Background and AimTo evaluate the role of multiplex polymerase chain reaction (PCR) for diagnosis... more Background and AimTo evaluate the role of multiplex polymerase chain reaction (PCR) for diagnosis of gastrointestinal tuberculosis (GITB).MethodsThis was a prospective observational study conducted from July 2015 to November 2016 at a tertiary care teaching institution in north India. Fifty individuals with clinically suspected GITB and older than 18 years of age were recruited. Patients underwent radiological investigations, esophagogastroduodenoscopy, or colonoscopy as clinically indicated. Multiple biopsies for tissue diagnosis and PCR were taken. All specimens were subjected to Ziehl Neelsen staining, histopathology, and multiplex PCR using specific primers for genes IS6110, MPB64, and Protein b. The performance of the assay was assessed using a composite reference standard for diagnosis of tuberculosis. It comprised a combination of clinical characteristics and microbiological methods, including smear, Bactenecin (BACTEC) culture, histopathology, and response to antitubercular therapy.ResultsA final diagnosis of tuberculosis was made in 32 cases (Duodenal‐4, Ileo‐colonic‐28). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of histopathology for the diagnosis of tuberculosis was 28.12, 100, 100, and 43.9%, respectively. The sensitivity, specificity, PPV and NPV of BACTEC Mycobacteria Growth Indicator Tube (MGIT) culture for the diagnosis of tuberculosis was 9.3, 100, 100, and 38.29%, respectively. The sensitivity, specificity, PPV, and NPV of multiplex PCR for the diagnosis of tuberculosis was 87.5, 100, 100, and 86.2%, respectively.ConclusionMultiplex PCR using specific primers for genes IS6110, MPB64, and Protein b had a higher sensitivity compared to conventional techniques for the diagnosis of GITB.
To evaluate the radiological findings of duodenal tuberculosis with particular emphasis on the ba... more To evaluate the radiological findings of duodenal tuberculosis with particular emphasis on the barium findings. A retrospective analysis of 805 cases of gastrointestinal tuberculosis from January 1997 to December 2011 over a period of 15 years was conducted. Thirty two cases (4%) of duodenal tuberculosis were found. The diagnosis of duodenal tuberculosis was based on histopathology following surgery or endoscopic biopsy from the duodenum, ultrasound-guided aspiration cytology/biopsy of lymph nodes or response to anti-tubercular treatment. The patients' clinical presentation was broadly classified into obstructive features and dyspeptic features. Single and/ or double contrast upper gastrointestinal barium studies were reviewed in each case for the segment involved, presence and length of strictures, ulcerations, polypoidal masses, extrinsic impression and complications (viz. perforations and fistulae). The study included 20 males and 12 females with age range of 7-70 years (mean...
Background and study aims Impact of intravenous fluid administration on prophylaxis against post-... more Background and study aims Impact of intravenous fluid administration on prophylaxis against post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) has not been rigorously evaluated among patients at high-risk for PEP. Patients and methods Effect of volume and type of fluid administered on PEP incidence was studied through a secondary analysis of high-risk patients who underwent endoscopic retrograde cholangopancreatography (ERCP) as a part of a randomized controlled trial in which all patients received rectal indomethacin. Periprocedural fluid was defined as fluid infused during and after ERCP. Results A total 960 patients were randomized during the trial, of whom 476 (49.6 %) received periprocedural fluids (mean volume = 1245 mL [± 629]). There was a trend towards a lower incidence of PEP in patients who received periprocedural fluid vs. those who did not (5.2 % vs. 8.0 %, P = 0.079). Among those receiving fluids, those who did not develop PEP received a higher mean...
Background and AimTo evaluate the role of multiplex polymerase chain reaction (PCR) for diagnosis... more Background and AimTo evaluate the role of multiplex polymerase chain reaction (PCR) for diagnosis of gastrointestinal tuberculosis (GITB).MethodsThis was a prospective observational study conducted from July 2015 to November 2016 at a tertiary care teaching institution in north India. Fifty individuals with clinically suspected GITB and older than 18 years of age were recruited. Patients underwent radiological investigations, esophagogastroduodenoscopy, or colonoscopy as clinically indicated. Multiple biopsies for tissue diagnosis and PCR were taken. All specimens were subjected to Ziehl Neelsen staining, histopathology, and multiplex PCR using specific primers for genes IS6110, MPB64, and Protein b. The performance of the assay was assessed using a composite reference standard for diagnosis of tuberculosis. It comprised a combination of clinical characteristics and microbiological methods, including smear, Bactenecin (BACTEC) culture, histopathology, and response to antitubercular therapy.ResultsA final diagnosis of tuberculosis was made in 32 cases (Duodenal‐4, Ileo‐colonic‐28). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of histopathology for the diagnosis of tuberculosis was 28.12, 100, 100, and 43.9%, respectively. The sensitivity, specificity, PPV and NPV of BACTEC Mycobacteria Growth Indicator Tube (MGIT) culture for the diagnosis of tuberculosis was 9.3, 100, 100, and 38.29%, respectively. The sensitivity, specificity, PPV, and NPV of multiplex PCR for the diagnosis of tuberculosis was 87.5, 100, 100, and 86.2%, respectively.ConclusionMultiplex PCR using specific primers for genes IS6110, MPB64, and Protein b had a higher sensitivity compared to conventional techniques for the diagnosis of GITB.
To evaluate the radiological findings of duodenal tuberculosis with particular emphasis on the ba... more To evaluate the radiological findings of duodenal tuberculosis with particular emphasis on the barium findings. A retrospective analysis of 805 cases of gastrointestinal tuberculosis from January 1997 to December 2011 over a period of 15 years was conducted. Thirty two cases (4%) of duodenal tuberculosis were found. The diagnosis of duodenal tuberculosis was based on histopathology following surgery or endoscopic biopsy from the duodenum, ultrasound-guided aspiration cytology/biopsy of lymph nodes or response to anti-tubercular treatment. The patients' clinical presentation was broadly classified into obstructive features and dyspeptic features. Single and/ or double contrast upper gastrointestinal barium studies were reviewed in each case for the segment involved, presence and length of strictures, ulcerations, polypoidal masses, extrinsic impression and complications (viz. perforations and fistulae). The study included 20 males and 12 females with age range of 7-70 years (mean...
Background and study aims Impact of intravenous fluid administration on prophylaxis against post-... more Background and study aims Impact of intravenous fluid administration on prophylaxis against post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) has not been rigorously evaluated among patients at high-risk for PEP. Patients and methods Effect of volume and type of fluid administered on PEP incidence was studied through a secondary analysis of high-risk patients who underwent endoscopic retrograde cholangopancreatography (ERCP) as a part of a randomized controlled trial in which all patients received rectal indomethacin. Periprocedural fluid was defined as fluid infused during and after ERCP. Results A total 960 patients were randomized during the trial, of whom 476 (49.6 %) received periprocedural fluids (mean volume = 1245 mL [± 629]). There was a trend towards a lower incidence of PEP in patients who received periprocedural fluid vs. those who did not (5.2 % vs. 8.0 %, P = 0.079). Among those receiving fluids, those who did not develop PEP received a higher mean...
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Papers by Saroj Sinha