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1.
World J Gastrointest Endosc ; 6(11): 541-8, 2014 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-25400868

RESUMO

Colonoscopic surveillance is advocated in patients with inflammatory bowel disease (IBD) for detection of dysplasia. There are many issues regarding surveillance in IBD: the risk of colorectal cancer seems to be decreasing in the majority of recently published studies, necessitating revisions of surveillance strategy; surveillance guidelines are not based on concrete evidence; commencement and frequency of surveillance, cost-effectiveness and adherence to surveillance have been issues that are only partly answered. The traditional technique of random biopsy is neither evidence-based nor easy to practice. Therefore, highlighting abnormal areas with newer technology and biopsy from these areas are the way forward. Of the newer technology, digital mucosal enhancement, such as high-definition white light endoscopy and chromoendoscopy (with magnification) have been incorporated in guidelines. Dyeless chromoendoscopy (narrow band imaging) has not yet shown potential, whereas some forms of digital chromoendoscopy (i-Scan more than Fujinon intelligent color enhancement) have shown promise for colonoscopic surveillance in IBD. Other techniques such as autofluorescence imaging, endomicroscopy and endocytoscopy need further evidence. Surveillance with genetic markers (tissue, serum or stool) is at an early stage. This article discusses changing epidemiology of colorectal cancer development in IBD and critically evaluates issues regarding colonoscopic surveillance in IBD.

2.
Bioorg Med Chem Lett ; 21(21): 6523-6, 2011 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-21917452

RESUMO

A series of novel N-(3-aryl-1,2,4-triazol-5-yl) cinnamamide derivatives were designed on basis of structural similarity to the known FAS II inhibitors. Topliss operational method was used to optimize the potency of molecules. The minimum inhibitory concentration (MIC) of all synthesized compounds was determined against Mycobacterium tuberculosis H(37)R(v) using resazurin microtitre assay (REMA) plate method. The synthesized compounds exhibit antimycobacterial activity in the range of 5-95µM with a good safety profile.


Assuntos
Amidas/química , Antituberculosos/síntese química , Antituberculosos/farmacologia , Cinamatos/síntese química , Cinamatos/farmacologia , Mycobacterium tuberculosis/efeitos dos fármacos , Antituberculosos/química , Cinamatos/química , Avaliação Pré-Clínica de Medicamentos , Humanos , Testes de Sensibilidade Microbiana
3.
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
4.
J Gastroenterol Hepatol ; 22(8): 1232-5, 2007 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-17688663

RESUMO

BACKGROUND: The model for end-stage liver disease (MELD), which employs objective variables, statistical weighting and a continuous scale, has replaced the Child-Turcotte-Pugh (CTP) classification as the scoring system of choice in several liver transplant centers. However, the predictive ability of MELD has never been prospectively evaluated in India. The aim of this study was to examine the MELD score, the CTP score and the recently proposed modified CTP score in Indian patients with liver cirrhosis to determine their correlation and compare their prognostic significance for short-term survival. METHODS: A total of 76 patients with cirrhosis (mean age 46.97 years) were prospectively evaluated and followed up for 6 months. MELD score, CTP score and modified CTP score were calculated at baseline. The correlation between variables was evaluated by Pearson's correlation test. Receiver-operating characteristic (ROC) curves were used to determine the cutoff values for each score with the best sensitivity and specificity in discriminating between patients who survived and those who died. RESULTS: Alcoholic liver disease was the most common (50%) etiology of cirrhosis. MELD score and CTP score showed very good correlation (Pearson correlation r = 0.983). ROC curve showed area under curve (c-statistics) for MELD score, CTP score and modified CTP score as 0.764, 0.804 and 0.817, respectively. CONCLUSION: The MELD score was not found to be superior to CTP score and modified CTP score for short-term prognostication of patients with cirrhosis in this study.


Assuntos
Cirrose Hepática/mortalidade , Adolescente , Adulto , Idoso , Doença Crônica , Feminino , Humanos , Cirrose Hepática/etiologia , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Prognóstico , Curva ROC , Análise de Sobrevida
5.
Indian J Pediatr ; 74(3): 310-1, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17401278

RESUMO

Paraesophageal hernia in children is relatively rare entity. These children usually present with recurrent respiratory tract infection or vague GI symptoms. An 11 year female presented with episodic vomiting, heartburn and features of hypocalcemic tetany. Investigations revealed right paraesophageal hernia. Reduction of the contents and repair of the defect with fundoplication was done. Patient is asymptomatic on follow-up.


Assuntos
Refluxo Gastroesofágico/etiologia , Hérnia Hiatal/congênito , Hérnia Hiatal/complicações , Criança , Feminino , Humanos , Índice de Gravidade de Doença
6.
J Gastroenterol Hepatol ; 22(3): 395-9, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17295773

RESUMO

BACKGROUND: Cirrhotic cardiomyopathy has been reported to be a major cause of morbidity and mortality in liver transplant recipients. However, there is scant data from Asia. With liver transplantation programs gradually being established in the region, Asian hepatologists are bound to face this entity. METHODS: Thirty patients with alcoholic cirrhosis and 30 with cirrhosis of nonalcoholic etiology were enrolled, after excluding those with recent bleeding, gross ascites, severe anemia and other conditions which could alter cardiovascular status. Thirty healthy subjects without cardiovascular risk factors were enrolled as controls. Hepatic function status was assessed by biochemical tests and prothrombin time. Cardiac structural and functional assessment was performed non-invasively using transthoracic echocardiography. RESULTS: Deceleration time was significantly (P < 0.05) prolonged in both the cirrhotic groups (235.03 +/- 44.23 ms and 255.87 +/- 46.16 ms) compared to controls (185.83 +/- 25.04 ms), indicative of diastolic dysfunction in cirrhotic patients. Other parameters, viz. ejection fraction, E : A ratio, left ventricular relative wall thickness, interventricular septal thickness and left ventricular systolic as well as diastolic chamber dimensions did not show statistically significant difference between any of the groups. Cardiac structural and functional parameters were not correlated with the severity of liver dysfunction. There was no statistically significant difference between the alcoholic and nonalcoholic groups. CONCLUSIONS: Asian patients with cirrhosis do have evidence of diastolic dysfunction. Cardiac structural and functional parameters did not correlate with the severity of liver dysfunction. Cardiac dysfunction seemed to be the consequence of cirrhosis itself, rather than of alcohol.


Assuntos
Cardiopatias/etiologia , Cirrose Hepática/complicações , Adulto , Feminino , Humanos , Índia , Cirrose Hepática Alcoólica/complicações , Masculino
7.
Trop Gastroenterol ; 27(2): 84-6, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-17089618

RESUMO

BACKGROUND: Small-bowel diarrhea is reported to account for 10% of all cases of chronic diarrhea. Data on the etiology and clinical presentation of chronic small-bowel diarrhea in adult Indians is scarce. METHODS: 50 patients (mean age 32.8 years; 26 men) with chronic small bowel diarrhea were evaluated clinically, and investigated to determine etiology. The diagnosis of small-bowel diarrhea was based on history, stool volume and associated symptoms. RESULTS: Abdominal pain (n=22, 44%) and weight loss (n=37, 74%) were the most common symptoms, apart from diarrhea. Anemia (70%) and hypoalbuminemia (48%) were other important biochemical abnormalities. Intestinal tuberculosis (26%) and celiac disease (26%) were the most common causes of chronic small-bowel diarrhea. CONCLUSION: Tuberculosis of intestine and celiac disease are common causes of small-bowel diarrhea in our population. Tropical sprue seems to be a rare cause.


Assuntos
Diarreia/etiologia , Enteropatias/diagnóstico , Intestino Delgado , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Doença Crônica , Feminino , Humanos , Índia/epidemiologia , Enteropatias/complicações , Enteropatias/epidemiologia , Masculino , Pessoa de Meia-Idade
8.
Trop Gastroenterol ; 27(1): 44-5, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16910061

RESUMO

Intestinal amyloidosis presenting with small bowel diarrhoea with malabsorption is an infrequent clinical entity. The present case report includes such a case and discusses the diagnostic approach in such a case.


Assuntos
Amiloidose/complicações , Amiloidose/diagnóstico , Enteropatias/complicações , Enteropatias/diagnóstico , Síndromes de Malabsorção/etiologia , Adulto , Diarreia/etiologia , Feminino , Humanos
10.
Indian J Gastroenterol ; 23(3): 99-101, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15250567

RESUMO

BACKGROUND: Small bowel mucosa is a recognized potential source of bleeding in portal hypertension. However, the frequency of its involvement is not known. AIMS: To document the nature, severity and frequency of endoscopic and histologic changes in the jejunum in patients with portal hypertension. METHODS: Forty consecutive patients with portal hypertension and 43 patients with non-ulcer dyspepsia (controls) underwent push enteroscopy and jejunal, duodenal and gastric biopsies. Biopsies were randomized and examined by a blinded pathologist for inflammation and vascular dilatation, which was quantified by morphometry. RESULTS: Endoscopic jejunopathy was observed in 6 patients and none of the control subjects. All patients with jejunopathy had portal hypertensive gastropathy (PHG) and 5 had duodenopathy. Vascular dilatation was observed in 15 patients and 25 control subjects (p = ns). The degree of vascular dilatation was similar in both groups. Inflammatory changes were observed in 24 patients and 25 control subjects (p = 0.05). CONCLUSIONS: Endoscopic jejunopathy was present in 15% of patients with portal hypertension. These changes were mild in 83% of them. All patients with jejunopathy also had PHG. Histologic changes were similar in patients and control subjects.


Assuntos
Hipertensão Portal/complicações , Mucosa Intestinal/irrigação sanguínea , Doenças do Jejuno/etiologia , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Endoscopia do Sistema Digestório/métodos , Feminino , Humanos , Doenças do Jejuno/diagnóstico , Doenças do Jejuno/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Índice de Gravidade de Doença
11.
Indian J Gastroenterol ; 23(2): 74-5, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15176544

RESUMO

Cystic mesenteric tumors are rare abdominal neoplasms. We report a 55-year-old man with recurrent benign mesothelioma arising from the left colonic mesentery and extending into the scrotal sac. He recovered well after excision of the abdominal and scrotal mass.


Assuntos
Cisto Mesentérico/patologia , Mesotelioma/patologia , Neoplasias Peritoneais/patologia , Escroto/patologia , Diagnóstico Diferencial , Seguimentos , Humanos , Laparotomia/métodos , Masculino , Cisto Mesentérico/cirurgia , Mesotelioma/cirurgia , Pessoa de Meia-Idade , Neoplasias Peritoneais/cirurgia , Medição de Risco , Índice de Gravidade de Doença
12.
Trop Gastroenterol ; 25(3): 139-40, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15682662

RESUMO

So far, no association has been described between multifactiorial disorders such as insulin- dependent diabetes mellitus and extrahepatic portal vein obstruction (EHPVO), which is the most common cause of extra-hepatic portal hypertension in children. We describe 3 cases of EHPVO who developed type 1 diabetes mellitus.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Veia Porta/anormalidades , Adolescente , Criança , Constrição Patológica , Feminino , Humanos , Hipertensão Portal/complicações
13.
Trop Gastroenterol ; 25(4): 174-5, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15912978

RESUMO

We report the findings in a 54-year-old male with chronic hepatitis C with granulomas liver biopsy. Unfortunately, this patient died before treatment could be started.


Assuntos
Granuloma/virologia , Hepatite C Crônica/complicações , Hepatopatias/virologia , Humanos , Masculino , Pessoa de Meia-Idade
15.
J Assoc Physicians India ; 52: 626-8, 2004 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-15847356

RESUMO

BACKGROUND: Prokinetic drugs are widely used for treatment of non-ulcer dyspepsia (NUD). AIMS AND OBJECTIVES: To assess the efficacy and tolerability of a new prokinetic agent, itopride hydrochloride in patients of NUD and compare it with domperidone. METHODS: Fifty-six patients who fulfilled the inclusion and exclusion criteria were enrolled in the study. Patients underwent upper gastrointestinal endoscopy to rule out organic pathology as a cause for their symptoms. The patient's symptoms were graded on a 4-point scale (0 to 3) at the beginning of treatment and at the end of Week-one and Week-two Patients were randomly allocated to receive either one tablet of itopride hydrochloride 50mg three times daily or one tablet of domperidone 10mg three times daily for two weeks. Pre-treatment and post-treatment hemogram, liver function and renal function tests, prolactin level and ECG were done in all patients. The response to therapy was evaluated by assessing the relief of symptoms at the end of two weeks on a 5-point scale. Statistical analysis was done using two-tailed paired t-test; Wilcoxon matched pairs ranks sum test, Mann-Whitney-U test and chi-square test as applicable. RESULTS: Of the fifty-five patients enrolled in the study (age range of 18-60 yrs, median age of 35yrs), 26 were males and twenty nine were females. They had a median duration of symptoms for 4 weeks. Twenty-seven patients received itopride and 28 received domperidone. One patient did not follow up in the domperidone group, thus 54 patients were evaluable for analysis. Moderate to complete symptomatic relief was observed in 22 (81%) patients in the itopride group and 19 patients (70%) in the domperidone group (p > 0.05, NS). Both the drugs were well tolerated and neither caused prolongation of QT interval nor any abnormality in any serum biochemistry values. CONCLUSION: Therapy with itopride resulted in good symptomatic relief, was safe, well tolerated and comparable in efficacy to domperidone in relieving the symptoms of NUD. By virtue of its efficacy and tolerability, it could be an ideal choice for providing symptomatic relief to patients suffering from non-ulcer dyspepsia.


Assuntos
Benzamidas/administração & dosagem , Compostos de Benzil/administração & dosagem , Domperidona/administração & dosagem , Dispepsia/diagnóstico , Dispepsia/tratamento farmacológico , Administração Oral , Adolescente , Adulto , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Seguimentos , Gastroscopia/métodos , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Valores de Referência , Índice de Gravidade de Doença , Método Simples-Cego , Resultado do Tratamento
16.
Indian J Gastroenterol ; 22(5): 190-1, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-14658538

RESUMO

We report a 22-year-old woman who presented with an abdominal wall lump in the right upper quadrant 15 days after starting antitubercular treatment for right pleural effusion. CT scan revealed a right liver lobe subcapsular abscess communicating vith subcutaneous tissue. Aspiration of pus revealed acid-fast bacilli. She responded to 9 months of antitubercular treatment.


Assuntos
Abscesso Abdominal/etiologia , Tuberculose Hepática/complicações , Adulto , Feminino , Humanos , Tomografia Computadorizada por Raios X , Tuberculose Hepática/diagnóstico por imagem , Tuberculose Pleural/complicações
18.
Liver Transpl ; 9(7): 754-9, 2003 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-12827565

RESUMO

Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of sepsis in patients with cirrhosis and after liver transplantation. The association between nasal carriage of MRSA and sepsis in these patients is unclear. The goal of this study was to investigate the relationship between MRSA carriage before liver transplantation and subsequent sepsis after transplantation. This was a retrospective study of 374 consecutive adults who underwent orthotopic liver transplantation between 1998 and 2001 and for whom full data were available. Of these, 157 had been screened for MRSA as part of a study assessing the prevalence of MRSA infection. All MRSA carriers were treated with nasal mupirocin and chlorhexidine baths. The records of MRSA carriers and noncarriers were analyzed for Child and Model for End-Stage Liver Disease (MELD) score, posttransplantation MRSA, and other infections and mortality. Of the 157 patients who had an MRSA screen, 35 patients were MRSA nasal carriers. These carriers had significantly greater MELD score (mean, 16.2 compared with 13.1; P =.02) and Child scores (mean, 10 versus 9; P =.001) than noncarriers. The incidence of posttransplantation MRSA infection was significantly higher in MRSA carriers (31% versus 9%; P =.002). The incidence of other posttransplantation infection was not significantly different in the two groups. There was no significant difference in survival between the two groups (1-year patient survival, 74% and 82%, respectively). Patients carrying MRSA are predisposed to an increased risk of sepsis after liver transplantation with a trend to increased mortality. Screening for MRSA should be considered in high-risk patients being assessed for liver transplantation.


Assuntos
Transplante de Fígado/efeitos adversos , Resistência a Meticilina , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus , Adolescente , Adulto , Idoso , Portador Sadio , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cavidade Nasal/microbiologia , Complicações Pós-Operatórias , Estudos Retrospectivos , Risco , Staphylococcus aureus/efeitos dos fármacos , Resultado do Tratamento
19.
Indian J Gastroenterol ; 22(1): 29-30, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-12617454

RESUMO

A 2-year-old male child, who was operated on 18 months earlier for tuberculous meningitis with hydrocephalus by placement of a ventriculo-peritoneal shunt, presented with the lower end of the shunt tube coming out through the anus. Colonoscopy showed the shunt tube coming out through the colon 22 cm from the anal opening. The cranial end, along with a malfunctioning valve, were disconnected surgically, and the shunt was removed endoscopically using a pediatric flexible colonoscope.


Assuntos
Perfuração Intestinal/etiologia , Derivação Ventriculoperitoneal/efeitos adversos , Pré-Escolar , Endoscopia do Sistema Digestório , Humanos , Masculino
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