Effectiveness of Brassica juncea (mustard green) leaf decoction as an adjunct in the treatment of type 2 diabetes mellitus among Filipinos: a randomized clinical trial / The Health Sciences Journal

INTRODUCTION@#This study aimed to determine the effectiveness of mustard green leaf decoction as an adjunct to drug treatment in controlling blood glucose among Filipinos with type 2 diabetes mellitus.@*METHODS@#Participants were randomly assigned to receive mustard green decoction or a placebo solution for eight weeks on top of their oral anti-hyperglycemic medication. Fasting blood sugar and complete blood counts were determined at baseline, Week 4 and Week 8, and compared within and across the two groups.@*RESULTS@#There was a decreasing trend in the blood sugar level in the mustard green group while the opposite was noted in the placebo group. The mean FBS levels of the mustard green group were significantly lower than that of the placebo group at the Week 8 determination (6.10 vs 8.69 mmol/ L, p = 0.004). The decrease in blood sugar level on the eighth week in the mustard green group was significant compared with the baseline level (p = 0.008).@*CONCLUSION@#This study has demonstrated that the intake of Brassica juncea decoction can significantly decrease blood sugar levels among type 2 diabetics compared to metformin alone.

Effectiveness of Brassica juncea (mustard green) leaf decoction as an adjunct in the treatment of type 2 diabetes mellitus among Filipinos: a randomized clinical trial / The Health Sciences Journal

Introduction This study aimed to determine the effectiveness of mustard green leaf decoction as an adjunct to drug treatment in controlling blood glucose among Filipinos with type 2 diabetes mellitus.Methods Participants were randomly assigned to receive mustard decoction or a placebo solution for eight weeks on top of their oral anti-hyperglycemic medication. Fasting blood sugar and complete blood counts were determined at baseline, Week 4 and Week 8, and compared within and across the two groups. Results There was a decreasing trend in the blood sugar in the mustard green group while the opposite was noted in the placebo group. The mean FBS levels of the mustard green group were significantly lower than that of the placebo group at the Week 8 determination (6.10 vs 8.69 mmol/L, p=0.0004). The decrease in blood sugar level on the eight week in the mustard green group was significant compared with the baseline level (p=0.008).Conclusion This study had demonstrated that the intake of Brassica juncea decoction can significantly decrease blood sugar level among type 2 diabetics compared to metformin alone. 

Evaluation of the effect of presence of blood in the stomach on endoscopic diagnostic tests for Helicobacter pylori infection.

Introduction: Presence of blood in the stomach has been thought to affect the performance of diagnostic tests used in detecting Helicobacter pylori (H. pylori) in the stomach. This study evaluated the effect of blood on the efficacy of rapid urease test (RUT) and microscopic appearance of the biopsy after staining with Giemsa stain. Materials and Methods: Patients with bleeding oesophageal varices who met the inclusion criteria were tested for H. pylori by RUT and microscopic examination of the biopsy. A repeat endoscopy, RUT and histology were done one month following initial presentation. The performance of the diagnostic tests was evaluated with and without the presence of intraluminal blood. A combined result of the two tests, RUT and histology, carried out in presence or absence of blood for the diagnosis of H. pylori, when considered together was considered as the gold standard. Results: Thirty six patients included in the study were in the ages ranging between 15-60 years (mean age = 44.14 years ±2.1). The combination of tests at both visits showed 20/36 (55.6%) patients were positive for H. pylori. The decrease in H. pylori positivity in the presence of blood was significant for RUT (8.3% vs. 38.9%; P=0.005) and combined test (19.4% vs. 47.2%; P=0.02) but the decrease in positivity for histology (11.1% vs 30.6%) was not significant (P=0.08). In the presence of blood, the sensitivity of RUT, histology and combined tests were 15%, 20% and 35%, respectively. In the absence of blood, the sensitivity of RUT, histology and combination of tests was 70%, 55% and 85%, respectively. Conclusion: Blood in the stomach significantly decreased the sensitivity of RUT, histology and the combination of both. Negative results of these tests in acute upper gastro intestinal (GI) bleeding should therefore be interpreted carefully.

Serum pepsinogen I and II levels in various gastric disorders with special reference to their use as a screening test for carcinoma stomach.

INTRODUCTION: The role of serum pepsinogen in the diagnosis of gastric carcinoma is well established. Its role in other common upper alimentary disorders has not been widely studied. The aim of this study was to describe the effect of various gastric disorders on the levels of pepsinogen I, pepsinogen II and pepsinogen I/II ratio, with an emphasis on the diagnosis of carcinoma stomach in the South Indian population. METHODS: A total of 210 patients in seven groups, including one control group, were studied. The groups included patients with carcinoma stomach, Helicobacter pylori gastritis, peptic ulcer, portal hypertensive gastropathy, non-ulcer dyspepsia and erosive gastritis. Serum pepsinogen I, pepsinogen II and pepsinogen I/II ratio were estimated using an enzyme-linked immunosorbent assay technique. RESULTS: Patients with carcinoma of the stomach, when compared with controls, had a significantly lower pepsinogen I level (87.2 microg/L vs. 158.1 microg/L, p=0.0002) and pepsinogen I/II ratio (4.3 vs. 7.2, p = 0.0001). No significant change in pepsinogen levels occurred in the other groups. The cut-off levels of pepsinogen I (115.3 microg/L) and pepsinogen I/II ratio (6.2), determined by THE ROC curve, when applied in parallel provided a sensitivity of 97% and a negative predictive value of 91.4% for the diagnosis of carcinoma stomach. When the tests were applied in parallel, the likelihood ratio of a negative test was 0.06, indicating that individuals without carcinoma stomach were 16 times more likely to have a negative test than those with carcinoma. This fulfilled the essential prerequisites of an ideal screening test. CONCLUSION: Serum pepsinogen estimation is a useful diagnostic tool in the diagnosis of carcinoma stomach. The significance of serum pepsinogen level in portal hypertensive gastropathy, non-ulcer dyspepsia, peptic ulcer, Helicobacter pylori gastritis and erosive gastritis was not established.

Can duodenal ulcer perforation be linked to herpes simplex virus infection?

BACKGROUND: Both Herpes simplex infection and duodenal ulcer recur frequently, tend to remain localized, and show remissions and exacerbations. Published data on a link between the two are contradictory, and there are no data on the association of Herpes simplex infection with perforated duodenal ulcer. METHODS: 187 patients in four groups were studied: group I--controls (n = 35), group II--non-ulcer dyspepsia (n = 35), group III--chronic non-perforated duodenal ulcer (n = 35), and group IV--perforated duodenal ulcer (n = 82). Titers of IgG antibodies against HSV-1 and HSV-2 were determined using enzyme immunoassays. RESULTS: The seropositivity rate for both HSV-1 (80%) and HSV-2 (77%) was high in the control population. Among patients with perforated duodenal ulcer, antibodies against HSV-1 (94%) but not those against HSV-2 (83%), were found more frequently than in groups I and III. HSV-1 seropositivity was significantly higher in patients with a short duration of preperforation symptoms. Absolute titers for both anti-HSV-1 and anti-HSV-2 were higher in patients with perforated duodenal ulcer than in controls and those with chronic non-perforated duodenal ulcer. CONCLUSION: Herpes simplexvirus, especially HSV-1, may have a role in the causation of perforated duodenal ulcers.

Diagnostic peritoneal lavage (DPL)--is it useful decision making process for management of the equivocal acute abdomen?

Patients with a traumatic or non-traumatic acute abdominal conditions often have equivocal findings regarding the need for surgery. Ultrasound and computed tomography, though useful, have limitations and not always available in peripheral hospitals. Diagnostic peritoneal lavage (DPL) was investigated as an aid to decision-making in such patients. After preliminary X-ray and ultrasound, DPL was performed in 50 patients with an equivocal acute abdomen (18 trauma, 32 non-trauma). It was found that overall sensitivity, specificity, accuracy, and positive and negative predictive values were high for patients with trauma. All the above parameters except specificity and negative predictive value (NPV) were also found to be high for the non-trauma group. DPL was found to be a bedside investigation, which helped in taking the decision to operate on patients with both traumatic and non-traumatic acute abdomen.

Evaluation of sequential intermittent pneumatic compression for filarial lymphoedema.

BACKGROUND: Lymphoedema is a major cause of morbidity in patients with lymphatic filariasis. There is no effective medical treatment and the results of surgery are uncertain. There are very few published studies assessing the volumetric response to the use of sequential intermittent pneumatic compression (SIPC) in patients. METHODS: A 12-celled instrument capable of providing sequential compression from the distal to proximal direction was used in 28 patients with unilateral grades II (n=17) and III (n=11) filarial lymphoedema in a planned 4-week session. The patients were followed up for 6 months after compression therapy by water displacement volumetry. RESULTS: We found that 12 patients with grade II filarial lymphoedema had >26% reduction in oedema volume immediately after compression, but this reduction (>26%) was maintained in only 7 at 6 months. The corresponding figures for grade III filarial lymphoedema were 6 and 4, respectively. The effect in grade III was less sustained than grade II. No complications attributable to SIPC were seen. An added advantage of SIPC was a significant decrease in attacks of adenolymphangitis after compression when compared to pre-compression frequency. These observations were seen even with non-compliance to both foot care measures and use of bandages to maintain reduction in oedema volume. CONCLUSION: SIPC reduces morbidity in filarial lymphoedema though the effect is not sustained. It is simple, easy to use and could form part of the morbidity control programme for lymphatic filariasis.

Can fall in anti-H. pylori IgG titres indicate eradication?

At present, it is not clear whether a fall in serological titres of anti-H. pylori IgG can be used for confirming eradication. A prospective study was conducted using varying cut-off levels from (10% to 50%) fall in anti-H. pylor IgG levels as a test of eradication in comparison to urease and histology. It was found that sensitivity was highest using a 10% cut-off but specificity wasvery low. Increasing cut-off values increased specificity but resulted in declining sensitivity without altering accuracy much. It appears that in the short term, percentage decline in serological titres can at best serve as a crude test of eradication.

Indicators for surgery in adhesive bowel obstruction.

INTRODUCTION: There is lack of data on risk factors, which, if present, would indicate the need for surgery in patients with adhesive bowel obstruction. METHODS: A Cohort of 100 consecutive patients with adhesive obstruction was studied prospectively to compare clinical and investigative parameters between the operative and conservative group. RESULTS: It was found that female gender, previous obstetric or gynaecological procedures, pulse and BP on admission, nature of nasogastric aspirate, single distended loop on abdominal x-ray as also predominant ileal distension were independent factors indicating a high probability of surgical intervention. CONCLUSION: Patients with 2 or more risk factors had 12 times higher probability of surgery and in those with 3 or more the relative risk was 30 times. Patients with such risk factors should be monitored closely after admission and should be taken for surgery after an initial short trial of conservative measures.

Prospective randomized comparison of sodium tetradecyl sulphate & polidocanol for oesophageal variceal sclerotherapy.

BACKGROUND & OBJECTIVE: A number of sclerosing agents have been tried for sclerotherapy of oesophageal varices. However, none of them have emerged as an ideal agent. Hence, this study was designed to compare the efficacy and safety of sodium tetradecyl sulphate and polidocanol for sclerotherapy of oesophageal varices. METHODS: A total of 100 consecutive patients with bleeding oesophageal varices were included in the study. Patients with associated gastric varices and hypersplenism were excluded. Of the 100 patients, 50 received emergency sclerotherapy with either 3 per cent sodium tetradecyl sulphate or 3 per cent polidocanol, randomized using the sealed envelope technique. Following control of bleeding, these patients were included in the elective sclerotherapy schedule. The remaining 50 patients with past history of bleeding varices received elective sclerotherapy. Thus all 100 patients received elective sclerotherapy at 4 weekly intervals. RESULTS: There was no significant difference between the sodium tetradecyl sulphate and polidocanol groups with respect to the control of acute variceal bleeding (100% vs 96%), the mean number of injection sessions (4.5 +/- 0.3 vs 4.7 +/- 0.4) and the mean amount of scleroscent required (33.3 +/- 2.7 ml vs 37.0 +/- 3.3 ml) per patient for variceal eradication. The cost of polidocanol required for variceal obliteration was significantly higher than that of sodium tetradecyl sulphate (P < 0.001). The use of sodium tetradecyl sulphate in contrast to polidocanol was associated with a significantly higher incidence of variceal recurrence (11% vs 0%) and other complications such as oesophageal ulcer (14% vs 2%), retrosternal pain (22% vs 2%), fever (16% vs 4%), tachycardia (14% vs 2%) and dysphagia (20% vs 6%). Rebleeding rate and mortality rate were not significantly different between the two groups. INTERPRETATION & CONCLUSION: Polidocanol is superior to sodium tetradecyl sulphate as it has lower incidence of complications, even though the drugs are similar in efficacy in the control of bleeding and obliteration of varices in long-term.

Anti - H. pylori IgG seroprevalence rates in asymptomatic children and adults from South India.

This study was undertaken to determine the seroprevalence of H.pylori in asymptomatic children and compare it with that seen in the asymptomatic adult population from south India. One hundred and five children and one hundred adults admitted to the wards for conditions other than gastrointestinal disorders were included for this study. H.pylori status was determined by ELISA for IgG. The prevalence of H.pylori in children of various ages varied from 44% to 46% with an overall prevalence of H.pylori in children of 45%. 67% of adults were infected with H.pylori which was significantly higher than children (P = 0.002). The prevalence of H.pylori increased markedly with age with the maximum colonization (74%) occurring in young adults (16-30 years). The antibody levels too followed a similar pattern. In conclusion, it was seen that almost half the children in south India acquire H.pylori infection early in life which increases slowly and steadily with a peak prevalence in the young adults. Gender does not affect the prevalence in children and adults. As age advances further there is a slight decline in the prevalence of H.pylori infection. The immune response reflected by the levels of the antibody levels also follows the same pattern.

Redistribution of gastric Helicobacter pylori after surgery for duodenal ulcer.

OBJECTIVES: To study the distribution of H. pylori in the stomach before and after truncal vagotomy and drainage (TV + D) for chronic duodenal ulcer. METHODS: Twenty two consecutive patients studied prospectively. H. pylori positivity detected by urease test and histology (Giemsa stain). One or both tests positive indicated positive H. pylori status. Biopsies taken from antrum, body, fundus and stoma (postoperatively) to document H. pylori status before and 6 months after TV + D. RESULTS: Antral prevalence of H. pylori significantly decreased after surgery while fundal colonization significantly increased. No change was seen in body of stomach. CONCLUSION: There is significant redistribution of H. pylori after TV + D. This has important diagnostic implications in evaluation of postoperative symptoms.

Role of operative flexible choledochoscopy in calculous biliary tract disease.

BACKGROUND: In India, no study is available regarding the use of operative choledochoscopy in the management of choledocholithiasis. ERCP facilities are not always available at many centres and usually require the expertise of a medical gastroenterologist. In contrast, operative choledochoscopy is a simpler procedure that can easily be learned and practised by many surgeons at the time of CBD exploration. AIMS: To study the role of the flexible choledochoscopy in the diagnosis and management of calculous biliary tract disorders. METHODS: Twenty four patients with choledocholithiasis underwent flexible choledochoscopy. Stones were removed either with Desjardin's forceps or by choledochoscopic instrumentation. Postoperative T-tube cholangiography was done to detect any retained stones. RESULTS: Flexible choledochoscopy was performed in a total of 24 patients. Choledochoscopy was done through a choledochotomy in 23 and through the cystic duct in one patient. The choledochoscope was used following conventional CBD exploration in 18 of the 23 patients. Complete clearance of stones was confirmed by choledochoscopy in 12 of the 18 patients and additional stones were seen in the remaining 6 patients. Fogarty balloon catheter and Dormia forceps were used to extract these stones. A CBD stricture was seen in 4 of these 18 patients and choledochoscopic biopsy was done in one of them. In 5 of the 23 patients, the choedochoscope was used as the initial exploring instrument. Impacted CBD stones were detected in 3 of the 5 patients, external compression of the CBD due to periampullary carcinoma in one and stones in both the ampulla and common hepatic duct in the last patient. Postoperative T-tube cholangiography was done in 10 patients and did not reveal any retained stones. Drainage procedures were carried out in 13 patients: 11 had choledochoduodenostomy and 2 had transduodenal sphincteroplasty. Choledochoscopy was a direct aid in choosing the operative procedure in 21 patients. CONCLUSIONS: Flexible choledochoscopy is the most effective method of CBD exploration and is essential in all patients with choledocholithiasis. No additional morbidity or mortality is caused by this procedure.

Factors influencing response to lymphonodovenous shunt in filarial lymphoedema.

BACKGROUND: Although several studies have been published on lymphonodovenous shunt, there are no objective data either on the outcome of lymphoedema or on various parameters likely to influence the results. METHODS: A trial of lymphonodovenous shunt was carried out in 75 patients with unilateral filarial lymphoedema. The primary aim of the trial was to identify a cohort of responders as against non-responders and to correlate the outcome with various factors such as age, gender, duration and preoperative grade of lymphoedema, number of preoperative attacks of adenolymphangitis, operative impression of the lymph node, effect of venous reflex and type of nodovenous anastomoses. Change in oedema volume was measured objectively by water displacement method using the normal limb as a control. RESULTS: There was no operative mortality. Predominant postoperative complications included wound haematoma (8.5%), wound infection (13.6%) and transient lymphorrhoea (13.6%). In the immediate postoperative period, a reduction of 25%-50% in the oedema volume was recorded in 46.7% of cases and of more than 50% in 17.3% cases. The difference in response with respect to the type of lymphonodovenous shunt was not statistically significant, although the end-to-side type of shunt showed marginally better results. The response was significantly higher in patients with preoperative oedema volume more than 2 L. There was a significant reduction in postoperative attacks of adenolymphangitis, irrespective of the reduction in oedema volume. Of the 75 patients, 22 showed regression of oedema volume to preoperative or higher levels in the postoperative phase. A majority (21/22) could be identified as non-responders within 3 months of surgery. CONCLUSION: The best results of lymphonodovenous shunt were seen in patients with large-volume lymphoedema. The results are better when combined with early excisional surgery. Other factors did not significantly affect the outcome. Non-responders could be identified within 3 months after surgery. Even in patients who did not respond well, a significant decrease in the frequency of adenolymphangitis attacks was observed. Higher initial oedema volume and history of higher frequency (25-50 per year) of adenolymphangitis attacks can be considered as indicators for good response to lymphonodovenous shunt.

What happens to Helicobacter pylori after vagotomy and drainage?

H. pylori is currently identified as the dominant risk factor for chronic duodenal ulcer. The effect of surgery in the form of truncal vagotomy and drainage on the H. pylori status is not well known. Forty three patients with obstructed duodenal ulcer who were positive for H. pylori preoperatively by the urease test on the antral mucosal biopsy specimens were recalled for repeat endoscopy and urease test from the same site at 1 month, 3 months, 6 months and more than 1 year after surgery. The H. pylori positivity declined from 100% preoperatively to 69%, 71%, 73% and 80% at these intervals postoperatively respectively. The fall in H. pylori status after surgery was significant at all intervals. Since surgery for duodenal ulcer in the form of truncal vagotomy and drainage is curative for duodenal ulcer in over 90% of patients whereas H. pylori is suppressed in approximately 20% of patients only, it appears that its effect is independent of H. pylori status. Further studies are required to confirm whether a fall in H. pylori positivity in the antrum is absolute or is due to proximal migration of the organism.

Helicobacter pylori infection and erosive gastritis.

One hundred and eleven patients were included in the study. Thirty seven had erosive gastritis, thirty four chronic gastritis and forty were controls without any gastrointestinal diseases confirmed by symptoms and upper gastrointestinal endoscopy. Patients with erosive gastritis were divided into non-steroidal anti-inflammatory drug (NSAID) users and non-users. H pylori status was determined by urease test, serology and/or histology. The prevalence of H pylori was compared between the various groups. The prevalence of H pylori infection in erosive gastritis, chronic gastritis and controls was 68%, 76% and 65%, respectively, the difference was not significant (P > 0.05), 8 out of 11 patients with erosive gastritis and NSAID use (73%) were positive for H pylori. Likewise 17/26 patients with erosive gastritis without NSAID use (65%) were positive for H pylori (P > 0.05). Body of the stomach (65%) was the commonest site for erosions compared to antrum (43%) or fundus (27%) (P < 0.02). H pylori infection does not predispose to erosive gastritis. NSAID use does not affect H pylori prevalence. Routine H pylori eradication is, therefore, not indicated in patients with erosive gastritis infection. Body of the stomach is the most predominant site for erosions.

Helicobacter pylori infection in duodenal ulcer with gastric outlet obstruction.

One hundred and three patients were included in the study. Thirty seven had duodenal ulcer (DU) (Group I), 35 DU with gastric outlet obstruction (GOO) with presence of an active ulcer in the duodenum (Group II). Thirty one had DU with GOO but no active ulcer (Group III). Presence of H. pylori infection was determined by urease test, serology and/or histology. The prevalence of H. pylori in these groups was compared. Levels of Anti-H. pylori IgG antibody titres were also compared. The patients with duodenal ulcer (DU) were significantly younger (38 +/- 2 years) compared to those with established gastric outlet obstruction without ulcer (45 +/- 2 years) (P = 0.02). The prevalence of H. pylori infection in DU (95%), DU with GOO with ulcer (91%) and DU with GOO but no ulcer (90%) was not significantly different (p > 0.05). Anti-H. pylori IgG antibody titre levels were 72 +/- 6 EU/ml in Group III. The titre levels between Group I and Group III were significantly different (P < 0.05). The prevalence of H. pylori infection is high is patients with DU and is unaltered by gastric outlet obstruction. The presence or absence of an active ulcer with gastric outlet obstruction does not affect its association with H. pylori infection.

Prevalence of Helicobacter pylori infection in disorders of the upper gastrointestinal tract in south India.

BACKGROUND: Helicobacter pylori (H. pylori) is the most common human infection. Though most individuals are asymptomatic, H. pylori plays a key role in the aetiology of many upper gastrointestinal disorders. The prevalence of duodenal ulcer in south India is high but there are very few reports regarding the prevalence of H. pylori infection in various upper gastrointestinal disorders in south Indians. Therefore, we studied the prevalence of H. pylori infection in upper gastrointestinal disorders in south Indians. METHODS: Three hundred and thirty-five patients with various upper gastrointestinal disorders were included in the study. Seventy-five patients with no gastrointestinal disease based on symptoms and endoscopy were taken as controls. The H. pylori status was determined by the urease test, serology and histology and the prevalence compared between various upper gastrointestinal disorders, with controls and with one another. RESULTS: The prevalence of H. pylori was high in the patients and controls. Duodenal ulcer patients had a significantly higher prevalence compared to controls (p < 0.001) and those with other upper alimentary disorders. There was no significant difference between patients with other disorders and controls nor between each other (p > 0.05). CONCLUSION: The prevalence of H. pylori infection is high in south India. It is closely associated with duodenal ulcer. More population-based studies are required to evaluate the relationship of H. pylori with other disorders of the upper gastrointestinal tract.