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Singh AK, Sachdeva S, Chittem R, Dalal A. Role of Biliary Stenting After Stone Clearance in Patients Awaiting Cholecystectomy: The Jury Is Still Out! Am J Gastroenterol 2024:00000434-990000000-01038. [PMID: 38372294 DOI: 10.14309/ajg.0000000000002587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Affiliation(s)
- Alok Kumar Singh
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
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Affiliation(s)
- Shrey Bhatt
- Department of Gastroenterology, G B Pant Hospital, J L N Marg, New Delhi, 110 001, India
| | - Ajay Kumar
- Department of Gastroenterology, G B Pant Hospital, J L N Marg, New Delhi, 110 001, India
| | - Ashok Dalal
- Department of Gastroenterology, G B Pant Hospital, J L N Marg, New Delhi, 110 001, India
| | - Ujjwal Sonika
- Department of Gastroenterology, G B Pant Hospital, J L N Marg, New Delhi, 110 001, India.
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Singh AK, Srivastava S, Sonika U, Sachdeva S, Aneesh P, Kumar A, Sharma BC, Dalal A. Motorized Power Spiral Enteroscopy (MSE): Is Routine Bougienage of the Upper Esophageal Sphincter (UES) Necessary? Cureus 2024; 16:e52342. [PMID: 38361713 PMCID: PMC10867537 DOI: 10.7759/cureus.52342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction Wire-guided bougienage of the upper esophageal sphincter (UES) was performed routinely before per-oral motorized power spiral enteroscopy (MSE). In the present study, we aimed to answer the clinical question of whether routine bougienage of UES is required. Methods This was a retrospective study that included 20 patients who underwent antegrade spiral enteroscopy for various indications. The feasibility and safety of anterograde MSE without prior bougie dilatation of the upper esophageal sphincter were assessed. The technical success rate (TSR), diagnostic yield, and adverse events (AEs) were also assessed. Results In 16 out of the 20 patients, a spiral enteroscope was taken directly across UES into the esophagus without a prior bougie dilatation. The spiral enteroscope could not be negotiated across UES only in one patient, and bougie dilatation was done. The technical success rate was 100%. The diagnostic yield was 80%. Four patients reported AEs. Conclusions MSE had a good technical success rate and diagnostic yield. Routine dilatation of the UES before the procedure may be unnecessary.
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Affiliation(s)
- Alok Kumar Singh
- Gastroenterology and Hepatology, G.B. Pant Hospital, New Delhi, IND
| | | | - Ujjwal Sonika
- Gastroenterology and Hepatology, G.B. Pant Hospital, New Delhi, IND
| | - Sanjeev Sachdeva
- Gastroenterology and Hepatology, G.B. Pant Hospital, New Delhi, IND
| | - Payila Aneesh
- Gastroenterology and Hepatology, G.B. Pant Hospital, New Delhi, IND
| | - Ajay Kumar
- Gastroenterology and Hepatology, G.B. Pant Hospital, New Delhi, IND
| | - Barjesh C Sharma
- Gastroenterology and Hepatology, G.B. Pant Hospital, New Delhi, IND
| | - Ashok Dalal
- Gastroenterology and Hepatology, G.B. Pant Hospital, New Delhi, IND
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Pandey T, Sonika U, Dalal A, Kumar A, Palle SH, Gera R, Choudhary H, Sachdeva S, Srivastava S, Sharma BC. Quality of life and nutritional status of patients with refractory or recurrent corrosive-induced esophageal strictures on long-term endoscopic dilation. Indian J Gastroenterol 2023:10.1007/s12664-023-01484-z. [PMID: 38044358 DOI: 10.1007/s12664-023-01484-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Affiliation(s)
- Toshali Pandey
- Department of Gastroenterology, Maulana Azad Medical College, New Delhi, 110 002, India
| | - Ujjwal Sonika
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, Room No. 209 Academic Block, Jawahar Lal Nehru Marg, New Delhi, 110 002, India.
| | - Ashok Dalal
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, Room No. 209 Academic Block, Jawahar Lal Nehru Marg, New Delhi, 110 002, India
| | - Ajay Kumar
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, Room No. 209 Academic Block, Jawahar Lal Nehru Marg, New Delhi, 110 002, India
| | - Sri Harsha Palle
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, Room No. 209 Academic Block, Jawahar Lal Nehru Marg, New Delhi, 110 002, India
| | - Raghav Gera
- Department of Gastroenterology, Maulana Azad Medical College, New Delhi, 110 002, India
| | - Harshita Choudhary
- Department of Gastroenterology, Maulana Azad Medical College, New Delhi, 110 002, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, Room No. 209 Academic Block, Jawahar Lal Nehru Marg, New Delhi, 110 002, India
| | - Siddharth Srivastava
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, Room No. 209 Academic Block, Jawahar Lal Nehru Marg, New Delhi, 110 002, India
| | - Barjesh Chander Sharma
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, Room No. 209 Academic Block, Jawahar Lal Nehru Marg, New Delhi, 110 002, India
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Sachdeva S, George R, Dalal A, Kumar A. Paraneoplastic pseudoachalasia: A rare manifestation of Hodgkin's lymphoma. Indian J Gastroenterol 2023; 42:852-854. [PMID: 37067691 DOI: 10.1007/s12664-022-01302-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Affiliation(s)
- Sanjeev Sachdeva
- Department of Gastroenterology, G B Pant Hospital, University of Delhi, New Delhi, 110 002, India.
| | - Roshan George
- Department of Gastroenterology, G B Pant Hospital, University of Delhi, New Delhi, 110 002, India
| | - Ashok Dalal
- Department of Gastroenterology, G B Pant Hospital, University of Delhi, New Delhi, 110 002, India
| | - Ajay Kumar
- Department of Gastroenterology, G B Pant Hospital, University of Delhi, New Delhi, 110 002, India
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Singh AK, Sachdeva S, Srivastava S, Sonika U, Kumar A, Sharma BC, Puri AS, Dalal A. Comparing Myelosuppression Frequency in Indian Inflammatory Bowel Disease Patients: A Randomized Trial of Full Dose Versus Gradual Escalation of Thiopurines. Cureus 2023; 15:e50969. [PMID: 38259414 PMCID: PMC10801346 DOI: 10.7759/cureus.50969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION We aimed to compare the frequency of myelosuppression in patients initiating azathioprine (AZA) at full dose versus those undergoing gradual dose escalation. METHODS Forty patients with inflammatory bowel disease were recruited over one year and randomized into two groups of 20. Group A initiated AZA at a full dose of 2 mg/kg, while group B started at 1 mg/kg with subsequent dose increases at regular intervals. RESULTS Seventeen patients from each group were included in the final analysis. During follow-up, two patients (11.8%) from group A and four patients (23.5%) from group B experienced relapses (p=0.65). Myelosuppression occurred in two patients (11.8%) from each group. Absolute neutrophil counts in group A tended to have lower median values than those in group B, particularly four weeks after AZA initiation. Univariate analysis identified serum proteins, albumin, and bilirubin as significantly associated with leukopenia, but these factors were not significant according to multivariate analysis. CONCLUSIONS The incidence of myelosuppression was similar between the groups. Patients with full-dose initiation of AZA had numerically fewer relapses during the follow-up period.
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Affiliation(s)
- Alok Kumar Singh
- Department of Gastroenterology, G.B. Pant Hospital, New Delhi, IND
| | - Sanjeev Sachdeva
- Department of Gastroenterology, G.B. Pant Hospital, New Delhi, IND
| | | | - Ujjwal Sonika
- Department of Gastroenterology, G.B. Pant Hospital, New Delhi, IND
| | - Ajay Kumar
- Department of Gastroenterology, G.B. Pant Hospital, New Delhi, IND
| | - Barjesh C Sharma
- Department of Gastroenterology, G.B. Pant Hospital, New Delhi, IND
| | - Amarender S Puri
- Department of Gastroenterology, Medanta - The Medicity Hospital, Gurugram, IND
| | - Ashok Dalal
- Department of Gastroenterology, G.B. Pant Hospital, New Delhi, IND
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Sharma BC, Maharshi S, Sachdeva S, Mahajan B, Sharma A, Bara S, Srivastava S, Kumar A, Dalal A, Sonika U. Nutritional therapy for persistent cognitive impairment after resolution of overt hepatic encephalopathy in patients with cirrhosis: A double-blind randomized controlled trial. J Gastroenterol Hepatol 2023; 38:1917-1925. [PMID: 37354045 DOI: 10.1111/jgh.16266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/27/2023] [Accepted: 06/06/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND AND AIM Minimal hepatic encephalopathy (MHE) reflects cognitive impairment in patients with liver cirrhosis and is associated with poor prognosis. We assessed the effects of nutritional therapy on cognitive functions, health-related quality of life (HRQOL), anthropometry, endotoxins, and inflammatory markers in cirrhotic patients with MHE. METHODS In a double-blind randomized controlled trial, cirrhotic patients with MHE were randomized to nutritional therapy (group I: 30-35 kcal/kg/day and 1.0-1.5 g of protein/kg/day) and no nutritional therapy (group II: diet as patients were taking before) for 6 months. MHE was diagnosed based on psychometric hepatic encephalopathy score (PHES). Anthropometry, ammonia, endotoxins, inflammatory markers, myostatin, and HRQOL were assessed at baseline and after 6 months. Primary endpoints were improvement or worsening in MHE and HRQOL. RESULTS A total of 150 patients were randomized to group I (n = 75, age 46.3 ± 12.5 years, 58 men) and group II (n = 75, age 45.2 ± 9.3 years, 56 men). Baseline PHES (-8.16 ± 1.42 vs -8.24 ± 1.43; P = 0.54) was comparable in both groups. Reversal of MHE was higher in group I (73.2% vs 21.4%; P = 0.001) than group II. Improvement in PHES (Δ PHES 4.0 ± 0.60 vs -4.18 ± 0.40; P = 0.001), HRQOL (Δ Sickness Impact Profile 3.24 ± 3.63 vs 0.54 ± 3.58; P = 0.001), anthropometry, ammonia, endotoxins, cytokines, and myostatin levels was also significantly higher in group I than group II. Overt hepatic encephalopathy developed in 6 patients in group I and 13 in group II (P = 0.04). CONCLUSIONS Nutritional therapy is effective in treatment of MHE and associated with improvement in nutritional status, HRQOL, ammonia, endotoxins, inflammatory markers, and myostatin levels.
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Affiliation(s)
| | | | - Sanjeev Sachdeva
- Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India
| | - Bhawna Mahajan
- Department of Biochemistry, G.B. Pant Hospital, New Delhi, India
| | - Ashok Sharma
- Department of Radiology, G.B. Pant Hospital, New Delhi, India
| | - Sushma Bara
- Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India
| | | | - Ajay Kumar
- Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India
| | - Ashok Dalal
- Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India
| | - Ujjwal Sonika
- Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India
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Sachdeva S, Vaithiyam VS, Srivastava S, Dalal A. Endoscopic ultrasound related partial splenic artery embolization: A gifted outcome. Indian J Gastroenterol 2023; 42:734-735. [PMID: 36719542 DOI: 10.1007/s12664-022-01301-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Sanjeev Sachdeva
- Department of Gastroenterology, G B Pant Hospital, New Delhi, 110 002, India.
| | | | | | - Ashok Dalal
- Department of Gastroenterology, G B Pant Hospital, New Delhi, 110 002, India
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George R, Sonika U, Mahajan B, Sharma A, Dalal A, Sachdeva S, Kumar A. Diagnostic utility of urine neutrophil gelatinase-associated lipocalin and renal resistive index in patients of decompensated cirrhosis with acute kidney injury. Dig Liver Dis 2023; 55:1230-1235. [PMID: 37244788 DOI: 10.1016/j.dld.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/18/2023] [Accepted: 03/10/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND The differentiation between types of acute kidney injury(AKI) in decompensated cirrhosis(DC) patients in clinical practice is done by clinical adjudication. Biomarkers have good diagnostic accuracy for predicting acute tubular necrosis(ATN), however they are not available routinely. AIMS We compared the diagnostic accuracy of urine neutrophil gelatinase-associated lipocalin(UNGAL) and renal resistive index(RRI) in predicting type of AKI among DC patients. METHODS Consecutive DC patients with AKI stage≥1B seen between June/2020 to May/2021 were evaluated. UNGAL levels and RRI were measured at diagnosis of AKI(Day 0) and 48hrs(Day 3) after volume expansion. Diagnostic accuracy of UGNAL and RRI was compared for differentiating ATN and non-ATN AKI by area under receiver operating characteristic curve(AUROC), using clinical adjudication as gold standard. RESULTS 388 DC patients were screened, 86 patients(Pre-renal AKI[PRA] n=47,55%; Hepatorenal syndrome[HRS] n=25,29%;ATN n= 14,16%) were included. The AUROC of UNGAL for differentiating ATN-AKI and non-ATN AKI at day 0 was 0.97(95%CI, 0.95-1.0) and on day 3 was 0.97(95%CI, 0.94-1.0). The AUROC of RRI for differentiating ATN and non-ATN AKI at day 0 was 0.68(95%CI, 0.55-0.80) and on day 3 was 0.74(95%CI, 0.63-0.84). CONCLUSION UNGAL has an excellent diagnostic accuracy in predicting ATN-AKI in DC patients both at day 0 and 3.
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Affiliation(s)
- Roshan George
- Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, 110002 New Delhi, India
| | - Ujjwal Sonika
- Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, 110002 New Delhi, India
| | - Bhawna Mahajan
- Department of Biochemistry, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, 110002 New Delhi, India
| | - Ashok Sharma
- Department of Radiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, 110002 New Delhi, India
| | - Ashok Dalal
- Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, 110002 New Delhi, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, 110002 New Delhi, India
| | - Ajay Kumar
- Department of Gastroenterology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, 110002 New Delhi, India.
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Vengurlekar D, Walker C, Mahajan R, Dalal A, Chavan V, Galindo MA, Iyer A, Mansoor H, Silsarma A, Isaakidis P, Spencer H. Linezolid resistance in patients with drug-resistant TB. Int J Tuberc Lung Dis 2023; 27:567-569. [PMID: 37353865 DOI: 10.5588/ijtld.22.0632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023] Open
Affiliation(s)
- D Vengurlekar
- Médecins Sans Frontières (MSF) Operational Centre Brussels, Mumbai, India
| | - C Walker
- MSF Operational Centre Brussels, Southern Africa Medical Unit, Cape Town, South Africa, MSF Luxembourg Operational Research Unit (LuxOR), Luxembourg, Luxembourg
| | - R Mahajan
- MSF Operational Centre Barcelona-Athens, New Delhi, India
| | - A Dalal
- Jupiter Hospital, Mumbai, India
| | - V Chavan
- Médecins Sans Frontières (MSF) Operational Centre Brussels, Mumbai, India
| | - M A Galindo
- Médecins Sans Frontières (MSF) Operational Centre Brussels, Mumbai, India
| | - A Iyer
- Médecins Sans Frontières (MSF) Operational Centre Brussels, Mumbai, India
| | - H Mansoor
- Médecins Sans Frontières (MSF) Operational Centre Brussels, Mumbai, India
| | - A Silsarma
- Médecins Sans Frontières (MSF) Operational Centre Brussels, Mumbai, India
| | - P Isaakidis
- MSF Operational Centre Brussels, Southern Africa Medical Unit, Cape Town, South Africa, Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - H Spencer
- MSF Operational Centre Brussels, Southern Africa Medical Unit, Cape Town, South Africa
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Sachdeva S, Kumbar C, Lone S, Dalal A, Goyal S. Fungating umbilical nodule in gastric carcinoma. Indian J Gastroenterol 2023:10.1007/s12664-023-01392-2. [PMID: 37378807 DOI: 10.1007/s12664-023-01392-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Affiliation(s)
- Sanjeev Sachdeva
- Department of Gastroenterology, G B Pant Hospital, University of Delhi, New Delhi, 110 002, India.
| | - Chidanand Kumbar
- Department of Gastroenterology, G B Pant Hospital, University of Delhi, New Delhi, 110 002, India
| | - Shabir Lone
- Department of Gastroenterology, G B Pant Hospital, University of Delhi, New Delhi, 110 002, India
| | - Ashok Dalal
- Department of Gastroenterology, G B Pant Hospital, University of Delhi, New Delhi, 110 002, India
| | - Surbhi Goyal
- Department of Pathology, G B Pant Hospital, University of Delhi, New Delhi, 110 002, India
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Pandey T, Sonika U, Dalal A, Kumar A, Gera R, Choudhary H, Sachdeva S, Srivastava S, Sharma BC. Validity and Reliability of the European Organization Research and Treatment of Cancer Quality of Life Questionnaire-Oesophagogastric 25 in Indian Patients With Corrosive-Induced Benign Refractory Esophageal Strictures. Cureus 2023; 15:e37190. [PMID: 37159769 PMCID: PMC10163362 DOI: 10.7759/cureus.37190] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 04/09/2023] Open
Abstract
Background The European organization Research and Treatment of Cancer Quality of Life Questionnaire-Oesophagogastric 25 (EORTC QLQ-OG 25) is designed for patients with esophagogastric cancer. Its performance has never been tested with benign disorders. A health-related quality-of-life questionnaire does not exist for patients with benign corrosive-induced esophageal strictures. Hence, we evaluated the EORTC QLQ-OG 25 in Indian patients with corrosive strictures. Methods The English or Hindi version of QLQ-OG 25 was administered to 31 adult patients undergoing outpatient esophageal dilation at GB Pant hospital, New Delhi. These patients had refractory or recurrent esophageal strictures due to corrosive ingestion and had not undergone reconstructive surgery. Score distribution was analyzed, and item performance was determined based on floor and ceiling effects. Convergent validity, discriminant validity, and internal consistency were checked. Results The average time to finish the questionnaire was 6.70 minutes. Most scales fulfilled convergent validity (corrected item-total correlation >0.4), barring the Odynophagia scale and one item of the Dysphagia scale. Most scales exhibited divergent validity except for odynophagia and one item of dysphagia. Cronbach's alpha was >0.70 for all scales except odynophagia. Responses to questions evaluating taste, cough, swallowing saliva, and talking were highly skewed and had prominent floor effects. Overall, the questionnaire demonstrated good internal consistency, convergent validity, and divergent validity in benign corrosive-induced refractory esophageal strictures patients. Conclusion The EORTC QLQ-OG 25 can be satisfactorily used in patients with benign esophageal strictures to assess health-related quality of life.
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Ahuja H, Sharma BC, Sachdeva S, Mahajan B, Sharma A, Bara S, Srivastava S, Kumar A, Dalal A, Sonika U. A double blind randomized controlled trial to assess efficacy of nutritional therapy for prevention of recurrence of hepatic encephalopathy in patients with cirrhosis. J Gastroenterol Hepatol 2023; 38:433-440. [PMID: 36574769 DOI: 10.1111/jgh.16096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/05/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIM Overt hepatic encephalopathy (OHE) has high risk of recurrence and is associated with poor survival. The role of nutrition therapy is well documented in cirrhosis, but its efficacy in preventing the recurrence of OHE has not been studied. METHODS In double blind RCT, we randomly assigned 150 patients with liver cirrhosis, with history of OHE in recent past to receive nutrition therapy (group I) or no nutrition therapy (group II) and followed up for 6 months. The primary efficacy end points were occurrence of breakthrough episodes and time to breakthrough episode of OHE. Secondary end points were OHE related hospitalizations and time to hospitalization involving OHE. Other parameters included anthropometry, changes in serum cytokines (IL-1, IL-6, IL-10, and TNF-α), endotoxin and myostatin. RESULTS There was significant reduction in occurrence of breakthrough episodes of OHE in group I [10 vs 36, hazard ratio 0.20; P < 0.001], OHE-related hospitalization [8 vs 24, hazard ratio 0.27; P < 0.001)]. Times to breakthrough episode of OHE and OHE-related hospitalization were longer in group I. At the end of 6 months, inflammatory and anthropometry parameters showed significant improvement in group I compared with worsening of serum albumin, anthropometric parameters, IL-6, IL-10 and TNF-α in group II. At the end of 6 months, ascites (50 vs 66, P = 0.01), gastrointestinal bleed (2 vs 11, P = 0.007), and jaundice (16 vs 41, P < 0.001) were lower in group I. CONCLUSIONS Treatment with nutrition therapy prevented recurrence of OHE and decreased OHE-related hospitalizations as compared with no nutrition therapy.
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Affiliation(s)
- Hardik Ahuja
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | | | - Sanjeev Sachdeva
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Bhawna Mahajan
- Department of Biochemistry, GB Pant Hospital, New Delhi, India
| | - Ashok Sharma
- Department of Radiology, GB Pant Hospital, New Delhi, India
| | - Sushma Bara
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | | | - Ajay Kumar
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Ashok Dalal
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Ujjwal Sonika
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
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Kumar M, Sonika U, Sachdeva S, Dalal A, Narang P, Mahajan B, Singhal A, Srivastava S. Natural History of Asymptomatic Walled-off Necrosis in Patients With Acute Pancreatitis. Cureus 2023; 15:e34646. [PMID: 36895535 PMCID: PMC9990741 DOI: 10.7759/cureus.34646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 02/07/2023] Open
Abstract
Background and objectives Studies on the natural history of asymptomatic walled-off necrosis (WON) in acute pancreatitis (AP) are scarce. We conducted a prospective observational study to look for the incidence of infection in WON. Material and methods In this study, we included 30 consecutive AP patients with asymptomatic WON. Their baseline clinical, laboratory, and radiological parameters were recorded and followed up for three months. Mann Whitney U test and unpaired t-tests were used for quantitative data and chi-square and Fisher's exact tests were used for qualitative data analysis. A p-value <0.05 was considered significant. Receiver operating characteristic curve (ROC) analysis was done to identify the appropriate cutoffs for the significant variables. Results Of the 30 patients enrolled, 25 (83.3%) were males. Alcohol was the most common etiology. Eight patients (26.6%) developed an infection on follow-up. All were managed by drainage either percutaneously (n=4, 50%) or endoscopically (n=3, 37.5%). One patient required both. No patient required surgery and there was no mortality. Median baseline C-reactive protein (CRP) was higher in infection group 76 (IQR=34.8) mg/L vs asymptomatic group, 9.5 mg/dl (IQR=13.6), p<0.001. IL-6 and tumor necrosis factor (TNF)-alpha was also higher in the infection group. The size of the largest collection (157.50±33.59 mm vs 81.95±26.22 mm, P<0.001) and CT severity index (CTSI) (9.50±0.93 vs 7.82±1.37, p<0.01) were also higher in infection group as compared to the asymptomatic group. ROC curve analysis of baseline CRP (cutoff 49.5mg/dl), size of WON (cutoff 127mm) and CTSI (cutoff of 9) showed AUROC (area under ROC) of 1, 0.97, and 0.81 respectively for the future development of infection in WON. Conclusion Around one-fourth of asymptomatic WON patients developed an infection during three-months follow-up. Most patients with infected WON can be managed conservatively.
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Affiliation(s)
- Manish Kumar
- Gastroenterology, Govind Ballabh Pant Hospital, New Delhi, IND
| | - Ujjwal Sonika
- Gastroenterology, Govind Ballabh Pant Hospital, New Delhi, IND
| | | | - Ashok Dalal
- Gastroenterology, Govind Ballabh Pant Hospital, New Delhi, IND
| | - Poonam Narang
- Radiology, Govind Ballabh Pant Hospital, New Delhi, IND
| | - Bhawna Mahajan
- Biochemistry, Govind Ballabh Pant Hospital, New Delhi, IND
| | - Ankush Singhal
- Biochemistry, Govind Ballabh Pant Hospital, New Delhi, IND
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15
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Chieng CY, Dalal A, Ilankovan V. Occupational exposure and risk of oral and oropharyngeal squamous cell carcinoma: systematic review and 25-year retrospective cohort study of patients. Br J Oral Maxillofac Surg 2023; 61:39-48. [PMID: 36443129 DOI: 10.1016/j.bjoms.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/23/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
Social habits such as smoking and drinking alcohol are well-known causative agents for oral and oropharyngeal squamous cell carcinoma (OSCC/OPSCC). Human papillomavirus (HPV) is a known causative agent for OPSCC. However, we often encounter patients with no identifiable risk factors. There is growing evidence of the role of occupational carcinogens in the pathogenesis of oral cancer. The aim of this study therefore was to identify any occupational carcinogens linked to oral cancer. We carried out a systematic review of the literature using PubMed, EMBASE, and Medline, along with a retrospective review of patients treated in a regional unit over 25 years. Occupations were classified based on the UK Standard of Classification 2020. Data analysis was completed using the chi-squared test. A total of 17 papers met the inclusion criteria for review. In our retrospective study a total of 874 patients were identified of whom 31% were blue-collar workers, 32.8% were white-collar workers, 20.2% were unemployed/housewives, and 16% workers in other occupations. The majority of blue-collar workers were in the construction industry and had maximum exposure to hydrocarbons and exhaust fumes. The aetiology of oral and oropharyngeal SCC is multifactorial and there is no consensus on the role of occupational carcinogens. We showcase our patient cohort and discuss the occupational exposures that appear to make them susceptible to OSCC and OPSCC. Further multicentre studies are required to enable us to understand fully the pathogenesis of oral cancer and help us to inform relevant organisations, the aim being to reduce the incidence of occupation-related cancer.
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Affiliation(s)
- C Y Chieng
- Oral & Maxillofacial Surgery Department, University Hospital Dorset NHS Foundation Trust, United Kingdom.
| | - A Dalal
- Oral & Maxillofacial Surgery Department, University Hospital Dorset NHS Foundation Trust, United Kingdom
| | - V Ilankovan
- Oral & Maxillofacial Surgery Department, University Hospital Dorset NHS Foundation Trust, United Kingdom
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16
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Sachdeva S, George R, Dalal A, Goyal S. Primary pancreatic echinococcosis: A rare mimicking of choledochal cyst. Dig Liver Dis 2022; 54:1727-1728. [PMID: 35792036 DOI: 10.1016/j.dld.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Sanjeev Sachdeva
- Departments of Gastroenterology, GB Pant Hospital, New Delhi 110002, India.
| | - Roshan George
- Departments of Gastroenterology, GB Pant Hospital, New Delhi 110002, India
| | - Ashok Dalal
- Departments of Gastroenterology, GB Pant Hospital, New Delhi 110002, India
| | - Surbhi Goyal
- Departments of Pathology, GB Pant Hospital, New Delhi 110002, India
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17
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Dahale AS, Srivastava S, Saluja SS, Sachdeva S, Dalal A, Varakanahalli S. Correction to: Management of scope-induced type I duodenal perforations: Over-the-scope clip versus surgery. Indian J Gastroenterol 2022:10.1007/s12664-022-01309-5. [PMID: 36385354 DOI: 10.1007/s12664-022-01309-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Amol S Dahale
- Department of Gastroenterology, Dr. D Y Patil Medical College and Hospital, Pimpri, Pune, 411 018, India
| | - Siddharth Srivastava
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, 1, J L N Marg, New Delhi, 110 002, India.
| | - Sundeep Singh Saluja
- Department of Gastrointestinal Surgery, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, 110 002, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, 1, J L N Marg, New Delhi, 110 002, India
| | - Ashok Dalal
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, 1, J L N Marg, New Delhi, 110 002, India
| | - Shivakumar Varakanahalli
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, 1, J L N Marg, New Delhi, 110 002, India
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18
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Affiliation(s)
- Sanjeev Sachdeva
- Department of Gastroenterology, G B Pant Hospital, New Delhi, 110 002, India
| | - Ujjwal Sonika
- Department of Gastroenterology, G B Pant Hospital, New Delhi, 110 002, India.
| | - Ashok Dalal
- Department of Gastroenterology, G B Pant Hospital, New Delhi, 110 002, India
| | - Sukrit Singh Sethi
- Department of Gastroenterology, G B Pant Hospital, New Delhi, 110 002, India
| | - Manish Kumar
- Department of Gastroenterology, G B Pant Hospital, New Delhi, 110 002, India
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19
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Sonika U, Sachdeva S, Kumar A, Srivastava S, Dahale A, Sharma BC, Kumar M, Pandey T, Yadav DP, Maharshi S, Nair SV, Dalal A. Impact of the COVID-19 Pandemic on Gastroenterology Training in India. Journal of Digestive Endoscopy 2022. [DOI: 10.1055/s-0042-1748636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Abstract
Introduction The coronavirus disease 2019 (COVID-19) pandemic has affected the healthcare system. The residents who are at the frontline of this pandemic have suffered the most. The extent of the training loss due to the COVID-19 pandemic on gastroenterology (GE) training is not studied in India.
Methods We designed a 36-question based google survey and distributed it to the GE residents all across India, via email. All the responses collected were analyzed using appropriate statistical methods.
Results A total of 140 responses were received. No significant decrease in teaching sessions/ classes was reported. Most of the residents (83.5%) reported inability to complete the target thesis enrolment. The number of patients seen by the residents in outpatient department, patients managed in wards and endoscopic procedures done by residents have decreased significantly (p-valve <0.001 for all). An overwhelming 89.9% (n = 125) of the GE residents were posted for COVID-19 duties. Almost half (50.4%) of them were COVID-19 positive.
Conclusion The COVID-19 pandemic has affected the training of GE residents in India immensely and an extension period of 3 months may be offered to them.
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Affiliation(s)
- Ujjwal Sonika
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Ajay Kumar
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | | | - Amol Dahale
- Department of Gastroenterology, DY Patil Medical College, Pune, Maharashtra, India
| | | | - Manish Kumar
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | | | - Devesh Prakash Yadav
- Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Sudhir Maharshi
- Department of Gastroenterology, SMS Medical College, Jaipur, Rajasthan, India
| | - Sandeep V. Nair
- Department of Gastroenterology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Ashok Dalal
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
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20
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Jain A, Sharma BC, Mahajan B, Srivastava S, Kumar A, Sachdeva S, Sonika U, Dalal A. L-ornithine L-aspartate in acute treatment of severe hepatic encephalopathy: A double-blind randomized controlled trial. Hepatology 2022; 75:1194-1203. [PMID: 34822189 DOI: 10.1002/hep.32255] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 11/13/2021] [Accepted: 11/18/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Data on the use of intravenous L-ornithine L-aspartate (LOLA) in the treatment of overt HE (OHE) is limited. We evaluated the role of intravenous LOLA in patients of cirrhosis with OHE grade III-IV. APPROACH AND RESULTS In a double-blind randomized placebo-controlled trial, 140 patients were randomized to a combination of LOLA, lactulose, and rifaximin (n = 70) or placebo, lactulose, and rifaximin (n = 70). LOLA was given as continuous intravenous infusion at a dose of 30 g over 24 h for 5 days. Ammonia levels, TNF-α, ILs, and endotoxins were measured on days 0 and 5. The primary outcome was the improvement in the grade of HE at day 5. Higher rates of improvement in grade of HE (92.5% vs. 66%, p < 0.001), lower time to recovery (2.70 ± 0.46 vs. 3.00 ± 0.87 days, p = 0.03), and lower 28-day mortality (16.4% vs. 41.8%, p = 0.001) were seen in the LOLA group as compared with placebo. Levels of inflammatory markers were reduced in both groups. Significantly higher reductions in levels of blood ammonia, IL-6, and TNF-α were seen in the LOLA group. CONCLUSIONS Combination of LOLA with lactulose and rifaximin was more effective than only lactulose and rifaximin in improving grades of HE, recovery time from encephalopathy, with lower 28-day mortality.
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Affiliation(s)
- Arpan Jain
- Department of GastroenterologyGB Pant HospitalNew DelhiIndia
| | | | - Bhawna Mahajan
- Department of BiochemistryGB Pant HospitalNew DelhiIndia
| | | | - Ajay Kumar
- Department of GastroenterologyGB Pant HospitalNew DelhiIndia
| | | | - Ujjwal Sonika
- Department of GastroenterologyGB Pant HospitalNew DelhiIndia
| | - Ashok Dalal
- Department of GastroenterologyGB Pant HospitalNew DelhiIndia
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21
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Sachdeva S, Dalal A, Sonika U, Srivastava S. Mediastinal dumbbell pancreatic pseudocyst: An amazing cause of dysphagia. Dig Liver Dis 2022; 54:413-414. [PMID: 33139194 DOI: 10.1016/j.dld.2020.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/11/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Sanjeev Sachdeva
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India.
| | - Ashok Dalal
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Ujjwal Sonika
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
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22
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Mishra A, Puri AS, Sachdeva S, Dalal A. Efficacy of hepatitis B vaccination in patients with ulcerative colitis: a prospective cohort study. Intest Res 2022; 20:445-451. [PMID: 35124949 DOI: 10.5217/ir.2021.00106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/08/2021] [Indexed: 11/05/2022] Open
Abstract
Background/Aims Response to vaccine in patients with inflammatory bowel disease is lower than in the general population. We aimed to evaluate the efficacy of hepatitis B virus (HBV) vaccination in patients with ulcerative colitis (UC) versus controls. Methods We prospectively compared antibody response to HBV vaccination in 100 patients with UC versus controls. HBV vaccination was given to all the cases and controls at 0, 1 and 6 months. Anti-hepatitis B surface (anti-HBs) titers were then measured 4 weeks after the first and the third dose. Adequate immune response (AIR) was considered if the anti-HBs titer was >10 IU/L and effective immune response (EIR) if the anti-HBs titer was >100 IU/L. Results Median anti-HBs titer was lower in patients with UC than controls (67 IU/L vs. 105 IU/L, P<0.01). AIR and EIR were significantly lower in patients than in controls (82% vs. 96%, P=0.001; 41% vs. 66%, P<0.001, respectively). Univariate analysis showed that age <30 years, mild to moderate severity of disease, disease duration <5 years, male sex, post first dose anti-HBs titer >2 IU/L and non-exposure to corticosteroids, azathioprine and biologicals were predictors of AIR in patients with UC (P<0.05). Multivariate analysis revealed that only non-exposure to corticosteroids, azathioprine and biologicals, male sex, and disease duration <5 years were independent predictors of AIR. Conclusions Response rate to the HBV vaccination in patients with UC was significantly lower as compared to the controls. Male sex, shorter disease duration, and non-exposure to immunomodulators were independent predictors of AIR.
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Affiliation(s)
- Anurag Mishra
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Amarender Singh Puri
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Ashok Dalal
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
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23
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Verma A, Girish MI, Dahale AS, Dalal A, Sachdeva S. CMV Colitis in Immunocompetent Patients—A Case Series. Journal of Digestive Endoscopy 2022. [DOI: 10.1055/s-0041-1742134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Anushka Verma
- Department of Physiology, Lady Hardinge Medical College, New Delhi, India
| | - Muppa Indrakeela Girish
- Department of Gastroenterology and Hepatology, DY Patil Medical College, Pune, Maharashtra, India
| | - Amol S. Dahale
- Department of Gastroenterology and Hepatology, DY Patil Medical College, Pune, Maharashtra, India
| | - Ashok Dalal
- Department of Gastroenterology and Hepatology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology and Hepatology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
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24
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Kumar M, George R, Vaithiyam V, Sakhuja P, Dahale AS, Dayal A, Dalal A, Sonika U, Sachdeva S, Kumar A. Enhanced Liver Fibrosis Score: Is It Useful for Evaluation of Fibrosis Severity in Chronic Hepatitis C Infection? Cureus 2022; 14:e21168. [PMID: 35165618 PMCID: PMC8831389 DOI: 10.7759/cureus.21168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction: The assessment of liver fibrosis is important in patients with chronic hepatitis C (CHC). In recent years, non-invasive tests like enhanced liver fibrosis (ELF) have been developed as an alternative to liver biopsy for estimating the severity of liver fibrosis. Therefore, we aimed to assess whether the ELF score can be used for fibrosis severity estimation using liver biopsy as the gold standard. Materials and methods: Forty-nine patients with CHC were enrolled in this study. Liver biopsy, ELF assessment, and transient elastography (TE) were performed in all patients, and severity of fibrosis on histopathology was assessed by meta-analysis of histological data in viral hepatitis (METAVIR) score. In addition, the diagnostic performance of ELF was evaluated by receiver operator characteristic curve (ROC) analyses, and liver biopsy histopathology was taken as the gold standard for the severity of liver fibrosis. Results: The area under receiver operator characteristic curve (AUROC) for significant fibrosis of ELF score was 0.64 (95% confidence interval {CI}, 0.48-0.79) and of TE was 0.85 (95% CI, 0.73-0.96). The AUROC for advance fibrosis of ELF was 0.77 (95% CI, 0.57-0.97) and TE was 0.98 (95% CI, 0.94-1.0). The calculated cut-offs of ELF overestimated fibrosis in 53.06% (26/49) of patients and underestimated fibrosis in 6.12% (3/49) patients. AUROC of TE was significantly better than ELF for diagnosis of significant fibrosis (p=0.004) and advanced fibrosis (p=0.034). Conclusion: The ELF score can be used for estimating the severity of fibrosis but it is inferior to TE in estimating liver fibrosis severity.
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25
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Dahale AS, Puri AS, Verma A, Sachdeva S, Dalal A, Banerjee D. Extrapulmonary Tuberculosis in Cirrhosis: Too Familiar-Too Much Unknown. J Clin Exp Hepatol 2022; 12:1021-1022. [PMID: 35677517 PMCID: PMC9168710 DOI: 10.1016/j.jceh.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/05/2021] [Indexed: 12/12/2022] Open
Key Words
- ADA, adenosine deaminase
- DILI, drug-induced liver injury
- E, ethambutol
- EPTB, extrapulmonary tuberculosis
- H, isoniazid
- L, levofloxacin
- NASH, nonalcoholic steatohepatitis
- R, rifampicin
- S, streptomycin
- SAAG, serum-ascites albumin gradient
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Affiliation(s)
- Amol S. Dahale
- Address for correspondence: Amol S. Dahale, Department of Medical Gastroenterology, Dr DY Patil Medical College, Pune, India.
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26
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Dalal A, Dahale A, Gupta M, Saxena P, Kumar A, Sonika U, Kumar M, Srivastava S, Sachdeva S, Sharma B, Puri A. Endoscopic retrograde cholangiopancreaticography-related complications – Experience from tertiary care teaching centre over half a decade. J Minim Access Surg 2022; 18:526-532. [PMID: 35046182 PMCID: PMC9632712 DOI: 10.4103/jmas.jmas_272_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction: Endoscopic retrograde cholangiopancreaticography (ERCP) is an essential therapeutic procedure with a significant risk of complications. Data regarding the complications and predictors of adverse outcomes such as mortality are scarce, especially from India and Asia. We aimed to look at the incidence and outcome of complications in ERCP patients. Materials and Methods: This study is a retrospective analysis of prospectively collected data of all the patients who underwent ERCP and had a complication from January 2012 to December 2018. Data were recorded in predesigned pro forma. The data analysis was done by appropriate statistical tests. RESULTS: A total of 17,163 ERCP were done. A total of 570 patients (3.3%) had complications; perforation (n = 275, 1.6%) was most common followed by pancreatitis (n = 177, 1.03%) and bleeding (n = 60, 0.35%). The majorities of perforations were managed conservatively (n = 205, 74.5%), and 53 (19%) required surgery. Overall, 69 (0.4%) patients died. Of these, 30 (10.9%) patients died with perforation. Age (odds ratio [OR]: 1.04, 95% confidence interval [CI]: 1.005–1.07) and need of surgery (OR: 5.11, 95% CI: 1.66–15.77) were the predictors of mortality in patients with perforation. The majority pancreatitis were mild (n = 125, 70.6%) and overall mortality was 5.6% (n = 10). Conclusion: ERCP complications have been remained static over the years, with perforation and pancreatitis contributing the most. Most perforations can be managed conservatively with good clinical outcomes.
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27
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Ramchandani JP, Gupta A, Goh M, Dalal A. Kikuchi-Fujimoto disease: a rare cause of histiocytic necrotising lymphadenitis in young ethnic women. Ann R Coll Surg Engl 2021; 104:e79-e80. [PMID: 34812682 DOI: 10.1308/rcsann.2021.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Kikuchi-Fujimoto is a rare but self-limiting disease usually affecting young ethnic females. The main clinical presentation is fever and cervical lymphadenopathy. Here we describe the cases of two patients with cervical lymphadenopathy, fever and fatigue. In addition, patients can present with neutropenia; hence, early diagnosis is crucial to exclude a malignant cause.
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Affiliation(s)
| | - A Gupta
- King's College London Medical School, UK
| | - M Goh
- OMFS Department, Poole Hospital, UK
| | - A Dalal
- OMFS Department, Poole Hospital, UK
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28
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Sachdeva S, Dalal A, Dahale AS, Sonika U. Triple-A Syndrome: A rare cause of pediatric achalasia. Dig Liver Dis 2021; 53:1352-1353. [PMID: 32900647 DOI: 10.1016/j.dld.2020.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/15/2020] [Accepted: 08/20/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Sanjeev Sachdeva
- Department of Gastroenterology, GB Pant Hospital, New Delhi 110002, India.
| | - Ashok Dalal
- Department of Gastroenterology, GB Pant Hospital, New Delhi 110002, India
| | - Amol S Dahale
- Department of Gastroenterology, GB Pant Hospital, New Delhi 110002, India
| | - Ujjwal Sonika
- Department of Gastroenterology, GB Pant Hospital, New Delhi 110002, India
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29
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Dahale AS, Puri AS, Sachdeva S, Agarwal AK, Kumar A, Dalal A, Saxena PD. Reappraisal of the Role of Ascitic Fluid Adenosine Deaminase for the Diagnosis of Peritoneal Tuberculosis in Cirrhosis. Korean J Gastroenterol 2021; 78:168-176. [PMID: 34565786 DOI: 10.4166/kjg.2021.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/24/2021] [Accepted: 07/26/2021] [Indexed: 11/03/2022]
Abstract
Backgrounds/Aims Although peritoneal tuberculosis (TB) is one of the important differential diagnoses among cirrhotic patients with ascites, a peritoneal biopsy is not always available. High ascitic fluid adenosine deaminase (ADA) has been indicative of peritoneal TB. On the other hand, studies to assess its diagnostic utility based on the confirmation of peritoneal biopsy in cirrhotic patients are scarce. Methods Patients with new-onset ascites were enrolled prospectively from a tertiary hospital. Peritoneal biopsy was applied according to clinical judgment when required. Based on pathology diagnosis of the peritoneum, the diagnostic efficacy of ascitic fluid ADA for peritoneal TB was evaluated in total and cirrhotic patients, respectively. Results Among 286 patients enrolled, 78 were diagnosed with peritoneal TB. One hundred and thirty-two patients had cirrhosis, and 30 of those were diagnosed with peritoneal TB. The mean ADA was 72.2 U/L and 22.7 U/L in the peritoneal and non-peritoneal TB group, respectively, among the total study population, and 64.0 U/L and 19.1 U/L in the peritoneal and non-peritoneal TB group, respectively, among the subgroup with cirrhosis. The area under the curve for ADA to diagnose peritoneal TB was 0.96 in the total study population with a cutoff value of 41.1 U/L, and 0.93 in cirrhotic patients with a cutoff value of 39.9 U/L. Conclusions The ascitic fluid ADA measurements showed high diagnostic performance for peritoneal tuberculosis in patients with ascites regardless of cirrhosis at a similar cutoff value.
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Affiliation(s)
| | - Amarender Singh Puri
- Department of Gastroenterology, G. B. Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, G. B. Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Anil K Agarwal
- Department of Gastrointestinal Surgery, G. B. Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Ajay Kumar
- Department of Gastroenterology, G. B. Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Ashok Dalal
- Department of Gastroenterology, G. B. Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Pritul D Saxena
- Department of Gastroenterology, G. B. Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
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30
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Dalal A, Kumar A, Arivarasan K, Dahale A, Sachdeva S, Sonika U, Pawar A. Colonic Stenting Using Side-Viewing Endoscope: A Case Report. Journal of Digestive Endoscopy 2021. [DOI: 10.1055/s-0040-1713833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AbstractColonic self-expandable metal stents (SEMS) are widely used as palliation for malignant obstruction. The conventional method involves using a forward-viewing endoscope as part of the procedure. Sometimes, however, the sharp angle of the stricture poses difficulty in evaluating the stricture, so a guidewire is placed across the stricture. Here, we present a case where a side-viewing endoscope was employed for colonic stent placement and propose its use in patients with sharp bends to increase success.
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Affiliation(s)
- Ashok Dalal
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Ajay Kumar
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - K Arivarasan
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Amol Dahale
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Ujjwal Sonika
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Ankush Pawar
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
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Kumar M, Sachdeva S, Kumar A, Sonika U, Gupta M, Srivastava S, Dahale A, Dalal A. Gastric Foreign Bodies in Prison Inmates. Journal of Digestive Endoscopy 2021. [DOI: 10.1055/s-0041-1731963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Abstract
Objective Gastric foreign bodies are a common problem brought to an endoscopist. Prisoners are more prone to ingesting unusual foreign bodies for a secondary gain. The objective of this study was to study the profile of foreign body ingestion among the prisoners brought to a tertiary care center.
Methods This is a retrospective case series. All the prisoners brought for endoscopic removal of foreign bodies between January 2018 to December 2019 were included in the analysis. Patients’ baseline characteristics, type of foreign body, management, and outcome were noted
Results A total of eight inmates presented with ingestion of foreign body to our department. Most common foreign bodies ingested were drug packets and mobile phones. All ingestions were for secondary gain. Endoscopic removal was successful in all cases.
Conclusion Endoscopic removal can be tried with all necessary precautions by an expert endoscopist.
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Affiliation(s)
- Manish Kumar
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Ajay Kumar
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Ujjwal Sonika
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Manish Gupta
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | | | - Amol Dahale
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Ashok Dalal
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
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Jakhar D, Das A, Kaul S, Kaur I, Madke B, Dalal A. Prevalence and characteristics of dermatological manifestations in COVID-19 positive dermatologists: Report from a web-based survey in India. J Eur Acad Dermatol Venereol 2021; 35:e832-e833. [PMID: 34297886 PMCID: PMC8447020 DOI: 10.1111/jdv.17532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/07/2021] [Accepted: 07/06/2021] [Indexed: 01/08/2023]
Affiliation(s)
- D Jakhar
- Dermosphere clinic, New Delhi, India
| | - A Das
- Department of Dermatology, KPC Medical College & Hospital, Kolkata, India
| | - S Kaul
- Department of Internal Medicine, John H Stroger Hospital of Cook county, Chicago, USA
| | - I Kaur
- Department of Dermatology, North Delhi Municipal Corporation Medical College & Hindu Rao Hospital, New Delhi, India
| | - B Madke
- Department of Dermatology, Venereology and Leprology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi Meghe, Wardha, Maharashtra, India
| | - A Dalal
- Department of Dermatology, Saheed Hasan Khan Mewati Government Medical College and Hospital, Nuh, India
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Sachdeva S, Jain A, Dalal A, Puri A. Primary Esophageal Lymphoma: A Rare Entity. GE Port J Gastroenterol 2021; 29:366-368. [PMID: 36159195 PMCID: PMC9485927 DOI: 10.1159/000515840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/25/2021] [Indexed: 12/15/2022]
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Brennan PA, Dalal A, Knighton J, Jones R, Oeppen RS. Pilot study to evaluate safety culture perception in the operating theatres of an acute NHS Trust using the National Air Traffic Services (NATS) App. Br J Oral Maxillofac Surg 2021; 59:1085-1089. [PMID: 34281735 DOI: 10.1016/j.bjoms.2021.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 11/19/2022]
Abstract
An area critical to safety in an organisation is the perceived and actual culture. National Air Traffic Services (NATS) work closely with large safety-critical industries including various aviation companies to enable them to identify strengths and vulnerabilities with the aim of improving safe practice. NATS have developed a simple free downloadable self-assessment App that individuals can use to assess their own culture perception in their organisation. The App has 16 questions arranged in four domains but to our knowledge it has not been used to date in healthcare. As part of the initiatives to improve staff culture, we evaluated operating theatre colleagues' safety perception in our large acute NHS Trust in a pilot study using the NATS safety App. Staff downloaded the App to their smart device before completing it. Responses were sent anonymously through the App and collated by NATS. A total of 146 colleagues downloaded and completed the questionnaire. One hundred and seventeen staff (80%) felt encouraged to report safety concerns, but 86% (n=126) confirmed a lack of available support from healthcare managers. Only 43% of respondents (n=63) would find it easy to challenge colleagues if they observed unsafe behaviour. This pilot study has identified positive indicators of an evolving NHS safety culture, and some concerns about speaking up, support, and challenging colleagues without fear. These issues are known to occur across healthcare. Further work is needed in the NHS to provide a supportive environment to improve patient safety, and lower hierarchy in surgical teams.
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Affiliation(s)
- P A Brennan
- Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK.
| | - A Dalal
- Poole Hospital, Longfleet Road, Poole BH15 2JB, UK
| | - J Knighton
- Queen Alexandra Hospital, Portsmouth PO6 3LY, UK
| | - R Jones
- Queen Alexandra Hospital, Portsmouth PO6 3LY, UK
| | - R S Oeppen
- Southampton University Hospitals Trust, Tremona Road, Southampton SO16 6YD, UK
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35
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Padia G, Mahajan B, Kumar A, Sonika U, Dahale AS, Sachdeva S, Dalal A, George R. Cystatin C and interleukin-6 for prognosticating patients with acute decompensation of cirrhosis. JGH Open 2021; 5:459-464. [PMID: 33860096 PMCID: PMC8035439 DOI: 10.1002/jgh3.12516] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 11/10/2022]
Abstract
Background and Aim Systemic inflammation and organ dysfunction/failure can complicate acute decompensation (AD) of cirrhosis with progression to acute‐on‐chronic liver failure (ACLF), leading to increased mortality. There are few studies on serum biomarkers predicting renal dysfunction (RD) or ACLF in AD. Serum cystatin C (CysC) and interleukin‐6 (IL‐6) were evaluated for predicting RD, ACLF, and mortality in AD patients. Methods Consecutive AD patients seen from January 2018 to June 2019 were included. IL‐6 and CysC were measured in serum at the time of index presentation. Patients were followed for 90 days or until primary (development of RD) or secondary outcomes (development of ACLF or mortality). Multivariate analysis was performed to find whether CysC and IL‐6 can independently predict primary and secondary outcomes. Results A total of 124 patients were screened; 88 patients were included. On follow up, 22 (27.3%) developed RD, 11 (11/57, 19.3%) developed ACLF, and 21 (24%) died. The CysC predicted RD (odds ratio [OR] 7.97, 95% confidence interval [CI] 2.70–23.53, P = 0.001) and ACLF (OR 5.486, 95% CI 1.456–20.6, P = 0.012) development. IL‐6 was not an independent predictor of RD (P = 0.315), ACLF (P = 0.168), and mortality (P = 0.225). Conclusion Serum CysC can predict the development of RD and ACLF in patients of cirrhosis with AD.
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Affiliation(s)
- Gaurav Padia
- Department of Gastroenterology G B Pant Institute of Postgraduate Medical Education and Research (GIPMER) New Delhi India
| | - Bhawana Mahajan
- Department of Biochemistry G B Pant Institute of Postgraduate Medical Education and Research (GIPMER) New Delhi India
| | - Ajay Kumar
- Department of Gastroenterology G B Pant Institute of Postgraduate Medical Education and Research (GIPMER) New Delhi India
| | - Ujjwal Sonika
- Department of Gastroenterology G B Pant Institute of Postgraduate Medical Education and Research (GIPMER) New Delhi India
| | - Amol S Dahale
- Department of Gastroenterology G B Pant Institute of Postgraduate Medical Education and Research (GIPMER) New Delhi India
| | - Sanjeev Sachdeva
- Department of Gastroenterology G B Pant Institute of Postgraduate Medical Education and Research (GIPMER) New Delhi India
| | - Ashok Dalal
- Department of Gastroenterology G B Pant Institute of Postgraduate Medical Education and Research (GIPMER) New Delhi India
| | - Roshan George
- Department of Gastroenterology G B Pant Institute of Postgraduate Medical Education and Research (GIPMER) New Delhi India
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Dalal A, Sonika U, Kumar M, George R, Kumar A, Srivastava S, Sachdeva S, Sharma BC. COVID-19 Rapid Antigen Test: Role in Screening Prior to Gastrointestinal Endoscopy. Clin Endosc 2021; 54:522-525. [PMID: 33657784 PMCID: PMC8357579 DOI: 10.5946/ce.2020.295] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 12/23/2020] [Indexed: 01/27/2023] Open
Abstract
Background/Aims The severe acute respiratory syndrome coronavirus 2 pandemic has affected the gastrointestinal (GI) endoscopy units globally owing to the risk of transmission. We present our data on the use of rapid antigen test (RAT) as a screening tool prior to endoscopy to prevent the transmission of coronavirus disease (COVID-19).
Methods This study was a retrospective analysis of patients who underwent any GI endoscopic procedure from July 2020 to October 2020 at a tertiary referral center in New Delhi, India. All patients underwent screening for COVID-19 using RAT, and endoscopy was performed only when the RAT was negative. The data are presented as numbers and percentages.
Results A total of 3,002 endoscopic procedures were performed during the study period. Only one endoscopic procedure was performed in a COVID-19 positive patient. A total of 53 healthcare workers were involved in conducting these procedures. Only 2 healthcare workers (3.8%) were diagnosed COVID-19 positive, presumably due to community-acquired infection, during this period.
Conclusions The COVID-19 RAT is easily usable as a simple screening tool prior to GI endoscopy during the COVID-19 pandemic.
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Affiliation(s)
- Ashok Dalal
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Ujjwal Sonika
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Manish Kumar
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Roshan George
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Ajay Kumar
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Siddharth Srivastava
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Barjesh Chander Sharma
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
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Abstract
Kaposiform haemangioendothelioma, an endothelial borderline tumour, is typically seen in childhood involving extremities. It has been closely associated with a consumptive coagulopathy state, Kasabach-Merritt phenomenon (KMP). Extracutaneous involvement is uncommon. Intestinal involvement is quite uncommon and can masquerade as an acute abdomen. A 24-day-old neonate presented with bilious vomiting and fever for 5 days. Sections from the resected gangrenous duodenum contained a submucosal tumour composed of infiltrating nodules of slit-like or crescentic CD34-positive spindled-to-flattened endothelial-lined vascular spaces along with zones of fibrosis. No nuclear pleomorphism or necrosis identified. The findings were classic example of kaposiform haemangioendothelioma with an absence of any deranged coagulation profile. The index case raises interest given its congenital incidental presentation at an uncommon site, like duodenum, and absence of coexistent KMP.
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Affiliation(s)
- Arti Khatri
- Pathology, Chacha Nehru Children's Hospital, New Delhi, India
| | - Nidhi Mahajan
- Pathology, Chacha Nehru Children's Hospital, New Delhi, India
| | - Niyaz Ahmed Khan
- Paediatric Surgery, Chacha Nehru Children's Hospital, New Delhi, India
| | - Ashok Dalal
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
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Abstract
Intraductal papillary mucinous neoplasms (IPMNs) are mucin-secreting cystic neoplasm of pancreas. They have a malignant potential. They are usually localised to the pancreas but occasionally can involve surrounding structures (1.9%-6.6%), like bile duct and duodenum, and are labelled as IPMN with invasion. Jaundice as a manifestation of IPMN is not common (4.5%). It can present as jaundice as a result of invasion of common bile duct (CBD) resulting in stricture formation or uncommonly as a result of fistulising to CBD with resultant obstruction of CBD by thick mucin secreted by this tumour. As only few cases (around 23) of mucin-filled CBD are reported in the literature. We are presenting our experience in dealing a rare case of obstructive jaundice caused by IPMN fistulising into CBD, highlighting the difficulties faced in managing such case, especially with regards to biliary drainage and what can be the optimum management in such cases.
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Affiliation(s)
- Manish Kumar
- Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Ujjwal Sonika
- Gastroenterology, GB Pant Hospital, New Delhi, India
| | | | - Ashok Dalal
- Gastroenterology, GB Pant Hospital, New Delhi, India
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Sachdeva S, Sethi SS, Kumar A, Dalal A. Choledocholithiasis in autosomal dominant polycystic kidney disease. Dig Liver Dis 2021; 53:127-128. [PMID: 32553703 DOI: 10.1016/j.dld.2020.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/16/2020] [Accepted: 05/18/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Sanjeev Sachdeva
- Department of Gastroenterology, GB Pant Hospital, New Delhi 110002, India.
| | - Sukrit Singh Sethi
- Department of Gastroenterology, GB Pant Hospital, New Delhi 110002, India
| | - Ajay Kumar
- Department of Gastroenterology, GB Pant Hospital, New Delhi 110002, India
| | - Ashok Dalal
- Department of Gastroenterology, GB Pant Hospital, New Delhi 110002, India
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Sachdeva S, Sahu BK, Sonyabapu AD, Dalal A, Sonika U. Abdominal
CT
in a pregnant woman: Bane or boon? JGH Open 2021; 5:155-156. [PMID: 33490628 PMCID: PMC7812491 DOI: 10.1002/jgh3.12471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/25/2020] [Indexed: 11/07/2022]
Affiliation(s)
| | - Bimal K Sahu
- Department of Gastroenterology GB Pant Hospital New Delhi India
| | | | - Ashok Dalal
- Department of Gastroenterology GB Pant Hospital New Delhi India
| | - Ujjwal Sonika
- Department of Gastroenterology GB Pant Hospital New Delhi India
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Dahale AS, Srivastava S, Saluja SS, Sachdeva S, Dalal A, Varakanahalli S. Management of scope-induced type I duodenal perforations: Over-the-scope clip versus surgery. Indian J Gastroenterol 2021; 40:287-294. [PMID: 33974228 PMCID: PMC8195754 DOI: 10.1007/s12664-021-01152-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 01/18/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Scope-induced duodenal perforation is a life-threatening complication and surgery remains the standard of care. With the advent of over-the-scope clip (OTSC), scope-induced perforations are increasingly managed conservatively, though there is no study comparing this form of non-surgical treatment with surgery. We aimed to compare OTSC and surgery in the management of scope-induced perforation of the duodenum. METHODS We retrospectively collected data of scope-induced duodenal perforation patients. Perforations identified and treated within 24 h of procedure were analyzed. Factors analyzed were spectrum, etiology, baseline parameters, perforation size, outcome, comorbidities, and duration of hospital stay. RESULTS A total of 25 patients had type I duodenal perforations, out of whom five were excluded due to delayed diagnosis and treatment. Of the twenty, eight were treated with OTSC placement while the rest underwent surgery. Age was comparable and the majority were females. Baseline parameters and comorbidities were similar in both the groups. The median size of perforation was 1.5 cm in both the OTSC group and the surgical group. All patients were treated with standard of care according to institutional protocols. Patients in the OTSC group were started orally after 48 h of OTSC placement, while in the surgery group median time to oral intake was 7 days. Two patients in the surgical group died while there was no mortality in the OTSC group (p = 0.48). Median hospital stay was shorter in the OTSC group (2 days vs. 22 days, p = 0.003). CONCLUSIONS OTSC is a feasible and better option in type I duodenal perforations with a shorter hospital stay.
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Affiliation(s)
- Amol S. Dahale
- Department of Gastroenterology, Dr. D Y Patil Medical College and Hospital, Pimpri, Pune, 411 018 India
| | - Siddharth Srivastava
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, 1, J L N Marg, New Delhi, 110 002 India
| | - Sundeep Singh Saluja
- Department of Gastrointestinal Surgery, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, 110 002 India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, 1, J L N Marg, New Delhi, 110 002 India
| | - Ashok Dalal
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, 1, J L N Marg, New Delhi, 110 002 India
| | - Shivakumar Varakanahalli
- Department of Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, 1, J L N Marg, New Delhi, 110 002 India
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Sethi S, Puri A, Sachdeva S, Dalal A. Erythrophagocytosis in colonic mucosa: real-time amazing display. BMJ Case Rep 2020; 13:13/12/e238921. [PMID: 33310835 PMCID: PMC7735084 DOI: 10.1136/bcr-2020-238921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Sukrit Sethi
- Gastroenterology, GB Pant Hospital, New Delhi, Delhi, India
| | - Amarender Puri
- Gastroenterology, GB Pant Hospital, New Delhi, Delhi, India
| | | | - Ashok Dalal
- Gastroenterology, GB Pant Hospital, New Delhi, Delhi, India
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Sachdeva S, Dalal A, Kumar A, George R. Multifocal gastric metastasis of malignant melanoma: An ominous endoscopic appearance: Gastric metastasis of malignant melanoma. Dig Liver Dis 2020; 52:1512. [PMID: 32507693 DOI: 10.1016/j.dld.2020.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 05/08/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Sanjeev Sachdeva
- Department of Gastroenterology, GB Pant Hospital, New Delhi (India)-110002.
| | - Ashok Dalal
- Department of Gastroenterology, GB Pant Hospital, New Delhi (India)-110002
| | - Ajay Kumar
- Department of Gastroenterology, GB Pant Hospital, New Delhi (India)-110002
| | - Roshan George
- Department of Gastroenterology, GB Pant Hospital, New Delhi (India)-110002
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Affiliation(s)
- Ujjwal Sonika
- Department of Gastroenterology, Academic Block GB Pant Hospital New Delhi India
| | - Ashok Dalal
- Department of Gastroenterology, Academic Block GB Pant Hospital New Delhi India
| | - Ajay Kumar
- Department of Gastroenterology, Academic Block GB Pant Hospital New Delhi India
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Abstract
AbstractA 35-year-old male prisoner with a history of mobile phone ingestion was refereed to our center for management. Clinical examination was unremarkable. After confirmation on abdominal X-ray, we removed it endoscopically without any complication. To the best of our knowledge, this is only the second case report of successful endoscopic removal of mobile phone.
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Affiliation(s)
- Ankush Pawar
- Department of Gastroenterology, G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Ashok Dalal
- Department of Gastroenterology, G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Amol Dahale
- Department of Gastroenterology, G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Amarender Singh Puri
- Department of Gastroenterology, G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
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Dalal A, Puri AS, Sachdeva S, Sakuja P. Nonsurgical management of gastroduodenal tuberculosis: Nine-year experience from a tertiary referral center. Endosc Int Open 2019; 7:E1248-E1252. [PMID: 31579706 PMCID: PMC6773584 DOI: 10.1055/a-0957-2754] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 10/15/2018] [Indexed: 12/02/2022] Open
Abstract
Background and study aims Gastroduodenal tuberculosis (GDTB) is an uncommon disease. Surgery has been standard of care both for diagnosis and management of GDTB. The aim of this study was to evaluate the efficacy of non-surgical management of GDTB using a combination of anti-tuberculous therapy (ATT) along with endoscopic dilatation of the tuberculous stricture. Patients and methods Patients suspected to have gastroduodenal TB were evaluated: clinical, endoscopic, radiological, and histopathological data were recorded. Patients in whom a definite diagnosis of tuberculosis could not be confirmed on mucosal biopsies underwent endoscopic mucosal resection (EMR). Patients were treated with ATT and endoscopic dilatation was done if indicated. Patients were followed up to evaluate clinical, radiological and endoscopic response. Results Over a 9-year period from 2009 to 2017, 52 patients (mean age 28.5yrs) were diagnosed with GDTB. The most common presenting symptoms were vomiting (n = 51, 98 %) and weight loss (n = 52,100 %). The most common anatomical site of involvement was D1-D2 junction (n = 22, 42 %). Histopathological diagnosis could be made in 43 patients (82.6 %); 36 (69 %) on mucosal biopsies and in 7 of 10 patients (70 %) who underwent snare biopsy/EMR. Endoscopic dilatation was done in 37 patients (71 %) and median dilatation sessions were two. Failure of endotherapy occurred in four patients (7.6 %). All responders had complete amelioration of symptoms after 4 to 6 weeks of combination therapy. Median period of follow-up was 23.5 months and none of the patients reported any recurrence of symptoms. Conclusion ATT and endoscopic dilatation combined has a high success rate in management of GDTB and should be considered the standard of care.
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Affiliation(s)
- Ashok Dalal
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Amarender Singh Puri
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India,Corresponding author Dr. Amarender Singh Puri Professor, Department of GastroenterologyAcademic Block, GB Pant Hospital1 JLN Marg, New DelhiIndia 110002+91-11- 23239442
| | - Sanjeev Sachdeva
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Puja Sakuja
- Department of Pathology, G B Pant Hospital, New Delhi, India
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Dahale AS, Srivastava S, Sonika U, Dalal A, Goyal A, Sakhuja P, Sachdeva S, Puri AS. Role of linear endosonography in the diagnosis of biopsy-negative malignant esophageal strictures: Exploring the unexplored. JGH Open 2019; 4:113-116. [PMID: 32280752 PMCID: PMC7144779 DOI: 10.1002/jgh3.12225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 06/13/2019] [Indexed: 11/09/2022]
Abstract
Background and Aim Endoscopic biopsy is standard for the diagnosis of esophageal malignancy. However, few cases present with smooth stricture with repetitive negative biopsy results. We aimed to use linear endoscopic ultrasound (EUS) and fine-needle aspiration (FNA) in the diagnosis of biopsy-negative suspected malignant esophageal strictures. Methods We retrospectively analyzed the data from August 2017 to December 2018 of biopsy-negative esophageal strictures. All adult patients with twice-negative biopsies and with smooth overlying esophageal mucosa on endoscopy were included. Clinical, epidemiological, endoscopic, imaging, and EUS findings were noted and analyzed. Results Eighteen patients underwent EUS for suspicion of malignant esophageal stricture. Seven were excluded as they were submucosal tumors. Eleven patients showed the presence of malignancy on EUS FNA samples. Nine were males. Computed tomography showed esophageal wall thickening in eight (16-38 mm) and esophageal mass in three patients. EUS showed loss of a normal five-layered wall structure of the esophagus in all patients. Fine-needle aspiration cytology demonstrated squamous cell carcinoma (n = 4), adenocarcinoma (n = 4), poorly differentiated carcinoma (n = 2), and neuroendocrine carcinoma (n = 1). There were no complications. Conclusion EUS with FNA is effective and safe for the diagnosis of biopsy-negative malignant esophageal strictures.
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Affiliation(s)
- Amol S Dahale
- Department of Gastroenterology G B Pant Institute of Postgraduate Medical Education and Research New Delhi India
| | - Siddharth Srivastava
- Department of Gastroenterology G B Pant Institute of Postgraduate Medical Education and Research New Delhi India
| | - Ujjwal Sonika
- Department of Gastroenterology G B Pant Institute of Postgraduate Medical Education and Research New Delhi India
| | - Ashok Dalal
- Department of Gastroenterology G B Pant Institute of Postgraduate Medical Education and Research New Delhi India
| | - Aditi Goyal
- Department of Pathology G B Pant Institute of Postgraduate Medical Education and Research New Delhi India
| | - Puja Sakhuja
- Department of Pathology G B Pant Institute of Postgraduate Medical Education and Research New Delhi India
| | - Sanjeev Sachdeva
- Department of Gastroenterology G B Pant Institute of Postgraduate Medical Education and Research New Delhi India
| | - Amarender S Puri
- Department of Gastroenterology G B Pant Institute of Postgraduate Medical Education and Research New Delhi India
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Abstract
Introduction Peritoneal tuberculosis (PTB) is a paucibacillary disease with poor mycobacterial yield in ascitic fluid. The Xpert® MTB/RIF assay (Gene Xpert) is a new tool for the diagnosis of tuberculosis (TB) and has not yet been studied on peritoneal tissue. The present study aimed to investigate the yield of the Xpert® MTB/RIF assay on peritoneal tissue obtained at peritoneoscopy. Methods This is a retrospective study and the data were collected from hospital records. The patients who underwent peritoneoscopy along with Xpert® MTB/RIF assay on peritoneal tissue were included in this study. Those with proven PTB were considered as cases while those with other diagnoses as controls. Using the reference standard of TB diagnosis, sensitivity, specificity, and accuracy of Xpert® MTB/RIF assay were calculated. Results Total of 36 patients was analyzed in this study: 28 as cases and eight as controls. Peritoneoscopy was carried out for diagnosis and biopsy. Histopathology in cases revealed caseating granulomas in 16 while 11 had non-caseating granulomas. Nine patients showed acid-fast bacillus positivity on peritoneal tissue. The most common finding on peritoneoscopy was tubercles with adhesions (n = 14, 50%), followed by tubercles only (n = 12, 42.9%). Xpert® MTB/RIF assay was positive in 17 (60.7%) patients with a sensitivity of 60.71%, specificity of 100%, and an accuracy of 69.44%. Two patients expressed rifampicin resistance. Conclusion Xpert® MTB/RIF assay on peritoneal tissue has fair sensitivity and excellent specificity. The multidrug resistance and the ability to provide results rapidly make it clinically useful.
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Affiliation(s)
- Amol S Dahale
- Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, IND
| | - Amarender S Puri
- Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, IND
| | - Ajay Kumar
- Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, IND
| | - Ashok Dalal
- Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, IND
| | - Anil Agarwal
- Gastrointestinal Surgery, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, IND
| | - Sanjeev Sachdeva
- Gastroenterology, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, IND
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Dalal A, Ives C. Tape to view: novel technique to improve axillary access. Ann R Coll Surg Engl 2019; 101:617. [PMID: 31232621 DOI: 10.1308/rcsann.2019.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- A Dalal
- Breast Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - C Ives
- Breast Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
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50
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Sherman S, Amitay-Laish I, Kremer N, Dalal A, Solomon Cohen E, Bercovich E, Noyman Y, Levi A, Pavlovsky L, Prag Naveh H, Hodak E. Mycosis fungoides is associated with melanoma in Israeli patients. Eur J Cancer 2019. [DOI: 10.1016/s0959-8049(19)30535-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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