Jayanthi Venkataraman

NOD2 gene mutations associate weakly with ulcerative colitis but not with Crohn's disease in Indian patients with inflammatory bowel disease ☆

BACKGROUND Three mutations (two missense and one frameshift) in the NOD2 gene are associated with Crohns disease (CD) in a proportion of patients with Crohns disease in North America, Europe and Australia. These three mutations are not found in Indian patients with CD. We undertook new studies to identify polymorphisms in the NOD2 gene in the Indian population and to detect whether any of these were associated with inflammatory bowel disease (IBD) in this population. METHODS Individual exons of the NOD2 gene were amplified by PCR and subjected to denaturing high performance liquid chromatography (DHPLC) to detect heteroduplex formation. All 12 exons of the NOD2 gene were amplified and Sanger-sequenced to detect polymorphisms in the NOD2 gene. 310 patients with CD, 318 patients with ulcerative colitis (UC) and 442 healthy controls (HC) were recruited for association studies. DNA from these participants was evaluated for the identified eight polymorphisms by Sequenom analysis. RESULTS Heteroduplex formation was noted by DHPLC in exons 2 and 4 of the NOD2 gene. Sequencing of the entire NOD2 gene data revealed eight polymorphisms - rs2067085, rs2066842, rs2066843, rs1861759, rs2111235, rs5743266, rs2076753, and rs5743291 - of which the latter four were described for the first time in Indians. None of these polymorphisms was associated with CD. The SNPs rs2066842 and rs2066843 were in significant linkage disequilibrium. Both SNPs showed a significant association with UC (P=0.03 and 0.04 respectively; odds ratio 1.44 and 1.41 respectively). CONCLUSION Four NOD2 polymorphisms were identified for the first time in the Indian population. Of 8 NOD2 polymorphisms, none were associated with CD but two were weakly associated with UC. NOD2 polymorphisms do not play a major role in CD genesis in India.

Prevalence and risk factors for unsuspected spontaneous ascitic fluid infection in cirrhotics undergoing therapeutic paracentesis in an outpatient clinic

BackgroundSpontaneous bacterial peritonitis (SBP) has been typically described in hospitalized patients. There are little data on ascitic fluid infection in asymptomatic outpatients. The present study was aimed at determining the prevalence and risk factors for asymptomatic ascitic fluid infection among patients with liver cirrhosis attending an outpatient clinic.MethodsBetween January 2008 and December 2009, consecutive patients with cirrhosis (n = 110) undergoing therapeutic paracentesis in an outpatient setting were studied. Patients with fever, abdominal pain, hepatic encephalopathy, recent gastrointestinal bleeding, impaired renal function, previous history of SBP and on antibiotic treatment were excluded. Baseline demographic details, and etiology and severity of liver disease were recorded. Ascitic fluid cell count, culture and biochemical tests were done using standard laboratory techniques.ResultsThe causes of cirrhosis were alcohol (55.5%), hepatitis B (21.8%), hepatitis C (9.1%) and others (13.6%). A total of 278 paracenteses were done in them (average 2.5 [1.1] times per patient). Spontaneous ascitic fluid infection was found in 7 (2.5%) paracentesis, including spontaneous bacterial peritonitis in one (0.4%), monomicrobial nonneutrocytic bacterascites (MNB) in two (0.7%) and culture-negative neutrocytic ascites (CNNA) in four (1.4%). Escherichia coli, Klebsiella spp. and Staphylococcus aureus were grown. There was no difference between cirrhotic outpatients with and without infection in age, gender, alcohol consumption, etiology of cirrhosis, Child-Pugh score, serum albumin and ascitic fluid total protein. There was no death due to spontaneous ascitic fluid infection.ConclusionAsymptomatic ascitic fluid infection was very infrequent in patients with cirrhosis attending an outpatient clinic and undergoing therapeutic paracentesis.

Distinguishing tuberculosis and Crohn's disease in developing countries: How certain can you be of the diagnosis?

Distinguishing tuberculosis and Crohns disease in patients presenting with chronic abdominal pain and diarrhea is a huge diagnostic challenge, particularly in tuberculosis endemic countries. A large number of patients with Crohns disease are initially misclassified as having Intestinal tuberculosis in places where tuberculosis is endemic before they are treated for Crohns disease. Although a variety of endoscopic, radiological and histological criteria have been recommended for the differentiation, it often proves difficult in routine clinical practice. Future prospective studies are required in patients with granulomatous colitis to prevent unnecessary inappropriate anti tuberculous therapy for patients with Crohns disease and appropriate early treatment for a patient with tuberculosis.

Prevalence of hepatitis C virus antibodies in systemic lupus erythematosus.

Raimondo et al. [7] searched for HBV DNA in liver from 98 liver-disease-free individuals who underwent liver resection or needle biopsy during abdominal surgery. OBI was detected in 16 of the 98 cases (16.3%), and majority of OBI cases were seropositive. They concluded that about one in six of the Italian general population might be carriers of OBI. Taking together, the introduction of more sensitive tests and/or inclusion of liver samples revealed that OBI prevalence is really higher even in healthy participants.

Variceal recurrence, rebleeding rates and alterations in clinical and laboratory parameters following post‐variceal obliteration using endoscopic sclerotherapy

To study the rates of variceal recurrence and rebleeding following sclerotherapy and its effect on clinical and laboratory parameters in patients with portal hypertension.

Stomach carcinoma in the Indian subcontinent: A 16-year trend

BACKGROUND Gastric malignancy is one of the most common causes for cancer-related deaths. Reports from the west have shown a paradigm shift in the site of occurrence with malignancies of the gastric cardium increasing in frequency, reports which are contrary to information from the Middle East and South Asia. AIM To determine trend changes in distribution of gastric malignancy between 1989 and 2004 in the southern state of Tamil Nadu in India. MATERIALS AND METHODS The study period was divided into four cohorts of four years each (1989-1992, 1993-1996, 1997-2000 and 2001-2004) for the analysis of the changes in trend for subsite specificity, age and gender predilection. RESULTS Clinically, there were no significant differences in the presenting symptoms or physical signs in the four cohorts. The antrum was the most common site of predilection, no site-specific change was noted and males continued to be more commonly affected of the two sexes. Gastric cancer was significantly higher above the age of 40 years in all the four subsites and cohorts. A decrease in the mean age was observed for men with cancers of the esophagogastric junction (OGJ) (P < 0.0001) and the proximal stomach (P < 0.0001), while junctional malignancy (P < 0.0001), cancers of the proximal stomach (P < 0.0001) and the antrum (P = 0.03) tended to occur progressively later among women. CONCLUSION No change in site specificity or gender predilection for gastric adenocarcinoma has been noted in the past 16 years. However, a gender-dependent paradigm shift in the mean age of presentation is discernible for cancers involving the OGJ, proximal stomach and antrum.

Gastrointestinal Evaluation in Chronic Kidney Diseases

Background: Upper gastrointestinal (GI) symptoms are common in patients with severe chronic renal failure. The aim of this prospective study is to determine the prevalence of GI abnormalities and Helicobacter pylori (H. pylori) infection and assess the importance of GI evaluation among in pretransplantation with CKD patients Material and Methods: Between August 2008 and July 2010, 287 patients with CKD who were candidates for renal transplantation were included for the study. Endoscopic changes were described and multiple antral gastric biopsies were taken for detection of H. pylori infection. Gastric biopsy findings were compared to findings in 100 consecutive patients with normal renal function undergoing endoscopy for assessment of dyspepsia. Results: There were 197 males 90 females. The Mean age was 36.7 years. Duration of hemodialysis treatment prior to endoscopy was 17 ± 12.3 months. Symptoms of GI disturbance were found in 82(28.6%) of the 287 patients. In the 172 patients with endoscopic abnormalities, there were 49 asymptomatic and 123 symptomatic cases (P<0.001). Helicobacter pylori were present in 78 patients in the dialysis patients versus 29 in the control group. Conclusion: Upper GI abnormalities are common among CKD patients. Gastric erosions, esophagitis, antral erosion are common lesions in these patients. There is no association between patient symptoms and these lesions. There were no relation between H.pylori and symptoms. These patients should undergo endoscopic evaluation periodically and they should be treated prior to ultimate renal transplantation.

Recurrent abdominal pain in a 16-year-old girl.

A 16-year-old girl was admitted with acute onset of abdominal pain associated with vomiting. There was no abdominal distension, fever, jaundice or gastrointestinal bleeding. She had two similar episodes in the preceding 6 months. On examination, there was mild tenderness in the epigastrium. Her blood sugar, renal parameters, results of liver function tests and serum amylase were normal. The blood samples collected for analysis are shown in Figure 1. Upper gastrointestinal endoscopy was unremarkable.

Clinical predictors and gender-wise variations in dyssynergic defecation disorders

BackgroundThere is insufficient data from India regarding clinical predictors of dyssynergic defecation.AimTo identify demography, symptom, and colonoscopic parameters that can predict dyssynergic defecation (DD) among patients with chronic constipation (CC) and to compare the profile among male and female patients with DD.MethodsData collected from three centers during June 2014 to May 2017 included age, gender, symptom duration, form and consistency of stools, digital examination, colonoscopy, and anorectal manometry (ARM). Patients were grouped based on ARM diagnosis: group I (normal study) and group II (DD). The two groups were compared for demography, symptom profile, and colonoscopy findings. Gender-wise subset analysis was done for those with the normal and abnormal ARM using chi-square and unpaired t tests.ResultsOf 236 patients with CC evaluated, 130 (55%) had normal ARM and 106 (45%) had DD. Male sex, straining during defecation, bleeding per rectum, and abnormal colonoscopic diagnosis were significantly more common in group II. While bleeding per rectum and absence of urge to defecate were more common in males (p < 0.02), straining, digital evacuation, and hard stools were commoner in females with DD.ConclusionStraining during defecation, bleeding per rectum, and abnormal colonoscopy findings were more common in patients with DD. Symptoms of bleeding per rectum and absence of urge to defecate in men and straining during defecation in female patients were significantly associated with DD. Symptoms differ in males and females with DD.

An Insight into Antibiotic Resistance to Bacterial Infection in Chronic Liver Disease

Background End stage liver disease leads to immune dysfunction which predisposes to infection. There has been a rise in antibiotic resistant infections in these patients. There is scanty data f from India or idea regarding the same. Aim of the study The present study was undertaken to determine the type of infection acquired and the prevalence of antibiotic resistant infections in cirrhotic patients at a tertiary referral center in South India. Materials and methods In this retrospective study, all consecutive cirrhotic patients hospitalized between 2011 and 2013 with a microbiologically-documented infection were enrolled. Details of previous admission and antibiotics if received were noted. In culture positive infections, the source of infection (ascites, skin, respiratory tract: sputum/endotracheal tube aspirate, pleural fluid; urine and blood) and microorganisms isolated and their antibiotic susceptibility was noted. Results A total of 92 patients had 240 culture positive samples in the study period. Majority were Klebseilla followed by Escherichia coli and Enterococcus in nosocomial and health care associated infections. However, Enteroccocus was followed by E. coli and Klebsiella in community acquired infections. The antibiotic sensitivity pattern was analyzed for the major causative organisms such as E. coli, Klebsiella and Enterococcus. Most common resistant strains were extended spectrum beta lactamase producing enterobacteriacae (ESBL) followed by carbapenemase producing Klebsiella and methicillin resistant Staphylococcus aureus. Conclusion Noscomial infection is the most common type, with Klebsiella and E. coli and there is significant rise in ESBL producing organism.