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A C Anand

Publications and source records attributed to A C Anand.

At least 19 recordsLinked to original sources
PubMed1997

Does non-dysenteric intestinal amoebiasis exist?

BACKGROUND: Chronic abdominal pain and frequent bowel disturbance are common symptoms experienced by more than 15% of apparently healthy people. In areas endemic for Entamoeba histolytica infection, these symptoms are often diagnosed as non-dysenteric intestinal amoebiasis even though no causal relation between such symptoms and E histolytica has been established and clinical presentation of non-dysenteric intestinal amoebiasis and irritable bowel syndrome (IBS) is not distinct. This study was done to assess the clinical significance of E histolytica infection in causation of such symptoms. METHODS: Patients with symptoms suggestive of non-dysenteric intestinal amoebiasis were recruited from a survey to assess the prevalence of abdominal symptoms in the general population (group A; n = 78) and from medical outpatient clinics (group B; n = 66). Participants who had symptoms as well as symptom-free controls (group C; n = 100) were clinically examined and underwent stool examination, amoebic serology, colonoscopic examination, histopathological examination of colonoscopic biopsy samples, and a trial of antiamoebic therapy (only for participants with symptoms) with metronidazole and mebendazole. FINDINGS: There were no significant differences between the 144 patients with symptoms and the 100 symptom-free controls in the proportion with E histolytica in stools (26 [18%] vs 18 [18%]), serological evidence of E histolytica infection (61 [42%] vs 41 [41%]), colonoscopic abnormalities (five of 66 vs one of 33), or histopathological abnormalities (36 [49%] of 73 vs ten [30%] of 33). Cyst-positive and cyst-negative individuals showed no significant difference in serological evidence of E histolytic infection, histological abnormalities, or response to therapeutic trial with metronidazole. A diagnosis of IBS was suggested on the basis of consensus criteria and Kruis diagnostic index in 127 of 144 patients with symptoms. The diagnosis of non-dysenteric intestinal amoebiasis could be made in only one patient, who had relapse of symptoms within 6 weeks of antiamoebic therapy and therefore the relapse did not meet criteria for the diagnosis of non-dysenteric intestinal amoebiasis. More than 60% of cyst-positive as well as cyst-negative patients with symptoms showed either complete or partial response to treatment strategy for IBS. INTERPRETATION: Chronic bowel symptoms, such as pain in abdomen and frequent bowel disturbance, have no association with either past or present infection with E histolytica. Most patients with such symptoms are likely to have IBS. The clinical entity of non-dysenteric intestinal amoebiasis, if it exists, must be extremely rare.

Abdominal Pain↗
PubMed1997

Liver transplantation for alcoholic liver disease: evaluation of a selection protocol.

We have used a formal transplant protocol to select patients with alcoholic liver disease (ALD) for transplantation. We retrospectively analyzed all the patients with ALD who were referred specifically for transplantation to our Liver Unit between 1987 and 1994. Patients were selected for liver transplantation if they had end-stage liver disease and had remained abstinent from the time they were medically advised to stop alcohol intake. Of the 180 patients referred for transplantation, 43 (none of whom were transplanted) had case records insufficiently complete for full analysis; this may bias the analysis. Of the remaining 137 patients, 39 were transplanted and 4 were awaiting transplantation at the time of analysis. Of the patients who were not accepted for transplantation, 13 died during the assessment, 7 were considered to be unlikely to survive the procedure, 29 were found to be medically unsuitable, 16 psychologically unsuitable, 7 patients refused the offer of transplantation, and an additional 19 either showed clinical improvement or were considered too well for transplantation. Special investigations, such as brain computerized tomography (CT) scan and echocardiograph, changed the clinical decision to transplant in only a small number of cases (4% and 5%, respectively). Nine of the transplanted patients died and the remaining were followed up for a median of 25 (range, 7-63) months. One year actuarial survival for the transplanted patients was 79%, for those considered too sick was 0%, for medically unsuitable patients was 44%, for psychologically unsuitable patients was 65% and for those considered too well was 94%. Only 5 of the transplanted patients (13%) reverted to drinking. The observed actuarial survival of nontransplanted patients was compared with the expected survival calculated by 'the Beclere model.' The observed actuarial survival in the nontransplanted groups was much better than anticipated from the Beclere model, which therefore, is not applicable to our patients. The proportional hazards regression analysis of our nontransplanted patients identified serum bilirubin, serum albumin, blood urea, ascites, and spontaneous bacterial peritonitis as factors significantly predictive of their probability of survival. Using a model based on these parameters, the expected survival of our transplanted patients was calculated. Although we applied the model to a different population, the observed actuarial survival in the transplanted patients was found to be better than their expected survival (P < or = .001). Our protocol was useful in selecting suitable patients with ALD for liver transplantation, which resulted in significant survival advantage with low recidivism rate.

Adult↗
PubMed1997

Early indicators of prognosis in fulminant hepatic failure: an assessment of the King's criteria.

BACKGROUND/AIMS: An accurate and early assessment of the individual patient is critical in deciding whether liver transplantation is indicated in the treatment of fulminant hepatic failure. Based on analysis of patients treated between 1973 and 1985, the Liver Unit at King's College Hospital, London, developed a prognostic model to identify patients with a poor prognosis. The present study was done to determine the applicability of this model in fulminant hepatic failure patients seen at our center in the 1990s. METHODS: The records of 145 patients with fulminant hepatic failure, treated conservatively at Queen Elizabeth Hospital, Birmingham between 1990 and 1994, were analyzed. An additional 81 patients, who were transplanted for fulminant hepatic failure during the same period were excluded from the study. RESULTS: Application of King's College Hospital criteria at the time of admission to this hospital in the acetaminophen group, had a positive predictive value of 88%, negative predictive value of 65% and predictive accuracy of 71%. The positive predictive value, negative predictive value and predictive accuracy of these criteria for non-acetaminophen-induced fulminant hepatic failure, were 79%, 50% and 68%. Multivariate analysis identified prothrombin time, serum creatinine, white cell count and abnormal potassium levels as independent predictors of mortality in acetaminophen-induced fulminant hepatic failure; and prothrombin time alone in fulminant hepatic failure induced by other etiologies. CONCLUSIONS: The King's College Hospital criteria for predicting outcome of fulminant hepatic failure were found to have a slightly lower predictive accuracy than shown in the original study.

Acetaminophen↗
PubMed1996

End-stage primary biliary cirrhosis in a first generation migrant south Asian population.

Primary biliary cirrhosis (PBC) is uncommonly described from Asia and it is an extremely rare cause of chronic liver disease in India. Six first generation migrant Asian patients with PBC were seen at the Liver Unit, Queen Elizabeth Hospital, Birmingham during the period 1982-94. All were women and their ages at presentation ranged from 31 to 63 (median 40) years. All were symptomatic for a median of 6 months prior to referral to the unit for transplantation. Itching with or without jaundice was a common presenting feature. Diagnosis was based on raised serum IgM levels, presence of antimitochondrial antibody (titres 100-400) and diagnostic histology. Only one patients had an associated autoimmune disease (coeliac disease). Serum bilirubin level was above 100 mumol/l at the time of presentation in four patients. Four of these patients with end-stage PBC are first generation migrants from south Asia, who have been resident in the West Midlands for the past 10 to 34 years. The total south Asian population of the West Midlands is 276,754; thus, from these four patients alone the estimated prevalence of PBC in the migrant south Asian population is at least 14 per million. However, such data cannot be used to give any accurate assessment of prevalence, for which a population screening programme is required. A higher incidence in the migrant population than in their countries of origin is compatible with an environmental aetiology.

Adult↗
PubMed1995

Timing, significance, and prognosis of late acute liver allograft rejection.

Liver allograft rejection is usually divided into acute (cellular) rejection and chronic (ductopenic) rejection. Most cases of acute rejection occur within four weeks of transplantation. There is a paucity of published literature on late acute rejection (LAR) in liver allografts and little is known about factors affecting its occurrence and outcome. To study the predisposing factors, clinical presentation, and prognosis of LAR, data prospectively collected on consecutive adult patients who underwent liver transplantation between 1982 and 1994, were analyzed. LAR was defined as histologically confirmed acute cellular rejection occurring 30 or more days after liver transplantation. Of the 717 patients, 59 (7.5%) had 71 episodes of LAR. Fifty-seven episodes were seen during the first year after transplantation, the remaining occurring between 1 and 6 years. Age, sex, pretransplant diagnosis, donor match of HLA, and blood groups was not associated with risk of LAR. Twenty-seven (38%) episodes were preceded by subtherapeutic blood levels of cyclosporine/FK506 (< 100 ng/ml and < 5 ng/ml, respectively) while an additional 6 (8%) had marginally low blood levels (< 150 ng/ml and < 10 ng/ml, respectively). Treatment with high-dose prednisolone resulted in complete resolution of rejection in 36 (51%) episodes, partial response in 21, and no response in 14 patients. Sixteen patients (27%) developed chronic rejection and graft loss. Development of chronic rejection was not affected by age or sex of the patient, timing of LAR, or histological severity of AR. Delayed response to therapy during an earlier episode of AR, and histological findings of centrilobular necrosis or bile duct loss at the time of diagnosis of LAR were associated with high risk of progression to chronic rejection and graft loss.

Adolescent↗
PubMed1994

Low grade pyrexia: is it chronic fatigue syndrome?

Eighty seven consecutive patients presenting with prolonged low grade pyrexia (99 degrees-101 +/- F) during 1984-93 were followed up for a mean duration of 2.9 years. Mean age was 37.55 years (SD + 10.16) and 66 (75.8%) were females. Onset of pyrexia was acute in 57 patients and was associated with chilly sensation (42), Fatigue (69), Arthralgias (61), myalgias (55) and several other non specific symptoms. Clinical examination showed paucity of physical signs with 7 patients showing tender lymphadenopathy, 7 showing splenomegaly, 5 hepatomegaly, and 1 phylctenular conjunctivitis. Psychiatric examination was within normal limits. Extensive investigations for any viral or other infection, autoimmune disorder or malignancy were unrewarding. Patients were followed up for an average of 2.9 (2 to 5 years). Thirteen patients had become asymptomatic within one year of onset of symptoms, 38 by two years and 45 by the end of three years. This syndrome may be a variant of chronic fatigue syndrome.

Adolescent↗
PubMed1993

Renal functions in obstructive jaundice: a pre and post operative assessment.

Surgery in patients with surgical obstructive jaundice is known to be associated with increased risk of post-operative acute renal failure. A prospective study was carried out to evaluate the renal function in patients with obstructive jaundice. Renal functions of thirty two patients with jaundice secondary to mechanical obstruction of the biliary tract were evaluated pre-operatively and 7 days after surgical biliary decompression. Although no significant difference was seen in the mean values of pre and post operative renal function variables, two patients had overt renal failure, one with pre-operative cholangitis and acute tubular necrosis and another with carcinoma of the pancreas and postoperative acute renal failure. The overall satisfactory outcome in our obstructive jaundice patients may be related to pre-operative and intraoperative preparation with intravenous fluids and mannitol. It is concluded that patients with obstructive jaundice can be satisfactorily treated with special preoperative care including good hydration and mannitol therapy during anaesthesia and surgery.

Acute Kidney Injury↗
PubMed1992

Acute filarial myositis.

An uncommon case of filariasis presenting as acute myositis is described. The patient was treated initially with steroids and antihistamines with no response. Later on with the confirmation of filariasis he was treated with diethyl carbamazine with complete recovery.

Acute Disease↗