Biomedical subjects
Publications and source records attributed to R Aggarwal.
Ulcerative colitis is known to be associated with autoimmune diseases. We report two patients with coexistent ulcerative colitis and immune thrombocytopenia, a rare association.
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Although sclerosing cholangitis is well recognized to occur in patients with idiopathic inflammatory bowel disease, pancreatitis as a complication of ulcerative colitis is uncommon. We describe a patient who had idiopathic ulcerative colitis, primary sclerosing cholangitis and calcific pancreatitis with endocrine pancreatic deficiency, a rare combination.
BACKGROUND: Portal vein thrombosis (PVT) is a common cause of portal hypertension in children from developing countries. Deficiencies of proteins C and S and elevated anticardiolipin antibody (aCL) levels have been shown to predispose to venous thrombosis. We studied these factors in children with idiopathic PVT. METHODS: 19 children with PVT (mean [SD] age 5.7 [2.1] y; 15 boys) were studied; all had had variceal bleeding, and had PVT on ultrasonography. Functional protein C activity was measured using a clotting assay; if it was normal, a clotting assay for functional protein S activity was performed. IgG aCL levels were measured in all sera using an in-house standardized solid-phase ELISA. RESULTS: Protein C functional activity ranged from 4% to 109%. Eight children had activity below 70%, the lower cut-off of the normal range. Protein S assay, done in 10 of the 11 children with normal protein C activity levels, was normal (above the cut-off level of 65% of the normal range). IgG aCL levels were abnormally elevated (>mean + 2SD of 16 healthy control children) in nine children; of these, three had associated protein C deficiency. Thus, of the 19 children with idiopathic PVT, 14 had abnormality in one or more tests. CONCLUSION: A majority of children with PVT of unknown etiology have functional protein C deficiency or abnormally elevated levels of aCL antibodies.
Acute hepatitis E and falciparum malaria can each present with fulminant hepatic failure and are common in tropical countries. However, co-existence of these two conditions has not been reported. We report a 20-year-old girl who presented with fever and altered sensorium. Peripheral smear was positive for Plasmodium falciparum, and IgM anti-HEV was positive. She died despite antimalarial drugs and supportive management. Postmortem liver tissue showed changes suggestive of acute viral hepatitis.
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INTRODUCTION: Gastric Helicobacter pylori infection is believed to be associated with a higher risk of hepatic encephalopathy among patients with cirrhosis of liver. However, the role of this infection in causation of subclinical hepatic encephalopathy has not been studied in detail. METHODS: Patients with cirrhosis of liver but no hepatic encephalopathy underwent venous blood ammonia measurement, psychometric tests (number connection tests [NCT] and figure connection tests [FCT]), and gastric biopsies for presence of H. pylori infection. The results of blood ammonia and psychometric tests in the H. pylori-positive and -negative study subjects were compared. RESULTS: Of 58 patients with liver cirrhosis studied, 31 had evidence of gastric H. pylori infection. Venous blood ammonia levels were comparable in patients with (median 29 mmol/L; range 18-47) and without (34 [15-48] mmol/L; p=ns) H. pylori infection. The time taken to complete NCT trail A (median 37 s [range 25-69] versus 36.5 [26-62]), NCT trail B (64 s [48-91] versus 63.5 [42-88]), FCT trail A (59 s [31-115] versus 58 [38-590]) and FCT trail B (76 s [55-187] versus 82 [36-125]) were similar in those with and those without H. pylori infection. For each of the four tests, the proportion of subjects with abnormal test results was similar among H. pylori-positive and -negative subjects. CONCLUSION: Presence of H. pylori infection among patients with cirrhosis of liver but no overt hepatic encephalopathy is not associated with increase in blood ammonia concentration or deterioration in psychomotor function.
Hepatitis E is a self-limited enterically transmitted acute viral hepatitis that occurs frequently in epidemic outbreaks and as sporadic hepatitis in the Indian sub-continent, Southeast and Central Asia, the Middle East, parts of Africa, and Mexico. Hepatitis E virus (HEV) is excreted in faeces and is transmitted predominantly by the faecal-oral route, usually through contaminated water. The reservoir of the virus during the inter-epidemic periods in disease-endemic countries may reside in the environment, in sub-clinically HEV-infected humans, and/or animals infected with an HEV-like virus. Chronic infection is unknown. Diagnosis of HEV infection is usually made by detection of anti-HEV antibodies or HEV-RNA in patients serum specimens. Clinical illness due to HEV infection is similar to other forms of viral hepatitis except in pregnant women, in whom the illness is particularly severe with a mortality as high as 25%. Asymptomatic and anicteric infections may occur. No specific treatment is available, and the most effective mode of preventing this disease is use of clean water and proper sanitation. Recombinant vaccines are being developed that may be particularly useful for travellers to the disease-endemic areas and for pregnant women.
BACKGROUND: Pneumatic dilation (PD) is an established therapeutic option for achalasia cardia. Recently, intrasphincteric botulinum toxin (BT) has been used to treat achalasia cardia in view of its simplicity and safety. However, it is likely to be a costly treatment as repeated injections are often needed due to its short-lasting effect. No economic analysis of PD and BT strategies has been done in India. METHODS: A decision tree was constructed using decision analysis software (DATA 4.0; TreeAge Software, Williamstown, MA, USA). Probability estimates for BT injection and PD (and, in case of failure, surgery) were obtained from published literature, preferably from India. Direct "out-of-pocket" costs (in Indian rupees; currently US$ 1 = 49 rupees approximately) for baseline analysis were obtained from our hospital and from some private hospitals. Sensitivity analysis was done using a wide range of probability and cost estimates. RESULTS: Intrasphincteric BT injection strategy was more costly at 18,520 rupees per patient than PD strategy (4,568 rupees), yielding an incremental cost of 13,952 rupees per patient successfully treated. Sensitivity analysis supported the conclusions of the baseline analysis. CONCLUSION: Primary intrasphincteric BT injection strategy was costlier than primary PD strategy in the treatment of achalasia cardia in India, and therefore cannot be justified despite its efficacy, relative ease of administration and safety.
A modified technique of sutureless Fasanella-Servat Operation (F.S.O.) using special curved haemostat for the correction of mild to moderate acquired ptosis with good Levator Palpebrae Superioris (L.P.S.) action (12 m.m.) was performed in a large series of 50 eyes. Excellent correction was achieved in 94.6% eyes with mild ptosis & 61.6% eyes with moderate ptosis. No operative and post operative complications were observed. The technique was found to be very safe, quick and effective.
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Pulsed Doppler transmitral flow-velocity provides a non-invasive method for serial evaluation of diastolic function. However confounding influence of loading conditions and heart rate on transmitral flow makes many conclusions suspect. To study the effect of preload, various parameters of Doppler mitral spectrum were studied in 11 patients with stable effort angina, angiographic coronary artery disease and intact global and segmental systolic function, before and after administration of sublingual isosorbide dinitrate (group 1). Following isosorbide dinitrate administration, there was a significant increase in heart rate (p less than 0.001), decrease in left ventricular end-diastolic volume (p less than 0.01), no change in left ventricular ejection fraction and systolic blood pressure. Peak E velocity, E velocity-time integral, E/A velocity time integrals ratio, acceleration and deceleration rates and diastolic filling period were significantly reduced whereas peak A velocity, A velocity time integral, acceleration and deceleration times and atrial filling period were unchanged. In 10 age-matched patients (group 2), atrial pacing performed to achieve similar degree of increase in heart rate as in group 1 (10 +/- 1 vs 12. +/- 4, p = NS), resulted in a decrease in E velocity time integral, E/A velocity time integrals ratio and diastolic filling period (p less than 0.01) without any significant change in any other parameter. Absolute A velocity time integral, acceleration and deceleration times are the only parameters of transmitral diastolic flow-velocity profile which are relatively independent of preload and heart rate provided the change is small.
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Clinical records of the first 45 consecutive patients (66 lesions) in whom the Probe TM a balloon on the wire, was used for percutaneous transluminal coronary angioplasty have been reviewed. The aim of this analysis was to establish the efficacy and safety of this device. Majority of the lesions taken up were considered severe and difficult to cross. The probe was the 1st catheter used in 51 lesions (77%) and in 15 lesions (23%) it was used after other balloon catheters. In 88% (58/66) of lesions treated the Probe reduced the stenosis to less than 50% of the luminal diameter. Of the 45 patients treated 39 (87%) had a successful result. Of the 19 patients with multiple lesions 74% (14/19) had complete revascularisation and in 16% (3/29) had the most significant vessel dilated. Two patients (3%) required urgent coronary artery bypass surgery for acute occlusions. There was no hospital death. Of 50 probe devices used 5 (10%) malfunctioned: the balloon ruptured (at 5 Bars pressure) in 2 instances, balloon twisted causing "Volvulous" in 1 and balloon failed to deflate in 2 cases. The probe has significant advantages over other balloon systems for treating severe coronary lesions because of its low profile. It is however a delicate catheter system and prone to malfunction if not handled with care. Our results show that it is an excellent system for opening difficult and tight coronary lesions.
Hepatitis B infection is a major global health problem with a high morbidity and mortality. With safe and effective vaccines available, it is now possible to prevent it. Many countries have started national hepatitis B control programmes but no attempt has been made to do this in our country. An analysis of the available data on the epidemiology of hepatitis B infection in India reveals that perinatal maternofoetal transmission accounts for only a minority of hepatitis B virus carriers in India. Therefore, a policy of screening pregnant mothers for the presence of hepatitis B surface antigen and selective immunization of babies born to those who are surface antigen positive will have very little effect on the hepatitis B carrier rate in our population. Universal immunization of all newborns will have a much greater impact, it will be logistically simpler and more cost-effective--the cost of preventing one hepatitis B carrier being nearly one-fourth of that with selective immunization. We recommend that hepatitis B vaccine should be included in our country's expanded programme of immunization.