INTRODUCTION: Enteric perforation is a serious complication of typhoid fever and the condition has a high morbidity and mortality in many developing countries including India. No consensus exists concerning the best proc...INTRODUCTION: Enteric perforation is a serious complication of typhoid fever and the condition has a high morbidity and mortality in many developing countries including India. No consensus exists concerning the best procedure to be performed in these cases. AIM: Aim: The purpose of this study was to analyse our clinical experience in surgical management of enteric perforation and to determine the prognostic factors associated with morbidity and mortality. METHODS: It was a prospective study of patients who underwent surgery for typhoid intestinal perforation at SMS Medical College and Hospital, Jaipur, India, between April 2012 and October 2013. Laparotomy was performed by a midline incision. Management of perforation was based on the intraoperative findings and the procedure to be performed was decided by the operating surgeon. RESULTS: 88 patients were studied with a male to female ratio of 6.3:1. The mean age was 36.4 years. The peak incidence was between 21 to 30 years. All the patients presented with abdominal pain and distension. More than 90% patients showed free gas under diaphragm. 71% patients had a single perforation and 97% patients had perforations confined to ileum. Debridement with double layered closure was performed in about 58% patients, ileostomy in 25% and resection anastomosis in 18% of patients. Overall complication rate was 44.3% with surgical site infection being the most common morbidity. The mortality rate was 17.1% which was significantly affected by perforation-admission interval of more than 48 hours, number of perforations and occurrence of postoperative complications. CONCLUSION: Typhoid fever leading to development of intestinal perforation continues to be a significant health problem with a high morbidity and mortality especially in rural India. The management of the disease requires an early and appropriate surgical intervention.
BACKGROUND: Chronic liver disease questionnaire (CLDQ) is an established disease specific tool to assess the health related quality of life (HRQOL) in patients with CLD irrespective of the etiology and severity. The obje...BACKGROUND: Chronic liver disease questionnaire (CLDQ) is an established disease specific tool to assess the health related quality of life (HRQOL) in patients with CLD irrespective of the etiology and severity. The objective of the study was to develop the Hindi language version of CLDQ and to assess the validity of the Hindi CLDQ. METHODS: CLDQ was adapted into Hindi language by following a standard method of forward and back-translation by two bilingual translators, revision by expert panel and formulation of a consensual version followed by pilot testing and appropriate modifications before final administration. Hindi CLDQ along with short form 36 (SF-36) were administered in 494 patients with chronic liver disease (CLD) and 103 healthy controls (HC). To assess reproducibility, Hindi CLDQ was re-administered in a subsample of 20 patients. Internal consistency was assessed by Cronbach’s alpha coefficient. Structural validity was assessed by exploratory factor analysis and construct validity was assessed with help of correlation of SF-36 scores and CLDQ pattern across disease severity groups. RESULTS: The Cronbach’s alpha coefficient was 0.93 and intra class coefficient correlation was 0.88 for the average CLDQ score, suggestive of good reliability. An inverse relationship of the average CLDQ score with the disease severity (CLDQ score of Child A vs. B vs. C = 5.2±1.10 vs. 4.73±1.24 vs. 4.15±1.19 respectively; p<0.001) and good correlation with SF-36 scores (average CLDQ score with PCS & MCS; r=0.63 & 0.55; p<0.001) was suggestive of good validity of Hindi CLDQ. The factor analysis identified 6 domains accounting for 62% of variability. The derived cut-off of 6 for the average CLDQ had the AUC of 0.826 with a sensitivity of 76.7. CONCLUSION: Hindi version of CLDQ is found to be a reliable and a valid tool comparable to the original English version. The HRQOL of patients with CLD is lower than healthy controls and HRQOL decreases with increase in disease severity.
Hossain IA, Faruque MO, Akter S
… +3 more, Bhuiyan FR, Rahman MK, Ali L
Trop Gastroenterol
· 2016 · PMID 30234279
BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is a hepatic manifestation of insulin resistance and serum uric acid (SUA) levels seemed to be elevated during this disorder. There is a paucity of data regarding the...BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is a hepatic manifestation of insulin resistance and serum uric acid (SUA) levels seemed to be elevated during this disorder. There is a paucity of data regarding the association of SUA with NAFLD in prediabetes. In this context, the present study has been undertaken to investigate this association. METHODS: In a cross-sectional analytical design, a total of 110 prediabetic subjects [M/F; 63/47, age in ranges, 45 (25-68)] were recruited in the study and divided into non NAFLD (n = 62) and NAFLD (n = 48) group after examined with ultrasonogram. Insulin resistance (HOMA-IR) was calculated by homeostasis model assessment. RESULTS: NAFLD subjects had significantly higher levels of SUA compared to non NAFLD subjects (6.10 ± 1.42 vs. 5.38 ± 1.14, p = 0.004). They also had significantly higher levels of HOMA-IR (2.4 ± 1.09 vs. 1.4 ± 0.45, p < 0.001). In binary logistic regression analysis, HbA1c (OR = 3.505, p = 0.002), SUA (OR = 1.514, p = 0.023) and HOMA-IR (OR = 1.478, p = 0.029) were found to be significant determinants of NAFLD after adjusting the effects of BMI and triglyceride (TG). In multiple linear regression analysis, SUA showed significant positive association with HOMA-IR (ß = 0.355, p = 0.027) and TG (ß = 0.325, p = 0.033) after adjusting the effects of BMI and HbA1c. CONCLUSIONS: Increased levels of serum uric acid are significantly associated with NAFLD and this association seemed to be mediated by insulin resistance among prediabetic subjects.
Mahmoud HS, Ghweil AAS, Osman GS
… +2 more, Ezz-Eldin S Bazeed S, Helal MM
Trop Gastroenterol
· 2016 · PMID 30234278
BACKGROUND: Hyaluronic acid (HA) is an attractive potential marker for noninvasive diagnosis of liver fibrosis instead of liver biopsy for both patients and physicians. AIM: To assess the role of HA for diagnosing the pr...BACKGROUND: Hyaluronic acid (HA) is an attractive potential marker for noninvasive diagnosis of liver fibrosis instead of liver biopsy for both patients and physicians. AIM: To assess the role of HA for diagnosing the progression of steatosis to steato-hepatitis (SH) and fibrosis in patients with Chronic Hepatitis C virus (HCV) infection. METHODS: 90 patients with chronic HCV infection, 77 (85.6%) males and 13 (14.4%) females, were included. Blood samples were collected for routine laboratory investigations, liver function tests and serum HA measurements. A liver biopsy was taken for histopathological examination. RESULTS: Steatosis was found in 37 patients (41.1%), fibrosis in 29 patients (32.2%) and SH in 51 patients (56.7%). The mean serum HA for all patients was 86.4±48.2 ng/L. HA levels were significantly higher in patients with fibrosis (95.6±53 vs 54.5±3.5) and SH (88.7±52 vs 49.9±12) than those without (P value = 0.001and 0.001 respectively). HA levels were also significantly higher in patients with an advanced degree of fibrosis, SH and steatosis as compared to those with mild degrees (P value = 0.000, 0.001 and 0.01 respectively). Positive correlations were found between serum HA and the degree of fibrosis, SH and steatosis (P value =0.000 and r = + 0.758, 0.701and 0.727 respectively). The mean HA cut off value for the diagnosis of fibrosis and SH was taken to be 70 and 60 ng/L providing a diagnostic accuracy of 94.1% and 91.6% respectively. CONCLUSION: Serum HA level is a good noninvasive marker for the diagnosis of fibrosis and steato-hepatitis in patients with chronic HCV infection.
Aggarwal M, Agarwal N, Mishra TS
… +2 more, Sharma N, Singh S
Trop Gastroenterol
· 2016 · PMID 30234277
BACKGROUND: Laparoscopic cholecystectomy (LC) is routinely done for symptomatic gallstone disease; however, its role in relieving dyspeptic symptoms in cholelithiasis is controversial. AIM: The study was designed to asse...BACKGROUND: Laparoscopic cholecystectomy (LC) is routinely done for symptomatic gallstone disease; however, its role in relieving dyspeptic symptoms in cholelithiasis is controversial. AIM: The study was designed to assess the role of laparoscopic cholecystectomy in relieving dyspeptic symptoms in patients having cholelithiasis with only dyspeptic symptoms. METHODS: Patients with cholelithiasis having only dyspeptic symptoms not attributable to other causes (like Helicobacter pylori) were subjected to laparoscopic cholecystectomy. Dyspepsia scores (Dyspepsia Severity Assessment Score-DSAS and Gastrointestinal Quality of Life Index- GIQLI) were measured before and after surgery and analyzed using Greenhouse-Geisser, McNemar’s and ANOVA tests. RESULTS: 27 patients (M:F=1:26, mean age=40.48±10.60 years) having dyspepsia with asymptomatic gallstones were included in the study. There was significant improvement in DSAS (20.11±4.36 vs 28.63±3.42; p<0.001) and GIQLI(106.11±5.77 vs 122.56±7.95; p<0.001) after 2 months of LC. All symptoms improved individually; relief in early satiety and vomiting was the maximum (outcome benefit ratios=0.954, p=0.007 and 0.937, p=0.005 respectively). Multiple gallstones caused more dyspepsia than single (p=0.005). There was no significant difference between H. pylori positive and negative groups in terms of improvement of DSAS and GIQLI scores after LC (p=0.897 and p=0.375 respectively; however dyspepsia was seen to improve significantly within both groups). CONCLUSION: Dyspepsia may be a symptom of gallstone disease, and these patients can benefit from LC especially when early satiety and vomiting are the main symptoms. A larger sample size may offer more insight.
Pancreatic cancer is an aggressive disease with rapid invasion and metastasis. Extracellular matrix degrading enzymes play an important role in cancer cell invasion and migration. Cathepsins are a group of proteolytic en...Pancreatic cancer is an aggressive disease with rapid invasion and metastasis. Extracellular matrix degrading enzymes play an important role in cancer cell invasion and migration. Cathepsins are a group of proteolytic enzymes, which are responsible for the matrix turnover. Among the cathepsins, more number of studies have focused upon cysteine cathepsins. The function and activities of these enzymes are interwoven and their interplay causes the activation of one another by following a proteolytic cascade. This review focuses on differential expression of cathepsins in different types of pancreatic cancer and controls, importance of cathepsins in various phenomena responsible for tumorigenesis and its spread in experimental and human studies. Thus, cathepsins and its expression in pancreatic cancer may be used as potential biomarkers and may prove to be important therapeutic targets if tested clinically.
BACKGROUND/AIMS: Liver abscess is a significant health problem in developing countries and the complications associated with it are frequently fatal. Hence identification of these complications and anticipating the same...BACKGROUND/AIMS: Liver abscess is a significant health problem in developing countries and the complications associated with it are frequently fatal. Hence identification of these complications and anticipating the same will lead to reduction in the mortality and morbidity rate. Such a work will facilitate in identifying patients with risk of complications and will allow for planning of an early intervention. The aim of this study was to identify the predictors of risk of complications in patients with liver abscess. MATERIALS AND METHODS: The data for this retrospective study was obtained from hospital records and included 100 patients diagnosed to have solitary or multiple liver abscess. Complications were defined and history, lab and radiological findings and course of treatment were observed and analyzed in correlation with occurrence of complications. A predictive scoring system was designed for 15 points by giving two points to the factors with 100% correlation and one point to other factors with strong correlation. The score was applied to a validation cohort of 114 different patients and results were noted. RESULTS: Out of the 100 cases studied 24 cases had complications of and the predictive factors included history of alcoholism (> 10 yrs), INR > 1.7 , TLC > 20000/cc and pleural effusion, while other factors had a varying degree of correlation with complication occurrence. It was observed that the new scoring system was successful in identifying patients at risk of developing complications with 100% sensitivity and 93.75% specificity. CONCLUSION: Management of liver abscess can be clearly defined by dividing patients into categories depending upon a new scoring system described in the study and intervention can be planned.