Biomedical subjects
Publications and source records attributed to N D Patel.
The cases are reported of three off road cyclists with isolated soft tissue injuries to the right lower leg, caused by the chain ring as they struggled to release their feet from clipless pedals. Correct adjustment of the pedals to facilitate quick release of the feet is required to prevent such injuries.
Gastric antral vascular ectasia (GAVE) syndrome is an uncommon cause of chronic gastrointestinal bleeding and iron deficiency anaemia. We describe two cases of GAVE, one pernicious anaemia related and the other portal hypertension related. In both the cases, progressive mucosal changes, which lead to development of GAVE, were documented. Those changes were progression of multiple antral erythematous spots into linear configuration and lastly to watermelon stomach. One of the cases was treated with tranexamic acid with good response.
AIMS AND OBJECTIVES: 1) To evaluate the utility of PCR in differentiating intestinal tuberculosis from Crohn's disease. 2) To compare histological features of tuberculosis and Crohn's disease. MATERIAL AND METHODS: A total of 60 cases of diagnosed intestinal tuberculosis and 20 Crohn's disease were included in the study. Clinical data, radiological and endoscopic findings and response to treatment were taken into consideration. Endoscopic biopsies from affected areas were subjected to histopathological examination and polymerase chain reaction (PCR) assay. Acid fast staining on tissue and culture was done whenever possible. RESULTS: Clinical symptoms, radiological and endoscopic findings were almost similar between intestinal tuberculosis and Crohn's disease. PCR was positive in 21.6% cases of intestinal tuberculosis and 5% Crohn's disease. Nine out of 42 cases (21.4%) without granuloma were also positive by PCR. There was no statistical difference for PCR positivity between patients with intestinal tuberculosis with or without granuloma on histology and also between caseating and non-caseating granuloma. CONCLUSION: PCR assay showed high specificity (95%) for the diagnosis of intestinal tuberculosis hence may be valuable method to differentiate intestinal tuberculosis from Crohn's disease.
OBJECTIVES: To analyze the role of HLA genotypes in persistence of chronic hepatitis B in Western India. METHODS: HLA genotyping for class II-DR was done in 26 subjects having chronic hepatitis B infection (HBsAg positive) and in 100 healthy controls. Statistics were done using Halden's modification of Woolf's formula. RESULT: Significant association of chronic hepatitis B infection was found for class II-DR antigens DRB1*15XX (57.6 vs. 25%) and DRB1*11XX (23 vs. 4%). DRB1*13XX (0 vs. 19%) was negatively associated with chronic hepatitis B infection. CONCLUSION: HLA phenotype, which varies with different regions, is one of the factors in persistence of hepatitis B infection. Our study supports negative association of DRB1*13XX to persistence of HBV. Also there may be role of DRB1*11XX and DRB1*15XX in persistence of HBV and development of chronic HBV hepatitis.
OBJECTIVES: To analyze association of different HLA genotypes for predisposition to type-I autoimmune hepatitis in Western India. METHODS: This study was undertaken on patients of type-I autoimmune hepatitis (defined by international criteria by IAHG, 1999). HLA genotyping for class I and II was done in 20 patients of autoimmune hepatitis and 100 healthy controls. Statistics were done using Halden's modification of Woolfs formula. RESULT: Significant association of autoimmune hepatitis was found amongst class I antigens--HLA B27 [20 vs. 0 %] & HLA cw4 [40 vs. 15 %] and amongst class II antigens--DRBI*01XX [25 vs. 2%], DRB1*14XX [30 vs. 12%], DRB1*15XX [40 vs. 25%] and DRB1*07XX [20 vs. 9 %] at DRB1 locus. Stronger association was found with HLA B27, cw4 & HLA DRB1 *01XX. CONCLUSION: Our data indicate that predisposition to autoimmune hepatitis is different in Indian patients and not associated with HLA DRB1*03XX or *04XX, as seen in Western world.
OBJECTIVE: To report our local experience of the sternoclavicular syndrome and sample the experience of other rheumatologists in the UK. METHODS: We studied case records of 23 patients referred to the Southend rheumatology clinic and data obtained from a postal questionnaire survey of British rheumatologists. RESULTS: We describe 58 cases (20 males and 38 females, mean age 47.2 yr). The disease was unilateral in 40 patients. Shoulder and/or arm pain (38 cases) with limitation of shoulder movements was an important presenting feature; other presenting features were anterior chest wall pain (14 cases) and neck pain (15 cases). Peripheral joint involvement was seen in 12 cases. Skin rash was reported in 12 cases (psoriasis, 6; acne, 2; none had pustulosis). No patients had symptoms or signs of sacroiliitis, and HLA-B27 was negative in 22 out of 23 patients. 99Technetium scintiscanning showed increased uptake in the sternoclavicular region in 31/34 patients (91.1%), but not in the sacroiliac areas. Plain radiographs were abnormal in 18 cases (sclerosis, 9; erosions, 2; soft tissue swelling, 2; bony expansion, 5). CT and/or MRI scans (available in 27 cases) showed erosions in 12 and osteitis in 18. Available histology showed a variable picture, including inflammation, bone erosion, sterile osteomyelitis and fibrosis. The majority of patients (45) were treated with non-steroidal anti-inflammatory drugs: 12 received steroids and 10 received disease-modifying anti-rheumatic drugs (methotrexate, 4; sulphasalazine, 6). Follow-up information was available for 38 patients, of whom 14 became asymptomatic and 24 had chronic disease with intermittent flares. CONCLUSION: Sternoclavicular disease is not uncommon in the UK. It can present with pain in the shoulder, neck or anterior chest wall, and may be underdiagnosed. Our results do not show a link with acne or pustulosis. Features of spondyloarthropathies, such as sacroiliitis and HLA-B27 positivity, were rare in this survey.
Bleeding abnormalities are common in patients with end-stage renal disease (ESRD). Although von Willebrand factor (vWF) abnormalities have been suspected in patients with ESRD, none have been clearly defined. Because vWF function is related to its collagen-binding capacity, we investigated whether this parameter might be altered in patients with ESRD. We measured vWF binding to type III collagen and levels of vWF antigen and ristocetin cofactor in 20 patients undergoing hemodialysis before and after routine hemodialysis sessions, in 10 patients with ESRD who had not previously undergone dialysis, and in 22 healthy, nonsmoking persons who served as controls. We found significant increases of vWF antigen levels in all patients with ESRD (undialyzed: mean, 6.4 +/- 3.0 U/ml, p < 0.001; before dialysis: mean, 5.1 +/- 4.0 U/ml, p < 0.001; after dialysis: mean, 4.8 +/- 3.4 U/ml, versus 0.81 +/- 0.26 U/ml in controls, p < 0.001). The ristocetin cofactor levels were increased in the patients who had not undergone dialysis (mean, 1.30 +/- 1.26 U/ml, p = 0.04), whereas both before and after hemodialysis groups (means, 0.71 U/ml and 0.75 U/ml, respectively) were not significantly different from controls (mean, 0.72 +/- 0.30 U/ml, p = 0.96 and p = 0.8, respectively). Patients with ESRD who had not undergone dialysis showed no difference in vWF binding to collagen (mean, 1.21 +/- 0.63 U/ml) compared with the control group (mean, 1.16 +/- 0.13).(ABSTRACT TRUNCATED AT 250 WORDS)
We have previously shown that von Willebrand factor (vWF), a glycoprotein which plays a critical role in the adhesion of platelets to injured blood vessels, is present within vascular subendothelium. We investigated the identity of the subendothelial binding site(s) for vWF by examining vWF binding to subendothelial constituents and solubilized a 150-kD protein with SDS-urea that bound vWF. This protein had an amino-acid composition similar to that of the type VI collagen alpha-1/alpha-2 chains, was recognized by specific polyclonal antibodies against type VI collagen, and had a similar acidic isoelectric point. Furthermore, we found that purified type VI collagen also bound vWF. Thus, we have identified the extracted 150-kD protein as type VI collagen. This protein may play a significant role in the binding of vWF to vascular subendothelium in vivo.
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We describe six cases of hepatic sarcoidosis. Clinical presentation was with weight loss, hepatomegaly and abnormal liver function tests. In addition there was fever, itching, splenomegaly and abdominal lymphadenopathy in some. CT scan revealed mediastinal lymphadenopathy in all. Liver biopsy showed noncaseating epithelioid granulomas. Serum angiotensin converting enzyme was elevated in four cases. All patients had received anti-tuberculosis treatment with clinical diagnosis of hepatic tuberculosis. None of them improved, while some showed clinical deterioration. All patients responded to corticosteroids with disappearance of symptoms and normalization of liver function tests.
INTRODUCTION: Nonalcoholic steatohepatitis (NASH) is common cause of chronic liver disease strongly associated with insulin resistance leading to fibrosis. No factors that determine increasing fibrosis have been well recognized. Liver biopsy is considered as gold standard for diagnosis and prognosis of this disease. AIM: To identify independent predictive factors of liver fibrosis in patients of NASH with diabetes. MATERIAL AND METHODS: During the year 2001 and 2002 total 36 patients of NASH associated with diabetes were included in the study. The diagnosis of NASH was based on 1) presence of steatosis, inflammation and ballooning on liver biopsy 2) Intake of alcohol < 20 gm of ethanol per week 3) Exclusion of other liver diseases. Patients were labeled as diabetic if random glucose was > 200 mg/dL or fasting glucose more than 140 mg/dL on 2 occasion or having documented use of oral hypoglycemic medications or insulin. Clinical and biochemical variables such as age, sex, obesity, hypercholesterolemia, AST, ALT and AST: ALT were examined for predictors of fibrosis using univariate and multiple regression statistical analysis. Obesity was defined as BMI > 30 for both males and females. Hypercholesterolemia was considered when fasting cholesterol level was above 95th percentile of normal on at least 2 occasions. Fibrosis was noted as present or absent on histology. RESULTS: Of 36 patients 17 were females and 19 males with age range of 25 to 75 years, mean age 50.8 years. Fibrosis was present in 11 (30.5%) and absent in 25 (69.4%) patients. Univariate and multiple correlations co-efficient failed to detect significant association of fibrosis with above mentioned variables. However multiple regression and logistic regression analysis (MLR) detected statistical significance for AST, ALT levels and AST: ALT ratio between fibrosis and no fibrosis in 80.6% patients. CONCLUSION: There is no definite noninvasive test that helps to predict liver fibrosis however AST, ALT levels and AST: ALT ratio may help to determine the fibrosis in patients of NASH with diabetes in majority of cases.