Evaluation of fecal myeloperoxidase as a biomarker of disease activity and severity in ulcerative colitis.

BACKGROUND: Subclinical inflammation in ulcerative colitis (UC) can predispose to relapses and biomarkers can detect mucosal inflammation. AIMS: To study the role of fecal myeloperoxidase (FMPO) in assessing disease activity and response to therapy in UC. METHODS: Patients with UC attending our hospital from July 2005 to September 2006 were studied. All patients underwent clinical, endoscopic, and histological assessment for disease extent and severity. Estimation of FMPO levels at baseline and on follow-up was carried out. Age-matched healthy controls were studied for FMPO levels. RESULTS: A total of 55 patients of UC (30 males, 25 females, mean age 38.6 ± 12 years) and 54 age-matched controls (mean age 37.6 ± 13.6 years) were studied. Cases had higher median MPO levels than controls (0.42 [IQR 0.84] vs. 0.06 [IQR 0.12]); (p < 0.001). Cases with endoscopically more severe disease (Gr III & IV; n = 18) had higher median FMPO levels compared to those with milder disease (Gr II, n = 37), [0.075 (IQR 1.315) vs. 0.315 (IQR 0.813); p = 0.02]. The median MPO level in 27 patients was 0.58 [IQR 0.89] units/ml at presentation which on follow-up decreased significantly to 0.18 [IQR 0.42] units/ml (p value 0.002). However, there was no significant association between FMPO and endoscopic extent and histological scores of activity and chronicity. CONCLUSIONS: Fecal MPO is an effective biomarker for assessing disease activity and response to therapy in patients with ulcerative colitis.

Pancreatic Rest - An Unusual Cause of Dyspepsia: A Case Report with Literature Review.

Ectopic pancreatic tissue, also known as a pancreatic rest, is an uncommon congenital anomaly defined as extrapancreatic tissue located far from the pancreas and without any connection via vascular or anatomical means. The pancreatic rests are usually asymptomatic, but a variety of clinical symptoms have been described in the literature. This report describes the clinical scenario of severe dyspeptic symptoms of eight weeks duration in a young female. She underwent upper gastroscopic examination, which revealed a nodular lesion in the antral portion of the stomach. After partial gastrectomy and proton pump inhibitors of 1-month duration her symptoms improved. The histological specimen revealed the presence of pancreatic rest and no evidence of malignancy was noted. The patient is symptom-free and has been followed up in our clinic for the last 18 months.

Combining corticosteroids and acyclovir in the management of varicella pneumonia: a prospective study.

BACKGROUND: Studies found in the literature which describe the treatment of varicella pneumonia with a combination of acyclovir and corticosteroids tend to be retrospective in nature and limited with regard to the data supplied. METHODS: This prospective study was performed at King Abdul Aziz Specialist Hospital in Taif, Saudi Arabia. The study covered adult patients admitted with a diagnosis of varicella pneumonia over a period of 10 years (January 2003 to December 2012). All patients were treated uniformly according to the predefined protocol with acyclovir and corticosteroids. The clinical characteristics, laboratory investigations, hospital course, any complications and the treatment outcomes were studied. RESULTS: A total of 32 patients (25 males, mean age 43.5 ±14.5 years) were enrolled into this study; 3 patients (2 patients aged <12 years, 1 patient with advanced cardiac failure) were excluded. Of these 32 patients, 18 (58%) were current smokers, 16 patients (50%) were admitted to the intensive care unit and of these, 14 (87.5%) required mechanical ventilation. The mean duration of intensive care unit stay was 5.59 ±5.37 days. All patients were treated with intravenous acyclovir, corticosteroids and antibiotics were added when indicated. 31 patients improved and were discharged home. There was one death (a 32 year-old female with underlying systemic lupus erythematosus). CONCLUSIONS: Patients with varicella pneumonia are at high risk of respiratory failure. Early implementation of supportive therapy seems to positively influence the recovery rate and outcome. Our study supports treatment using a combination of acyclovir and corticosteroids.

Hemorrhagic manifestation of megaloblastic anemia: report of two cases and literature review.

Megaloblastic anemia is not uncommon in developing countries. Its presentation as thrombocytopenia and hemorrhagic manifestation are, however, rare. We describe the clinical scenario in two young patients who presented to the emergency room of Sir Ganga Ram Hospital, a tertiary care center in New Delhi, India, with pancytopenia and bleeding diathesis. Both patients improved after B12 supplementation. Reports of two cases and a brief review is presented.

Sudden retinal vein thrombosis in a patient with nephrotic syndrome.

The authors report a sudden painless blindness in a 42-year-old male with membranous nephropathy of idiopathic origin. He was admitted with a history of decreased urine output and painful abdomen of a 3-day duration in the Department of Nephrology, Sheri Kashmir Institute of Medical Sciences, Srinagar, Kashmir - a tertiary care centre in the state of Jammu and Kashmir, India. On evaluation, he was found to have renal vein thrombosis. On day 3 of admission, he suddenly developed progressive painless blindness. Indirect ophthalmoscopic examination showed retinal vein thrombosis. Patient's clinical condition deteriorated due to his underlying condition and he succumbed to his illness. Renal vein thrombosis as a complication of nephrotic syndrome is well known. To the best of our knowledge, this is the first case of retinal vein thrombosis in the course of nephrotic syndrome.

Biomarkers in the management of ulcerative colitis: a brief review.

Several attempts have been made in the last two decades to investigate ulcerative colitis (UC) patients during the natural course of the disease so as to identify appropriate surrogate markers of disease activity. Most patients with quiescent inflammatory bowel disease have low grade inflammation and it is possible that relapse occurs only once the inflammatory process crosses a critical intensity. Since inflammation is a continuous process, its direct assessment may provide us a quantitative pre-symptomatic measure of imminent relapse. If substantial, it may allow targeted treatment early, to avert relapse or formulate newer therapeutic strategies to maintain symptomatic remission. It is clinically very important to identify these patients at a subclinical stage, noninvasively, by various biomarkers. Biomarkers help to gain an objective measurement of disease activity as symptoms are often subjective. Biomarkers also help to avoid invasive procedures which are often a burden to the patient and the health care system. If an ideal biomarker existed for UC, it would greatly facilitate the work of the gastroenterologist treating these patients. Both "classical" and "emerging" biomarkers of relevance for UC have been studied, but the quest for an ideal biomarker still continues. In this brief review we describe various biomarkers of clinical importance.

Laparoscopic exploration of the common bile duct and removal of dead worm in a patient of cholangitis after endoscopic retrograde cholangiopancreatography failure.

We describe a dead ascaris-induced extrahepatic bilary obstruction in a young female who presented with acute cholangitis. The dead ascaris was removed by laparoscopic exploration of common bile duct after endoscopic retrograde cholangiopancreatography failure. Patient had an uneventful hospital course after the procedure and was discharged afebrile after 3 days of hospital stay.