Metabolic consequences following colonic resection in patients with Familial Adenomatous Polyposis [FAP]

Introduction: The colon is an active metabolic organ, and its removal leads to sodium depletion, chronic activation of the renin-angiotensin-aldosterone system (RAAS), hyperaldosteronism and abnormal glucose tolerance. Previous work has studied patients who have undergone colectomy for inflammatory bowel disease (IBD), so results may be confounded by the effects of inflammation and/or prior medication use. Patients with familial adenomatous polyposis (FAP) undergo prophylactic colectomy with ileorectal anastomosis (IRA), restorative proctocolectomy (RPC) or proctocolectomy with end-ileostomy (PPC), usually in their late teens. These patients do not have IBD and are usually not on medication, thus providing a better group to study. Aims: The aim of the work in this thesis was to determine the prevalence of metabolic disturbances following colectomy in patients with FAP, and to evaluate the efficacy of oral rehydration therapy (ORT) in correcting and preventing these metabolic disturbances. Methods: This thesis comprises three clinical studies of patients with FAP who had undergone colectomy, using validated questionnaires and diaries (food and bowel habit symptom diaries), clinical and biochemical data (one observational study and two single-blinded, placebo-controlled randomised trials). This thesis also describes the immunohistochemistry findings related to small intestinal adaptation following colectomy. Findings: Nearly half of our patients (47%) demonstrated activation of RAAS post colectomy with increased plasma aldosterone values, a state of dehydration and poor quality of life. ORT reversed these metabolic disturbances leading to a positive impact on the quality of life. Incorporating ORT in the standard post-operative care plan resulted in prevention of RAAS activation. Conclusions: Metabolic disturbances are common following colectomy. ORT forms a safe, efficient and cost-effective treatment strategy to restore the metabolic homeostasis and also prevent metabolic disturbances if incorporated from the immediate post-operative period.Open Acces

Risk Assessment in Specialised Home gardens of Kerala

Home gardens have emerged as the best agricultural production system in Kerala due to limiting land availability and the shrinking operational land unit. Time and act of commercialization have transformed the homegardens to more diversified and specialized home gardens. A critical study of risks in the specialized homegarden production systems is the need of the hour to enhance its productivity. This paper analyses the various risk factors in home gardens

Models and Potentials in Hadron Spectroscopy

In the past twenty years, hadron spectroscopy has made immense progress. Experimental facilities have observed different multiquark states during these years. There are different models and phenomenological potentials to study the nature of interquark interaction. In this work, we have reviewed different quark potentials and models used in hadron spectroscopy.Comment: 35 pages, 1 figur

Dermatomyositis And Polymyositis

Idiopathic inflammatory myositis (IIM) is classified into 4 subtypes based on clinical and histopathological features. Polymyositis and dermatomyositis (PM/DM) are 2 of those subtypes in addition to immune-mediated necrotizing myopathy and inclusion body myositis. The presence of autoantibodies and inflammatory infiltration in the muscles suggests that idiopathic inflammatory myositis is an autoimmune condition, but the target autoantigens have not yet been identified. Apart from symmetric proximal muscle weakness, polymyositis and dermatomyositis have several clinical manifestations in common when compared to inclusion body myositis and necrotizing myopathy and can be grouped for discussion. The most commonly used criteria for PM/DM are Peter/Bohan Criteria.[1]: 1. Symmetric proximal muscle weakness. 2. Elevated serum muscle enzymes. 3. Myopathic changes in electromyography (EMG). 4. Characteristic muscle biopsy abnormalities. 5. Typical rash of dermatomyositis for diabetes mellitus