Lymphocytic colitis presenting as intestinal obstruction: a rare case report

Lymphocytic colitis is a rare syndrome of watery diarrhoea, normal colonoscopy findings and mucosal inflammation. The patient does not present with bloody diarrhoea as there is no mucosal ulceration. A 30-year-old male presented with complaints of pain abdomen for 6 months. Ultrasound showed oedematous ileo-cecal junction with ileocolic lymphadenopathy which was managed with antibiotics. He presented again with symptoms of intestinal obstruction in the following month. On laparotomy, there was ileo-cecal thickening for which right hemicolectomy was done. The biopsy report came as lymphocytic colitis. This is a very rare presentation for a case of lymphocytic colitis.

Predictors of acute kidney injury in patients undergoing adult cardiac surgery

Background: Acute kidney injury (AKI) after cardiac surgery (CS) is not uncommon and has serious effects on mortality and morbidity. A majority of patients suffer mild forms of AKI. There is a paucity of Indian data regarding this important complication after CS. Aims and Objectives: The primary objective was to study the incidence of AKI associated with CS in an Indian study population. Secondary objectives were to describe the risk factors associated with AKI-CS in our population and to generate outcome data in patients who suffer this complication. Methods: Serial patients (n = 400) presenting for adult CS (emergency/elective) at a tertiary referral care hospital in South India from August 2016 to November 2017 were included as the study individuals. The incidence of AKI-CS AKI network (AKIN criteria), risk factors associated with this condition and the outcomes following AKI-CS are described. Results: Out of 400, 37 (9.25%) patients developed AKI after CS. AKI associated with CS was associated with a mortality of 13.5% (no AKI group mortality 2.8%, P = 0.001 [P < 0.05]). When AKI was severe enough to need renal replacement therapy, the mortality increased to 75%. Patients with AKI had a mean hospital stay 16.92 ± 12.75 days which was comparatively longer than patients without AKI (14 ± 7.98 days). Recent acute coronary syndrome, postoperative atrial fibrillation, and systemic hypertension significantly predicted the onset of AKI-CS in our population. Conclusions: The overall incidence of AKI-CS was 9.25%. The incidence of AKI-CS requiring dialysis (Stage 3 AKIN) AKI-CS was lower (2%). However, mortality risks were disproportionately high in patients with AKIN Stage 3 AKI-CS (75%). There is a need for quality improvement in the care of patients with AKI-CS in its most severe forms since mortality risks posed by the development of Stage 3 AKIN AKI is higher than reported in other index populations from high resource settings.

Pathophysiological and pharmacological modulation of melatonergic system.

Pineal gland once considered as rudimentary or vestigial, has become a principal endocrine gland that regulates the body’s internal environment, after the discovery of melatonin - a hormone produced by it. Melatonin is also synthesized from extrapineal sites such as retina, skin, platelets, bone marrow, and gastrointestinal tract. The chronobiological property of this hormone in maintaining the circadian rhythm by synchronizing with the dark-light cycle is well-established. Melatonin also possesses anti-inflammatory, anti-depressant, anti-oxidant, oncostatic, immunomodulatory, antiepileptic, and glucose-regulating properties. These pleiotropic effects of melatonin on diverse organ systems either through a receptor or non-receptor mediated pathways are under investigation. This review highlights the pathophysiological and pharmacological actions of melatonin along with melatonergic agonists in “real life” clinical practice.

C–reactive protein estimation: A quantitative analysis for three nonsteroidal anti‑inflammatory drugs: A randomized control trial.

Context: C‑reactive protein (CRP) estimation for quantitative analysis to assess anti‑inflammatory action of nonsteroidal anti‑inflammatory drugs (NSAIDs) after surgery in maxillofacial surgery. Aims: This study was to evaluate the efficacy of CRP as a quantitative analysis for objective assessment of efficacy of three NSAIDs in postoperative inflammation and pain control. Settings and Design: The parallel study group design of randomization was done. Totally 60 patients were divided into three groups. CRP was evaluated at baseline and postoperatively (immediate and 72 h) after surgical removal of impacted lower third molar. The respective group received the drugs by random coding postoperatively. Subjects and Methods: The assessment of pain control and inflammation using NSAIDs postoperatively after surgical removal of impacted lower third molar was qualitatively and quantitatively assessed with CRP levels. The blood sample of the patient was assessed immediate postoperatively and after 72 h. The visual analog scale (VAS) was used for assessment of pain and its correlation with CRP levels. Statistical Analysis: Comparison of difference in levels of CRP levels had P < 0.05 with immediate postoperative and baseline levels. The duration of surgery with association of CRP levels P = 0.425 which was nonsignificant. The pain score was increased with mefenamic acid (P = 0.003), which was significant on VAS. Results: Diclofenac had the best anti‑inflammatory action. There was a significant increase in CRP levels in immediate postoperative values and 72 h. CRP test proved to be a useful indicator as a quantitative assessment tool for monitoring postsurgical inflammation and therapeutic effects of various anti‑inflammatory drugs. Conclusions: CRP test is a useful indicator for quantitative assessment for comparative evaluation of NSAIDs.

Genetic analysis of OCT1 gene polymorphisms in an Indian population.

BACKGROUND: Genetic variants of the organic cation transporter (OCT1) gene could influence interindividual variation in clinical response to metformin therapy. The genetic basis for the single-nucleotide polymorphism (SNP) of OCT1 gene has been established in other populations, but it remains to be elucidated in the Indian population. This study is focused on OCT1 gene variants rs2282143 (P341L, 1022C>T), rs628031 (M408V, 1222A>G) and rs622342 (1386C>A) frequency distributions in the South Indian Tamilian population. MATERIALS AND METHODS: A total of 112 unrelated healthy subjects of South Indian Tamilian origin, aged 18–60 years, of either sex were recruited for the study. Genotyping was determined using the quantitative real time-polymerase chain reaction and polymerase chain reaction followed by restriction fragment length polymorphism methods. RESULTS: Allele frequencies of rs2282143, rs628031and rs622342 polymorphisms were 8.9%, 80.3% and 24.5%, respectively. Interethnic differences in the genotype and allele frequencies of OCT1 gene polymorphism were observed when compared with other major populations. The SNPs rs2282143, T allele and rs628031, G allele were more common in Asians (5.5–16.8% and 76.2–81%) and African Americans (8.2% and 73.5%) than in Caucasians (0–2% and 57.4–60%). CONCLUSION: This is the first time the frequency of OCT1 gene polymorphism was determined in the Indian population, and is similar to the frequencies observed in African-Americans and other Asian populations but different from those in Caucasians. The data observed in this study would justify further pharmacogenetic studies to potentially evaluate the role of OCT1 gene polymorphism in the therapeutic efficacy of metformin.

Radiofrequency ablation of liver tumors: experience with open and percutaneous approach.

BACKGROUND: Radiofrequency ablation (RFA), a thermal coagulation technique, has been used for ablation of primary and secondary liver tumors. METHODS: Over a 24-month period, 41 patients, including 20 with hepatocellular cancer (HCC), 14 with liver metastases from colorectal tumors and 7 with metastases from other tumors, underwent RFA in our institution. Ablation was done using intra-operative (n=27) or percutaneous ultrasonographic (n=14) guidance. A zone of ablation larger than the size of the lesion on CT scan indicated successful RFA. RESULTS: The mean size of lesions was 4.9 cm for HCC and 3.1 cm for metastases. Among 20 patients with HCC, 16 had complete tumor ablation and one had failure of localization. All patients with liver metastases had successful tumor ablation. There was no procedure-related death. Two patients had hemoperitoneum and one experienced skin burn. During a median follow up of 16 months, five patients with HCC and two with colorectal metastases died. One patient had tumor recurrence at the ablation site and two developed fresh solitary metastatic lesions; all three are disease-free after repeat ablation treatment. CONCLUSIONS: RFA is a safe and promising technique for the treatment of non-resectable HCC and liver metastases, in the short term.