Ductal carcinoma in situ (DCIS) is considered a heterogeneous lesion at the molecular level. Howe... more Ductal carcinoma in situ (DCIS) is considered a heterogeneous lesion at the molecular level. However, there is a paucity of literature about the existence of molecular subtypes in DCIS which can predict their biological behavior at the preinvasive stage. Precise prevalence of molecular subtypes of pure DCIS and DCIS component of infiltrating duct carcinoma (IDC) was evaluated using immunohistochemistry and correlated with known prognostic factors. DCIS cases were classified as luminal A (46.6% in each group), luminal B (pure DCIS 20% and DCIS component of IDC 13.3%), HER2 overexpressing, basal and nonbasal (pure DCIS 3.3% and 26.6% and DCIS component of IDC 3.3% and 33.3%, respectively), and triple negative, nonbasal (pure DCIS and DCIS component of IDC 3.3% each). The molecular phenotype of DCIS correlated well with that of the coexisting IDC. This study demonstrated molecular heterogeneity in DCIS; however, similar molecular phenotypes were seen in the coexisting IDC suggesting th...
Attempts at identification of an ideal prognostic/predictive biomarker in phyllodes tumour (PT) h... more Attempts at identification of an ideal prognostic/predictive biomarker in phyllodes tumour (PT) have not been fruitful so far. Studies evaluating c-kit expression in PT have shown contradictory results. Recently aldehyde dehydrogenase 1A1 (ALDH1A1) was proposed as a stem cell marker for malignant PT but its expression has not been studied in benign and borderline tumours. We aimed to evaluate expression and prognostic significance of c-kit and ALDH1A1 in different grades of PT. Epithelial and stromal c-kit and ALDH1A1 expression were studied in 104 PT cases (86 primary and 18 recurrent tumours) and compared with different clinico-pathological features and recurrence rates. Stromal c-kit expression at 1 % cutoff correlated with increasing tumour grade, larger tumour size, hypercellularity, nuclear atypia, stromal overgrowth, infiltrative margins and mitotic count. These associations, however, were lost with higher (5 or 10 %) cutoffs. Conversely, decreased c-kit expression in the epithelial component correlated with increasing tumour grade, regardless of the cutoffs used. Stromal ALDH1A1 expression did not have significant associations with tumour grade or other adverse clinico-pathological features, regardless of different cutoffs. None of the cases showed significant epithelial ALDH1A1 expression. Expression of c-kit was associated with poorer overall survival (p = 0.011), while ALDH1A1 expression was associated with shorter recurrence-free survival (p = 0.036). In conclusion, c-kit expression was associated with higher tumour grade and adverse clinico-pathological features. However, these associations are cutoff dependent, partly explaining the variability in previously reported studies. ALDH1A1 expression did not have significant correlations with tumour grade and adverse clinico-pathological variables.
Background: BD ductal access during ERCP may be difficult in certain cases. Operators may persist... more Background: BD ductal access during ERCP may be difficult in certain cases. Operators may persist in attempts to gain BD access despite increasing procedurerelated ampullary swelling and distorted ampullary anatomy. Precut ES may be used to gain BD access, but if done aggressively, it can be complicated by retroperitoneal perforation, bleeding and pancreatitis. However, by waiting several days after failed precut ES, ampullary tissue edema will resolve and BD access may actually be easier than in the native (uncut) papilla. Aim: To evaluate safety and efficacy of repeat ERCP for BD access within several days after initial failed precut ES. Methods: Retrospective analysis. Intent to treat. 1997-2004. Procedures were done by a single experienced biliary endoscopist. Inclusion criteria: patients undergoing ERCP for non-emergent BD access where BD access failed despite precut endoscopic sphincterotomy (ES) and where repeat ERCP for BD access was attempted several days later. Outcomes were: Success at repeat ERCP and ERCP-related complications. All patients received prophylactic antibiotics during and after ERCP. Results: 26 patients met inclusion criteria. 18/26 had a prophylactic narrow caliber pancreatic stents placed at index ERCP. Successful BD access was obtained in 20/26 patients. Failed repeat BD access occurred in 6/20 due to: fungating ampullary carcinoma (1), BD orifice found to be widely patent on repeat endoscopic view and ERC therefore not neccessary (1), failure to re-identify ampullary orifice (1), perforation (2). There were no complications following index ERCP. Complications from follow-up ERCP included one duodenal bulb perforation requiring surgical repair, with complete recovery; one self-contained duodenal wall perforation, treated conservatively. There were no cases of pancreatitis, bleed, cardiopulmonary events or deaths. One patient was ASA IV. The remainder were ASA III. Median time between ERCPs was 7 days. Conclusions: A two-stage attempt to gain desired non-emergent BD access that includes precut biliary ES at index ERCP appears safe, and may facilitate BD access at the follow-up ERCP. Prophylactic pancreatic stenting is likely to reduce complications after index ERCP. Expertise in precut ES is mandatory.
CONTEXT: There is controversy concerning the merits of enteral and parenteral nutrition in the ma... more CONTEXT: There is controversy concerning the merits of enteral and parenteral nutrition in the management of patients with severe acute pancreatitis.OBJECTIVE: This study was undertaken to evaluate the effect of enteral nutrition versus parenteral nutrition on serum markers of inflammation and outcome in patients with severe acute pancreatitis.SETTING: Tertiary care centre in North India.DESIGN: A prospective clinical trial.METHODS: Fifty consecutive patients with severe acute pancreatitis were randomized in a prospective trial to receive total enteral nutrition (n=25) or total parenteral nutrition (n=25). Enteral nutrition was delivered distal to the ligament of Treitz. Serum C-reactive protein, transferrin levels, albumin, surgical intervention, infections, duration of hospital stay and mortality were compared in the two groups.RESULTS: The mean age in the enteral nutrition group was 38.4+/-13.8 years and in the total parenteral nutrition group 41.1+/-11.3 years. The etiological factors were alcohol (n=19), gallstones (n=23), idiopathic (n=7) and drug-induced (n=1). There was a significant decrease in serum C-reactive protein values in both the enteral nutrition group and the total parenteral nutrition group at one week and two weeks (P<0.001 for both). Serum albumin rose from a prenutritional value of 2.82+/-0.51 g/dL to 3.34+/-0.45 g/dL on day 14 of nutritional support in the enteral nutrition group (P=0.003); in the total parenteral nutrition group, the level rose from 3.10+/-0.59 g/dL to 3.21+/-0.30 g/dL (P=0.638). A significant rise in transferrin value was observed from day 0 to day 14 in enteral nutrition group (169+/-30 to 196+/-36 mg/dL; P<0.001) whereas, in the total parenteral nutrition group, a less significant difference (191+/-41 to 201+/-29 mg/dL; P=0.044) was observed. There was no significant difference in surgical intervention (56.0% versus 60.0%; P=1.000), infective complications (64.0% versus 60.0%; P=1.000), hospital stay (42 days, 15-108 days, versus 36 days, 20-77 days; median, range; P=0.755), or mortality (20.0% versus 16.0%; P=1.000) in enteral nutrition versus total parenteral nutrition, respectively.CONCLUSION: Enteral nutrition and total parenteral nutrition are comparable in the management of severe acute pancreatitis in terms of hospital stay, need for surgical intervention, infections and mortality.
In a kindred of 46 individuals of an Indian Sikh family with no history of consanguinity, 8 suffe... more In a kindred of 46 individuals of an Indian Sikh family with no history of consanguinity, 8 suffered from site specific colon (caecum) cancer (not associated with polyposis). The clinical features in the affected kindred were indicative of a "cancer family syndrome". The study of the family depicted an autosomal dominant transmission pattern of site specific colon cancer, with probably 100% penetrance in the affected individuals. A low percentage of mitotic index (MI) was observed in the two probands who were available for the study. No structural or numerical chromosomal aberrations were observed in either case. It is probable that the gene responsible in this family could have begun by mutation at the germ cell level in the 1st generation and remained in a heterozygous condition in the affected individuals.
Proceedings of the 2008 International Conference on Advanced Infocomm Technology, Jul 29, 2008
... Wireless Sensor Networks Gurpreet Singh Motorola Software Group Motorola India Ltd Bangalore,... more ... Wireless Sensor Networks Gurpreet Singh Motorola Software Group Motorola India Ltd Bangalore, India 091-9916504573 gurpreetlayal@gmail.com Rashmi Gupta Global Development Center Cisco Systems India Ltd Bangalore, India 091-9916504572 rashmi.igit@gmail.com ...
Acute suppurative cholangitis is a serious complication of biliary obstructions due to infection.... more Acute suppurative cholangitis is a serious complication of biliary obstructions due to infection. Salmonella enterica serovar Typhi is an important biliary pathogen. Bile samples from 445 patients with biliary diseases as well as those requiring biliary drainage for other miscellaneous gastrointestinal diseases were investigated bacteriologically with special emphasis on Salmonella. Fecal samples or rectal swabs were also obtained from 402 of these patients. Bactericholia was detected in 68.8% patients and Salmonella in 5.8% of all bile samples. Other strains of salmonellae were also present in a fair number of the samples. Some of the patients had the same type of bacterial isolates from their stool samples as those from their bile samples. Colonization of the biliary system may not be clinically apparent, but is associated with an increased risk of infection.
Tropical Gastroenterology Official Journal of the Digestive Diseases Foundation, 2006
Diseases of the biliary tract can get complicated by infection. Endotoxin may theoretically be re... more Diseases of the biliary tract can get complicated by infection. Endotoxin may theoretically be responsible for damage to the gall bladder due to its numerous pathophysiological effects. The aim of the present study was to detect and semi-quantitate the amount of endotoxin present in the bacteriologically positive bile samples and to correlate the endotoxin levels with the clinical profile of the patients. One hundred patients with gall bladder diseases and with infected bile constituted the population for investigation. The clinical profile included presence of fever, jaundice, abdominal pain and gall bladder stones. Endotoxin detection and semi-quantitation in the bile samples were carried out using the Limulus amoebocyte assay: Of 100 infected bile samples investigated, 9 samples (9%) were positive for endotoxin ranging from 1.9 EU/ml to 15 EU/ml. Four of them had Klebsiella pneumoniae, 2 had Acinetobacter anitratus and one each of the remaining 3 samples was positive for (i) Escherichia coli and Serratia marcescens (ii) Pseudomonas aeruginosa and (iii) Salmonella enteritidis. The stool sample of the patient with S. enteritidis in the bile also grew the same microorganism. Statistical analysis showed a significant increase in the presence ofjaundice (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05) and abdominal pain (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01) in the endotoxin positive patients compared to the endotoxin negative ones. Hitherto this is the first report that investigated the endotoxin levels in the bile of patients with gall bladder and biliary tract diseases, along with their biliary bacterial profile. Further research is warranted on the effects of endotoxin on gall stone formation.
The Indian Journal of Medical Research, Sep 1, 2005
Smoking plays a dominant role in premature atherosclerosis particularly among males in South Asia... more Smoking plays a dominant role in premature atherosclerosis particularly among males in South Asian countries. It initiates and promotes atherosclerosis by altering cardiac haemodynamics, causing dyslipidaemia and producing oxidative damage. Not much information is available from our country. We therefore undertook this study to see the effect of smoking on electrocardiogram (ECG), blood pressure, lipids, apolipoprotein B level and free radical activity in young asymptomatic male smokers.
ABSTRACT Dendrimers are repeatedly branched, roughly spherical large molecules. The name comes fr... more ABSTRACT Dendrimers are repeatedly branched, roughly spherical large molecules. The name comes from the Greek word dendron, which translates to &quot;tree&quot;. Synonymous terms for dendrimer include arborols and cascade molecules. However, dendrimer is currently the internationally accepted term. A dendrimer is typically symmetric around the core, and often adopts a spherical three-dimensional morphology. The word dendron is also encountered frequently. A dendron usually contains a single chemically addressable group called the focal point. Dendrimers are a new class of three- dimensional, man- made molecules produced by a usual synthetic route which incorporates repetitive branching sequences to create a unique novel architecture. These are highly controlled structures with all bonds emanate from a core and like a tree.
Hepatobiliary Pancreatic Diseases International Hbpd Int, Aug 1, 2010
BACKGROUND: Biliary leak is an uncommon but significant complication following cholecystectomy. E... more BACKGROUND: Biliary leak is an uncommon but significant complication following cholecystectomy. Endotherapy is an established method of treatment. However, the optimal intervention is not known.METHOD: Eighty-five patients with postcholecystectomy biliary leaks from July 2000 to March 2009 were retrospectively evaluated.RESULTS: The study population was 20 males and 65 females with a mean age of 42.47 years. Patients presented with abdominal pain (46), jaundice (23), fever (23), abdominal distension (42), or bilious abdominal drain (67). Endoscopic retrograde cholangiopancreatography detected a leak at the cystic duct stump in 45 patients, stricture with middle common bile duct leak in 4, leak from the right hepatic duct in 3, and a ligated common bile duct in 32. Twelve also had bile duct stones. One had a broken T-tube with stones. Endotherapy was possible in 53 patients. Three patients with stones, one with a broken T-tube with stones, and 4 with stricture of the common bile duct with a leak were managed with sphincterotomy and stenting. Eight patients with a cystic duct stump leak with stones were managed with sphincterotomy and stone extraction. Three outpatients and 12 inpatients with a cystic duct stump leak were managed with sphincterotomy and stent and sphincterotomy and nasobiliary drain, respectively. Five patients with a cystic duct stump leak were managed with stenting. Sixteen with coagulopathy were managed with only nasobiliary drain (9) or stent (7). Leak closure was achieved in 100% patients. Four developed mild pancreatitis which improved with conservative treatment.CONCLUSIONS: Endoscopic intervention is a safe and effective method of treatment of postcholecystectomy biliary leaks. However, management should be individualized based on factors such as outpatients or inpatients, presence of stone, stricture, ligature, or coagulopathy.
The Indian Journal of Medical Research, Apr 1, 2013
Gamma H2AX, a marker of DNA double stranded breaks (DSB) has been found to be over expressed in v... more Gamma H2AX, a marker of DNA double stranded breaks (DSB) has been found to be over expressed in various tumours. The objective of the present work was to study the expression of γH2AX in infiltrating ductal carcinoma (IDC) and fibroadenoma (FA) cases and to associate the expression in IDC with cytomorphological features and DNA ploidy. The expression of γH2AX was studied in fine needle aspirates of 16 cases of IDC and 15 FA cases. The expression in IDC was correlated with the cytological grade, apoptotic (AI) and mitotic indices (MI) and ploidy status. A high γH2AX expression was noted in IDC as compared to FA. Amongst the IDC cases the γH2AX was found to be significantly over expressed in DNA diploid IDC cases as compared to the aneuploid ones. The study suggests a role of γH2AX in breast carcinogenesis which needs to be explored further. Moreover, the γH2AX expression together with ploidy status may serve as a means of assigning the patients of IDC to a better prognostic category irrespective of the cytomorphogical parameters.
Tropical Gastroenterology Official Journal of the Digestive Diseases Foundation, 2004
C-reactive protein (CRP) assay is widely used as a clinical tool for the evaluation of bacterial ... more C-reactive protein (CRP) assay is widely used as a clinical tool for the evaluation of bacterial infections. No study has been undertaken to evaluate the presence of CRP and/or the estimation of this protein in the bile of patients with diseases of the gallbladder (GB). In the present study, we estimated the quantity of CRP in bile (n=358) as well as serum samples (n=186) obtained from patients with GB and biliary tract diseases, using the semiquantitative Avitex CRP kit. Bacteriological study was also done on the bile samples. CRP was positive in the bile of 56 patients, (15.6%) many of who had bacteriobilia. CRP was also present in 49 of the serum samples studied (26.3%). Control serum samples did not show any CRP within detectable limits. Hitherto, this is the first report that investigated the level of CRP in the bile of patients with GB and biliary tract diseases, along with biliary bacterial profile.
The effect of different concentrations of drug and permeation enhancer (Dimethylsulfoxide) on ion... more The effect of different concentrations of drug and permeation enhancer (Dimethylsulfoxide) on iontophoretic transport of salbutamol sulphate was investigated in vitro. The iontophoretic transport was measured at constant (optimum) current density and pH as a function of varied concentration of drug, and at a fixed drug concentration as a function of permeation enhancer to know (i) how does drug concentration affect the efficiency of delivery? (ii) to what extent permeation enhancer affects the percutaneous delivery of drugs? (iii) what would be the combined effect of iontophoresis and permeation enhancer on permeation of drugs? Results showed that the use of different concentrations of drug in donor half cell (4, 8 and 16 mg/ml) increases the steady state flux both in passive diffusion (at pH 10.3) and iontophoresis (anodal at pH 7.4 and cathodal at pH 11) using 0.3 mA/cm 2 current density. With the use of different concentrations of permeation enhancer (5, 10, 15 % w/v) in passive diffusion significantly increased (p < 0.05, t-test) the transport of drug and enhancement was 4, 6 and 7.6 folds respectively compared to the control. The maximum steady state flux was obtained with the use of 15 % w/v DMSO. Iontophoresis in conjugation with permeation enhancer had a significant synergistic effect in terms of transport of drug across skin.
Ductal carcinoma in situ (DCIS) is considered a heterogeneous lesion at the molecular level. Howe... more Ductal carcinoma in situ (DCIS) is considered a heterogeneous lesion at the molecular level. However, there is a paucity of literature about the existence of molecular subtypes in DCIS which can predict their biological behavior at the preinvasive stage. Precise prevalence of molecular subtypes of pure DCIS and DCIS component of infiltrating duct carcinoma (IDC) was evaluated using immunohistochemistry and correlated with known prognostic factors. DCIS cases were classified as luminal A (46.6% in each group), luminal B (pure DCIS 20% and DCIS component of IDC 13.3%), HER2 overexpressing, basal and nonbasal (pure DCIS 3.3% and 26.6% and DCIS component of IDC 3.3% and 33.3%, respectively), and triple negative, nonbasal (pure DCIS and DCIS component of IDC 3.3% each). The molecular phenotype of DCIS correlated well with that of the coexisting IDC. This study demonstrated molecular heterogeneity in DCIS; however, similar molecular phenotypes were seen in the coexisting IDC suggesting th...
Attempts at identification of an ideal prognostic/predictive biomarker in phyllodes tumour (PT) h... more Attempts at identification of an ideal prognostic/predictive biomarker in phyllodes tumour (PT) have not been fruitful so far. Studies evaluating c-kit expression in PT have shown contradictory results. Recently aldehyde dehydrogenase 1A1 (ALDH1A1) was proposed as a stem cell marker for malignant PT but its expression has not been studied in benign and borderline tumours. We aimed to evaluate expression and prognostic significance of c-kit and ALDH1A1 in different grades of PT. Epithelial and stromal c-kit and ALDH1A1 expression were studied in 104 PT cases (86 primary and 18 recurrent tumours) and compared with different clinico-pathological features and recurrence rates. Stromal c-kit expression at 1 % cutoff correlated with increasing tumour grade, larger tumour size, hypercellularity, nuclear atypia, stromal overgrowth, infiltrative margins and mitotic count. These associations, however, were lost with higher (5 or 10 %) cutoffs. Conversely, decreased c-kit expression in the epithelial component correlated with increasing tumour grade, regardless of the cutoffs used. Stromal ALDH1A1 expression did not have significant associations with tumour grade or other adverse clinico-pathological features, regardless of different cutoffs. None of the cases showed significant epithelial ALDH1A1 expression. Expression of c-kit was associated with poorer overall survival (p = 0.011), while ALDH1A1 expression was associated with shorter recurrence-free survival (p = 0.036). In conclusion, c-kit expression was associated with higher tumour grade and adverse clinico-pathological features. However, these associations are cutoff dependent, partly explaining the variability in previously reported studies. ALDH1A1 expression did not have significant correlations with tumour grade and adverse clinico-pathological variables.
Background: BD ductal access during ERCP may be difficult in certain cases. Operators may persist... more Background: BD ductal access during ERCP may be difficult in certain cases. Operators may persist in attempts to gain BD access despite increasing procedurerelated ampullary swelling and distorted ampullary anatomy. Precut ES may be used to gain BD access, but if done aggressively, it can be complicated by retroperitoneal perforation, bleeding and pancreatitis. However, by waiting several days after failed precut ES, ampullary tissue edema will resolve and BD access may actually be easier than in the native (uncut) papilla. Aim: To evaluate safety and efficacy of repeat ERCP for BD access within several days after initial failed precut ES. Methods: Retrospective analysis. Intent to treat. 1997-2004. Procedures were done by a single experienced biliary endoscopist. Inclusion criteria: patients undergoing ERCP for non-emergent BD access where BD access failed despite precut endoscopic sphincterotomy (ES) and where repeat ERCP for BD access was attempted several days later. Outcomes were: Success at repeat ERCP and ERCP-related complications. All patients received prophylactic antibiotics during and after ERCP. Results: 26 patients met inclusion criteria. 18/26 had a prophylactic narrow caliber pancreatic stents placed at index ERCP. Successful BD access was obtained in 20/26 patients. Failed repeat BD access occurred in 6/20 due to: fungating ampullary carcinoma (1), BD orifice found to be widely patent on repeat endoscopic view and ERC therefore not neccessary (1), failure to re-identify ampullary orifice (1), perforation (2). There were no complications following index ERCP. Complications from follow-up ERCP included one duodenal bulb perforation requiring surgical repair, with complete recovery; one self-contained duodenal wall perforation, treated conservatively. There were no cases of pancreatitis, bleed, cardiopulmonary events or deaths. One patient was ASA IV. The remainder were ASA III. Median time between ERCPs was 7 days. Conclusions: A two-stage attempt to gain desired non-emergent BD access that includes precut biliary ES at index ERCP appears safe, and may facilitate BD access at the follow-up ERCP. Prophylactic pancreatic stenting is likely to reduce complications after index ERCP. Expertise in precut ES is mandatory.
CONTEXT: There is controversy concerning the merits of enteral and parenteral nutrition in the ma... more CONTEXT: There is controversy concerning the merits of enteral and parenteral nutrition in the management of patients with severe acute pancreatitis.OBJECTIVE: This study was undertaken to evaluate the effect of enteral nutrition versus parenteral nutrition on serum markers of inflammation and outcome in patients with severe acute pancreatitis.SETTING: Tertiary care centre in North India.DESIGN: A prospective clinical trial.METHODS: Fifty consecutive patients with severe acute pancreatitis were randomized in a prospective trial to receive total enteral nutrition (n=25) or total parenteral nutrition (n=25). Enteral nutrition was delivered distal to the ligament of Treitz. Serum C-reactive protein, transferrin levels, albumin, surgical intervention, infections, duration of hospital stay and mortality were compared in the two groups.RESULTS: The mean age in the enteral nutrition group was 38.4+/-13.8 years and in the total parenteral nutrition group 41.1+/-11.3 years. The etiological factors were alcohol (n=19), gallstones (n=23), idiopathic (n=7) and drug-induced (n=1). There was a significant decrease in serum C-reactive protein values in both the enteral nutrition group and the total parenteral nutrition group at one week and two weeks (P<0.001 for both). Serum albumin rose from a prenutritional value of 2.82+/-0.51 g/dL to 3.34+/-0.45 g/dL on day 14 of nutritional support in the enteral nutrition group (P=0.003); in the total parenteral nutrition group, the level rose from 3.10+/-0.59 g/dL to 3.21+/-0.30 g/dL (P=0.638). A significant rise in transferrin value was observed from day 0 to day 14 in enteral nutrition group (169+/-30 to 196+/-36 mg/dL; P<0.001) whereas, in the total parenteral nutrition group, a less significant difference (191+/-41 to 201+/-29 mg/dL; P=0.044) was observed. There was no significant difference in surgical intervention (56.0% versus 60.0%; P=1.000), infective complications (64.0% versus 60.0%; P=1.000), hospital stay (42 days, 15-108 days, versus 36 days, 20-77 days; median, range; P=0.755), or mortality (20.0% versus 16.0%; P=1.000) in enteral nutrition versus total parenteral nutrition, respectively.CONCLUSION: Enteral nutrition and total parenteral nutrition are comparable in the management of severe acute pancreatitis in terms of hospital stay, need for surgical intervention, infections and mortality.
In a kindred of 46 individuals of an Indian Sikh family with no history of consanguinity, 8 suffe... more In a kindred of 46 individuals of an Indian Sikh family with no history of consanguinity, 8 suffered from site specific colon (caecum) cancer (not associated with polyposis). The clinical features in the affected kindred were indicative of a "cancer family syndrome". The study of the family depicted an autosomal dominant transmission pattern of site specific colon cancer, with probably 100% penetrance in the affected individuals. A low percentage of mitotic index (MI) was observed in the two probands who were available for the study. No structural or numerical chromosomal aberrations were observed in either case. It is probable that the gene responsible in this family could have begun by mutation at the germ cell level in the 1st generation and remained in a heterozygous condition in the affected individuals.
Proceedings of the 2008 International Conference on Advanced Infocomm Technology, Jul 29, 2008
... Wireless Sensor Networks Gurpreet Singh Motorola Software Group Motorola India Ltd Bangalore,... more ... Wireless Sensor Networks Gurpreet Singh Motorola Software Group Motorola India Ltd Bangalore, India 091-9916504573 gurpreetlayal@gmail.com Rashmi Gupta Global Development Center Cisco Systems India Ltd Bangalore, India 091-9916504572 rashmi.igit@gmail.com ...
Acute suppurative cholangitis is a serious complication of biliary obstructions due to infection.... more Acute suppurative cholangitis is a serious complication of biliary obstructions due to infection. Salmonella enterica serovar Typhi is an important biliary pathogen. Bile samples from 445 patients with biliary diseases as well as those requiring biliary drainage for other miscellaneous gastrointestinal diseases were investigated bacteriologically with special emphasis on Salmonella. Fecal samples or rectal swabs were also obtained from 402 of these patients. Bactericholia was detected in 68.8% patients and Salmonella in 5.8% of all bile samples. Other strains of salmonellae were also present in a fair number of the samples. Some of the patients had the same type of bacterial isolates from their stool samples as those from their bile samples. Colonization of the biliary system may not be clinically apparent, but is associated with an increased risk of infection.
Tropical Gastroenterology Official Journal of the Digestive Diseases Foundation, 2006
Diseases of the biliary tract can get complicated by infection. Endotoxin may theoretically be re... more Diseases of the biliary tract can get complicated by infection. Endotoxin may theoretically be responsible for damage to the gall bladder due to its numerous pathophysiological effects. The aim of the present study was to detect and semi-quantitate the amount of endotoxin present in the bacteriologically positive bile samples and to correlate the endotoxin levels with the clinical profile of the patients. One hundred patients with gall bladder diseases and with infected bile constituted the population for investigation. The clinical profile included presence of fever, jaundice, abdominal pain and gall bladder stones. Endotoxin detection and semi-quantitation in the bile samples were carried out using the Limulus amoebocyte assay: Of 100 infected bile samples investigated, 9 samples (9%) were positive for endotoxin ranging from 1.9 EU/ml to 15 EU/ml. Four of them had Klebsiella pneumoniae, 2 had Acinetobacter anitratus and one each of the remaining 3 samples was positive for (i) Escherichia coli and Serratia marcescens (ii) Pseudomonas aeruginosa and (iii) Salmonella enteritidis. The stool sample of the patient with S. enteritidis in the bile also grew the same microorganism. Statistical analysis showed a significant increase in the presence ofjaundice (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05) and abdominal pain (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01) in the endotoxin positive patients compared to the endotoxin negative ones. Hitherto this is the first report that investigated the endotoxin levels in the bile of patients with gall bladder and biliary tract diseases, along with their biliary bacterial profile. Further research is warranted on the effects of endotoxin on gall stone formation.
The Indian Journal of Medical Research, Sep 1, 2005
Smoking plays a dominant role in premature atherosclerosis particularly among males in South Asia... more Smoking plays a dominant role in premature atherosclerosis particularly among males in South Asian countries. It initiates and promotes atherosclerosis by altering cardiac haemodynamics, causing dyslipidaemia and producing oxidative damage. Not much information is available from our country. We therefore undertook this study to see the effect of smoking on electrocardiogram (ECG), blood pressure, lipids, apolipoprotein B level and free radical activity in young asymptomatic male smokers.
ABSTRACT Dendrimers are repeatedly branched, roughly spherical large molecules. The name comes fr... more ABSTRACT Dendrimers are repeatedly branched, roughly spherical large molecules. The name comes from the Greek word dendron, which translates to &quot;tree&quot;. Synonymous terms for dendrimer include arborols and cascade molecules. However, dendrimer is currently the internationally accepted term. A dendrimer is typically symmetric around the core, and often adopts a spherical three-dimensional morphology. The word dendron is also encountered frequently. A dendron usually contains a single chemically addressable group called the focal point. Dendrimers are a new class of three- dimensional, man- made molecules produced by a usual synthetic route which incorporates repetitive branching sequences to create a unique novel architecture. These are highly controlled structures with all bonds emanate from a core and like a tree.
Hepatobiliary Pancreatic Diseases International Hbpd Int, Aug 1, 2010
BACKGROUND: Biliary leak is an uncommon but significant complication following cholecystectomy. E... more BACKGROUND: Biliary leak is an uncommon but significant complication following cholecystectomy. Endotherapy is an established method of treatment. However, the optimal intervention is not known.METHOD: Eighty-five patients with postcholecystectomy biliary leaks from July 2000 to March 2009 were retrospectively evaluated.RESULTS: The study population was 20 males and 65 females with a mean age of 42.47 years. Patients presented with abdominal pain (46), jaundice (23), fever (23), abdominal distension (42), or bilious abdominal drain (67). Endoscopic retrograde cholangiopancreatography detected a leak at the cystic duct stump in 45 patients, stricture with middle common bile duct leak in 4, leak from the right hepatic duct in 3, and a ligated common bile duct in 32. Twelve also had bile duct stones. One had a broken T-tube with stones. Endotherapy was possible in 53 patients. Three patients with stones, one with a broken T-tube with stones, and 4 with stricture of the common bile duct with a leak were managed with sphincterotomy and stenting. Eight patients with a cystic duct stump leak with stones were managed with sphincterotomy and stone extraction. Three outpatients and 12 inpatients with a cystic duct stump leak were managed with sphincterotomy and stent and sphincterotomy and nasobiliary drain, respectively. Five patients with a cystic duct stump leak were managed with stenting. Sixteen with coagulopathy were managed with only nasobiliary drain (9) or stent (7). Leak closure was achieved in 100% patients. Four developed mild pancreatitis which improved with conservative treatment.CONCLUSIONS: Endoscopic intervention is a safe and effective method of treatment of postcholecystectomy biliary leaks. However, management should be individualized based on factors such as outpatients or inpatients, presence of stone, stricture, ligature, or coagulopathy.
The Indian Journal of Medical Research, Apr 1, 2013
Gamma H2AX, a marker of DNA double stranded breaks (DSB) has been found to be over expressed in v... more Gamma H2AX, a marker of DNA double stranded breaks (DSB) has been found to be over expressed in various tumours. The objective of the present work was to study the expression of γH2AX in infiltrating ductal carcinoma (IDC) and fibroadenoma (FA) cases and to associate the expression in IDC with cytomorphological features and DNA ploidy. The expression of γH2AX was studied in fine needle aspirates of 16 cases of IDC and 15 FA cases. The expression in IDC was correlated with the cytological grade, apoptotic (AI) and mitotic indices (MI) and ploidy status. A high γH2AX expression was noted in IDC as compared to FA. Amongst the IDC cases the γH2AX was found to be significantly over expressed in DNA diploid IDC cases as compared to the aneuploid ones. The study suggests a role of γH2AX in breast carcinogenesis which needs to be explored further. Moreover, the γH2AX expression together with ploidy status may serve as a means of assigning the patients of IDC to a better prognostic category irrespective of the cytomorphogical parameters.
Tropical Gastroenterology Official Journal of the Digestive Diseases Foundation, 2004
C-reactive protein (CRP) assay is widely used as a clinical tool for the evaluation of bacterial ... more C-reactive protein (CRP) assay is widely used as a clinical tool for the evaluation of bacterial infections. No study has been undertaken to evaluate the presence of CRP and/or the estimation of this protein in the bile of patients with diseases of the gallbladder (GB). In the present study, we estimated the quantity of CRP in bile (n=358) as well as serum samples (n=186) obtained from patients with GB and biliary tract diseases, using the semiquantitative Avitex CRP kit. Bacteriological study was also done on the bile samples. CRP was positive in the bile of 56 patients, (15.6%) many of who had bacteriobilia. CRP was also present in 49 of the serum samples studied (26.3%). Control serum samples did not show any CRP within detectable limits. Hitherto, this is the first report that investigated the level of CRP in the bile of patients with GB and biliary tract diseases, along with biliary bacterial profile.
The effect of different concentrations of drug and permeation enhancer (Dimethylsulfoxide) on ion... more The effect of different concentrations of drug and permeation enhancer (Dimethylsulfoxide) on iontophoretic transport of salbutamol sulphate was investigated in vitro. The iontophoretic transport was measured at constant (optimum) current density and pH as a function of varied concentration of drug, and at a fixed drug concentration as a function of permeation enhancer to know (i) how does drug concentration affect the efficiency of delivery? (ii) to what extent permeation enhancer affects the percutaneous delivery of drugs? (iii) what would be the combined effect of iontophoresis and permeation enhancer on permeation of drugs? Results showed that the use of different concentrations of drug in donor half cell (4, 8 and 16 mg/ml) increases the steady state flux both in passive diffusion (at pH 10.3) and iontophoresis (anodal at pH 7.4 and cathodal at pH 11) using 0.3 mA/cm 2 current density. With the use of different concentrations of permeation enhancer (5, 10, 15 % w/v) in passive diffusion significantly increased (p < 0.05, t-test) the transport of drug and enhancement was 4, 6 and 7.6 folds respectively compared to the control. The maximum steady state flux was obtained with the use of 15 % w/v DMSO. Iontophoresis in conjugation with permeation enhancer had a significant synergistic effect in terms of transport of drug across skin.
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