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Dutta AK, Jain A, Jearth V, Mahajan R, Panigrahi MK, Sharma V, Goenka MK, Kochhar R, Makharia G, Reddy DN, Kirubakaran R, Ahuja V, Berry N, Bhat N, Dutta U, Ghoshal UC, Jain A, Jalihal U, Jayanthi V, Kumar A, Nijhawan S, Poddar U, Ramesh GN, Singh SP, Zargar S, Bhatia S. Guidelines on optimizing the use of proton pump inhibitors: PPI stewardship. Indian J Gastroenterol 2023; 42:601-628. [PMID: 37698821 DOI: 10.1007/s12664-023-01428-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/10/2023] [Indexed: 09/13/2023]
Abstract
Proton pump inhibitors (PPIs) have been available for over three decades and are among the most commonly prescribed medications. They are effective in treating a variety of gastric acid-related disorders. They are freely available and based on current evidence, use of PPIs for inappropriate indications and duration appears to be common. Over the years, concerns have been raised on the safety of PPIs as they have been associated with several adverse effects. Hence, there is a need for PPI stewardship to promote the use of PPIs for appropriate indication and duration. With this objective, the Indian Society of Gastroenterology has formulated guidelines on the rational use of PPIs. The guidelines were developed using a modified Delphi process. This paper presents these guidelines in detail, including the statements, review of literature, level of evidence and recommendations. This would help the clinicians in optimizing the use of PPIs in their practice and promote PPI stewardship.
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Affiliation(s)
- Amit Kumar Dutta
- Department of Gastroenterology, Christian Medical College and Hospital, Vellore, 632 004, India.
| | | | - Vaneet Jearth
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Ramit Mahajan
- Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | | | - Vishal Sharma
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | | | | | - Govind Makharia
- All India Institute of Medical Sciences, New Delhi, 110 029, India
| | | | - Richard Kirubakaran
- Center of Biostatistics and Evidence Based Medicine, Vellore, 632 004, India
| | - Vineet Ahuja
- All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Neha Berry
- BLK Institute of Digestive and Liver Disease, New Delhi, 201 012, India
| | - Naresh Bhat
- Aster CMI Hospital, Bengaluru, 560 092, India
| | - Usha Dutta
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Uday Chand Ghoshal
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Ajay Jain
- Choithram Hospital and Research Center, Indore, 452 014, India
| | | | - V Jayanthi
- Sri Ramachandra Medical College, Chennai, 600 116, India
| | - Ajay Kumar
- Institute of Digestive and Liver Diseases, BLK - Max Superspeciality Hospital, New Delhi, 201 012, India
| | | | - Ujjal Poddar
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India
| | | | - Shivram P Singh
- Kalinga Gastroenterology Foundation, Cuttack, 753 001, India
| | - Showkat Zargar
- Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Kashmir, 190 011, India
| | - Shobna Bhatia
- Sir H N Reliance Foundation Hospital, Mumbai, 400 004, India
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Affiliation(s)
- V. Jayanthi
- Tamil Nad Hospital, Devaki Hospital Ltd., and BRS Hospital, Chennai, India
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Kedia S, Sharma R, Makharia G, Ahuja V, Desai D, Kandasamy D, Eapen A, Ganesan K, Ghoshal UC, Kalra N, Karthikeyan R, Madhusudhan KS, Philip M, Puri A, Puri S, Sinha SK, Banerjee R, Bhatia S, Bhat N, Dadhich S, Dhali GK, Goswami BD, Issar SK, Jayanthi V, Misra SP, Nijhawan S, Puri P, Sarkar A, Singh SP, Srivastava A, Abraham P, Ramakrishna BS. Indian guidelines on imaging of the small intestine in Crohn's disease: A joint Indian Society of Gastroenterology and Indian Radiology and Imaging Association consensus statement. Indian J Radiol Imaging 2019; 29:111-132. [PMID: 31367083 PMCID: PMC6639863 DOI: 10.4103/ijri.ijri_153_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
The Indian Society of Gastroenterology (ISG) Task Force on Inflammatory Bowel Disease and the Indian Radiological and Imaging Association (IRIA) developed combined ISG-IRIA evidence-based best-practice guidelines for imaging of the small intestine in patients suspected to have or having Crohn's disease. The 29 consensus statements, developed through a modified Delphi process, are intended to serve as reference for teaching, clinical practice, and research.
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Affiliation(s)
- Saurabh Kedia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Raju Sharma
- Radiadiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Govind Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Vineet Ahuja
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Devendra Desai
- Division of Gastroenterology, P D Hinduja Hospital, Mumbai, Maharashtra, India
| | | | - Anu Eapen
- Department of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, India
| | - Karthik Ganesan
- Department of Radiodiagnosis, Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP, India
| | - Naveen Kalra
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - R Karthikeyan
- Department of Radiodiagnosis, SRM Institute of Medical Sciences and Research, Chennai, India
| | | | - Mathew Philip
- Department of Gastroenterology, PVS Memorial Hospital, Kochi, Kerala, India
| | - Amarender Puri
- Department of Gastroenterology, GB Pant Institute of Medical Education and Research, New Delhi, India
| | - Sunil Puri
- Department of Radiodiagnosis, GB Pant Institute of Medical Education and Research, New Delhi, India
| | - Saroj K Sinha
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupa Banerjee
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Shobna Bhatia
- Department of Gastroenterology, KEM Hospital, Mumbai, India
| | - Naresh Bhat
- Department of Gastroenterology, Aster CMI Hospital, Bengaluru, Karnataka, India
| | - Sunil Dadhich
- Department of Gastroenterology, SN Medical College, Jodhpur, Rajasthan, India
| | - G K Dhali
- Department of Gastroenterology, School of Digestive and Liver Diseases, Institute of Post Graduate Medical, Education and Research, Kolkata, West Bengal, India
| | - B D Goswami
- Department of Gastroenterology, Guwahati Medical College, Guwahati, Assam, India
| | - S K Issar
- Department of Gastroenterology, Jawaharlal Nehru Hospital and Research Centre, Bhilai, Chhattishgarh, India
| | - V Jayanthi
- Department of Gastroenterology, Gleneagles Global Hospitals, Chennai, India
| | - S P Misra
- Department of Gastroenterology, MLN Medical College, Allahabad, UP, India
| | - Sandeep Nijhawan
- Department of Gastroenterology, Gleneagles Global Hospitals, Chennai, India
| | - Pankaj Puri
- Department of Gastroenterology, Military Hospital, Jodhpur, Rajasthan, India
| | - Avik Sarkar
- Department of Radiodiagnosis, School of Digestive and Liver Diseases, Institute of Post Graduate Medical, Education and Research, Kolkata, West Bengal, India
| | - S P Singh
- Department of Gastroenterology, SCB Medical College, Cuttack, Odisha, India
| | - Anshu Srivastava
- Department of Paediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP, India
| | - Philip Abraham
- Division of Gastroenterology, P D Hinduja Hospital, Mumbai, Maharashtra, India
| | - B S Ramakrishna
- Department of Gastroenterology, SRM Institute of Medical Sciences and Research, Chennai, India
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Srinivas M, Jain M, Bawane P, Jayanthi V. Chicago Classification normative metrics in a healthy Indian cohort for a 16-channel water-perfused high-resolution esophageal manometry system. Neurogastroenterol Motil 2018; 30:e13386. [PMID: 29856105 DOI: 10.1111/nmo.13386] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 04/30/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND High-resolution esophageal manometry (HREM) interpretation by the Chicago Classification (CC) derives its normal values from western volunteers using solid-state catheters. There is no normative data for the 16-channel water-perfused HREM system commonly used in India. AIMS To determine normal values for a 16-channel water-perfused HREM catheter in supine posture using healthy volunteers and substitute these normal values (if different from CC values) in the CC v3.0 algorithm. METHODS After ethics approval and informed consent, 53 volunteers (31 men) with no gastrointestinal (GI) symptoms or medications affecting GI motility underwent HREM by standard protocol. Age, gender, body mass index (BMI), and manometry parameters analyzed using Trace 1.3.3 software were collected. The median, range, and 5, 10, 75, and 95 percentiles (where applicable) were obtained for all HREM metrics. Normal value percentiles were defined as 95th (integrated relaxation pressure [IRP]), 10th-100th (distal contractile integral [DCI]), and minimum (distal latency [DL]). RESULTS The mean age was 30 years and the BMI was 24.2 kg m-2 . Compared to CC, our normal metrics were lower for IRP (13 mm Hg) and DCI (350-4500 mm Hg s cm). DCI >4500 and <70 (<5th percentile) were defined as hypercontractile and failed contraction, respectively. Abnormal DL (<4.5 s) and peristaltic break size (>5 cm) were similar to CC metrics. Applying these metrics, CC diagnoses changed in 15% (8/53) with downgrading of ineffective motility to fragmented peristalsis or normal, due to lower DCI cutoff used. CONCLUSIONS This is the first report of normative data for the 16-channel water-perfused system in supine posture. It revealed lower IRP and DCI, necessitating modification of CC cutoffs for this system.
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Affiliation(s)
- M Srinivas
- GI Motility Unit, Gleneagles Global Health City, Chennai, TN, India
| | - M Jain
- GI Motility Unit, Gleneagles Global Health City, Chennai, TN, India
| | - P Bawane
- GI Motility Unit, Gleneagles Global Health City, Chennai, TN, India
| | - V Jayanthi
- GI Motility Unit, Gleneagles Global Health City, Chennai, TN, India
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Perkins V, Hawlin J, Farhangmehr N, Jayanthi V. Post-Operative Care of the Oesophago-Gastric Cancer Patient - Are Junior Doctors Competent and Confident in Their Approach? Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kedia S, Sharma R, Makharia GK, Ahuja V, Desai D, Kandasamy D, Eapen A, Ganesan K, Ghoshal UC, Kalra N, Karthikeyan D, Madhusudhan KS, Philip M, Puri AS, Puri S, Sinha SK, Banerjee R, Bhatia S, Bhat N, Dadhich S, Dhali GK, Goswami BD, Issar SK, Jayanthi V, Misra SP, Nijhawan S, Puri P, Sarkar A, Singh SP, Srivastava A, Abraham P, Ramakrishna BS. Imaging of the small intestine in Crohn's disease: Joint position statement of the Indian Society of Gastroenterology and Indian Radiological and Imaging Association. Indian J Gastroenterol 2017; 36:487-508. [PMID: 29307029 DOI: 10.1007/s12664-017-0804-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 11/26/2017] [Indexed: 02/07/2023]
Abstract
The Indian Society of Gastroenterology (ISG) Task Force on Inflammatory Bowel Disease and the Indian Radiological and Imaging Association (IRIA) developed combined ISG-IRIA evidence-based best-practice guidelines for imaging of the small intestine in patients with suspected or known Crohn's disease. These 29 position statements, developed through a modified Delphi process, are intended to serve as reference for teaching, clinical practice, and research.
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Affiliation(s)
- Saurabh Kedia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Raju Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Govind K Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India.
| | - Vineet Ahuja
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Devendra Desai
- Division of Gastroenterology, P D Hinduja Hospital and Medical Research Centre, Veer Sawarkar Marg, Mumbai, 400 016, India
| | - Devasenathipathy Kandasamy
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Anu Eapen
- Department of Radiodiagnosis, Christian Medical College, Vellore, 632 004, India
| | - Karthik Ganesan
- Department of Radiodiagnosis, Sir H N Reliance Foundation Hospital and Research Centre, Prarthana Samaj, Raja Rammohan Roy Road, Mumbai, 400 004, India
| | - Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Naveen Kalra
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - D Karthikeyan
- Department of Radiodiagnosis, SRM Institutes for Medical Science, 1, Jawaharlal Nehru Salai, Vadapalani, Chennai, 600 026, India
| | | | - Mathew Philip
- Department of Gastroenterology, PVS Memorial Hospital, Kochi, 682 017, India
| | - Amarender Singh Puri
- Department of Gastroenterology, GB Pant Institute of Medical Education and Research, 1, Jawaharlal Nehru Marg, New Delhi, 110 002, India
| | - Sunil Puri
- Department of Radiodiagnosis, GB Pant Institute of Medical Education and Research, 1, Jawaharlal Nehru Marg, New Delhi, 110 002, India
| | - Saroj K Sinha
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Rupa Banerjee
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India
| | - Shobna Bhatia
- Department of Gastroenterology, KEM Hospital, Acharya Donde Marg, Parel, Mumbai, 400 012, India
| | - Naresh Bhat
- Department of Gastroenterology, Aster CMI Hospital, 43/2, New Airport Road, NH.7, Sahakara Nagar, Bengaluru, 560 092, India
| | - Sunil Dadhich
- Department of Gastroenterology, SN Medical College, Residency Road, Shastri Nagar, Jodhpur, 342 003, India
| | - G K Dhali
- Department of Gastroenterology, School of Digestive and Liver Diseases, Institute of Post Graduate Medical, Education and Research, Kolkata, 700 020, India
| | - B D Goswami
- Department of Gastroenterology, Guwahati Medical College, GMC Hospital Road, Bhangagarh, Guwahati, 781 032, India
| | - S K Issar
- Department of Gastroenterology, Jawaharlal Nehru Hospital and Research Centre, Hospital Sector, Bhilai, 490 009, India
| | - V Jayanthi
- Department of Gastroenterology, Gleneagles Global Hospitals, 439, Cheran Nagar, Perumbakkam, Chennai, 600 100, India
| | - S P Misra
- Department of Gastroenterology, MLN Medical College, Allahabad, 211 002, India
| | - Sandeep Nijhawan
- Department of Gastroenterology, SMS Medical College, J L N. Marg, Jaipur, 302 004, India
| | - Pankaj Puri
- Department of Gastroenterology, Military Hospital, Cantt Area, Jodhpur, 342 006, India
| | - Avik Sarkar
- Department of Radiodiagnosis, School of Digestive and Liver Diseases, Institute of Post Graduate Medical, Education and Research, Kolkata, 700 020, India
| | - S P Singh
- Department of Gastroenterology, SCB Medical College, Dock Road, Manglabag, Cuttack, 753 007, India
| | - Anshu Srivastava
- Department of Paediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Philip Abraham
- Division of Gastroenterology, P D Hinduja Hospital and Medical Research Centre, Veer Sawarkar Marg, Mumbai, 400 016, India
| | - B S Ramakrishna
- Institute of Gastroenterology, SRM Institutes for Medical Science, 1, Jawaharlal Nehru Salai, Vadapalani, Chennai, 600 026, India
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Preece J, Ching C, Yackey K, Jayanthi V, McLeod D, Alpert S, DaJusta D. Indicators and outcomes of transfer to tertiary pediatric hospitals for patients with testicular torsion. J Pediatr Urol 2017; 13:388.e1-388.e6. [PMID: 28527721 DOI: 10.1016/j.jpurol.2017.03.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/31/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Testicular torsion threatens testicular viability with increased risk of loss with delayed management. Still, healthy adolescents continue to be transferred from community hospitals to tertiary hospitals for surgical management for torsion even though adult urologists may be available. We sought to determine reasons behind patient transfer and to evaluate whether transfer to tertiary centers for testicular torsion leads to increased rates of testicular loss. MATERIALS AND METHODS A retrospective chart review was performed for patients presenting to our free-standing pediatric tertiary care facility with surgically confirmed testicular torsion during the 5-year period between January 2011 and January 2016. Data was collected regarding transfer status, patient demographics, time of presentation to our facility, duration of symptoms, patient workup, and surgical outcomes. Patients with perinatal or intermittent torsion were excluded. RESULTS One-hundred and twenty-five patients met the inclusion criteria. Thirty-six of those were transferred from outside facilities while 89 presented directly to our hospital. A greater proportion of the transferred patients presented during nights or weekends than those presenting directly to our facility (77.8% versus 51.7%, p = 0.009). Eighty-nine patients presented with symptom duration of less than 24 h and had potentially viable testicles. Of those, 23 were transferred and 66 presented directly to our hospital. Differences are shown in the Table. Transferred patients had twice the rate of testicular loss as those not transferred, although the results were not significant (30.4% versus 15.2%, p = 0.129). Patients undergoing ultrasound prior to transfer had prolonged symptom duration and faced higher rates of testicular loss when compared with patients not transferred, although the latter was not significant (mean duration 8.0 versus 4.9 h, p = 0.025, and testicular loss 40.0% versus 15.2%, p = 0.065, respectively). Patients transferred over 30 miles had over 2.5 times the rate of testicular loss than those not transferred (42.8% versus 15.2%, p = 0.029). DISCUSSION This study is unique in its examination of motivations for transfer of patients presenting with testicular torsion and in its evaluation of the impact of transfer on testicular salvage rates for potentially viable testicles (those with less than 24 h since symptom onset). CONCLUSION Patients are more likely to be transferred to our tertiary pediatric facility for management of testicular torsion during the night or weekend. Transferring patients for management of testicular torsion delays definitive management and threatens testicular viability, especially in those transferred greater distances. Urologists at the facility of initial patient presentation should correct testicular torsion when able.
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Affiliation(s)
- Janae Preece
- Section of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Christina Ching
- Section of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Katelyn Yackey
- Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Venkata Jayanthi
- Section of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Daryl McLeod
- Section of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Seth Alpert
- Section of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Daniel DaJusta
- Section of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH, USA
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Ramana Ramya J, Thanigai Arul K, Epple M, Giebel U, Guendel-Graber J, Jayanthi V, Sharma M, Rela M, Narayana Kalkura S. Chemical and structural analysis of gallstones from the Indian subcontinent. Mater Sci Eng C Mater Biol Appl 2017; 78:878-885. [PMID: 28576062 DOI: 10.1016/j.msec.2017.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 03/29/2017] [Accepted: 04/01/2017] [Indexed: 02/03/2023]
Abstract
Representative gallstones from north and southern parts of India were analyzed by a combination of physicochemical methods: X-ray diffraction (XRD), infrared spectroscopy (IR), scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDX), CHNS analysis, thermal analysis and Nuclear Magnetic Resonance (NMR) spectroscopy (1H and 13C). The stones from north Indian were predominantly consisting of cholesterol monohydrate and anhydrous cholesterol which was confirmed by XRD analysis. FTIR spectroscopy confirmed the presence of cholesterol and calcium bilirubinate in the south Indian gallstones. EDX spectroscopy revealed the presence of carbon, nitrogen, oxygen, calcium, sulfur, sodium and magnesium and chloride in both south Indian and north Indian gallstones. FTIR and NMR spectroscopy confirmed the occurrence of cholesterol in north Indian gallstones. The respective colour of the north Indian and south Indian gallstones was yellowish and black. The morphology of the constituent crystals of the north Indian and south Indian gallstones were platy and globular respectively. The appreciable variation in colour, morphology and composition of south and north Indian gallstones may be due to different food habit and habitat.
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Affiliation(s)
- J Ramana Ramya
- Crystal Growth Centre, Anna University, Chennai 600 025, Tamil Nadu, India
| | - K Thanigai Arul
- Department of Physics, AMET University, Kanathur, Chennai 603 112, Tamil Nadu, India
| | - M Epple
- Inorganic Chemistry and Center for Nanointegration Duisburg-Essen (CeNIDE), University of Duisburg-Essen, 45117 Essen, Germany
| | - U Giebel
- Inorganic Chemistry and Center for Nanointegration Duisburg-Essen (CeNIDE), University of Duisburg-Essen, 45117 Essen, Germany
| | - J Guendel-Graber
- Inorganic Chemistry and Center for Nanointegration Duisburg-Essen (CeNIDE), University of Duisburg-Essen, 45117 Essen, Germany
| | - V Jayanthi
- Department of Hepatology and Liver Transplantation, Global Hospitals and Health City, Chennai 600 100, Tamil Nadu, India
| | - M Sharma
- Jaswant Rai Speciality Hospital, Meerut 250 003, Uttar Pradesh, India
| | - M Rela
- Department of Hepatology and Liver Transplantation, Global Hospitals and Health City, Chennai 600 100, Tamil Nadu, India
| | - S Narayana Kalkura
- Crystal Growth Centre, Anna University, Chennai 600 025, Tamil Nadu, India.
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Kordzadeh A, Liu M, Jayanthi V. Does inguinal hernia repair affect male fertility? A systematic review. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Jayanthi V, Sarika S, Varghese J, Vaithiswaran V, Sharma M, Reddy MS, Srinivasan V, Reddy GMM, Rela M, Kalkura S. Composition of gallbladder bile in healthy individuals and patients with gallstone disease from north and South India. Indian J Gastroenterol 2016; 35:347-353. [PMID: 27633032 DOI: 10.1007/s12664-016-0685-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 08/08/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Gallstones (GS) in south India (SI) are predominantly pure pigment or mixed, while in North India (NI), these are either pure cholesterol or mixed. While cholesterol rich gallbladder (GB) bile predicts cholesterol GS, constituent of bile in primary pigment GS is not known. We compared the composition of GB bile from healthy liver donors and patients with GS from north and south India. METHODS Gallbladder bile from healthy liver donors from north (10) and south India (8) served as controls. Cases were patients from north (21) and south India (17) who underwent cholecystectomy for GS disease. Gallbladder bile from both cases and controls was analyzed for cholesterol, lecithin (phospholipid), and bile salts. Gallstones were classified as cholesterol, mixed, and pigment based on morphology and biochemical analysis. RESULTS The median cholesterol concentration in control bile from north was significantly high compared to south (p<0.001) with no difference in lecithin and bile salts (p NS). Except for one sample each from north and south, the cholesterol solubility of controls was within the critical micellar zone. Mixed GS were most frequent in north India (61.9 %) while pigment GS dominated in south (61.9 %). The median cholesterol concentration in bile samples of cholecystectomy patients from north India was significantly high GS (p < 0.00001) with significant lowering of bile salts and lecithin (p < 0.00001). In south India, patients with mixed GS had high cholesterol content in bile compared to controls and patients with pigment GS; bile in latter had significantly higher concentration of bile salt compared to controls and mixed GS. The ternary plot confirmed the composition of GB bile from north and south India. CONCLUSIONS Gallbladder bile in controls and patients with GS from north India had significantly high cholesterol concentration. In south India, patients with mixed GS had cholesterol rich bile while pigment GS had higher concentrations of bile salts.
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Affiliation(s)
- V Jayanthi
- Gastroenterology and Hepatology, Institute of Gastrosciences, Global Health City, 439, Cheran Nagar, Chennai, 600 100, India.
| | - S Sarika
- Crystal Growth Center, AC Technology, University of Madras, Chepauk, Chennai, 600 005, India
| | - Joy Varghese
- Institute of Liver Disease and Liver Transplant, Global Health City, 439, Cheran Nagar, Chennai, 600 100, India
| | - V Vaithiswaran
- Gastroenterology and Hepatology, Institute of Gastrosciences, Global Health City, 439, Cheran Nagar, Chennai, 600 100, India
| | - Malay Sharma
- Jaswant Rai Specialty Hospital, Mawana Road, Meerut, 250 001, India
| | - Mettu Srinivas Reddy
- Institute of Liver Disease and Liver Transplant, Global Health City, 439, Cheran Nagar, Chennai, 600 100, India
| | - Vijaya Srinivasan
- Gastroenterology and Hepatology, Institute of Gastrosciences, Global Health City, 439, Cheran Nagar, Chennai, 600 100, India
| | - G M M Reddy
- Chettinad Hospital and Research Institute, Rajiv Gandhi Salai, OMR Chennai, Kelambakkam, Chennai, 603 103, India
| | - Mohamed Rela
- Institute of Liver Disease and Liver Transplant, Global Health City, 439, Cheran Nagar, Chennai, 600 100, India
| | - S Kalkura
- Crystal Growth Center, AC Technology, University of Madras, Chepauk, Chennai, 600 005, India
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Thanthulage S, Jayanthi V, Kadirkamanathan S, Tang CB. P-240 Vitamin D levels in oesophageal and gastric cancer patients and their outcome. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw199.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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12
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Arul Selvan V, Srinivasan V, Sivasubramaniam B, Surendran R, Janani K, Srinivas M, Jayanthi V. Risk factors predisposing alcoholism to pancreatitis and chronic liver disease. Indian J Gastroenterol 2015; 34:82-3. [PMID: 25244962 DOI: 10.1007/s12664-014-0496-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- V Arul Selvan
- Department of Gastroenterology, Stanley Medical College, Royapuram, Chennai, 600 001, India
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13
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Ramya RS, Jayanthi N, Alexander PC, Vijaya S, Jayanthi V. Gastroesophageal reflux disease in pregnancy: a longitudinal study. Trop Gastroenterol 2014; 35:168-172. [PMID: 26012321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Gastroesophageal reflux (GER) symptoms are common in pregnancy. It often manifests for the first time in pregnancy during the first three months and ceases after delivery. AIM To study the prevalence of gastroesophageal reflux in each of the three trimesters by follow-up of pregnant women. To examine the association between dietary factors and GER in pregnancy. METHODS This was a prospective hospital-based study. Sixty four pregnant women in their first trimester attending an antenatal clinic were interviewed for symptoms of GER and for dietary details and followed up until term and delivery. RESULTS Fifty women (83.4%) experienced either heartburn or regurgitation during pregnancy. GER was commoner in primi-gravida (69.3%) and 50% remained symptomatic until term. Regurgitation was more common than heartburn and was often associated with nausea/vomiting. Women with an antenatal history of GERD had 3.79 times the odds of developing symptoms in the third trimester. There was no difference in weight gain in those with and without GER. Spicy food significantly increased the risk of heartburn and green vegetables were protective. CONCLUSIONS The incidence of GERD decreased over three trimesters. Weight gain did not increase the prevalence of GERD. Spicy food aggravated while green vegetables protected against GERD.
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Srinivas M, Uthappa MC, Palaniappan S, Jayanthi V. Ultrasound-guided glue injection of ileocolic artery aneurysm. Trop Gastroenterol 2014; 35:183-184. [PMID: 26012325 DOI: 10.7869/tg.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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15
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Gowdhaman D, Manaswini VS, Jayanthi V, Dhanasri M, Jeyalakshmi G, Gunasekar V, Sugumaran KR, Ponnusami V. Xylanase production from Bacillus aerophilus KGJ2 and its application in xylooligosaccharides preparation. Int J Biol Macromol 2013; 64:90-8. [PMID: 24296408 DOI: 10.1016/j.ijbiomac.2013.11.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [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: 08/23/2013] [Revised: 10/15/2013] [Accepted: 11/22/2013] [Indexed: 10/25/2022]
Abstract
Xylanolytic enzyme was produced using a newly isolated Bacillus aerophilus KGJ2 and low cost lignocellulosic sources in solid state fermentation. Seven different agricultural residues (wheat bran, tea dust, saw dust, paper waste, cassava bagasse, rice straw and rice husk) and six nitrogen source namely yeast extract, beef extract, peptone, ammonium nitrate, ammonium sulphate, and ammonium chloride were examined for xylanase production. Upon initial screening, wheat bran and ammonium chloride were chosen as suitable carbon source and nitrogen source respectively. Plackett-Burman fractional factorial design was employed to screen the important process variables affecting enzyme production. Substrate concentration, nitrogen source, moisture content and MgSO4·7H2O were identified as statistically significant variables. Subsequently Box-Behnken method was used to optimize the process conditions to achieve maximum xylanase yield. Under optimized conditions xylanase yield was 45.9 U/gds. Best xylanase activity was obtained at 70 °C and pH 4.0. It retained more than 90% activity after incubation at 80-90 °C for 60 min. The hydrolytic efficiency of xylanase on xylan was examined and xylobiose, xylotriose and xylotetrose were obtained as hydrolytic products.
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Affiliation(s)
- D Gowdhaman
- School of Chemical & Biotechnology, SASTRA University, Thirumalaisamudram, Thanjavur, India
| | - V S Manaswini
- School of Chemical & Biotechnology, SASTRA University, Thirumalaisamudram, Thanjavur, India
| | - V Jayanthi
- School of Chemical & Biotechnology, SASTRA University, Thirumalaisamudram, Thanjavur, India
| | - M Dhanasri
- School of Chemical & Biotechnology, SASTRA University, Thirumalaisamudram, Thanjavur, India
| | - G Jeyalakshmi
- School of Chemical & Biotechnology, SASTRA University, Thirumalaisamudram, Thanjavur, India
| | - V Gunasekar
- School of Chemical & Biotechnology, SASTRA University, Thirumalaisamudram, Thanjavur, India
| | - K R Sugumaran
- School of Chemical & Biotechnology, SASTRA University, Thirumalaisamudram, Thanjavur, India
| | - V Ponnusami
- School of Chemical & Biotechnology, SASTRA University, Thirumalaisamudram, Thanjavur, India.
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16
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Singh C, McLeod D, Baxter C, Alpert S, Jayanthi V. 478 LOWER URINARY TRACT RECONSTRUCTION WITH CONCOMITANT CECOSTOMY BUTTON FOR ANTEGRADE ENEMA. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.1870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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17
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Shankar VV, Jayanthi V, Srinath M, Kulkarni R. A radiological study on the trabecular pattern in the upper end of the femur in post-menopausal women. J Clin Diagn Res 2013; 7:6-10. [PMID: 23449504 PMCID: PMC3576738 DOI: 10.7860/jcdr/2012/4777.2658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 09/14/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Anatomically, the upper end of the femur is a common site for osteoporosis. Therefore, The trabecular pattern in the upper end of femur is analyzed on the basis of the presence or absence, the relative number and density of the trabeculae, trabecular group and also by the grading of trabeculae. The present study was undertaken to identify the trabecular pattern in the upper end of the femur radiographically in postmenopausal women and to establish that the changes in the trabecular pattern can be used for the diagnosis and the grading of osteoporosis. While osteoporosis is observed in both elderly men and women, its prevalence is much higher in post-menopausal women. The validated data from this study will be of use to all the clinicians to recognize the trabecular patterns and it will possibly help them in detecting osteoporosis and in limiting its progress in its early stages. METHOD Two hundred frontal projection pelvis radiographs of women who were between 18-100 years of age were studied during 2006-2007. In this study, an attempt was made to test the presence, pattern and the grading of the trabecular pattern in pre and post-menopausal females and to find out the influence of the post menopausal age on the trabecular patterns. All the readings were tabulated and subjected to analysis. RESULTS The distribution of the grading of the trabecular pattern in the upper end of the femur on the left and right sides for the severity of osteoporosis showed that as the number of years increased after menopause, the grading progressed from Grade N (Normal) to Grade A to Grade B to Grade C. CONCLUSION This study will be useful for anatomists, radiologists and clinicians for recognizing the trabecular pattern and it will possibly help them in detecting osteoporosis and in limiting its progress in its early stages.
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Affiliation(s)
| | - V Jayanthi
- Professor and Head, Department of Anatomy, Saptagiri Institute of Medical Sciences & Research Center, Bangalore-90, Karnataka, India
| | - M.G. Srinath
- Senior Professor, Department of Radiodiagnosis, M.S. Ramaiah Medical College, Bangalore-54, Karnataka, India
| | - Roopa Kulkarni
- Senior Professor, Department of Anatomy, M.S. Ramaiah Medical College, Bangalore. Karnataka, 560054, India
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18
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Chithra P, Chandrikha C, Kannan AS, Srinath S, Srinivasan V, Jayanthi V. Clinical and life style variables in functional dyspepsia and its sub-types. ACTA ACUST UNITED AC 2012; 33:33-8. [PMID: 22803293 DOI: 10.7869/tg.2012.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Several definitions and classifications have been designed to characterize functional dyspepsia (FD), the recent one being the ROME III criteria. There have been many studies in the western population which aimed at identifying the risk factors involved in functional dyspepsia. There are fewer studies from south Asian countries. AIM To determine the clinical and life style variables influencing functional dyspepsia and its sub-types in patients attending a tertiary care referral centre in the Indian subcontinent. METHODS Consecutive patients with upper gastrointestinal symptoms including, epigastric pain/burning, early satiety, postprandial fullness, heartburn and/or chest discomfort, alone or in combination, on more than 3 occasions a week, within the preceding 6 months and with a normal endoscopy were included in the study. Demographic details and the symptom profile including frequency of symptoms were recorded in a pre-structured, validated, modified proforma as per the ROME III criteria and analyzed to test the study hypothesis. RESULTS Of the 170 patients, the median age of presentation was 49 yrs and the male to female ratio was 0.62 (65:105). The mean BMI was 23.8 kg/m2. Women had a higher BMI than men. More than half of the study subjects were from the low socio-economic groups.77.6% had ulcer type symptoms and showed a decreasing trend with age. It was more common in patients with higher per capita income. Reflux type comprised of 60.6% with predominance in women. 7% had early satiety and 13.5% had postprandial fullness. Nausea and belch as an isolated (associated) phenomenon comprised of 18.8% and 17.1% respectively. None of the lifestyle variables or demographic characteristics showed a significant influence on symptom occurrence. CONCLUSIONS There was a considerable overlap of various sub-types of dyspepsia. There were no differences in life style characteristics or significant risk factors in the various subtypes of dyspepsia.
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Affiliation(s)
- P Chithra
- Department of Gastroenterology, Stanley Medical College Hospital, Chennai, India
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19
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Janani K, Krishnan A, Srinivasan P, Srinivasan V, Ramya RS, Alexander PC, Jayanthi V. Prevalence of gastrointestinal symptoms among the residents of Alamadhi village. Indian J Gastroenterol 2012; 31:274-6. [PMID: 23108723 DOI: 10.1007/s12664-012-0260-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- K Janani
- Department of Community Medicine, Stanley Medical College Hospital, Royapuram, Chennai, 600 001, Tamil Nadu, India
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20
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Shanmugam NP, Jayanthi V. Biliary atresia with cytomegalovirus. Indian Pediatr 2012; 49:157-158. [PMID: 22410523] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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21
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Shailajashetty, Lakshmi Kantha BM, Jayanthi V. Agenesis of isthmus of thyroid gland - a case report. Natl J Clin Anat 2012. [DOI: 10.4103/2277-4025.297941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Navaneethan U, Jayanthi V, Mohan P. Pathogenesis of cholangitis in obstructive jaundice-revisited. MINERVA GASTROENTERO 2011; 57:97-104. [PMID: 21372774] [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: 05/30/2023]
Abstract
Obstructive jaundice produces a number of biochemical and physiologic alterations in the biliary tract. Acute cholangitis occurs in an infected, usually obstructed biliary system, at the level of the common bile duct. The most common cause of obstruction is stones. Bacterial reflux from the biliary tract to the systemic circulation is considered to be the primary etiologic factor in bacteremia and the development of sepsis in cholangitis. The main factors in the pathogenesis of acute cholangitis are biliary tract obstruction, elevated intraluminal pressure, and infection of bile. The bile is normally sterile. The route of infection may be ascending, hematogenous or by lymphatics. Bactibilia (presence of bacteria in the biliary tract) increases in the presence of biliary obstruction, particularly partial and in the presence of foreign bodies like stones. Obstruction produces local changes in the host defenses, both in chemotaxis and phagocytosis along with systemic changes. The absence of bile and secretary IgA from the gastrointestinal tract because of biliary obstruction produces changes in the bacterial flora, loss of mucosal integrity, decreased endotoxin inactivation and promotes bacterial overgrowth, portal bacteremia, endotoxemia and increased translocation of endotoxin (LPS) to the liver, resulting in sepsis and also serving to inhibit hepatic macrophage (Kupffer cell) function in these patients. Early intervention in relieving biliary decompression is imperative in restoring normal function of the Kupffer cells in the liver and to prevent functional alterations in the liver because of chronic obstruction and cholestasis and to decrease the postoperative morbidity and mortality.
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Affiliation(s)
- U Navaneethan
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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23
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Mohan P, Ramakrishnan MK, Revathy S, Jayanthi V. Granulomatous colitis in oculocutaneous albinism. Dig Liver Dis 2011; 43:e1. [PMID: 19833565 DOI: 10.1016/j.dld.2009.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2009] [Revised: 09/07/2009] [Accepted: 09/11/2009] [Indexed: 12/11/2022]
Affiliation(s)
- P Mohan
- Department of Gastroenterology, Stanley Medical College, Chennai, India.
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24
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Abstract
BACKGROUND/AIM Current guidelines recommend screening cirrhotic patients with an endoscopy to detect esophageal varices and to institute prophylactic measures in patients with large esophageal varices. In this study, we aimed at identifying non-endoscopic parameters that could predict the presence and grades of esophageal varices. PATIENTS AND METHODS In a prospective study, 229 newly diagnosed patients with liver cirrhosis, without a history of variceal bleeding, were included. Demographic, clinical, biochemical and ultrasonographic parameters were recorded. Esophageal varices were classified as small and large, at endoscopy. Univariate analysis and multivariate logistic regression analysis were done to identify independent predictors for the presence and grades of varices. RESULTS Of the 229 patients (141 males; median age 42 years; range 17-73 years) with liver cirrhosis, 97 (42.3%) had small and 81 (35.4%) had large varices. On multivariate analysis, low platelet count (Odd's Ratio [OR], 4.3; 95% confidence interval [CI], 1.2-14.9), Child Pugh class B/C (OR, 3.3; 95% CI, 1.8-6.3), spleen diameter (OR, 4.3; 95% CI, 1.6-11.9) and portal vein diameter (OR, 2.4; 95% CI, 1.1-5.3) were independent predictors for the presence of varices. Likewise, for the presence of large esophageal varices, low platelet count (OR, 2.7; 95% CI, 1.4-5.2), Child Pugh class B/C (OR, 3.8; 95% CI, 2.3-6.5) and spleen diameter (OR, 3.1; 95% CI, 1.6-6.0) were the independent risk factors. CONCLUSION The presence and higher grades of varices can be predicted by a low platelet count, Child-Pugh class B/C and spleen diameter. These may be considered as non-endoscopic predictors for the diagnosis and management of large grade varices.
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Affiliation(s)
- Jijo V. Cherian
- Department of Gastroenterology, Stanley Medical College Hospital, Chennai, India
| | - Nandan Deepak
- Department of Medicine, Stanley Medical College Hospital, Chennai, India
| | - Rajesh Prabhu Ponnusamy
- Department of Gastroenterology, Stanley Medical College Hospital, Chennai, India,Address for correspondence: Dr. Rajesh Prabhu Ponnusamy, Department of Gastroenterology, Stanley Medical College and Hospital, Chennai, India. E-mail:
| | | | - V. Jayanthi
- Department of Gastroenterology, Stanley Medical College Hospital, Chennai, India
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25
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Boratne AV, Jayanthi V, Datta SS, Singh Z, Senthilvel V, Joice YS. Predictors of knowledge of selected mosquito-borne diseases among adults of selected peri- urban areas of Puducherry. J Vector Borne Dis 2010; 47:249-256. [PMID: 21178219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Affiliation(s)
- A V Boratne
- Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India.
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26
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Jayanthi V, Devi MN, Geethanjali BS, Rajini T. Anomalous origin of the left vertebral artery from the arch of the aorta: review of the literature and a case report. Folia Morphol (Warsz) 2010; 69:258-260. [PMID: 21120814] [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: 05/30/2023]
Abstract
The present report describes an anomalous case of the left vertebral artery arising from the aortic arch between the left common carotid artery and the left subclavian artery in a male cadaver during dissection in an anatomical laboratory. Aortic origin of the vertebral artery is a rare anatomic variant. Detailed knowledge of anomalous origin is important for patients who undergo four-vessel angiography. Normally, the vertebral artery arises from the first part of the subclavian artery on both sides. We also review the anomalous origin of the vertebral artery in the literature and discuss its clinical significance.
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Affiliation(s)
- V Jayanthi
- Department of Anatomy, Vydehi Institute of Medical Sciences and Research Centre, Whitefield, Bangalore, Karnataka, India.
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27
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Boratne AV, Datta SS, Singh Z, Purty AJ, Jayanthi V, Senthilvel V. Attitude and practices regarding mosquito borne diseases and socio-demographic determinants for use of personal protection methods among adults in coastal Pondicherry. Indian J Med Spec 2010. [DOI: 10.7713/ijms.2010.0024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Pazhanivel M, Jayanthi V. Diabetes mellitus and cirrhosis liver. MINERVA GASTROENTERO 2010; 56:7-11. [PMID: 20190718] [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: 05/28/2023]
Abstract
AIM Patients with chronic liver disease have a high prevalence of diabetes mellitus (DM). The aim of the study was to determine the prevalence of DM in cirrhosis and compare the virological profile, complications and outcome of cirrhotic patients with and without DM. METHODS This was a retrospective analysis of cirrhotic patients between January 2003 and December 2007. The study population was divided into two groups, based on the presence (Group I) or absence (Group II) of DM. Demography, duration of diabetes, Child's Pugh Score and complications of cirrhosis were noted. Serology for Hepatitis B (HBV) and Hepatitis C virus (HCV) was done. RESULTS A total of 582 cirrhotic patients were analyzed. A total of 103 patients suffered from DM (type II) (17.69%). The etiology of cirrhosis was ethanol in 266 (45.7%), Hepatitis B virus in 107 (18.38%) and Hepatitis C virus in 35 (6.01%) patients. Alcoholism was more frequent amongst non diabetic patients (49.7% Group II vs. 27.2% Group I P<0.001). The presence of HCV infection amongst cirrhotics with DM and those without DM was 13.6% versus 4.4% respectively (P<0.001). In comparison with HBV and alcohol, the prevalence of DM in HCV related cirrhosis was significantly greater (10.5% vs. 18.7% vs. 40%; P<0.001). CONCLUSIONS The prevalence of DM in cirrhosis was 17.69%. The prevalence of HCV infection appears to be higher amongst cirrhotics with diabetes when compared to alcohol and HBV infection.
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Affiliation(s)
- M Pazhanivel
- Department of Gastroenterology, Stanley Medical College, Royapuram, Chennai, India.
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29
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Jayanthi V, Udayakumar N. Budd-Chiari Syndrome. Changing epidemiology and clinical presentation. MINERVA GASTROENTERO 2010; 56:71-80. [PMID: 20190727] [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: 05/28/2023]
Abstract
Budd-Chiari Syndrome (BCS) is a rare cause of portal hypertension. Geographical variations occur, particularly in the clinical presentation, where there are distinct differences between West and South Asia. Idiopathic forms are common in south Asia, while hypercoagulable disorders are common causes of BCS in the West. The site of thrombosis is also different, with patients from South Asia presenting with combined obstruction of the hepatic veins and the inferior vena cava in contrast to isolated obstruction of the hepatic veins, common in the West. Ultrasound-Doppler studies confirm the diagnosis in the majority. Early radiological interventions, including transjugular intrahepatic portosystemic shunt, can cure the majority of cases with idiopathic forms. Prothrombotic forms are treated with long-term anticoagulants. Surgery is reserved to a selected few with long segment obstruction. Liver transplantation is indicated in patients with worsening clinical functional status not responding to medical and/or interventional management.
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Affiliation(s)
- V Jayanthi
- Department of Gastroenterology, Stanley Medical College, Chennai, India
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30
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Navaneethan U, Jayanthi V. Nutritional support in acute pancreatitis: when to start oral feeds. MINERVA GASTROENTERO 2010; 56:65-69. [PMID: 20190726] [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: 05/28/2023]
Abstract
Nutritional support in acute pancreatitis had always been a subject of great controversy in the past. The results of the recently published meta-analysis however have shown improved outcome with enteral feeding when compared to parenteral nutrition in patients with severe acute pancreatitis. However the time of initiation of oral feeds in acute pancreatitis is still a subject of controversy, given the fact that a large number of patients have a recurrence of abdominal pain when the oral feeds are initiated based on subjective parameters and the incident rise in duration of hospitalization and hospital costs. This brief communication highlights the present literature in the nutrition support in acute pancreatitis patients and discusses the future studies required to study the often neglected topic of nutrition therapy in acute pancreatitis.
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Affiliation(s)
- U Navaneethan
- Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio 45219, USA.
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31
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Bhardwaj AK, Singh DK, Rajini T, Jayanthi V, Singh G. Anatomic variations of superficial peroneal nerve: clinical implications of a cadaver study. Ital J Anat Embryol 2010; 115:223-228. [PMID: 21287977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Superficial peroneal nerve and its branches are frequently at risk for iatrogenic damage. Although different studies on anatomical variations of superficial peroneal nerve are available in the medical literature, such reports are rare from India. Hence the present study was undertaken on Indian population. A total of 60 specimens of inferior extremities from 30 properly embalmed and formalin fixed cadavers were dissected and examined for the location and course of the superficial peroneal nerve including number, level, course and distributions of branches. The superficial peroneal nerve in 28.3% specimens was located in the anterior compartment of the leg. In 8.3% specimens the superficial peroneal nerve branched before piercing between the peroneus longus and extensor digitorum longus muscle whereas in 11.7% specimens it branched after piercing the aforementioned muscles and before piercing the deep fascia. In 41 out of 60 specimens the sensory division of superficial peroneal nerve branched into the medial dorsal cutaneous nerve and intermediate dorsal cutaneous nerve distal to its emergence from the deep fascia and proximal to its relation to the extensor retinaculum. In 20 out of 60 specimens the accessory deep peroneal nerve, an additional branch from the sensory division of superficial peroneal nerve, through its course in the anterior compartment of the leg passed deep to the extensor retinaculum and supplied the ankle and the dorsum of foot. Hopefully the present study will help in minimizing iatrogenic damage to the superficial peroneal nerve and its branches while performing arthroscopy, local anesthetic block, surgical approach to the fibula, open reduction and internal fixation of lateral malleolar fractures, application of external fixators, elevation of a fasciocutaneous or fibular flaps for grafting, surgical decompression of neurovascular structures, or miscellaneous surgery on leg, foot and ankle.
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Lichtarowicz A, Srivastava E, Norman C, Rhodes J, Tregaskis B, Jayanthi V, Probert CS, Mayberry JF. A Study of the Menopause in Women with Ulcerative Colitis. J OBSTET GYNAECOL 2009. [DOI: 10.3109/01443619109007786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sumathi B, Ramalingam S, Navaneethan U, Jayanthi V. Risk factors for gastric cancer in South India. Singapore Med J 2009; 50:147-151. [PMID: 19296029] [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: 05/27/2023]
Abstract
INTRODUCTION Stomach cancer is the third most common cancer in South India. A higher incidence has been reported from certain states in northern India, where potential risk factors have been identified. Similar data is available only to a limited extent from southern India. The aim of this case-control study was to evaluate the effects of lifestyle habits and dietary factors on the risk of gastric cancer in South Indians. METHODS A hospital-based case-control study of matched pairs was conducted in Chennai, India, from 2002 to 2006 in a large tertiary care referral centre in South India. We studied 89 gastric cancer patients and 89 age- and gender-matched healthy controls of the same socioeconomic status. All subjects were interviewed face-to-face by a trained interviewer using a structured questionnaire to collect data about lifestyle habits, such as cigarette smoking, alcohol consumption, tobacco chewing and dietary factors, with special attention to known factors like salted fish, smoked and pickled foods as well as intake of vegetables and fruits. RESULTS The response rate was 100 percent. There were 64 male and 25 female patients. The male to female ratio was 2.6:1. The demographic characteristics were similar in the case and control populations. Less than ten percent of patients were below the age of 30 years. Approximately 50 percent were between 30 and 60 years of age, and the rest were over 60 years of age. Multivariate logistic regression models indicated that alcohol consumption (odds ratio [OR] 2.3, 95 percent confidence interval [CI] 1.1-4.9, p-value is 0.04) and consumption of pickled food (OR 1.8, 95 percent CI 1.2-3.9, p-value is 0.05) are independent risk factors for the development of gastric cancer. A protective effect of the consumption of pulses (OR 0.4, 95 percent CI 0.2-0.9, p-value is 0.05), showing a 55 percent reduction in risk, was also identified; this could be of use for possible control and prevention of this cancer. Tobacco chewing and cigarette smoking did not emerge as high risk factors for stomach cancer. CONCLUSION The study showed alcohol and pickled food consumption as independent risk factors for the development of gastric cancer, while consumption of pulses were protective. Cigarette smoking did not predict an increased risk of contracting the disease.
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Affiliation(s)
- B Sumathi
- Institute of Child Health, Chennai 600008, India
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Sumathi B, Navaneethan U, Jayanthi V. Appropriateness of indications for diagnostic upper gastrointestinal endoscopy in India. Singapore Med J 2008; 49:970-976. [PMID: 19122945] [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: 05/27/2023]
Abstract
INTRODUCTION Guidelines for an upper gastrointestinal endoscopy have been outlined for the Western population, but not yet for India. The study aimed to assess the appropriateness of upper gastrointestinal endoscopy for patients with dyspepsia and to identify the cut-off age for endoscopy from an Indian perspective. METHODS Patients referred for upper digestive endoscopy to a university clinic in India were prospectively studied between January 2004 and June 2005. Patients who presented with dyspepsia and those with isolated alarm symptoms without dyspepsia who underwent endoscopy were included. The cut-off age for the detection of upper gastrointestinal tract carcinoma in dyspepsia was derived. RESULTS A total of 3,432 endoscopies were performed during the study period. There were 2,068 men and 1,364 women. The overall mean age was 41.6+/-15 (range 7-85) years. 18.3 percent of 284 patients with malignancy were between 25 and 45 years of age. Using the receiver operator characteristic curve, the cut-off age for malignancy was between 35 and 44 years; specifically, the optimal cut-off age was 38 years for females and 43.5 years for males. CONCLUSION In the south Indian population with dyspepsia, there were more normal and benign lesions at endoscopy. The optimal cut-off ages for detecting malignancy for both genders were also determined.
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Affiliation(s)
- B Sumathi
- Department of Gastroenterology, Institute of Child Health and Hospital for Children, Chennai 600008, Tamil Nadu, India
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Ghoshal UC, Abraham P, Bhatt C, Choudhuri G, Bhatia SJ, Shenoy KT, Banka NH, Bose K, Bohidar NP, Chakravartty K, Shekhar NC, Desai N, Dutta U, Das G, Dutta S, Dixit VK, Goswami BD, Jain RK, Jain S, Jayanthi V, Kochhar R, Kumar A, Makharia G, Mukewar SV, Mohan Prasad VG, Mohanty A, Mohan AT, Sathyaprakash BS, Prabhakar B, Philip M, Veerraju EP, Ray G, Rai RR, Seth AK, Sachdeva A, Singh SP, Sood A, Thomas V, Tiwari S, Tandan M, Upadhyay R, Vij JC. Epidemiological and clinical profile of irritable bowel syndrome in India: report of the Indian Society of Gastroenterology Task Force. Indian J Gastroenterol 2008; 27:22-8. [PMID: 18541934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIMS To study the profile of irritable bowel syndrome (IBS), and the frequency of such symptoms among the general population, in India. METHODS In this prospective, multi-center study, data were obtained from 2785 patients with chronic lower gastrointestinal symptoms (complainants) with no alarm feature and negative investigations for organic causes visiting physicians at 30 centers, and from 4500 community subjects (non-complainants), using separate questionnaires. RESULTS Most complainants were middle-aged (mean age 39.4 years) and male (1891; 68%). The common symptoms were: abdominal pain or discomfort (1958; 70%), abdominal fullness (1951; 70%); subjective feeling of constipation (1404 of 2656; 53%), or diarrhea (1252 of 2656, 47%), incomplete evacuation (2134; 77%), mucus with stools (1506; 54%), straining at stools (1271; 46%), epigastric pain (1364; 49%) and milk intolerance (906; 32%). Median stool frequency was similar in patients who felt they had constipation or those who felt they had diarrhea. Information to subtype symptoms using standard criteria was available in 1301 patients; of these, 507 (39%) had constipation-predominant IBS ( 3 <or= stools/week), 50 (4%) had diarrhea-predominant IBS (>3 stools/day) and 744 (57%) had indeterminate symptoms. Among non-complainants, most subjects reported daily defecation frequency of one (2520 [56%]) or two (1535 [34%]). Among non-complainants, 567 (12.6%) reported abdominal pain, 503 (11%) irregular bowel, 1030 (23%) incomplete evacuation, 167 (4%) mucus and 846 (18%) straining at stools; a combination of abdominal pain or discomfort relieved by defecation, and incomplete evacuation was present in 189/4500 (4.2%) community subjects. CONCLUSIONS Most patients with IBS in India are middle-aged men, and have a sense of incomplete evacuation and mucus with stools. Abdominal pain or discomfort is frequent but not universal. Importantly, stool frequency was similar irrespective of whether the patients felt having constipation or diarrhea. Most (90%) non-complainant subjects had 1 or 2 stools per day; symptoms complex suggestive of IBS was present in 4.2% of community subjects.
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Santhosh S, Shaji RV, Eapen CE, Jayanthi V, Malathi S, Finny P, Thomas N, Chandy M, Kurian G, Chandy GM. Genotype phenotype correlation in Wilson's disease within families--a report on four south Indian families. World J Gastroenterol 2008; 14:4672-6. [PMID: 18698682 PMCID: PMC2738792 DOI: 10.3748/wjg.14.4672] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2007] [Revised: 07/20/2008] [Accepted: 07/27/2008] [Indexed: 02/06/2023] Open
Abstract
AIM To study the genotype phenotype correlation in Wilson's disease (WD) patients within families. METHODS We report four unrelated families from South India with nine members affected with WD. Phenotype was classified as per international consensus phenotypic classification of WD. DNA was extracted from peripheral blood and 21 exons of ATP7B gene and flanking introns were amplified by polymerase chain reaction (PCR). The PCR products were screened for mutations and the aberrant products noted on screening were sequenced. RESULTS Four separate ATP7B mutations were found in the four families. ATP7B mutations were identical amongst affected members within each family. Three families had homozygous mutations of ATP7B gene while one family had compound heterozygous mutation, of which only one mutation was identified. We noted concordance between ATP7B gene mutation and Wilson's disease phenotype amongst members within each family. The age of onset of symptoms or of detection of asymptomatic disease, baseline serum ceruloplasmin and baseline urinary copper levels were also similar in affected members of each family. Minor differences in phenotype and baseline serum ceruloplasmin level were noted in one family. CONCLUSION We report concordance between ATP7B mutation and WD phenotype within each family with > 1 member affected with WD. Homozygous ATP7B mutation was present in 3 of the 4 families studied. Our report supports allelic dominance as a determinant of WD phenotype. However, in one family with compound heterozygous mutation, there was a similar WD phenotype which suggests that there may be other factors determining the phenotype.
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Murugavel KG, Mathews S, Jayanthi V, Shankar EM, Hari R, Surendran R, Vengatesan A, Raghuram K, Rajasambandam P, Murali A, Srinivas U, Palaniswamy KR, Pugazhendhi T, Thyagarajan SP. Alpha-fetoprotein as a tumor marker in hepatocellular carcinoma: investigations in south Indian subjects with hepatotropic virus and aflatoxin etiologies. Int J Infect Dis 2008; 12:e71-6. [PMID: 18658001 DOI: 10.1016/j.ijid.2008.04.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Revised: 04/30/2008] [Accepted: 04/30/2008] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES The prevalence of hepatitis B virus (HBV) is reportedly the main cause of hepatocellular carcinoma (HCC) in India, where hepatitis C virus (HCV)-associated HCC is believed to be relatively less prevalent. We verified the usefulness of alpha-fetoprotein (AFP) as a tumor marker and analyzed the influence of viral etiology on AFP levels in HCC. METHODS Of a total of 1012 cases with liver disease, 202 were investigated for the presence of AFP (142 HCC cases, 30 cirrhosis cases, and 30 chronic liver disease (CLD) cases). In addition, serum samples from 30 healthy patients, 30 hepatitis B surface antigen (HBsAg) carriers, and 30 acute viral hepatitis cases were included as controls. AFP was quantitatively determined using a commercial ELISA (Quorum Diagnostics, Canada). Out of the 142 HCC cases screened for AFP, aflatoxin B1 (AFB1) detection was carried out in 38 HCC cases using an in-house immunoperoxidase test. RESULTS In HBV and HCV co-infected HCC cases, the AFP positivity was 85.7%. In HBV alone-associated HCC, the positivity was 62.9%, and 54.5% of AFB1 positive HCC cases showed AFP positivity. In HBV and HCV negative HCC cases, the positivity was 20.5%, and in HCV-associated HCC it was 17.6%. The HBV/HCV co-infected group and HBV alone positive HCC cases had significantly elevated levels of AFP. When AFP positivity was analyzed based on the marker profile of HBV, 89.7% of AFP positive cases were HBV-DNA positive. CONCLUSIONS The overall positivity pattern of AFP in HCC does indicate that higher levels of AFP are observed with hepatitis virus positivity, especially with HBV. Further studies must be carried out to correlate the serum levels of AFP with the size, number, and degree of differentiation of HCC nodules.
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Affiliation(s)
- Kailapuri G Murugavel
- Infectious Diseases Laboratory, YRG Centre for AIDS Research & Education, VHS Hospital Campus, Taramani, Chennai 600 113, India.
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Navaneethan U, Jayanthi V. Endoscopic management of biliary leaks. The answer for the future. MINERVA GASTROENTERO 2008; 54:141-150. [PMID: 18319687] [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: 05/26/2023]
Abstract
Bile duct diseases and biliary leaks are not uncommon complications and their management is challenging. Majority of bile leaks occur secondary to trauma, major liver, gallbladder and biliary tract surgeries. Early recognition of bile leaks by imaging combined with a high clinical suspicion is required. Bile leaks can be managed either conservatively, or through percutaneous drainage, or endoscopically or by surgical intervention. The innovations in endoscopic techniques have expanded the horizons for managing patients with bile leaks irrespective of their etiology. Endoscopic interventions through biliary sphincterotomy alone, biliary stenting with or without sphincterotomy, and nasobiliary drainage with or without sphincterotomy, use of self expanding covered metal stents and the recent use of biodegradable stents have been very effective in the management of all kinds of biliary leaks. All endoscopic techniques are based on the principle that eliminating the rise in pressure inside the bile duct by promoting decompression in the form of stent placement/sphincterotomy promotes healing of bile leaks. Further future developments in endoscopic techniques are expected to improve their effectiveness in managing patients with bile leaks.
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Affiliation(s)
- U Navaneethan
- University of Cincinnati College of Medicine, Ohio, USA.
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Udayakumar N, Jayanthi V. Autoimmune hepatitis in India. Getting to the heart of the matter. MINERVA GASTROENTERO 2008; 54:229-230. [PMID: 18319695] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Varghese J, Cherian JV, Solomon R, Jayanthi V. Predictors of variceal bleed among patients with liver cirrhosis in the era of sclerotherapy. Singapore Med J 2008; 49:239-242. [PMID: 18363007] [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: 05/26/2023]
Abstract
INTRODUCTION Variceal bleed is a common complication of portal hypertension. The bleed pattern has changed considerably with the introduction of variceal band ligation. The bleed pattern in developing countries where sclerotherapy continues to remain a viable option is not known. The aim of the study was to determine the predictors of first and subsequent bleed in individuals with liver cirrhosis. METHODS 205 subjects with liver cirrhosis and portal hypertension registered in the liver clinic between January and June 2004, were followed-up for 18 months after registration. Bleeders already on pharmacotherapy or endotherapy were excluded. Patient details included age, gender, duration of illness, aetiology, Child-Pugh-Turcotte score and grades of oesophageal varices, details of index and subsequent variceal bleed, and complications during follow-up. Logistic regression multivariate analysis was applied to predict the factors influencing variceal bleed. RESULTS There were 95 variceal bleeders and 110 non-bleeders. Age at presentation and gender did not predict a variceal bleed. Grades III and IV oesophageal varices and fundal varices were the significant risk factors for an index bleed (p-value is 0.001). 27 of the 95 bleeders (28.3 percent) had a second bleed after a mean interval of 8 (+/- 7.7) months. Predictors of rebleed were similar to the index bleed. Predictors of index bleed were also similar to those who had bled for the first time after registration. Overall bleed-related mortality was low (2.1 percent). CONCLUSION Higher grades of varices, presence of cherry-red spots and fundal varices predicted variceal bleed in patients with liver cirrhosis. Variceal bleed-related mortality was low in the era of sclerotherapy.
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Affiliation(s)
- J Varghese
- Department of Medical Gastroenterology, Stanley Medical College Hospital, Old Jail Road, Royapuram, Chennai 600001, Tamil Nadu, India.
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Prabhu PR, Cherian JV, Varghese SJ, Gunaseelan K, Murali A, Jayanthi V. Inguinal metastasis in gastric cancer-a path less trodden. Gastrointest Cancer Res 2008; 2:102-3. [PMID: 19259303 PMCID: PMC2630826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- P. Rajesh Prabhu
- Departments of Gastroenterology, Stanley Medical College, Chennai, India
| | - Jijo V. Cherian
- Departments of Gastroenterology, Stanley Medical College, Chennai, India
| | - S. Joye Varghese
- Departments of Gastroenterology, Stanley Medical College, Chennai, India
| | | | - A. Murali
- Departments of Gastroenterology, Stanley Medical College, Chennai, India
| | - V. Jayanthi
- Departments of Gastroenterology, Stanley Medical College, Chennai, India
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Jayanthi V, Udayakumar N. Acute liver failure in pregnancy: an overview. MINERVA GASTROENTERO 2008; 54:75-84. [PMID: 18299670] [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: 05/26/2023]
Abstract
Acute liver failure (ALF) in pregnancy is a common challenging clinical problem both in terms of correct diagnosis and management. Acute viral hepatitis is the most common cause of jaundice in pregnancy. The course of acute viral hepatitis is unaffected by pregnancy, except in patients with hepatitis E (HEV), particularly from endemic countries like India, where ALF carries a high mortality. In both HEV infection and herpes simplex infections, maternal and fetal mortality rates are significantly increased. ALF specific to pregnancy including pre-eclampsia, associated with hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome, acute fatty liver of pregnancy, and hepatic infarction result in increased maternal and fetal mortality if not recognized and acted on early. Early recognition of possible causes and prompt treatment are crucial for successful outcome of ALF in pregnancy. Treatment involves prompt delivery, whereupon the liver disease quickly reverses. This review article addresses the present understanding of ALF in pregnancy reviewing the common causes of ALF and their management in pregnancy.
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Affiliation(s)
- V Jayanthi
- Stanley Medical College, Chennai, India.
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Murugavel KG, Naranatt PP, Shankar EM, Mathews S, Raghuram K, Rajasambandam P, Jayanthi V, Surendran R, Murali A, Srinivas U, Palaniswamy KR, Srikumari D, Thyagarajan SP. Prevalence of aflatoxin B1 in liver biopsies of proven hepatocellular carcinoma in India determined by an in-house immunoperoxidase test. J Med Microbiol 2008; 56:1455-1459. [PMID: 17965344 DOI: 10.1099/jmm.0.47151-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related death in the world. The incidence of HCC in India is reportedly low and varies from 0.2 to 1.9 %. Aflatoxins, secondary metabolites produced by Aspergillus flavus and Aspergillus parasiticus, are potent human carcinogens implicated in HCC. The prevalence of aflatoxin B1 (AFB1) as co-carcinogen was analysed using an in-house immunoperoxidase test in 31 liver biopsies and 7 liver-resection specimens from histopathologically proven HCC, and in 15 liver biopsies from cirrhosis patients (control group). Serum was tested for hepatitis B and C serological markers using commercial assays, and for AFB1 using an in-house ELISA with a sensitivity of approximately 1 ng ml(-1) for AFB1. In spite of positive AFB1 immunostaining in HCC cases, all serum specimens, from both HCC and the control groups, were AFB1-negative. There were 18 (58.1 %) HCC cases that revealed AFB1 in liver biopsies; 68.8 % (n=11) of non-B non-C hepatitis cases with HCC and 46.1 % (n=6) of the hepatitis B surface-antigen-positive subjects were positive for AFB1. Out of the two hepatitis B/hepatitis C virus co-infected cases, one was positive for AFB1. Of seven tumour-resection samples, six were positive for AFB1. Only one case revealed AFB1 in the non-tumour area of the resected material. Thus AFB1 staining was significantly associated with tumour tissue (P=0.03). Aflatoxins proved to have a significant association with HCC in this peninsular part of the subcontinent. The impact seems to be a cumulative process, as revealed by the AFB1 deposits in HCC liver tissue, even though the serum levels were undetectable.
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Affiliation(s)
- K G Murugavel
- Department of Microbiology, Faculty of Medicine, Dr ALM PG Institute of Basic Medical Sciences, University of Madras, Taramani Campus, Chennai 600 113, India
| | - P P Naranatt
- Department of Microbiology, Faculty of Medicine, Dr ALM PG Institute of Basic Medical Sciences, University of Madras, Taramani Campus, Chennai 600 113, India
| | - E M Shankar
- Department of Microbiology, Faculty of Medicine, Dr ALM PG Institute of Basic Medical Sciences, University of Madras, Taramani Campus, Chennai 600 113, India
| | - S Mathews
- Medical Gastroenterology Unit of the Government General Hospital, Chennai 600 001, India
| | - K Raghuram
- Medical Gastroenterology Unit of the Government General Hospital, Chennai 600 001, India
| | - P Rajasambandam
- Medical Gastroenterology Unit of the Government General Hospital, Chennai 600 001, India
| | - V Jayanthi
- Medical and Surgical Gastroenterology Unit of the Government Stanley Medical College and Hospital, Chennai 600 001, India
| | - R Surendran
- Medical and Surgical Gastroenterology Unit of the Government Stanley Medical College and Hospital, Chennai 600 001, India
| | - A Murali
- Medical and Surgical Gastroenterology Unit of the Government Stanley Medical College and Hospital, Chennai 600 001, India
| | - U Srinivas
- Medical and Surgical Gastroenterology Unit of the Government Stanley Medical College and Hospital, Chennai 600 001, India
| | - K R Palaniswamy
- Medical and Surgical Gastroenterology Unit of the Government Stanley Medical College and Hospital, Chennai 600 001, India
| | - D Srikumari
- Government Kilpauk Medical College and Hospital, Chennai 600 029, India
| | - S P Thyagarajan
- Department of Microbiology, Faculty of Medicine, Dr ALM PG Institute of Basic Medical Sciences, University of Madras, Taramani Campus, Chennai 600 113, India
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Prabhu PR, Cherian JV, Varghese SJ, Revathy MS, Jayanthi V. Seizure and prominent abdominal veins. Lancet 2007; 370:1282. [PMID: 17920920 DOI: 10.1016/s0140-6736(07)61541-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- P Rajesh Prabhu
- Department of Gastroenterology, Stanley Medical College, Chennai, India.
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Mantoo S, Abraham G, Pratap GB, Jayanthi V, Obulakshmi S, Bhaskar SS, Lesley N. Nutritional status in renal transplant recipients. Saudi J Kidney Dis Transpl 2007; 18:382-6. [PMID: 17679750] [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: 05/16/2023] Open
Abstract
We performed this study to observe the nutritional status in our renal transplant recipients using serum parameters, body mass index (BMI), and dual energy x-ray absorptiometry (DEXA) that measured the fat distribution. We studied 109 patients who had chronic kidney disease due to different etiologies, and received mean hemodialysis before they underwent successful renal transplantation. The body mass index and the prevalence of type 2 diabetes mellitus revealed a significantly positive correlation with older age (p< 0.05). The mean values of serum sodium, chloride, potassium, calcium, and phosphorous were found to be within the normal range. There were no significant differences in these parameters according to age distribution. However, the mean serum creatinine was elevated, 154 +/- 18 micromol/L, which was compatible with a significant but stable renal dysfunction. iPTH levels in most of our patients were within two times the normal values (101+/- 81 pg/ml). The mean hemoglobin levels were low in all our patients (91.6 +/- 19.4 g/L). The mean bicarbonate levels were within normal limits (23 +/- 3.5 mmol/L), however there were some patients below normal. The plasma proteins and albumin were lower than normal; 62.2 +/- 8.6 g/L, and 36.1 +/- 5.1 g/L, respectively. We conclude that the BMI, fat distribution and percentage as measured by DEXA scan, as well as the prevalence of type 2 diabetes mellitus in our transplant population revealed a significantly positive correlation with older age. The elevated mean plasma iPTH levels, decreased mean serum bicarbonate, albumin, and hemoglobin levels are most likely related to renal allograft dysfunction which is usually inherent with the grafts and may eventually affect the nutritional status of the patients. Subsequently, the initial weight gain may be hampered by the graft dysfunction. Prospective long-term studies are required to confirm our findings on larger transplant populations.
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Affiliation(s)
- Sonali Mantoo
- Sri Ramachandra Medical College and Research Institute, Chennai, India
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Joye Varghese S, Balan N, Naveen B, Caroline Selvi K, Jayapalan K, Jayanthi V. Does autonomic dysfunction in cirrhosis liver influence variceal bleed? Ann Hepatol 2007; 6:104-7. [PMID: 17519833] [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 Autonomic dysfunction has been documented in cirrhosis liver. Its influence on variceal bleed is not known. AIM To determine the autonomic function amongst variceal bleeders in cirrhosis of the liver. MATERIALS AND METHODS Fifty cirrhotics (variceal bleeders: 34) belonging to either sex, Childs B, age more than 15 years and non diabetic constituted the study group. Parasympathetic function tests included valsalva ratio (E:I ratio) and deep breathing test. (Max.-Min. heart rate); sympathetic function included postural fall of B.P and a rise in diastolic B.P. with sustained hand grip. A cirrhotic was considered to have 'True' autonomic dysfunction when both parasympathetic and one of the two sympathetic tests were abnormal. RESULTS The mean age for men was 39.64 + 10.6 yrs and for women 39.54 + 15.8 yrs. The male female ratio was 3.5:1. Only 10 of the 50 patients (all bleeders) had 'true' autonomic dysfunction i.e. 20%. Parasympathetic dysfunction alone was positive in 19 (38%) and sympathetic in 10 patients (20%). The E:I ratio (p < 0.001) and an increase in diastolic B.P. during sustained hand grip (p < 0.04) were significantly positive amongst variceal bleeders. CONCLUSION 'True' autonomic dysfunction can predispose a cirrhotic to variceal bleed.
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Affiliation(s)
- S Joye Varghese
- Medical Gastroenterology, Stanley Medical College Hospital, Chennai, India.
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Ramalakshmi S, Baben B, Ashok BS, Jayanthi V, Leslie N, Abraham G. Association of carnitine deficiency in Indian continuous ambulatory peritoneal dialysis patients with anemia, erythropoietin use, residual renal function, and diabetes mellitus. Perit Dial Int 2007; 27 Suppl 2:S235-8. [PMID: 17556311] [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: 05/15/2023] Open
Abstract
OBJECTIVE In the present study, we aimed to determine levels of free carnitine in hemodialysis (HD) and peritoneal dialysis (PD) patients in India and to correlate carnitine deficiency with various clinical parameters. METHODS Patients on HD and PD at two tertiary care centers were selected for the study. Baseline data were obtained, and a free carnitine analysis was performed. Carnitine deficiency was defined as a free carnitine level of less than 40 micromol/L. RESULTS The total number of study patients was 96 (77 on HD, 19 on PD). In the PD group, the mean age was 56 years, with 26.3% of the patients being vegan, 47.4% having diabetes, and 57.9% having a daily urine output of <500 mL. The mean carnitine level in that group was 38.9 micromol/L, and 68.4% of the patients had a carnitine deficiency. A Pearson correlation test failed to show any association of carnitine level with parameters such as anemia, use of erythropoietin, non-vegetarian diet, diabetes, and hypertension. In the HD group, the mean age was 45 years, with 22% of the patients being vegan, 23% having diabetes, and 45.5% having a daily urine output of <500 mL. The mean carnitine level in the group was 38.2 micromol/L, and 64.3% of the patients had a carnitine deficiency. Residual renal function and duration of dialysis were different in HD patients with and without carnitine deficiency. Carnitine levels in the HD group correlated positively and statistically significantly with the presence of diabetes and hypertension. CONCLUSION This study is the first demonstration that Indian dialysis patients have carnitine deficiency.
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Ramalakshmi S, Baben B, Ashok BS, Jayanthi V, Leslie N, Abraham G. Association of Carnitine Deficiency in Indian Continuous Ambulatory Peritoneal Dialysis Patients with Anemia, Erythropoietin Use, Residual Renal Function, and Diabetes Mellitus. Perit Dial Int 2007. [DOI: 10.1177/089686080702702s40] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
♦ In the present study, we aimed to determine levels of free carnitine in hemodialysis (HD) and peritoneal dialysis (PD) patients in India and to correlate carnitine deficiency with various clinical parameters. ♦ Patients on HD and PD at two tertiary care centers were selected for the study. Baseline data were obtained, and a free carnitine analysis was performed. Carnitine deficiency was defined as a free carnitine level of less than 40 μmol/L. ♦ The total number of study patients was 96 (77 on HD, 19 on PD). In the PD group, the mean age was 56 years, with 26.3% of the patients being vegan, 47.4% having diabetes, and 57.9% having a daily urine output of <500 mL. The mean carnitine level in that group was 38.9 μmol/L, and 68.4% of the patients had a carnitine deficiency. A Pearson correlation test failed to show any association of carnitine level with parameters such as anemia, use of erythropoietin, non-vegetarian diet, diabetes, and hypertension. In the HD group, the mean age was 45 years, with 22% of the patients being vegan, 23% having diabetes, and 45.5% having a daily urine output of <500 mL. The mean carnitine level in the group was 38.2 μmol/L, and 64.3% of the patients had a carnitine deficiency. Residual renal function and duration of dialysis were different in HD patients with and without carnitine deficiency. Carnitine levels in the HD group correlated positively and statistically significantly with the presence of diabetes and hypertension. ♦ Conclusion This study is the first demonstration that Indian dialysis patients have carnitine deficiency.
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Affiliation(s)
| | | | | | - V. Jayanthi
- SRMC & RI, and Madras Medical Mission, Chennai, India
| | - Nancy Leslie
- SRMC & RI, and Madras Medical Mission, Chennai, India
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Santhosh S, Shaji RV, Eapen CE, Jayanthi V, Malathi S, Chandy M, Stanley M, Selvi S, Kurian G, Chandy GM. ATP7B mutations in families in a predominantly Southern Indian cohort of Wilson's disease patients. Indian J Gastroenterol 2007; 25:277-82. [PMID: 17264425] [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 analyze ATP7B mutations in Wilson's disease (WD) patients from the Indian subcontinent and to correlate these with WD phenotype. METHODS We studied 27 WD patients from 25 unrelated families. Twenty-two families were from three southern Indian states - Tamil Nadu andhra Pradesh and Kerala. We applied conformation- sensitive gel electrophoresis (CSGE) to screen for the mutations in patients and their families. PCR products exhibiting aberrant patterns in CSGE were subjected to direct DNA sequencing. As siblings affected by WD within a family share identical ATP7B genotype, we compared WD phenotype among affected siblings within families. RESULTS ATP7B mutations were detected in 22 of the 25 probands -13 were homozygotes and 9 were compound heterozygotes. Eleven novel mutations were detected. Only two common mutations were found: G3182A in 4 (16%) and C813A in 3 (12%) probands. 'Hot spots' for ATP7B mutations were exons 18 and 13. Lack of common dominant mutations prevented correlation of individual ATP7B mutations with WD phenotype. Symptomatic WD in a live sibling was not found in any family. In 8 families, a sibling died of presumed WD - in 6 of these, WD phenotype was identical to that in the proband. CONCLUSIONS We describe the spectrum of ATP7B mutations including 11 novel mutations in Indian WD patients and document lack of a single dominant mutation. Identical WD phenotype among siblings in only 6 of 8 families with >1 child affected by WD suggests that factors other than ATP7B mutations influence WD phenotype.
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Affiliation(s)
- S Santhosh
- Department of GI Sciences, Christian Medical College, Vellore, India
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