A Study of Spink 1 Mutation and other clinical correlates in idiopathic recurent acute pancreatitis and idiopathic chronic pancreatitis.

INTRODUCTION : Recurrent acute pancreatitis and chronic pancreatitis are labeled as idiopathic when no identifiable factors are found. The identifications of genetic mutations associated with pancreatitis have provided opportunities for identifying patients at risk for idiopathic pancreatitis. Recurrent pancreatitis is defined as two or more attacks of pancreatitis and chronic pancreatitis is defined as a continuing inflammatory disease of the pancreas characterized by irreversible morphological changes and typically causing pain and permanent loss of function. Many studies have been conducted on acute and chronic pancreatitis, but only few have focused on idiopathic chronic and recurrent acute pancreatitis. In clinical practice evaluation fails to detect the cause of pancreatitis in 10 – 30% of the patients, and these patients are labeled as idiopathic chronic and recurrent acute (RAP) pancreatitis. Evaluation is important in such patients since more than 50% of patients with RAP experience recurrent episodes that can lead to chronic pancreatitis. Very few studies have been conducted on idiopathic recurrent acute pancreatitis. RAP can be due to biliary disease, alcohol, trauma, hypercalcemia, hyperlipedemia, or anatomical variations. In clinical practice upto 30% do not have identificable factors and are labeled as idiopathic recurrent pancreatitis. AIM: To study of clinical profile and prevalence of SPINK 1 mutation in idiopathic recurrent acute and chronic pancreatitis. DESIGN: Prospective observational study of patients with idiopathic recurrent and chronic pancreatitis in a tertiary care hospital from November 2010 to 31st December 2011. RESULTS: Fifty patients were included out which 17 patients were idiopathic recurrent acute pancreatitis and 33 were chronic. Out of 17 patients with RAP mean age was 22.29 ± 9.7 years, duration of illness was 28.23 ± 10.34 months, 82% were male, 94% had BMI > 18.5 kg/ m2 41.17% had SPINK1 mutation. Out of 33 patients with chronic pancreatitis mean age was 31.75 ± 13.07 year, duration of illness was 31.33 ± 19.89 months, mean fasting sugar was 112.57 mg/dl, 67% were male, 93.94% had pain 87.8% had ductal dilatation on CT, 36.36% were SPINK 1 positive. CONCLUSION: SPINK1 mutation patients have more frequent episodes of pancreatitis and parenchymal calcification on CT. The clinical profile of idiopathic chronic pancreatitis is different fromwhat has been reported in the past

Bacterial infections in cirrhosis - does standard empirical therapy need a rethink?

Background: Patients with cirrhosis not only have a higher incidence and a greater severity of infections but infections increase the mortality and morbidity in cirrhosis. Third-generation cephalosporins and quinolones are currently the most commonly recommended first-line empirical therapy in most infections. This study was conducted to study the bacterial etiology, susceptibility of these organisms to these commonly used antibiotics.Methods: All patients of cirrhosis of liver admitted to a tertiary care centre underwent cultures from blood, urine and ascitic fluid and the incidence of infection was calculated. Sensitivity pattern of organisms to third generation cephalosporins and quinolones were studied.Results: A total of 150 patients were included in the study and 58 (37.8%) of them had one or more infections. Spontaneous bacterial peritonitis was the most common infection noted and gram-negative bacilli (E. coli) were the commonest organisms isolated. The overall response rate to quinolones and third generation cephalosporin’s was only 47%.Conclusions: Increasing use of antibiotics in empirical role has increased resistance to commonly used antibiotics. Empirical therapy should be decided based upon local epidemiological patterns and the same cannot be generalized

Thalidomide induced xerosis: an unwanted reaction

A 59-year-old male exhibited anemia for evaluation. Endoscopy was diagnostic of gastric antral vascular ectasia. He was given a trial of thalidomide after informing about the adverse effects. After starting thalidomide at 100 mg/day, his hemoglobin (Hb) improved. Post 1 month of therapy his Hb normalized, but he developed xerosis. He was given symptomatic treatment, but did not improve. Thalidomide was suspected to cause xerosis, it was discontinued for a month and post-discontinuation of drug he is symptom free for past 8 months. This paper reports a rare case of thalidomide induced xerosis with dermatological and neurological involvement

Quality of life in dyspepsia and its subgroups using EQ-5D (EuroQol) questionnaire

Background/Aim: Dyspepsia has a significant impact on the quality of life. Health-related quality of life (HRQoL) can be assessed by disease-specific and generic HRQoL instruments. The present study evaluated HRQoL and compared it among dyspepsia subgroups by using EQ (Euro QoL)-5D questionnaire. Patients and Methods: Patients with abnormal findings on upper gastrointestinal endoscopy were classified to have organic dyspepsia, whereas those with normal endoscopy were classified as functional dyspepsia if they met the ROME III criteria or as endoscopy negative recent dyspepsia if symptom duration was <6 months. HRQoL was assessed using the EQ-5D questionnaire, and the overall health status on a visual analogue scale (VAS); and the frequency of impairment in each dimension were compared between the dyspepsia subgroups. Results: The overall health status was affected equally in all three dyspepsia subgroups. Impairment in HRQoL was commonly seen in the dimensions of pain (98.4%), usual activities (66.20%), and anxiety/depression (70.60%), however, much less so in mobility (22.70%) and self-care (10.9%). Any impairment in HRQoL was not significantly different between the three subgroups in the dimensions of mobility and usual activities. Self-care was more commonly affected in organic dyspepsia, anxiety/depression was more common with functional dyspepsia, while pain, though significantly different among various subgroups, was very common in all three subgroups. Conclusion: HRQoL was equally affected in all three subgroups of dyspepsia but variably so in the different domains of EQ-5D. These differences need to be studied further to improve the management of different etiological subgroups of dyspepsia

Hereditary hemorrhagic telangiectasia

Background: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder, which affects various internal organs and has a tendency for bleeding. It has a classic triad of mucocutaneous telangiectasias, recurrent hemorrhages and positive familial history of first-degree relative. Epistaxis or gastrointestinal telangiectasia can be fatal in a small number of cases. Case Report: A 44-year-old woman came with complaints of recurrent episodes of hematemesis and epistaxis. Patient had a family history of similar complaints. Patient underwent esophagogastroduodenoscopy (EGD), which revealed telangiectasia in the stomach. Imaging of the abdomen showed features suggestive of arteriovenous shunting. Conclusion: HHT can remain undiagnosed for a long time, and is rarely being reported in the literature with management needing a multidisciplinary approach with early inputs from a gastroenterologist

A study to correlate carotid intima thickness by B-mode ultrasonography in patients documented with coronary artery disease

Aim of the study: To study the IMT of the common carotid arteries and correlate with documented coronary artery disease. Patients and Methods: The study was conducted in subjects with history of coronary artery disease in the past and who presented with acute coronary syndrome. After detailed history and examination, investigations were carried out as per our protocol. The sample size was 100, with 70 in the case group and 30 in the control group (matched).B-mode ultrasonography scanning of the carotid arteries was performed and measurements were made at proximal, middle and distal segments of the common carotid arteries. Univariate analysis was used to confirm the significance of the variables and multiple regressions were used to predict the risk, based on significant variables. Results: The total study sample consisted of 100 subjects, of whom 70 were cases and 30 were controls. The case group comprised of a total of 70 patients with a mean age of 58.72 years. In the control group of 30 patients, the mean age was 62.73 years. In the study group, 77.1% (n=54) were males and 22.9% (n=16) were females. In the study group, 51.4% (n=36) were smokers compared with 13.3% (n=4) among the control group (P=0.001 vhs). In the study group, 20% (n=14) had diabetes while this was 13.3% (n=4) among the control group. In the study group, 52.96% (n=37) had hypertension while 16.7% (n=5) had hypertension in the control group (P=0.001 vhs). The mean total cholesterol among the study group was 197.4mg/dl while in the control group it was 175.9 mg/dl. Thirty-two percent of the patients with CAD had anterior lateral wall ischemia, 21% had anterior wall, 21% lateral wall, 19% inferior wall and 7% unstable angina. The mean carotid IMT in the study group was 0.923 ± 0.123 and in control group it was 0.689 ± 0.051 (P=0.001). The mean carotid intima thickness was significantly high in the case group as compared with the control, and the P-value was highly significant. Conclusion: The carotid IMT was found to be higher in patients with coronary artery disease, and there was a statistically significant difference between cases and controls. Thus, our study shows that carotid IMT is a marker of atherosclerosis that is strongly associated with risk factors and can be used as a surrogate marker in the prediction of atherosclerosis in coronary artery disease. As it is easily reproducible, carotid B-mode ultrasonography is a safe, non-invasive and reproducible procedure that helps in the early identification of clinical coronary artery disease