Renal vein thrombosis in pancreatitis: a rare vascular complication.

Extrasplanchnic venous thrombosis is a rare complication of chronic pancreatitis. Thrombosis of inferior vena cava and renal vein, in particular, is extremely rare. We present our recent experience of managing two patients of chronic pancreatitis who presented with renal vein thrombosis. We also highlight the treatment dilemmas facing a clinician managing patients with this atypical and rare vascular complication.

Sustainable utilization of chemically depolymerized polyethylene terephthalate (PET) waste to enhance sand-bentonite clay liners.

Polyethene terephthalate (PET) waste poses major environmental harm which can be minimized by reusing it in clay soil stabilization. In general, various polymers are known to reduce hydraulic conductivity and increase the shear strength of clays. However, the application of the effect of a chemically depolymerized form of PET, i.e., Bis (2-Hydroxyethyl) terephthalate (BHET) has not been performed as an additive in Compacted Clay Liners (CCLs) for landfills. This research focuses on the effect of the air curing period (1 and 28 days) on the hydromechanical behavior of BHET-treated SBM (0, 1, 2, 3, and 4 % by dry weight). Results from One Dimensional Consolidation tests showed that an increase in BHET content reduced both compressibility and hydraulic conductivity of SBM due to pore clogging mechanism of swollen BHET hydrogel, however, hydraulic conductivity reduced over 28 days of curing due to loss in re-swelling availability of the hydrogel, thereby allowing less tortuous paths to flow. Results from Consolidated-Drained Direct Shear tests showed that for 1 and 28-days curing, BHET treatment to SBM increased the cohesion (c') due to strong polymer interparticle bridging, however, polymer coating over the sand grains causes a reduction in its surface roughness to decrease the frictional angle (ϕ'). SEM (Scanning Electron Microscopy) and EDX (Energy-dispersive X-ray spectroscopy) analysis on BHET-treated specimens support the flocculation of bentonite, polymer bridging of sand and clay-sand polymer links. A significant Pb2+ removal capacity was also observed with BHET-treated SBM from the batch tests. FTIR (Fourier Transform Infrared Spectroscopy) analysis on batch sorption specimens confirms the role of the carbonyl groups (C = O) and hydroxyl groups (OH) present in the BHET structure indicating the possibility to adsorb Pb2+. The findings of the study suggested that a mechanism of interaction exists between sand-bentonite and BHET polymer and it can be adopted in CCLs design.

Efficacy And Safety Of Adalimumab Biosimilar (Exemptia) In Moderate-To-Severe Steroid-Refractory Ulcerative Colitis Patients: Real-Life Outcomes In Resource-Constrained Setting At 24-Weeks Follow-Up.

BACKGROUND: Adalimumab (ADA) is approved for the management of lcerative colitis (UC) not responding to conventional therapy. Use of biologics in resource-constrained settings is very challenging. Currently, real-life data on the safety and efficacy of ADA biosimilar (Exemptia) in steroid-refractory UC patients are limited. AIM AND OBJECTIVES: To assess the efficacy and safety of ADA biosimilar (Exemptia) to treat steroid-refractory difficult-to-treat UC patients in a resource-constrained Indian setting at 24-weeks follow-up. MATERIALS AND METHODS: This was a retrospective single-center study to evaluate the efficacy and safety of ADA biosimilar (Exemptia) in steroid-refractory UC patients. All the eligible patients who received induction dose of 160 mg at week 0, 80 mg at week 2 and 40 mg at week 4 and 40 mg every 4 weeks as maintenance regimen from 01 September 2017 to 31 Jan 2019 were retrospectively included in this single-center analysis. Those patients who had shown sub-optimal response at 12 weeks received 40 mg every 2 weeks as maintenance therapy. Outcomes in terms of clinical remission, clinical response and mucosal healing were evaluated in the short term at 12 weeks and 24 weeks. RESULTS: Twenty-five patients were retrospectively included between the time period of 1 September 2017 to 31 July 2018 with a mean age of 35 years. ADA biosimilar was effective in inducing clinical remission in 16% patients at 12 and 24 weeks, clinical response was seen in 48% at week 12 and 44% at week 24. The mean baseline total Mayo score (TMS) for all patients was 10.16 which decreased to a mean score of 5.72 at 12 weeks and 5.52 at 24 weeks with therapy with the decrease of the score being statistically significant both at 12 and 24 weeks (p<0.05). Two patients (8%) developed pulmonary tuberculosis (TB). ADA biosimilar frequency was accelerated to once in 2 weeks in 14 (56%) patients who did not show an optimal response at 12 weeks. Of these 14 patients, 5 were responders and 9 were non-responders at 12 weeks. At 24 weeks, 6 patients showed clinical response and 7 were non-responders, while one patient had developed TB. CONCLUSION: ADA biosimilar (Exemptia) therapy is a safe and cost-effective alternative to original biologics in difficult-to-treat UC patients in resource-constrained Indian setting with comparable efficacy. Maintenance therapy at four weekly intervals can be considered in those patients who have shown an early clinical response at 12 weeks to minimize costs, but more studies are needed to confirm the same.

Prevalence and etiological profile of chronic obstructive pulmonary disease in nonsmokers.

BACKGROUND: Tobacco smoking has been recognized as the most important risk factor for chronic obstructive pulmonary disease (COPD) for a long time, but recent studies have shown that nonsmokers also contribute to a significant proportion of COPD. This study was performed to find out the proportion of nonsmoker individuals among COPD patients and to determine various etiologies in nonsmoker COPD patients. MATERIALS AND METHODS: This study was an observational cross-sectional study conducted in Department of Pulmonary Medicine, MLN Medical College, Allahabad. A total of 200 COPD patients, aged >18 years of either gender with COPD, diagnosed by clinical and spirometric criteria (GOLD guideline) were included in the study. RESULTS: Of the 200 COPD patients, the proportion of nonsmoker patients was 56.5%, and the smoker was 43.5%. Among 113 nonsmoker COPD patients, maximum number of patients (69.03%) belonged to low socioeconomic status but most important and statistically significant risk factor was exposure to biomass smoke (53.98%), other significant risk factors were treated pulmonary tuberculosis (32.74%), and long-standing asthma (14.16%). Risk factors that were not statistically significant were occupational exposure (9.73%), exposure to outdoor air pollution (3.54%), and lower respiratory tract infection during childhood (1.77%). The patients who were exposed to more than one risk factors, developed COPD at an earlier age. CONCLUSIONS: This study revealed that nonsmokers contribute a significant proportion of COPD patients. Multiple risk factors other than smoking also play a major role in the development of COPD, particularly exposure to biomass smoke, treated pulmonary tuberculosis, and long-standing asthma.

Right-side pulmonary agenesis with atrial septal defect in adult.

Pulmonary agenesis, a rare congenital condition, is incompatible with life when present bilateral, while unilateral agenesis is usually detected in infancy or early childhood. Rare asymptomatic patients may reach adulthood undiagnosed, with signs mimicking common conditions presenting as radiopaque hemithorax with ipsilateral mediastinal shift. Here, we describe a case of a young lady, with history of consanguinity, who presented with complaints, suggestive of lower respiratory tract infection, and was investigated and diagnosed to be a case of right-side pulmonary agenesis with large ostium secondum atrial septal defect. Our present case emphasizes the importance of presence of pulmonary agenesis with cardiac congenital anomaly, remaining asymptomatic until adulthood, particularly in patients born of parents with consanguineous marriages.

Autophagy modulation as a potential therapeutic target for liver diseases.

Autophagy is a critical intracellular pathway which maintains cellular function by lysosomal degradation of damaged proteins and organelles besides elimination of invading pathogens. Its primary function is to prevent cell death. Autophagy has diverse physiological functions namely; starvation adaptation, prevention of tumorigenesis, energy homeostasis, intracellular quality control and degradation of abnormal intracellular protein aggregates. Understanding the molecular mechanisms of autophagy has given key insights into the pathogenesis of various diseases like Non Alcoholic Steato-Hepatitis, Hepatitis B and C infections, Alpha-1 antitrypsin deficiency and hepatocellular carcinoma. Pharmacological modulation of autophagy may have a therapeutic potential in management of these liver diseases.

Modulation of TLR 3, 7 and 8 expressions in HCV genotype 3 infected individuals: potential correlations of pathogenesis and spontaneous clearance.

BACKGROUND: Hepatitis C virus is the major cause of chronic hepatitis worldwide which finally leads to the development of hepatocellular carcinoma. Toll like receptors (TLRs) play an important role in the course of many viral infections, but the role of TLRs in HCV pathogenesis has not been well elucidated so far. OBJECTIVE: The aim of this study was to analyse the mRNA expression of TLRs 3, 7, and 8 in different stages of HCV infection including chronic, cirrhosis, interferon treated resolved, and relapsed cases. METHODOLOGY: Total RNA from whole blood was extracted and mRNA expression of TLRs 3, 7, and 8 genes was analyzed by quantitative real-time RT-PCR using ß-Actin gene as an internal control. RESULTS: This study consisted of 100 HCV infected individuals and twenty healthy controls. TLR 3 expression was found to be significantly elevated in individuals who had spontaneously cleared the virus (p < 0.001), whereas TLR 7 was found to be 3.26 times more elevated in patients with cirrhosis of liver. In IFN induced individuals, TLR 8 expression levels were found to be 2.28-fold elevated as compared to control population. CONCLUSION: TLRs 3, 7, and 8 are prime biomarker candidates for HCV infection mRNA expression analysis which might improve current therapeutic approaches.

Impact of host IL28B rs12979860, rs8099917 in interferon responsiveness and advanced liver disease in chronic genotype 3 hepatitis C patients.

BACKGROUND AND AIMS: Genetic polymorphisms near interleukin 28B gene are associated with spontaneous and treatment induced clearance of hepatitis C virus (HCV). Our objective was to evaluate the impact of interleukin 28B single nucleotide polymorphism (rs12979860, rs8099917) variability in HCV genotype 3 infected populations. METHODS: 400 hepatitis C seroreactive patients from different population groups in Eastern and North Eastern part of India were assessed for host and viral genotypic analysis. 83 HCV genotype 3 infected patients were administered pegylated interferon- ribavirin therapy. Viral genotyping was performed using nested reverse transcriptase-PCR followed by direct sequencing methods. Host interleukin 28B genotyping was performed using real-time PCR based single nucleotide polymorphism analysis. RESULTS: Out of 400 hepatitis C seroreactive individuals, 73.25% were found to be RNA positive. HCV genotype 3 (65.87%) was found to be the major circulating strain in this region followed by genotype 1 (32.08%). rs12979860 CC genotype was significantly associated with sustained virological response in HCV genotype 3 infected population. In patients achieving rapid virological response, favourable CC/TT allele at rs12979860, rs8099917 was found to be predominant at both the alleles at 77%, 73.2% respectively; whereas in case of patients with relapsed HCV infection CT, TG alleles were found to be predominant. Additionally, CC genotypes at rs12979860 were found to be associated with sustained virological response in patients with high viral load (OR = 6.75, 0.05

Role of ultrathin transnasal esophagogastroduodenoscopy: experience with 50 patients.

Conventional gastroscopes have a diameter of 8.8-12 mm; ultrathin endoscopes have an outer diameter of 5.3-5.9 mm. We share our experience with 50 patients who underwent transnasal esophagogastroduodenoscopy using an ultrathin endoscope. The indications included endoscopyassisted nasogastric tube placement in 25 patients, tight lesions not negotiable with conventional endoscope in 9, restricted mouth opening in 9, corrosive injury in 3, restricted cervical spine movement in 2 and altered sensorium following cerebrovascular accident in 2 patients. Transnasal esophageal intubation failed in 1 patient each with oropharyngeal malignancy and lipoma annularis coli. Wire-guided naso-jejunal tube placement was done in 2 patients and transnasal percutaneous endoscopic gastrostomy was done in 1 patient. Two patients developed self-limiting epistaxis. Ultrathin transnasal esophagogastroduodenoscope is a useful tool in endoscopy units, particularly those dealing with oncology patients. Inability to deliver endotherapy due to small diameter of the working channel is a limitation.