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1.
J Gastroenterol Hepatol ; 37(6): 1004-1015, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35178742

RESUMO

BACKGROUND AND AIM: Inflammatory bowel disease (IBD) is emerging in the newly industrialized countries of South Asia, South-East Asia, and the Middle East, yet epidemiological data are scarce. METHODS: We performed a cross-sectional study of IBD demographics, disease phenotype, and treatment across 38 centers in 15 countries of South Asia, South-East Asia, and Middle East. Intergroup comparisons included gross national income (GNI) per capita. RESULTS: Among 10 400 patients, ulcerative colitis (UC) was twice as common as Crohn's disease (CD), with a male predominance (UC 6678, CD 3495, IBD unclassified 227, and 58% male). Peak age of onset was in the third decade, with a low proportion of elderly-onset IBD (5% age > 60). Familial IBD was rare (5%). The extent of UC was predominantly distal (proctitis/left sided 67%), with most being treated with mesalamine (94%), steroids (54%), or immunomodulators (31%). Ileocolic CD (43%) was the commonest, with low rates of perianal disease (8%) and only 6% smokers. Diagnostic delay for CD was common (median 12 months; interquartile range 5-30). Treatment of CD included mesalamine, steroids, and immunomodulators (61%, 51%, and 56%, respectively), but a fifth received empirical antitubercular therapy. Treatment with biologics was uncommon (4% UC and 13% CD), which increased in countries with higher GNI per capita. Surgery rates were 0.1 (UC) and 2 (CD) per 100 patients per year. CONCLUSIONS: The IBD-ENC cohort provides insight into IBD in South-East Asia and the Middle East, but is not yet population based. UC is twice as common as CD, familial disease is uncommon, and rates of surgery are low. Biologic use correlates with per capita GNI.


Assuntos
Colite Ulcerativa , Doença de Crohn , Doenças Inflamatórias Intestinais , Idoso , Sudeste Asiático , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/epidemiologia , Colite Ulcerativa/terapia , Doença de Crohn/diagnóstico , Doença de Crohn/tratamento farmacológico , Doença de Crohn/epidemiologia , Estudos Transversais , Diagnóstico Tardio , Ásia Oriental , Feminino , Humanos , Fatores Imunológicos , Incidência , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/terapia , Masculino , Mesalamina , Fenótipo
2.
Indian J Med Res ; 149(6): 748-754, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31496527

RESUMO

Background & objectives: Prokinetics are extensively prescribed leading to several adverse events (AEs). The aim of this study was to assess the prescription pattern in patients receiving prokinetics, and characteristics of adverse drug reactions (ADRs) in an outpatient department set up in a tertiary care hospital in western India. Methods: Patients attending outpatient departments of a tertiary care hospital and who had received prokinetic agent for at least seven days over the last one month were enrolled. Causality assessment of AEs was done and assessed for severity, preventability, seriousness and predictability. Results: A total of 304 patients [161 males (52.96%); 143 females (47.04%)] were enrolled. Most prescriptions (299/304, 98%) included domperidone, most commonly prescribed as fixed-dose combination (FDC) with pantoprazole (274/304, 90%). Prokinetic dose was not mentioned in 251/304 (83%) prescriptions, and 18/304 (6%) did not mention frequency. Of the 378 AEs reported from 179 patients (47.35%), 306 (81%) were mild, all non-serious; 272 (72%) not preventable and 291 (77%) predictable in nature. Decreased appetite (n=31, 8.2%) and fatigue (n=27,7.14%) were most commonly reported. Causality assessment by the World Health Organization-Uppsala Monitoring Centre scale showed that 180 AEs were related to suspected drug (17 probable and 163 possible ADRs). Significant correlation was observed for AEs with increasing number of drugs per prescription (Spearman's R=+0.8, P =0.05) and with increasing therapy duration (Spearman's R=+1.00, P <0.001). Interpretation & conclusions: Our findings showed that prokinetics were often prescribed as FDCs, with incomplete prescriptions. Domperidone was found to be associated with multiple AEs. It is suggested that regular prescription monitoring should be done in hospitals to encourage rational use of drugs.


Assuntos
Domperidona/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Pantoprazol/efeitos adversos , Prescrições , Adulto , Domperidona/uso terapêutico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/fisiopatologia , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Pantoprazol/uso terapêutico , Estudos Prospectivos , Centros de Atenção Terciária
3.
J Gastroenterol Hepatol ; 32(1): 237-243, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27218672

RESUMO

BACKGROUND AND AIM: Percutaneous radiologic interventions are increasingly being used in management of Budd-Chiari syndrome (BCS). Minimal invasive approach has resulted in excellent long-term outcomes. We evaluated the treatment efficacy and safety of radiological intervention in patients with BCS. METHODS: Between January 2008 and June 2014, 190 patients with BCS underwent endovascular procedures (hepatic vein, collateral vein or inferior vena cava [IVC] plasty with or without stenting, or transjugular intrahepatic portosystemic shunting [TIPSS]). Clinical features, biochemical profile, and stent patency were monitored pre-procedure and post-procedure, and for a median duration of 42 (12-88) months. RESULTS: Of 190 patients (mean [SD] age = 26.9 [11.5] years; 102 men), imaging revealed hepatic vein obstruction in 147 patients, IVC obstruction in 40 patients, and concomitant hepatic vein and IVC obstruction in three patients. At presentation, the radiological interventions included hepatic vein plasty/stenting in 38 patients, collateral vein stenting in three patients, IVC plasty/stenting in 40 patients, both IVC and hepatic vein stenting in three patients, and TIPSS in 106 patients. Response was seen in 153 patients (80.5%). Repeat interventions were required in 19 patients (10.0%). Complications were noted in nine patients (4.7%). CONCLUSION: Our study demonstrates that venous recanalization and TIPSS for BCS are safe and efficacious.


Assuntos
Síndrome de Budd-Chiari/cirurgia , Procedimentos Endovasculares/métodos , Adulto , Síndrome de Budd-Chiari/diagnóstico por imagem , Constrição Patológica , Feminino , Veias Hepáticas/diagnóstico por imagem , Veias Hepáticas/patologia , Humanos , Masculino , Derivação Portossistêmica Transjugular Intra-Hepática , Stents , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/patologia , Adulto Jovem
5.
Trop Gastroenterol ; 34(4): 252-8, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-25046888

RESUMO

BACKGROUND AND AIM: Patients with alcoholic hepatitis and alcoholic cirrhosis have significant morbidity and mortality. The model for end-stage liver disease (MELD) score is used to predict mortality in patients with liver disease. Our study aimed to validate the utility of MELD score versus Child Pugh Turcotte (CPT) and modified CPT (CPT+creatinine; CPTC) scores in predicting mortality among alcoholic liver disease (ALD) patients. METHODS: We examineda retrospective (n=110; mean age 44.5years; 109 men) and a prospective (n=96; mean age 45 years; 92 men) cohort of patients suffering from ALD, with varying disease severity, and compared the ability of MELD, CTP and CPTC scores to predict the 1-, 3- and 6-month mortality using concordance (c-) statistics. RESULTS: The median MELD, CPT and CPTC scores were 21, 10 and 11 in the retrospective group and 21, 10 and 10 in prospective groups, respectively. The 1-month, 3-month and 6-month mortality was 41 (37.3%), 59 (53.6%) and 81 (73.6%) in the retrospective group and 27 (28.1%), 41 (42.7%) and 65 (67.7%) in the prospective group. The predictive ability of MELD, CPT and CPTC was 0.72, 0.67, 0.68 for 1-month mortality, 0.73, 0.70, 0.68 for 3-month mortality and 0.83, 0.75, 0.73 for 6-month mortality in retrospective group and 0.86, 0.56, 0.63 for 1-month mortality, 0.80, 0.57, and 0.60 for 3-month mortality, and 0.88, 0.51, and 0.64 for 6-month mortality in the prospective cohort, respectively. The predictive accuracy of MELD was significantly better than CPT and CPTC scores in the prospective group. CONCLUSIONS: MELD is a valid prognostic score compared to CPT and CPTC scores for predicting short-term mortality in patients of alcoholic liver disease.


Assuntos
Doença Hepática Terminal/mortalidade , Hepatite Alcoólica/complicações , Índice de Gravidade de Doença , Adulto , Idoso , Doença Hepática Terminal/etiologia , Feminino , Humanos , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos
6.
J Clin Gastroenterol ; 46(5): 356-66, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22499071

RESUMO

Irritable bowel syndrome (IBS) is common in western Europe and North America, and many aspects of its epidemiology, risk factors, and natural history have been described in these regions. Recent data suggest, however, that IBS is also common in the rest of the world and there has been some evidence to suggest some differences in demographics and presenting features between IBS in the west and as it is experienced elsewhere. The World Gastroenterology Organization, therefore, established a Task Force comprising experts on the topic from all parts of the world to examine IBS from a global perspective. IBS does, indeed, seem to be common worldwide though with some significant variations in prevalence rates between regions and countries and there may well be some potentially interesting variations in presenting symptoms and sex distribution. The global map of IBS is far from complete; community-based prevalence data is not available from many areas. Furthermore, while some general trends are evident in terms of IBS impact and demographics, international comparisons are hampered by differences in diagnostic criteria, study location and methodology; several important unanswered questions have been identified that should form the basis for future collaborative research and have the potential to shed light on this challenging disorder.


Assuntos
Saúde Global , Síndrome do Intestino Irritável , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Síndrome do Intestino Irritável/diagnóstico , Síndrome do Intestino Irritável/epidemiologia , Síndrome do Intestino Irritável/patologia , Síndrome do Intestino Irritável/psicologia , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
7.
Trop Gastroenterol ; 33(4): 257-64, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23923351

RESUMO

BACKGROUND AND AIMS: Malnutrition is commonly associated with chronic liver disease. The presence of protein-calorie malnutrition has been shown to be associated with increased short- and long-term mortality in patients with acute and chronic liver disease. We undertook this study to assess the prognostic value of nutritional status in predicting survival in cirrhotic patients. The aim of our study was to determine whether assessment of nutritional status using the RFH-SGA score adds significantly to CP (Child-Pugh) and MELD scores in predicting patient prognosis and survival in cirrhotic patients. METHODS: Diagnosed cases of cirrhosis were enrolled and their nutritional assessment was done using the RFH-SGA score. All patients were followed up for a period of 6 months. The mortality rates in the various groups were compared with respect to their nutritional status. Multivariate analysis was used to determine the factors associated with mortality. RESULTS: A total of 73 cirrhotic patients were taken up for this study. Of these, 23 patients (31.5%) were well nourished, 21 (28.8%) had mild to moderate malnourishment and 29 (39.7%) were severely malnourished. Multivariate analyses of various parameters identified poor nutritional status, increased CP grade, increased creatinine, lower sodium levels and longer prothrombin time as being independently associated with poorer survival. CONCLUSIONS: RFH-SGA is a simple and inexpensive tool for assessing the nutritional status in cirrhotic patients and can reliably predict their disease prognosis and survival.


Assuntos
Cirrose Hepática/diagnóstico , Estado Nutricional , Medição de Risco/métodos , Adolescente , Adulto , Criança , Feminino , Seguimentos , Humanos , Incidência , Índia/epidemiologia , Cirrose Hepática/complicações , Cirrose Hepática/mortalidade , Masculino , Desnutrição/epidemiologia , Desnutrição/etiologia , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Adulto Jovem
8.
J Clin Exp Hepatol ; 12(3): 861-870, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35677520

RESUMO

Background: There is lack of data on long-term outcomes of patients with Budd-Chairi Syndrome (BCS) treated with medical therapy including anticoagulation alone. Methods: Consecutive patients (N = 138, mean [standard deviation, SD] age 29.3 [12.9] years; 66 men) with BCS, treated with medical therapy alone including anticoagulation, with minimum follow-up of 12 months were included. Initial response was classified as complete (CR), partial (PR) or nonresponse (NR) and on follow-up as loss of response (LoR) or maintenance of response (MoR). The association of baseline, clinical and biochemical parameters with different responses was evaluated. Results: Seventy-six patients (55.1%) had CR, 26 (18.8%) had PR and 36 (26.1%) had NR. None with PR or NR had CR later. At a median follow-up of 40 (range 12-174) months, LoR was more common in PR group than in CR group (12 [46.2%] vs 18 [23.7%], P = 0.03). LoR was associated with presence of ascites (odds ratio [OR] 1.5; 95% confidence interval [CI] 0.06-0.71), gastrointestinal bleed (OR 1.33; 95% CI 0.09-0.82) or jaundice (OR 1.01; 95% CI 0.11-0.97) at baseline and duration of follow-up (OR 0.018; 95% CI 1.006-1.030). Mortality was higher in NR (28 [77.8%]) compared with CR (15 [19.7%], P = 0.001) and PR (8 [30.8%], P = 0.001). On binary logistic regression analysis, presence of ascites at baseline was associated with LoR (OR 0.303 [0.098-0.931]). Conclusion: Patients with initial CR have better survival than nonresponders. One-third had LoR on follow-up. The presence of ascites at baseline is associated with LoR.

10.
J Gastroenterol Hepatol ; 26(7): 1151-6, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21375585

RESUMO

BACKGROUND AND AIMS: Barrett's esophagus (BE) is reported to be infrequent in Asians, with no data from India regarding its prevalence and risk factors. We investigated the frequency and risk factors of columnar mucosa with or without specialized intestinal metaplasia (SIM) in Indian patients with gastroesophageal reflux disease (GERD). METHODS: A total of 278 GERD patients over 2 years underwent gastroscopy and completed a questionnaire for possible BE risk factors. Patients with columnar mucosa on endoscopy underwent four-quadrant biopsy; BE was histologically defined as columnar mucosa with or without SIM. Patients without columnar mucosa at endoscopy were considered as controls and compared to patients with BE and those with SIM. RESULTS: Forty-six patients with GERD had columnar mucosa on histology (16.54%); 25 (8.99%) of these had SIM. The risk factors for BE were the presence of hiatus hernia (odds ratio [OR]: 3.14; 95% confidence interval [CI]: 1.2-8.17) and a history of eructation (OR: 2.28; CI: 1.11-4.66). The risk factors for SIM were age ≥ 45 years (OR: 2.63; CI: 1.03-6.71), hiatus hernia (OR: 3.95; CI: 1.24-12.56), and a history of eructation (OR: 3.41; CI: 1.19-9.78). Sex, severity of symptoms, dietary factors, tobacco or alcohol use, and body mass index were not associated with BE. The median circumferential segment length was 2 (1-10) cm, and the maximal length was 3 (2-11) cm in both groups. CONCLUSION: BE is not an uncommon finding among Indian GERD patients. Age ≥ 45 years, history of eructation, and the presence of hiatus hernia are associated with SIM.


Assuntos
Esôfago de Barrett/epidemiologia , Refluxo Gastroesofágico/complicações , Adulto , Esôfago de Barrett/diagnóstico , Esôfago de Barrett/etiologia , Biópsia , Endoscopia Gastrointestinal , Feminino , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/epidemiologia , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Prognóstico , Estudos Prospectivos , Fatores de Risco
12.
Trop Gastroenterol ; 30(1): 19-25, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19624083

RESUMO

The exact cause of irritable bowel syndrome (IBS) is not known. Multiple factors, like genetic, gut motility, visceral hypersensitivity, psychosocial factors and immune-mediated factors, are thought to contribute to the symptom complex of IBS. Till date an 'IBS gene' has not been defined, and there is a need for further studies. The concept that IBS as a diagnosis of exclusion is not acceptable any more. The treatment of IBS is targeted at the management of constipation, diarrhoea and abdominal pain and includes pharmacotherapy with tegaserod, alosetron and lubiprostone. Cognitive behavioral therapy is very beneficial.


Assuntos
Síndrome do Intestino Irritável/etiologia , Síndrome do Intestino Irritável/terapia , Alprostadil/análogos & derivados , Alprostadil/uso terapêutico , Animais , Antidepressivos/uso terapêutico , Carbolinas/uso terapêutico , Fibras na Dieta/uso terapêutico , Fármacos Gastrointestinais/uso terapêutico , Motilidade Gastrointestinal , Humanos , Hiperalgesia/complicações , Indóis/uso terapêutico , Síndrome do Intestino Irritável/genética , Síndrome do Intestino Irritável/psicologia , Loperamida/uso terapêutico , Lubiprostona , Parassimpatolíticos/uso terapêutico , Linhagem , Psicoterapia , Agonistas do Receptor de Serotonina/uso terapêutico , Resultado do Tratamento
13.
JGH Open ; 3(3): 224-227, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31276040

RESUMO

BACKGROUND AND AIM: Interpreting stool form diaries for subtyping patients with the irritable bowel syndrome (IBS) is cumbersome; a picture showing a trend would be easier to interpret. METHODS: Fifty-one consecutive adults with IBS (median age 35.5 years; 47 men), diagnosed using the Rome III criteria, were given a picture of the Bristol stool form scale (BSFS) and asked to record their stool frequency and form for 7 days. The numbers were plotted by a technician as dots on a chart. On the y axis, BSFS category 4 was marked as 0, harder stools as +1 to +3, and softer stools as -1 to -3; each bowel movement was represented on the x axis. A line graph was plotted by connecting the dots. Each "fecograph" was then given for visual interpretation to three gastroenterologists (observers). When most readings appeared to be 0, +1, or -1, it was to be reported as normal; most above +1 as IBS-constipation (IBS-C); most below -1 as IBS-diarrhea (IBS-D); and readings crossing 1 on either side as IBS-mixed (IBS-M). If no clear trend was noted, it was IBS-unclassified (IBS-U). Each observer reported all graphs in different orders twice, at 1-month intervals; thus, 306 reports were available. Interclass correlation coefficient (ICC) was calculated. RESULTS: Eighteen patients had IBS-C, 13 IBS-D, 4 IBS-M, and 16 IBS-U. The 51 fecographs were reported in mean 20 min 36 s. ICC for intra- and interobserver reliability was 0.62 (0.50-0.73). CONCLUSION: The fecograph is a reliable and easy-to-use tool to subtype patients with IBS.

14.
Indian J Gastroenterol ; 38(5): 411-440, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31802441

RESUMO

The Indian Society of Gastroenterology developed this evidence-based practice guideline for management of gastroesophageal reflux disease (GERD) in adults. A modified Delphi process was used to develop this consensus containing 58 statements, which were generated by electronic voting iteration as well as face-to-face meeting and review of the supporting literature primarily from India. These statements include 10 on epidemiology, 8 on clinical presentation, 10 on investigations, 23 on treatment (including medical, endoscopic, and surgical modalities), and 7 on complications of GERD. When the proportion of those who voted either to accept completely or with minor reservation was 80% or higher, the statement was regarded as accepted. The prevalence of GERD in India ranges from 7.6% to 30%, being < 10% in most population studies, and higher in cohort studies. The dietary factors associated with GERD include use of spices and non-vegetarian food. Helicobacter pylori is thought to have a negative relation with GERD; H. pylori negative patients have higher grade of symptoms of GERD and esophagitis. Less than 10% of GERD patients in India have erosive esophagitis. In patients with occasional or mild symptoms, antacids and histamine H2 receptor blockers (H2RAs) may be used, and proton pump inhibitors (PPI) should be used in patients with frequent or severe symptoms. Prokinetics have limited proven role in management of GERD.


Assuntos
Gastroenterologia/normas , Refluxo Gastroesofágico/epidemiologia , Refluxo Gastroesofágico/terapia , Guias de Prática Clínica como Assunto , Adulto , Antiácidos/uso terapêutico , Consenso , Dieta/efeitos adversos , Esofagite/epidemiologia , Esofagite/etiologia , Feminino , Refluxo Gastroesofágico/etiologia , Infecções por Helicobacter/complicações , Helicobacter pylori , Antagonistas dos Receptores H2 da Histamina/uso terapêutico , Humanos , Índia/epidemiologia , Masculino , Prevalência , Inibidores da Bomba de Prótons/uso terapêutico , Sociedades Médicas
15.
Indian J Gastroenterol ; 27(1): 22-8, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18541934

RESUMO

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 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.


Assuntos
Síndrome do Intestino Irritável/epidemiologia , Adulto , Feminino , Gastroenterologia , Humanos , Índia/epidemiologia , Síndrome do Intestino Irritável/fisiopatologia , Masculino , Estudos Prospectivos , Sociedades Médicas
17.
Indian Heart J ; 70 Suppl 3: S13-S19, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30595245

RESUMO

OBJECTIVE: Genetic polymorphisms of CYP2C9 and VKORC1 play major role in pharmacokinetics and pharmacodynamics of warfarin, respectively. Purpose of our study was to assess the utility of pretesting patients for the above mutations in predicting tendency for bleeding and achieving target INR. METHODS: This was an audit of data collected between July 2011 and December 2016. For safety and efficacy, patients were divided into two subgroups: those with or without bleeding and those who achieved target INR or not. Chi square test was applied to compare the between group differences and crude Odds Ratio (cOR) calculated. RESULTS: Among 521 patients evaluated, most common indication for warfarin therapy was valvular heart disease (210/521 = 40%); 36% (187/521) had at least one bleeding episode; 56% (269/479) had below target INR. 26% (136/521) had polymorphic alleles of CYP2C9 and 69% (358/521) had the GG haplotype of VKORC1. Polymorphic alleles of CYP2C9 or AG/AA haplotype had twice the odds of bleeding (cOR = 2.14 and 2.44 respectively) relative to those with wild CYP2C9 allele or GG haplotype. Combined CYP2C9 mutant alleles and/or AG/AA haplotypes had thrice the odds of bleeding (cOR = 3.12) relative to those with wild CYP2C9 alleles and GG haplotype. Those with GG haplotype had twice the odds (cOR = 1.81) and those with GG haplotype along with wild CYP2C9 allele had four times the odds (cOR = 4.27) of not achieving the target INR relative to those with other haplotype/alleles. All these associations were statistically significant (p < 0.05). CONCLUSIONS: Pretesting patients for genetic polymorphisms could aid in individualizing warfarin therapy.


Assuntos
Auditoria Clínica/métodos , Citocromo P-450 CYP2C9/genética , DNA/genética , Polimorfismo Genético , Tromboembolia Venosa/tratamento farmacológico , Vitamina K Epóxido Redutases/genética , Varfarina/farmacocinética , Idoso , Alelos , Anticoagulantes/farmacocinética , Estudos Transversais , Citocromo P-450 CYP2C9/metabolismo , Feminino , Seguimentos , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Tromboembolia Venosa/genética , Tromboembolia Venosa/metabolismo , Vitamina K Epóxido Redutases/metabolismo
18.
Indian J Gastroenterol ; 37(6): 526-544, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30617919

RESUMO

The Indian Motility and Functional Diseases Association and the Indian Society of Gastroenterology developed this evidence-based practice guideline for management of chronic constipation. A modified Delphi process was used to develop this consensus containing 29 statements, which were generated by electronic voting iteration as well as face to face meeting and review of the supporting literature primarily from India. These statements include 9 on epidemiology, clinical presentation, and diagnostic criteria; 8 on pathophysiology; and the remaining 12 on investigations and treatment. When the proportion of those who voted either to accept completely or with minor reservation was 80% or higher, the statement was regarded as accepted. The members of the consensus team believe that this would be useful for teaching, clinical practice, and research on chronic constipation in India and in other countries with similar spectrum of the disorders.


Assuntos
Consenso , Constipação Intestinal , Gastroenterologia/organização & administração , Guias de Prática Clínica como Assunto , Sociedades Médicas/organização & administração , Doença Crônica , Constipação Intestinal/diagnóstico , Constipação Intestinal/epidemiologia , Constipação Intestinal/etiologia , Constipação Intestinal/terapia , Medicina Baseada em Evidências , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade
19.
Indian J Gastroenterol ; 26 Suppl 1: S4-6, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17785882

RESUMO

OBJECTIVE: To determine the impact factor (IF) of the Indian Journal of Gastroenterology (IJG) for the years 2005 and 2006. METHODS: For each of the two years, the number of citations received during that year in the journals included in the Science Citation Index (SCI), obtained by searching the online SCI database, divided by items published in the IJG in the previous two calendar years was determined. Self-citations in the IJG of the items published during the preceding two calendar years were determined by manual search. IF was calculated from these data. RESULTS: The IF of IJG for the year 2005 was 0.384 and that for the year 2006 was 0.667. The latter may be an underestimate because some citations during the year 2006 may not yet have appeared in the database. These values were higher than the previously reported IF of IJG of 0.192 in 1990. CONCLUSION: The IF of IJG has shown significant improvement over time.


Assuntos
Gastroenterologia , Publicações Periódicas como Assunto/normas , Bibliometria , Índia
20.
Indian J Gastroenterol ; 26(1): 6-10, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17401226

RESUMO

INTRODUCTION: Acute liver failure due to acute hepatitis E carries a high mortality. METHODS: Clinical and laboratory parameters of 42 pregnant women (median age 25.5 years) with acute liver failure due to acute hepatitis E were retrospectively analyzed. RESULTS: 22 women delivered, whereas pregnancy continued in 20 women. The maternal mortality in these two groups was similar (9/22 [41%] versus 14/20 [70%], p=0.056). However, in patients with grade I, II or III hepatic encephalopathy, delivery of fetus was associated with reduced mortality in those who delivered as against those who continued pregnancy (5/16 (31%) vs. 13/20 (65%), p=0.046). On multivariate analysis, higher grade of encephalopathy at admission was associated with risk of death (p=0.005). CONCLUSION: Mortality in pregnant women with acute liver failure with acute hepatitis E is high, especially in patients who present with higher grades of encephalopathy.


Assuntos
Hepatite E/virologia , Falência Hepática Aguda/virologia , Complicações Infecciosas na Gravidez/virologia , Resultado da Gravidez , Adolescente , Distribuição de Qui-Quadrado , Feminino , Hepatite E/mortalidade , Humanos , Índia/epidemiologia , Falência Hepática Aguda/mortalidade , Mortalidade Materna , Análise Multivariada , Gravidez , Complicações Infecciosas na Gravidez/mortalidade , Estudos Retrospectivos , Fatores de Risco
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