Vaiphei K, Katyal R, Vinayak VK, Singh K. Effect of Giardia lamblia on duodenal disaccharidase levels in humans. Trop Gastroenterol 2000; 21:174-6. [PMID: 11194577] [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: 02/19/2023]
Abstract
The study was conducted to detect the effect of giardiasis on human disaccharidase levels. Forty patients attending the medical outpatient department of PGIMER, Chandigarh were enrolled. Twenty patients, positive for Giardia lamblia comprised the study group while 20 patients negative for Giardia lamblia were taken as controls. Upper gastrointestinal endoscopy was performed in all patients. Estimation of lactase, sucrase, maltase and trehalase was done in biopsies. Histopathological investigation was carried out in all biopsy specimens after Haematoxylin and Eosin staining. Complaints of pain abdomen and bloating occurred commonly in giardiasis. Four biopsy samples in study group showed mild increase in lymphomononuclear infiltrate. Giardia lamblia was detected in 7 biopsies. Lactase levels were decreased significantly (p < 0.05) in giardiasis. Rest of the enzymes were comparable to the controls. No differences in the enzyme activities were observed between males and females in either group and with the duration of symptoms.
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Affiliation(s)
- K D Singh
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
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Rana SV, Kumar A. Metallothionein induced by cadmium or zinc inhibits lipid peroxidation in rats exposed to dimethylnitrosamine. Arh Hig Rada Toksikol 2000; 51:279-86. [PMID: 11148932] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Dimethylnitrosamine (N-nitrosodimethyamine) is a potent inducer of microsomal lipid peroxidation in the liver and kidneys. The results of this study show that prior exposure of adult rats to cadmium or zinc antagonises the effect of dimethylnitrosamine on lipid peroxidation by inducing increased metallothionein synthesis. Increased concentration of reduced glutathione (GSH) in the liver and kidney of rats pre-treated with cadmium or zinc and exposed to dimethylnitrosamine suggests that metallothionein inhibits oxidative stress. The presented results have been corroborated by findings that exposure of adult rats to cadmium or zinc may activate genes for metallothionein and glutathione-S-transferase, the protective proteins against oxidative stress.
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Affiliation(s)
- S V Rana
- Department of Zoology, Ch. Charan Singh University, Meerut, India.
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Attri S, Rana SV, Vaiphei K, Sodhi CP, Katyal R, Goel RC, Nain CK, Singh K. Isoniazid- and rifampicin-induced oxidative hepatic injury--protection by N-acetylcysteine. Hum Exp Toxicol 2000; 19:517-22. [PMID: 11204554 DOI: 10.1191/096032700674230830] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The role of N-acetylcysteine (NAC), a glutathione (GSH) precursor, was investigated in protection against isoniazid- (INH) and rifampicin- (RIF) induced oxidative hepatic injury in young Wistar rats. The hepatotoxic dose of INH and RIF was 50 mg kg(-1) day(-1) each and the hepatoprotective dose of NAC was 100 mg kg(-1) day(-1). All drugs were administered intraperitoneally (i.p.) in sterile water (4.0 ml kg(-1) day(-1)) over a period of 3 weeks. Status of oxidative/antioxidative profiles was the mechanistic approach to assess the hepatotoxicity and/or hepatoprotection. The oxidative injury in INH-RIF co-exposed animals was closely associated with significant decline of GSH and related thiols, as well as with compromised antioxidant enzyme system. The oxidative stress was further supported by increased lipid peroxidation observed in these animals. The co-administration of NAC prevented the induction of oxidative stress in INH-RIF co-exposed animals. The amelioration of oxidative stress by NAC was faithfully reflected as normal morphology in these animals, except the presence of mild degree of portal triaditis in one animal co-exposed to INH-RIF and NAC. In contrast, the animals co-exposed to INH-RIF alone showed histological lesions which ranged from intralobular inflammation to patchy necrosis. These results suggest that INH-RIF-induced oxidative injury can be prevented by supporting the cellular antioxidant defense mechanism by NAC.
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Affiliation(s)
- S Attri
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Katyal R, Ojha S, Rana SV, Vaiphie K, Singh K, Singh V. Protective efficacy of trypsin inhibitor on the the gut following rotavirus infection in malnourished infant mice. Ann Nutr Metab 2000; 43:319-28. [PMID: 10749032 DOI: 10.1159/000012800] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Epidemiologic data suggest a close relationship between protein energy malnutrition (or protein energy malnourished) (PEM) and development of infectious diarrheal diseases. In the present studies, the impact of trypsin inhibitor (TI) on the gut following rotavirus (RV) infection was investigated in PEM young growing inbred balb/c mice. The animals were divided into four groups: (1) control; (2) PEM; (3) PEM+RV and (4) PEM+ RV+TI. Control and PEM animals were orally inoculated with normal saline, PEM+RV animals were given 50 microl RV (100ID50) and PEM+RV+TI animals were inoculated with 0.6 mg TI/g body weight + 50 micronl RV. The body weight of each animal was recorded. Six animals from each group were sacrificed on days 0, 1, 3, 5, 7 and 10 post inoculation by cervical dislocation. The intestines were removed, everted and homogenized in ice-cold saline. Leucine aminopeptidase (LAP), glutathione (GSH) levels and L-leucine uptake were determined in the jejunum and ileum. Body weight was decreased in PEM and PEM+RV groups compared to the controls. LAP and leucine uptake levels were elevated in the PEM group but decreased in the PEM+RV group. GSH levels were decreased in the PEM+RV group. Enzyme activity, GSH and LAP uptake levels were restored in the PEM+RV+TI group. The study shows the protective role of soybean TI against RV infection in malnourished mice.
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Affiliation(s)
- R Katyal
- Department of Biochemistry, Panjab University, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Rana SV, Chauhan A. Influence of methionine and zinc on liver collagen in molybdenotic rats: relationship with lipid peroxidation. Biol Trace Elem Res 2000; 73:85-91. [PMID: 10949972 DOI: 10.1385/bter:73:1:85] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/1998] [Revised: 02/09/1999] [Accepted: 03/06/1999] [Indexed: 11/11/2022]
Abstract
Protective effects of methionine and zinc on collagenesis in the liver of molybdenotic rats have been studied during present investigations. Further, the relationship between two important pathobiological phenomena (viz. lipid peroxidation and collagenesis) has also been examined. Biological observations suggest that cotreatment with methionine only improves the growth of molybdenotic rats; however, the hepatosomatic index improved in rats supplemented with both methionine and zinc. Administration of methionine and zinc to molybdenum-fed rats decreased liver collagen. Results on urinary hydroxyproline support these observations. Lipid peroxidation was also inhibited in the liver of protected rats. We suggest that collagenesis can be controlled by inhibiting the generation of reactive oxygen species. An improvement in liver function in rats protected with methionine and zinc has also been suggested.
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Affiliation(s)
- S V Rana
- Toxicology Laboratory, Department of Zoology, Ch. Charan Singh University, Meerut, India
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