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1.
Abdom Radiol (NY) ; 2021 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-34958408

RESUMO

PURPOSE: Assessment of disease activity in Crohn's helps predict important clinical outcomes. Among the various modalities available to assess disease activity, magnetic resonance enterography (MRE) is considered a safe and reliable imaging option. Various MRE-based scoring systems have been developed to measure disease activity, one of which being the MRE global score (MEGS). We aimed to correlate MEGS with some of the important indices of Crohn's disease activity. METHODOLOGY: Crohn's disease patients referred for MRE were included in the study. Along with demographic profile and relevant investigations, MRE parameters related to MEGS were also assessed. RESULT: A total of 47 patients were recruited for the study. Their median age was 34 years (range 18-68 years), and male:female ratio was 16:31. There was modest positive correlation between MEGS and faecal calprotectin (r = 0.3, p = 0.04), CRP level (r = 0.34, p = 0.02) and Harvey Bradshaw index (r = 0.3, p = 0.043), respectively. However, there was strong correlation between segmental MEGS and Simple Endoscopic Score in those with terminal ileal disease (r = 0.81, p < 0.001). Mural thickness was the only MRE parameter that correlated with active disease (OR - 1.35, 95% CI 1.01, 1.81, p = 0.041) on multivariate analysis. There was moderate inter-observer agreement (Lin's r = 0.78, p < 0.001). CONCLUSION: MEGS showed modest correlation with indices of Crohn's disease activity which corroborates the complementary role of MRE in management of such patients.

2.
Indian J Pathol Microbiol ; 64(Supplement): S8-S31, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34135135

RESUMO

The Indian Association of Pathologists and Microbiologists (IAPM) and Indian Society of Gastroenterology (ISG) decided to make a joint consensus recommendation for handling, processing, and interpretation of SI biopsies for the diagnosis and management of celiac disease (CD) recognizing the inhomogeneous practice of biopsy sampling, orientation, processing, and interpretation. A modified Delphi process was used to develop this consensus document containing a total of 42 statements and recommendations, which were generated by sharing the document draft, incorporating expert's opinion, followed by three cycles of electronic voting as well as a full-day face-to-face virtual ZOOM meeting and review of supporting literature. Of the 42 statements, 7 statements are on small intestinal (SI) biopsy in suspected patients of CD, site and the number of biopsies; 7 on handling, fixative, orientation, processing, and sectioning in pathology laboratories; 2 on histological orientation; 13 statements on histological interpretation and histological grading; 3 on the assessment of follow-up biopsies; 2 statements on gluten-free diet (GFD)-nonresponsive CD; 4 on challenges in the diagnosis of CD; 2 statements each on pathology reporting protocol and training and infrastructure in this area. The goal of this guideline document is to formulate a uniform protocol agreed upon both by the experienced pathologists and gastroenterologists to standardize the practice, improve the yield of small bowel biopsy interpretation, patients' compliance, overall management in CD, and generate unified data for patient care and research in the related field.


Assuntos
Doença Celíaca/diagnóstico , Consenso , Intestino Delgado/patologia , Patologistas/educação , Patologistas/organização & administração , Patologia Clínica/educação , Biópsia , Feminino , Gastroenterologia/educação , Gastroenterologia/métodos , Gastroenterologia/organização & administração , Humanos , Índia , Masculino , Patologia Clínica/métodos
3.
J Pediatr Hematol Oncol ; 43(3): e429-e430, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32433446

RESUMO

We report a probable case of abetalipoproteinemia in an infant who presented with unusual symptoms of late-onset vitamin K deficiency. Abetalipoproteinemia is a rare autosomal recessive disease caused by mutation of the microsomal triglyceride transfer protein gene, resulting in the absence of microsomal triglyceride transfer protein function in the small bowel. It is characterized by the absence of plasma apolipoprotein B-containing lipoproteins, fat malabsorption, hypocholesterolemia, retinitis pigmentosa, progressive neuropathy, myopathy, and acanthocytosis. A biopsy of the small intestine characteristically shows marked lipid accumulation in the villi of enterocytes. Large supplements of fat-soluble vitamins A, D, E, and K have been shown to limit neurologic and ocular manifestations. Dietary fat intake is limited to medium-chain triglycerides.


Assuntos
Abetalipoproteinemia/complicações , Deficiência de Vitamina K/complicações , Abetalipoproteinemia/sangue , Abetalipoproteinemia/diagnóstico , Abetalipoproteinemia/patologia , Duodeno/patologia , Enterócitos/patologia , Feminino , Humanos , Lactente , Recém-Nascido , Deficiência de Vitamina K/sangue , Deficiência de Vitamina K/diagnóstico , Deficiência de Vitamina K/patologia
4.
Indian J Cancer ; 56(4): 309-314, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31607698

RESUMO

CONTEXT: The incidence of colorectal cancers (CRCs) in young Indian patients is higher than the international average. CRCs in young patients are commonly of mucinous type and show microsatellite instability (MSI). AIMS: To ascertain the MSI status of mucinous CRCs in patients ≤40 years of age by molecular testing and to correlate this with immunohistochemical (IHC) analysis and tumor histology. SUBJECTS AND METHODS: Archived formalin-fixed paraffin embedded tissue blocks of 30 young mucinous CRC patients were retrieved. MSI testing was done using two mononucleotide markers - BAT26 and NR24. IHC analysis was done using MLH1, MSH2, and MSH6. Histological features of all cases were studied. Data were analyzed using the SPSS software and the Pearson's chi-square test and Fisher's exact test. RESULTS: Eight out of 30 cases (26.7%) showed MSI by molecular testing. IHC identified seven of these cases. Histological features showing a statistically significant association with MSI were the presence of a well-differentiated adenocarcinoma component (P = 0.003), peritumoral lymphocytes (P = 0.002) and tumor budding (P = 0.021). CONCLUSION: The detection of defective mismatch repair (MMR) proteins using IHC for MLH1, MSH2, and MSH6 and molecular testing using BAT26 and NR24 appears to be a good protocol to detect CRCs with MSI. Histology could be useful in identifying cases that require screening for presence of MMR protein defects.


Assuntos
Adenocarcinoma Mucinoso/genética , Biomarcadores Tumorais/genética , Neoplasias Colorretais/genética , Marcadores Genéticos/genética , Repetições de Microssatélites/genética , Adenocarcinoma Mucinoso/diagnóstico , Adenocarcinoma Mucinoso/patologia , Adulto , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/patologia , Reparo de Erro de Pareamento de DNA , Proteínas de Ligação a DNA/metabolismo , Feminino , Humanos , Imuno-Histoquímica , Masculino , Instabilidade de Microssatélites , Proteína 1 Homóloga a MutL/metabolismo , Proteína 2 Homóloga a MutS/metabolismo , Patologia Molecular , Adulto Jovem
5.
Indian J Med Ethics ; 4(3): 251, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31213420

RESUMO

We have read with interest and concern the article titled "Consultations on human infection studies in India: Do people's voices really count" by Sandhya Srinivasan and Veena Johari. The article expresses the opinions of 2 persons who have not visited CMC, nor have spoken to anyone concerned, to ascertain the authenticity of the information published or with regard to the purported research in CMC.


Assuntos
Encaminhamento e Consulta , Pesquisa , Humanos , Índia
6.
Indian J Pathol Microbiol ; 61(4): 610-613, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30303165

RESUMO

Highly active anti retroviral therapy (HAART) has dramatically improved life expectancy of human immunodeficiency virus (HIV) infected patients, converting HIV infection into a chronic illness with associated changes in its attendant renal complications. The past two decades have witnessed a decrease in the prevalence of HIV associated nephropathy (HIVAN), traditionally considered to be the hall mark of renal involvement in HIV infection. Simultaneously a host of other glomerular and tubulo-interstitial diseases have emerged, expanding the spectrum of HIV associated renal diseases, predominant among which is HIV associated immune complex mediated kidney diseases (HIVICK). Of the diverse glomerular diseases constituting HIVICK, fibrillary glomerulonephritis (FGN) remains a rarity, with only two existing reports to date, confined to patients co-infected with Hepatitis C virus (HCV). The pathogenetic role of HIV in these patients remains under a cloud because of previously well established association of HCV infection and FGN. We report a case of FGN in a HIV seropositive, HCV negative Indian patient, highlighting the diagnostic electron microscopy (EM) findings of FGN and strengthening the causal association of HIV with FGN. In view of increasing heterogeneity of renal complications in HIV infection, the diagnostic utility of a comprehensive renal biopsy evaluation inclusive of EM is emphasized for appropriate selection of treatment modalities.


Assuntos
Nefropatia Associada a AIDS/patologia , Glomerulonefrite/patologia , Nefropatia Associada a AIDS/diagnóstico , Biópsia , Glomerulonefrite/diagnóstico , Humanos , Rim/ultraestrutura , Masculino , Microscopia Eletrônica , Pessoa de Meia-Idade
7.
BMC Med Educ ; 18(1): 134, 2018 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-29884155

RESUMO

BACKGROUND: Self-directed learning (SDL) is defined as learning on one's own initiative, with the learner having primary responsibility for planning, implementing, and evaluating the effort. Medical education institutions promote SDL, since physicians need to be self-directed learners to maintain lifelong learning in the ever-changing world of medicine and to obtain essential knowledge for professional growth. The purpose of the study was to measure the self-directed learning readiness of medical students across the training years, to determine the perceptions of students and faculty on factors that promote and deter SDL and to identify the role of culture and curriculum on SDL at the Christian Medical College, Vellore, India. METHODS: Guglielmino's SDL Readiness Scale (SDLRS) was administered in 2015 to six student cohorts (452 students) at admission, end of 1st, 2nd, 3rd and 4th year of training, and at the beginning of internship in the undergraduate medicine (MBBS) program. Analysis of variance (ANOVA) was used to compare SDL scores between years of training. 5 student focus groups and 7 interviews with instructors captured perceptions of self-direction. Transcripts were coded and analyzed thematically. RESULTS: The overall mean SDLRS score was 212.91. There was no significant effect of gender and age on SDLR scores. There was a significant drop in SDLRS scores on comparing students at admission with students at subsequent years of training. Qualitative analysis showed the prominent role of culture and curriculum on SDL readiness. CONCLUSIONS: Given the importance of SDL in medicine, the current curriculum may require an increase in learning activities that promote SDL. Strategies to change the learning environment that facilitates SDL have to be considered.


Assuntos
Características Culturais , Educação de Graduação em Medicina/métodos , Docentes de Medicina/psicologia , Autoaprendizagem como Assunto , Estudantes de Medicina/psicologia , Adolescente , Análise de Variância , Estudos Transversais , Currículo , Avaliação Educacional/normas , Feminino , Grupos Focais , Humanos , Índia , Masculino , Pesquisa Qualitativa , Faculdades de Medicina , Adulto Jovem
8.
Nephrology (Carlton) ; 23(11): 1013-1022, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28846194

RESUMO

AIM: We report findings from a large single centre paediatric renal biopsy cohort in South Asia. METHODS: We analyzed all renal biopsies performed on children aged ≤18 years between 1996 and 2015 at our centre. The clinical characteristics and histological diagnosis pertaining to each case, distribution of renal diseases in children with various clinical presentations, and changes in the pattern of kidney disease during the study period were analyzed. RESULTS: A total of 1740 paediatric kidney biopsies were performed during the study period. The mean age was 12.8 ± 4.9 years (8 months to 18 years) and the male: female ratio was 1.5:1. The most common indication for renal biopsy was nephrotic syndrome (63.2%) followed by acute nephritic syndrome (13%). Minimal change disease was the most common cause of nephrotic syndrome while endocapillary proliferative glomerulonephritis (65.7% infection related), remained the commonest cause of acute nephritic syndrome. IgA nephropathy was the commonest cause of chronic kidney disease. Contrary to trends in European paediatric cohorts, the frequency of lupus nephritis increased over the two decades of the study, while that of endocapillary proliferative glomerulonephritis did not show any appreciable decline. CONCLUSION: This study provides the largest data on biopsy proven renal disease in children from South Asia published till date and highlights important differences in the spectrum and trends of kidney disease compared to data from other regions.


Assuntos
Biópsia , Nefropatias/patologia , Rim/patologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Sistema de Registros , Estudos Retrospectivos , Centros de Atenção Terciária
9.
Cardiovasc Toxicol ; 17(2): 175-184, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-27131982

RESUMO

Thioacetamide (TAA) administration is widely used for induction of liver cirrhosis in rats, where reactive oxygen radicals (ROS) and nitric oxide (NO) participate in development of liver damage. Cardiac dysfunction is an important complication of liver cirrhosis, but the role of ROS or NO in cardiac abnormalities during liver cirrhosis is not well understood. This was investigated in animals after TAA-induced liver cirrhosis and temporal changes in oxidative stress, NO and mitochondrial function in the heart evaluated. TAA induced elevation in cardiac levels of nitrate before development of frank liver cirrhosis, without gross histological alterations. This was accompanied by an early induction of P38 MAP kinase, which is influenced by ROS and plays an important signaling role for induction of iNOS. Increased nitrotyrosine, protein oxidation and lipid peroxidation in the heart and cardiac mitochondria, suggestive of oxidative stress, also preceded frank liver cirrhosis. However, compromised cardiac mitochondrial function with a decrease in respiratory control ratio and increased mitochondrial swelling was seen later, when cirrhosis was evident. In conclusion, TAA induces elevations in ROS and NO in the heart in parallel to early liver damage. This leads to later development of functional deficits in cardiac mitochondria after development of liver cirrhosis.


Assuntos
Doença Hepática Induzida por Substâncias e Drogas/metabolismo , Cardiopatias/metabolismo , Cirrose Hepática/metabolismo , Mitocôndrias Cardíacas/metabolismo , Miócitos Cardíacos/metabolismo , Óxido Nítrico/metabolismo , Espécies Reativas de Oxigênio/metabolismo , Tioacetamida , Animais , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Doença Hepática Induzida por Substâncias e Drogas/patologia , Feminino , Cardiopatias/induzido quimicamente , Cardiopatias/patologia , Peroxidação de Lipídeos , Fígado/metabolismo , Cirrose Hepática/induzido quimicamente , Cirrose Hepática/patologia , Masculino , Mitocôndrias Cardíacas/patologia , Dilatação Mitocondrial , Miócitos Cardíacos/patologia , Nitratos/metabolismo , Estresse Oxidativo , Ratos Wistar , Transdução de Sinais , Fatores de Tempo , Tirosina/análogos & derivados , Tirosina/metabolismo , Proteínas Quinases p38 Ativadas por Mitógeno/metabolismo
10.
J Clin Diagn Res ; 10(2): ED16-8, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27042477

RESUMO

Adenocarcinoma is the most common histological type of gastric tumour, accounting for approximately 95% of all gastric carcinomas. Gastrointestinal stromal tumours (GISTs) are rare mesenchymal neoplasms of the digestive tract. Synchronous adenocarcinoma and gastrointestinal stromal tumour (GIST) occurring in the stomach is rare and very few cases have been reported in literature. Synchronous tumours in the stomach are rarely diagnosed preoperatively. A 63-year-old gentleman was diagnosed with a gastric adenocarcinoma on endoscopic biopsy and underwent surgery. Postoperative histopathologic examination revealed 2 synchronous tumours with both adenocarcinoma and GIST. The adenocarcinoma was determined to be the aggressive tumour based on histologic features. GIST was categorized as a very low risk of malignancy, based on its size and mitosis. The patient underwent chemotherapy for adenocarcinoma. He is under follow up and is currently disease free. Careful histopathologic evaluation is required to detect co-existing rare synchronous tumours. Presence of the second tumour may require additional procedures or protocols.

11.
Br J Radiol ; 89(1060): 20150328, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26828967

RESUMO

OBJECTIVE: To identify the MRI parameters which best predict complete response (CR) to neoadjuvant chemoradiotherapy (CRT) in patients with locally advanced rectal cancer (LARC) and to assess their diagnostic performance. METHODS: This was a prospective study of pre- and post-CRT MRI and diffusion-weighted imaging (DWI) of 64 patients with LARC who underwent neoadjuvant CRT and subsequent surgery. Histopathological tumour regression grade was the reference standard. Multivariate regression analysis was performed to identify the best MRI predictors of CR to neoadjuvant CRT, and their diagnostic performance was assessed. RESULTS: The study cohort comprised 48 males and 16 females (n = 64), with mean age of 49.48 ± 14.3 years, range of 23-74 years. 11 patients had pathological complete response. The following factors predicted CR on univariate analysis: low initial (pre-CRT) tumour volume on T2 weighted high-resolution (HR) images and DWI, tumour volume-reduction rate (TVRR) of >95% on DWI and CR on post-CRT DWI (ydwiT0) as assessed by the radiologist. However, the best MRI predictors of CR on multivariate regression analysis were CR on post-CRT DWI (ydwiT0) as assessed by the radiologist and TVRR of >95% on DWI, and these parameters had an area under the curve (95% confidence interval) of 0.881 (0.74-1.0) and 0.843 (0.7-0.98), respectively. The sensitivity, specificity, positive-predictive value, negative-predictive value and accuracy of DWI in predicting CR was 81.8%, 94.3%, 75%, 96.1% and 76%; the sensitivity, specificity and accuracy of TVRR of >95% as a predictor of CR was 80%, 84.1% and 64.1%, respectively; however, this difference was not statistically significant. The interobserver agreement was substantial for ydwiT0. CONCLUSION: Visual assessment of CR on post-CRT DWI and TVRR of >95% on DWI were the best predictors of CR after neoadjuvant CRT in patients with LARC, and the former being more practical can be used in daily practice. ADVANCES IN KNOWLEDGE: In rectal cancer, ydwiT0 as assessed by the radiologist was the best and most practical imaging predictor of CR and scores over standard T2W HR images.


Assuntos
Adenocarcinoma/terapia , Quimiorradioterapia Adjuvante/métodos , Neoplasias Retais/terapia , Adenocarcinoma/patologia , Adulto , Idoso , Tomografia Computadorizada de Feixe Cônico/métodos , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Neoplasias Retais/patologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Resultado do Tratamento , Adulto Jovem
12.
Clin Teach ; 13(6): 405-410, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26777995

RESUMO

BACKGROUND: The Christian Medical College, Vellore, in collaboration with Tufts University, Boston, conducted an advanced workshop in e-learning for medical faculty members in India. CONTEXT: E-learning can enhance educational reforms for today's computer-literate generation, and keep faculty members up to speed in a rapidly changing world. The purpose of this paper is to report on the design and evaluation of a project-based faculty member development programme focused on developing faculty members as educators and as peer trainers who can use e-learning for educational reforms. INNOVATION: During a 2-day workshop, 29 participants in groups of two or three developed 13 e-learning projects for implementation in their institutions. Evaluation of the workshop was through written feedback from the participants at the end of the workshop and by telephone interview with one participant from each project group at the end of one year. Content analysis of qualitative data was perfomed. The participants reported that they were motivated to implement e-learning projects and recognised the need for and usefulness of e-learning. The majority of projects (10 out of 13) that were implemented 'to some extent' or 'to a great extent' faced challenges with a lack of resources and administrative support, but faculty members were able to overcome them. E-learning can enhance educational reforms for today's computer-literate generation IMPLICATIONS: Designing feasible e-learning projects in small groups and obtaining hands-on experience with e-learning tools enhance the effectiveness of subsequent implementation. To successfully incorporate e-learning when designing educational reforms, faculty member training, continuing support and infrastructure facilities are essential.


Assuntos
Instrução por Computador , Docentes de Medicina , Desenvolvimento de Pessoal/métodos , Instrução por Computador/métodos , Educação , Humanos , Ensino
13.
Am J Gastroenterol ; 111(1): 115-23, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26729543

RESUMO

OBJECTIVES: Although celiac disease (CeD) affects 1% of people in the northern part of India, it is believed to be uncommon in the southern and northeastern parts because of significant differences in dietary pattern and ethnicity. We estimated the prevalence of CeD in these three populations. In a subset, we also investigated differences in the prevalence of HLA-DQ 2/8 allelotype and dietary grain consumption. METHODS: A total of 23,331 healthy adults were sampled from three regions of India-northern (n=6207), northeastern (n=8149), and southern (n=8973)-and screened for CeD using IgA anti-tissue transglutaminase antibody. Positive tests were reconfirmed using a second ELISA. CeD was diagnosed if the second test was positive and these participants were further investigated. A subsample of participants was tested for HLA-DQ2/-DQ8 and underwent detailed dietary evaluation. RESULTS: Age-adjusted prevalence of celiac autoantibodies was 1.23% in northern, 0.87% in northeastern, and 0.10% in southern India (P<0.0001). Prevalence of CeD and latent CeD, respectively, was 8.53/1,000 and 3.70/1,000 in northern, 4.66/1,000 and 3.92/1,000 in northeastern, and 0.11/1,000 and 1.22/1,000 in the southern part. The population prevalence of genes determining HLA-DQ2 and/or -DQ8 expression was 38.1% in northern, 31.4% in northeastern, and 36.4% in southern India. Mean daily wheat intake was highest in northern (455 g) compared with northeastern (37 g) or southern part (25 g), whereas daily rice intake showed an inverse pattern. CONCLUSIONS: CeD and latent CeD were most prevalent in northern India and were the least in southern India. The prevalence correlated with wheat intake and did not reflect differences in the genetic background.


Assuntos
Doença Celíaca/epidemiologia , Adolescente , Adulto , Dieta , Grão Comestível , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
14.
Ann Med Surg (Lond) ; 4(4): 388-94, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26594357

RESUMO

BACKGROUND: Abdominal wall defects and hernias are commonly repaired with synthetic or biological materials. Adhesions and recurrences are a common problem. A study was conducted to compare Chitosan coated polypropylene mesh and a polypropylene-polydioxanone composite with oxidized cellulose coating mesh (Proceed™) in repair of abdominal wall defect in a Rabbit hernia model. METHODS: A randomized controlled experimental study was done on twelve New Zealand white rabbits. A ventral abdominal defect was created in each of the rabbits. The rabbits were divided into two groups. In one group the defect was repaired with Chitosan coated polypropylene mesh and Proceed mesh™ in the other. The rabbits were operated in two phases. They were followed up at four weeks and twelve weeks respectively after which the rabbits were sacrificed. They were evaluated by open exploration and histopathological examination. Their efficacy in reducing adhesion and ability of remodeling and tissue integration were studied. RESULTS: There was no statistical significance in the area of adhesion, the force required to remove the adhesions, tissue integration and remodeling between Chitosan and Proceed™ group. Histological analysis revealed that the inflammatory response, fibrosis, material degradation and remodeling were similar in both the groups. There were no hernias, wound infection or dehiscence in any of the studied animals. CONCLUSION: Chitosan coated polypropylene mesh was found to have similar efficacy to Proceed™ mesh. Chitosan coated polypropylene mesh, can act as an anti adhesive barrier when used in the repair of incisional hernias and abdominal wall defects.

15.
Indian J Pathol Microbiol ; 58(4): 427-32, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26549061

RESUMO

BACKGROUND: Intestinal amebiasis is one of the important differential diagnoses of Inflammatory Bowel Disorders in areas where it is highly prevalent. AIM: Studies comparing the clinical, endoscopic and histological features of these disorders have never been done, so we undertook this study. MATERIALS AND METHODS: A retrospective study comparing mucosal biopsies of 14 consecutive cases of intestinal amebiasis with 14 cases of Ulcerative colitis and 12 cases of Crohn's disease. A total of 65 biopsies from patients with amebiasis, 56 biopsies from patients with Crohn's disease and 65 biopsies of patients with Ulcerative colitis were reviewed. RESULTS AND CONCLUSIONS: Discrete small ulcers less than 2 cm in diameter in the cecum or rectosigmoid, with intervening normal mucosa, were the most common finding on endoscopy in patients with amebiasis. On histology, necrotic material admixed with mucin, proteinaceous exudate and blood clot lining ulcers, significant surface epithelial changes such as shortening and tufting adjacent to sites of ulceration, mild chronic inflammation extending into the deep mucosa and mild architectural alteration were features of amebiasis. Trophozoite forms of ameba were seen in the necrotic material lining sites of ulceration or lying separately, as well as over intact mucosa. Necrotic material lining ulcers was less common in IBD, but chronic inflammation, crypt abscess formation and architectural alteration were more severe.


Assuntos
Biópsia , Colonoscopia , Disenteria Amebiana/diagnóstico , Disenteria Amebiana/patologia , Histocitoquímica/métodos , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/patologia , Diagnóstico Diferencial , Humanos , Mucosa Intestinal/patologia , Estudos Retrospectivos
16.
Indian J Gastroenterol ; 34(1): 3-22, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25772856

RESUMO

In 2012, the Indian Society of Gastroenterology's Task Force on Inflammatory Bowel Diseases undertook an exercise to produce consensus statements on Crohn's disease (CD). This consensus, produced through a modified Delphi process, reflects our current recommendations for the diagnosis and management of CD in India. The consensus statements are intended to serve as a reference point for teaching, clinical practice, and research in India.


Assuntos
Doença de Crohn , Gastroenterologia/organização & administração , Sociedades Médicas/organização & administração , Administração Oftálmica , Adulto , Anti-Inflamatórios não Esteroides/administração & dosagem , Anticorpos Monoclonais/administração & dosagem , Azatioprina/administração & dosagem , Doença de Crohn/diagnóstico , Doença de Crohn/terapia , Glucocorticoides/administração & dosagem , Humanos , Imunossupressores/administração & dosagem , Índia , Infliximab/administração & dosagem , Quimioterapia de Manutenção , Mesalamina/administração & dosagem , Indução de Remissão
17.
Indian J Gastroenterol ; 33(6): 517-23, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25231910

RESUMO

BACKGROUND: There is limited data on celiac disease in patients with cryptogenic cirrhosis or idiopathic noncirrhotic intrahepatic portal hypertension (NCIPH). Our objective was to evaluate for celiac disease in patients with portal hypertension in India. METHODS: Consecutive patients with portal hypertension having cryptogenic chronic liver disease (cases) and hepatitis B- or C-related cirrhosis (controls) were prospectively enrolled. We studied tissue transglutaminase (tTG) antibody and duodenal histology in study patients. RESULT: Sixty-one cases (including 14 NCIPH patients) and 59 controls were enrolled. Celiac disease was noted in six cases (including two NCIPH patients) as compared to none in controls. In a significant proportion of the remaining study subjects, duodenal biopsy showed villous atrophy, crypt hyperplasia, and lamina propria inflammation, not accompanied by raised intraepithelial lymphocytes (IELs); this was seen more commonly in cases as compared to controls. An unexpectedly high rate of tTG antibody positivity was seen in study subjects (66 %) of cases as compared to 29 % in controls (p-value < 0.001), which could indicate false-positive test result. CONCLUSION: In this study, 10 % of patients with unexplained portal hypertension (cryptogenic chronic liver disease) had associated celiac disease. In addition, an unexplained enteropathy was seen in a significant proportion of study patients, more so in patients with cryptogenic chronic liver disease. This finding warrants further investigation.


Assuntos
Doença Celíaca/complicações , Hepatite Crônica/complicações , Hipertensão Portal/complicações , Cirrose Hepática/complicações , Adolescente , Adulto , Idoso , Anticorpos/sangue , Estudos de Casos e Controles , Criança , Duodeno/patologia , Feminino , Hepatite B/complicações , Hepatite C/complicações , Hepatite Crônica/sangue , Humanos , Hipertensão Portal/sangue , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Transglutaminases/sangue , Adulto Jovem
18.
Dig Endosc ; 26(6): 720-5, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24666384

RESUMO

BACKGROUND AND AIM: Narrow band imaging with magnification enables detailed assessment of duodenal villi and may be useful in predicting the presence of villous atrophy or normal villi. We aimed to assess the morphology of duodenal villi using magnification narrow band imaging and correlate it with histology findings in patients with clinically suspected malabsorption syndrome. METHODS: Patients with clinical suspicion of malabsorption presenting at a tertiary care center were prospectively recruited in this diagnostic intervention study. Patients underwent upper gastrointestinal endoscopy using magnification narrow band imaging. The villous morphology in the second part of the duodenum was assessed independently by two endoscopists and the presence of normal or atrophic villi was recorded. Biopsy specimen was obtained from the same area and was examined by two pathologists together. The sensitivity and specificity of magnification narrow band imaging in detecting the presence of duodenal villous atrophy was calculated and compared to the histology. RESULTS: One hundred patients with clinically suspected malabsorption were included in this study. Sixteen patients had histologically confirmed villous atrophy. The sensitivity and specificity of narrow band imaging in predicting villous atrophy was 87.5% and 95.2%, respectively, for one endoscopist. The corresponding figures for the second endoscopist were 81.3% and 92.9%, respectively. The interobserver agreement was very good with a kappa value of 0.87. CONCLUSION: Magnification narrow band imaging performed very well in predicting duodenal villous morphology. This may help in carrying out targeted biopsies and avoiding unnecessary biopsies in patients with suspected malabsorption.


Assuntos
Duodeno/patologia , Síndromes de Malabsorção/patologia , Microvilosidades/patologia , Imagem de Banda Estreita/métodos , Adulto , Biópsia , Endoscopia do Sistema Digestório/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade
19.
Indian J Med Ethics ; 11(1): 25-8, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24509105

RESUMO

Education in ethics is now a formal part of the undergraduate medical curriculum. However, most courses are structured around principles and case studies more appropriate to western countries. The cultures and practices of countries like India differ from those of western countries. It is, therefore, essential that our teaching should address the issues which are the most relevant to our setting. An anonymised, questionnaire-based, cross-sectional survey of medical students was carried out to get a picture of the ethical problems faced by students in India. The data were categorised into issues related to professional behaviour and ethical dilemmas. Unprofessional behaviour was among the issues reported as a matter of concern by a majority of the medical students. The survey highlights the need to design the curriculum in a way that reflects the structure of medical education in India, where patients are not always considered socio-culturally equal by students or the medical staff. This perspective must underpin any further efforts to address education in ethics in India.


Assuntos
Currículo , Educação de Graduação em Medicina , Ética Médica/educação , Estudantes de Medicina , Estudos Transversais , Coleta de Dados , Feminino , Humanos , Índia , Masculino , Inquéritos e Questionários
20.
Toxicol Rep ; 1: 707-717, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-28962284

RESUMO

Alterations in liver vascular tone play an important role in chronic liver disease. The hepatic stellate cell (HSC) and mediators such as nitric oxide (NO) and hydrogen sulfide (H2S) have been implicated in regulation of vascular tone and intra-hepatic pressure. Though these have been studied in chronic liver damage, changes in response to acute liver injury induced by hepatotoxins such as dimethyl nitrosamine are not well understood. Liver injury was induced in mice by a single intra-peritoneal injection of dimethylnitrosamine (DMN), following which animals were sacrificed at 24, 48 and 72 h. Changes in vascular mediators such as NO and H2S as well as stellate cell activation was then examined. It was found that a single low dose of DMN in mice is sufficient to induce activation of hepatic stellate cells within 24 h, accompanied by oxidative stress, compromised metabolism of H2S and decreased levels of the von Willebrand factor (vWF) cleaving protease; a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS13), which functions in intravascular thrombosis. A suppression of hepatic NO levels is also initiated at this time point, which progresses further and is sustained up to 72 h, at which point the HSC activation is still present. Compromised levels of ADAMTS13 and H2S metabolism however, begin to recover by 48 h and are almost similar to control by 72 h. In conclusion, these data suggest that even moderate acute insults in the liver can have far reaching consequences on a number of mediators of vascular flow in the liver.

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