Differentiating Crohn's disease(CD) and intestinal tuberculosis(ITB) has remained a dilemma for most of the clinicians in the developing world, which are endemic for ITB, and where the disease burden of inflammato...Differentiating Crohn's disease(CD) and intestinal tuberculosis(ITB) has remained a dilemma for most of the clinicians in the developing world, which are endemic for ITB, and where the disease burden of inflammatory bowel disease is on the rise. Although, there are certain clinical(diarrhea/hematochezia/perianal disease common in CD; fever/night sweats common in ITB), endoscopic(longitudinal/aphthous ulcers common in CD; transverse ulcers/patulous ileocaecal valve common in ITB), histologic(caseating/confluent/large granuloma common in ITB; microgranuloma common in CD), microbiologic(positive stain/culture for acid fast-bacillus in ITB), radiologic(long segment involvement/comb sign/skip lesions common in CD; necrotic lymph node/contiguous ileocaecal involvement common in ITB), and serologic differences between CD and ITB, the only exclusive features are caseation necrosis on biopsy, positive smear for acid-fast bacillus(AFB) and/or AFB culture, and necrotic lymph node on cross-sectional imaging in ITB. However,these exclusive features are limited by poor sensitivity, and this has led to the development of multiple multi-parametric predictive models. These models are also limited by complex formulae, small sample size and lack of validation across other populations. Several new parameters have come up including the latest Bayesian meta-analysis, enumeration of peripheral blood T-regulatory cells, and updated computed tomography based predictive score. However, therapeutic anti-tubercular therapy(ATT) trial, and subsequent clinical and endoscopic response to ATT is still required in a significant proportion of patients to establish the diagnosis. Therapeutic ATT trial is associated with a delay in the diagnosis of CD, and there is a need for better modalities for improved differentiation and reduction in the need for ATT trial.展开更多
AIM: To assess the prognostic significance of cathepsin L, a cysteine protease that degrades the peri-tumoral tissue, in patients with pancreatic cancer.
The article concentrates on the role of fluctuating parameters for removable population from the incubated class in a susceptible-incubated-infected model. The discrete analogous of this model is also investigated. Co...The article concentrates on the role of fluctuating parameters for removable population from the incubated class in a susceptible-incubated-infected model. The discrete analogous of this model is also investigated. Conditions for local asymptotic stability are derived for both the disease free and endemic cases. Numerical simulations are performed to validate the theoretical results.展开更多
Background:Helicobacter pylori infection has been associated with insulin resistance and non-alcoholic fatty liver disease(NAFLD).This study was done to evaluate the effect of H.pylori-eradication therapy(HPET)in pati...Background:Helicobacter pylori infection has been associated with insulin resistance and non-alcoholic fatty liver disease(NAFLD).This study was done to evaluate the effect of H.pylori-eradication therapy(HPET)in patients with NAFLD compared to standard management therapy(SMT).Methods:Eighty NAFLD patients with H.pylori co-infection were randomized into SMT(diet and exercise,n=36)and HPET(SMT plus amoxicillin,clarithromycin,and pantoprazole,n=44)groups.The controlled attenuation parameter(CAP),anthropometric parameters,liver enzymes,lipid profile,and glycemic parameters including homeostasis model assessment-insulin resistance(HOMA-IR)were measured and compared between two groups at the baseline and 24 weeks.Results:Sixty-four participants(SMT group[n=28]and HPET group[n=36])were included in amodified intention-to-treat analysis.Both the SMT group and the HPET group had a significant reduction in CAP scores at 24weeks(P=0.002 and P<0.001,respectively),but the change between the groups was insignificant(P=0.213).Successful eradication of H.pylori occurred in 68%of the HPET group and led to greater improvement in HOMA-IR at 24weeks compared to SMT or non-responder patients(P=0.007).The liver enzymes reduced significantly at 24weeks in both groups,but the changes between the groups were similar.The lipid parameters remained unchanged within the groups and between the groups at 24weeks.A significant increase in the levels of reduced glutathione was noted in the HPET group,but the change between the two groups was not statistically different.Conclusions:HPET was found to be comparable to SMT alone in reducing hepatic steatosis and liver enzymes at 24 weeks in NAFLD patients.However,successful eradication of H.pylori led to greater improvement in HOMA-IR(Trial registration CTRI/2017/05/008608).展开更多
Chronic hepatitis E virus(HEV)infection is increasingly being reported in immunosuppressed individuals with HIV,patients with haematological malignancy and transplant recipients.The diagnosis of cirrhosis and liver fa...Chronic hepatitis E virus(HEV)infection is increasingly being reported in immunosuppressed individuals with HIV,patients with haematological malignancy and transplant recipients.The diagnosis of cirrhosis and liver failure post chronic HEV is controversial due to lack of standard diagnostic criteria.The treatment benefits of ribavirin in chronic HEV of genotype 1 are not well reported.We report a case of chronic HEV infection of genotype 1 leading to chronic liver disease in a child cured of acute leukaemia.Our report also highlights the successful use of ribavirin for eradicating chronic HEV infection and its subsequent survival benefits.Chronic hepatitis E may be an emerging disease of immunosuppressed patients and should be suspected in the presence of cryptogenic transaminitis.Ribavirin is an effective therapy for controlling HEV.展开更多
文摘Differentiating Crohn's disease(CD) and intestinal tuberculosis(ITB) has remained a dilemma for most of the clinicians in the developing world, which are endemic for ITB, and where the disease burden of inflammatory bowel disease is on the rise. Although, there are certain clinical(diarrhea/hematochezia/perianal disease common in CD; fever/night sweats common in ITB), endoscopic(longitudinal/aphthous ulcers common in CD; transverse ulcers/patulous ileocaecal valve common in ITB), histologic(caseating/confluent/large granuloma common in ITB; microgranuloma common in CD), microbiologic(positive stain/culture for acid fast-bacillus in ITB), radiologic(long segment involvement/comb sign/skip lesions common in CD; necrotic lymph node/contiguous ileocaecal involvement common in ITB), and serologic differences between CD and ITB, the only exclusive features are caseation necrosis on biopsy, positive smear for acid-fast bacillus(AFB) and/or AFB culture, and necrotic lymph node on cross-sectional imaging in ITB. However,these exclusive features are limited by poor sensitivity, and this has led to the development of multiple multi-parametric predictive models. These models are also limited by complex formulae, small sample size and lack of validation across other populations. Several new parameters have come up including the latest Bayesian meta-analysis, enumeration of peripheral blood T-regulatory cells, and updated computed tomography based predictive score. However, therapeutic anti-tubercular therapy(ATT) trial, and subsequent clinical and endoscopic response to ATT is still required in a significant proportion of patients to establish the diagnosis. Therapeutic ATT trial is associated with a delay in the diagnosis of CD, and there is a need for better modalities for improved differentiation and reduction in the need for ATT trial.
基金Supported by Grants from Indian Council of Medical Research,New Delhi and Council of Scientific and Industrial Research,New Delhi
文摘AIM: To assess the prognostic significance of cathepsin L, a cysteine protease that degrades the peri-tumoral tissue, in patients with pancreatic cancer.
文摘The article concentrates on the role of fluctuating parameters for removable population from the incubated class in a susceptible-incubated-infected model. The discrete analogous of this model is also investigated. Conditions for local asymptotic stability are derived for both the disease free and endemic cases. Numerical simulations are performed to validate the theoretical results.
基金AIIMS Intramural grant[No.F.8-539/A-539/2017/RS]AIIMS Ethical committee No.IEC-236/05.05.2017,RP-25/2017,dated 25 May 2017.
文摘Background:Helicobacter pylori infection has been associated with insulin resistance and non-alcoholic fatty liver disease(NAFLD).This study was done to evaluate the effect of H.pylori-eradication therapy(HPET)in patients with NAFLD compared to standard management therapy(SMT).Methods:Eighty NAFLD patients with H.pylori co-infection were randomized into SMT(diet and exercise,n=36)and HPET(SMT plus amoxicillin,clarithromycin,and pantoprazole,n=44)groups.The controlled attenuation parameter(CAP),anthropometric parameters,liver enzymes,lipid profile,and glycemic parameters including homeostasis model assessment-insulin resistance(HOMA-IR)were measured and compared between two groups at the baseline and 24 weeks.Results:Sixty-four participants(SMT group[n=28]and HPET group[n=36])were included in amodified intention-to-treat analysis.Both the SMT group and the HPET group had a significant reduction in CAP scores at 24weeks(P=0.002 and P<0.001,respectively),but the change between the groups was insignificant(P=0.213).Successful eradication of H.pylori occurred in 68%of the HPET group and led to greater improvement in HOMA-IR at 24weeks compared to SMT or non-responder patients(P=0.007).The liver enzymes reduced significantly at 24weeks in both groups,but the changes between the groups were similar.The lipid parameters remained unchanged within the groups and between the groups at 24weeks.A significant increase in the levels of reduced glutathione was noted in the HPET group,but the change between the two groups was not statistically different.Conclusions:HPET was found to be comparable to SMT alone in reducing hepatic steatosis and liver enzymes at 24 weeks in NAFLD patients.However,successful eradication of H.pylori led to greater improvement in HOMA-IR(Trial registration CTRI/2017/05/008608).
文摘Chronic hepatitis E virus(HEV)infection is increasingly being reported in immunosuppressed individuals with HIV,patients with haematological malignancy and transplant recipients.The diagnosis of cirrhosis and liver failure post chronic HEV is controversial due to lack of standard diagnostic criteria.The treatment benefits of ribavirin in chronic HEV of genotype 1 are not well reported.We report a case of chronic HEV infection of genotype 1 leading to chronic liver disease in a child cured of acute leukaemia.Our report also highlights the successful use of ribavirin for eradicating chronic HEV infection and its subsequent survival benefits.Chronic hepatitis E may be an emerging disease of immunosuppressed patients and should be suspected in the presence of cryptogenic transaminitis.Ribavirin is an effective therapy for controlling HEV.
