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In general, the α-functionalization of carboxylic acid derivatives requires either a transition metal catalyst or a stoichiometric activating agent/strong base/external additive. A transition metal free α-chalcogenation of aliphatic carboxylic acid equivalents is reported herein via ion pair formation using K

Background/Aims: Coronavirus disease 2019 (COVID-19) is recognized to have variable clinical manifestations. The clinical presentation of patients with inflammatory bowel disease (IBD) having COVID-19 is unclear.Methods: We identified articles reporting about the clinical presentation of COVID-19 in those with underlying IBD from PubMed and Embase. The studies, irrespective of design or language, were included. The overall pooled frequency of various symptoms was estimated. Joanna Briggs Institute Critical appraisal checklist was used to assess the quality of studies.Results: Eleven studies, including 1,325 patients, were included in the pooled analysis. The pooled estimates for clinical presentation were; fever: 67.53% (95% confidence interval [CI], 45.38–83.88), cough: 59.58% (95% CI, 45.01–72.63), diarrhea: 27.26% (95% CI, 19.51–36.69), running nose: 27% (95% CI, 15.26–43.19) and dyspnea: 25.29% (95% CI, 18.52–33.52). The pooled prevalence rates for abdominal pain, nausea and vomiting were 13.08% (95% CI, 9.24–18.19), 10.08% (95% CI, 5.84–16.85) and 8.80% (95% CI, 4.43–16.70) per 100 population, respectively.Conclusions: The clinical presentation of COVID-19 in IBD patients is similar to the general population.

Pancreatic carcinoma (PC) is one of the leading causes of cancer-related deaths worldwide. Despite early detection and advances in therapeutics, the prognosis remains dismal. The outcome and therapeutic approach are dependent on the stage of PC at the time of diagnosis. The standard of care is surgery, followed by adjuvant chemotherapy. The advent of newer drugs has changed the landscape of adjuvant therapy. Moreover, recent trials have highlighted the role of neoadjuvant therapy and chemoradiotherapy for resectable and borderline resectable PC. As we progress towards a better understanding of tumor biology, genetics, and microenvironment, novel therapeutic strategies and targeted agents are now on the horizon. We have described the current and emerging therapeutic strategies in PC.

Percutaneous catheter drainage (PCD) is an effective way of drainage in acute pancreatitis (AP) and its role in persistent organ failure (OF) has not been studied. This study assessed the outcome of severe AP managed with PCD.We retrospectively analysed outcome of AP patients undergoing PCD for persistent OF with respect to success of PCD, etiology, severity scores, OF, imaging features and PCD parameters. Success of PCD was defined as resolution of with PCD and survived without surgical necrosectomy.Between January 2016 and May 2018, 83 patients underwent PCD for persistent OF at a mean duration of 25.59 ± 21.2 days from pain onset with successful outcome in 47 (56.6%) patients. Among PCD failures, eleven (13.25%) patients underwent surgery. Overall mortality was 31 (37.3%). On multivariate analysis, pancreatic necrosis50% and absence of extrapancreatic infection (EPI) predicted the success of PCD. Presence of infected necrosis did not affect the outcome of PCD in organ failure.PCD improves the outcome in patients with OF even when done early irrespective of the status of infection of necrosis. Therefore, PCD may be considered early in the course of patients with OF.

Objectives: To ascertain the role of antibiotics in induction and maintenance of remission in ulcerative colitis (UC) Methods: We searched electronic databases for keywords ulcerative colitis or inflammatory bowel disease and antibiotics or antimicrobials. We performed a meta-analysis of randomized trials comparing antibiotics with control/placebo for clinical response, need for second line therapy, colectomy, and adverse effects. Subgroup analysis to clarify the mode of administration, number of antibiotics or the setting of use (acute severe UC or active non–severe UC) were also performed. Results: Thirteen trials with 785 patients were included. The pooled odds ratio of achieving clinical response with antibiotics was 1.74 (95% CI, 1.17-2.58). No differences were noted in relapse rates, need for second line therapy, colectomy or, adverse effects with the use of antibiotics. Subgroup analysis showed no differences with use of single or combination of antibiotics. Analysis of trials only in the setting of acute severe colitis did not demonstrate any benefit. Conclusion: The use of oral antibiotics in the setting of non-severe active UC could have some benefit in clinical response. The use of antibiotics is not of benefit in acute severe colitis, but oral antibiotics need to be evaluated in adult patients.

Background The risk of severe acute respiratory syndrome‐related coronavirus 2 (SARS‐CoV‐2) infection and clinical outcomes of coronavirus disease (COVID‐19) in inflammatory bowel disease are unclear. Methods We searched PubMed and Embase with the keywords: inflammatory bowel disease, Crohn's disease, ulcerative colitis and COVID‐19, novel coronavirus and SARS‐CoV‐2. We included studies reporting the frequency of COVID‐19 infection and outcomes (hospitalisation, need for intensive care unit care and mortality) in patients with inflammatory bowel disease. We estimated the pooled incidence of COVID‐19 in inflammatory bowel disease and comparative risk vis‐a‐vis the general population. We also estimated the pooled frequency of outcomes and compared them in patients who received and did not receive drugs for inflammatory bowel disease. Results Twenty‐four studies were included. The pooled incidence rate of COVID‐19 per 1000 patients of inflammatory bowel disease and the general population were 4.02 (95% confidence interval [CI, 1.44–11.17]) and 6.59 [3.25–13.35], respectively, with no increase in relative risk (0.47, 0.18–1.26) in inflammatory bowel disease. The relative risk of the acquisition of COVID‐19 was not different between ulcerative colitis and Crohn's disease (1.03, 0.62–1.71). The pooled proportion of COVID‐19‐positive inflammatory bowel disease patients requiring hospitalisation and intensive care unit care was 27.29% and 5.33% while pooled mortality was 4.27%. The risk of adverse outcomes was higher in ulcerative colitis compared to Crohn's disease. The relative risks of hospitalisation, intensive care unit admission and mortality were lower for patients on biological agents (0.34, 0.19–0.61; 0.49, 0.33–0.72 and 0.22, 0.13–0.38, respectively) but higher with steroids (1.99, 1.64–2.40; 3.41, 2.28–5.11 and 2.70, 1.61–4.55) or 5‐aminosalicylate (1.59, 1.39–1.82; 2.38, 1.26–4.48 and 2.62, 1.67–4.11) use. Conclusion SARS‐CoV‐2 infection risk in patients with inflammatory bowel disease is comparable to the general population. Outcomes of COVID‐19‐positive inflammatory bowel disease patients are worse in ulcerative colitis, those on steroids or 5‐aminosalicylates but outcomes are better with biological agents., Key Summary Current knowledge Inflammatory bowel disease may be associated with an increased risk of various infections.Certain inflammatory bowel disease therapies may predispose to an increased risk of infections (e.g., anti tumour necrosis factor and tuberculosis, tofacitinib and herpes zoster).The effect of inflammatory bowel disease and inflammatory bowel disease therapies on coronavirus disease infection and outcomes is unclear. What are the new findings? In this meta‐analysis, we found that the risk of coronavirus disease in patients with inflammatory bowel disease is similar to the general population.The risk of coronavirus disease does not seem to be affected by the underlying type of inflammatory bowel disease, that is, Crohn's disease or ulcerative colitis.The risk of adverse outcomes in inflammatory bowel disease is more in patients receiving steroids and 5‐aminosalicylates.Biological agent use seems to be protective against adverse outcomes of coronavirus disease in inflammatory bowel disease patients.

A network of drainage patterns and associated morphometric analysis are important as it forms various attributes of a watershed. Analysis of these attributes is carried out by spatial analysis which is essential for studying several hydrological response interactions within the watershed catchment area. In the present work, five stream networks of a head watershed Verakhadi were derived from SOI toposheet (scale = 1:50,000), SRTM-GL1, AW3D30, GDEM-V2 and CartoDEM-V3.1. The calculated basin morphometric attributes of drainage network derived from all four 30-m-resolution satellite-based DEMs were compared with SOI toposheet-based drainage network which is essential for estimating the accuracy of watershed hydrological response to a natural event (storm). The capability of all four satellite-based DEMs to represent linear, areal and relief aspect of the drainage basin was evaluated. Morphometric parameter comparison of stream network derived from various DEMs is an indirect way of assessing the relative vertical accuracy of DEM. It is observed that DEMs with same spatial resolution can have variable morphometry derivatives due to different data acquisition and data processing techniques used for DEM generation. The outcome of this study will help to understand the complexity and susceptibility of the various morphometric factors arises while dealing with different data acquisition and processing techniques. The study suggests that SRTM-GL1 performs better in terms of drainage delineation and basin morphometry, followed by AW3D30, CartoDEM-V3.1 and GDEM-V2 when compared with SOI toposheet-derived terrain attributes.

Introduction: There is a Paucity of Studies exploring Gender disparity in health care access factors affecting it in Developing countries. Aims and objectives: Analysis of gender disparity in access to healthcare and its relationship with the patient’s age and distance from the Hospital. Materials and Methods: A retrospective observational cross sectional study based on outpatient data from a Private Medical College in Ghaziabad. Cross tabulation were done for Sex and age class(young, middle, older) and Estimates from hierarchical logistic regression were used to compute sex ratios (male/female) of patient visits as a function of age and distance (in kilometers) from the hospital and age. Results: A total of 1 lakh 86 patients visited Santosh Hospital Outpatient clinics 2,11,183 times in departments of Medicine, Surgery, Pulmonary Medicine, Paediatrics, Psychiatry, Orthopaedics and Dermatology from July 2018 to July 2019. Out of these 1 lakh 86 patients – 51022 were Males and 49844 were females (Sex ratio of 1.02). Sex ratio had a parabolic (U curve) relationship with Age implying that Sex ratio worsened at extreme age. The Sex ratio in age groups 0-18,19-30,31-45,46-60 and >60 are 1.21,1.06,0.91,1.01 and 1.14 respectively. On adjusting for department in multivariable logistic regression, distance from hospital (available in 820 patients) was significantly associated with probability of a male outpatient visit. Odds Ratio (1.23, 95% CI 1.02-1.48, P value = 0.046). Conclusion: Gender disparity was observed in access to healthcare, which was worse at extremes of age (younger and older age groups) and at higher distance from Hospital. Keywords: Sex Ratio, Gender disparity, Health access, Primary health care, Demographic profile.

Aim of the study: Decompensated hepatitis C virus (HCV) cirrhosis is a difficult to treat cohort, and there is no gold standard predictor of response to direct-acting antiviral (DAA) therapy. We conducted this study to look for factors responsible for improvement in post-therapy status, i.e. attainment of Child-Turcotte-Pugh (CTP) class A from B or C, and devise a new model to predict post-therapy response. Material and methods: Prospective analysis of data from decompensated HCV cirrhotics was done and association of each parameter with patient outcomes at 36 weeks after treatment was assessed. Results 34 patients (54.8%) attained CTP class A after treatment. Factors that were independently associated with disease outcome included albumin (odds ratio [OR] = 4.84, 95% confidence interval [CI]: 1.43-20.15, p = 0.018), alanine transaminase (ALT) (OR = 1.02, 95% CI: 1-1.04, p = 0.049), bilirubin (OR = 0.41, 95% CI: 0.2-0.75, p = 0.007) and estimated glomerular filtration rate (eGFR) (OR = 1.03, 95% CI: 1.0-1.06, p = 0.045). On multivariate analysis, bilirubin was significantly associated with treatment outcome (OR = 0.28, 95% CI: 0.1-0.64, p = 0.006). A composite model was devised using demographic, biochemical, and clinical features, which has sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 67.86%, 79.41%, 73.08%, 75%, and 73.63% respectively in predicting response to therapy. Only 7.6% of patients with a Model for End-Stage Liver Disease (MELD) score > 15 and none of the patients with CTP class C met the primary end-point of our study. Conclusions 55% of our cohort met the primary end-point at 36 weeks. Patients with CTP class C and a MELD score > 15 should be referred for liver transplantation followed by DAA therapy. Our model was good at predicting improvement in post-therapy liver function.

The detection of cytomegalovirus (CMV) in the setting of inflammatory bowel disease often creates confusion whether CMV is a ���bystander��� or ���disease.��� This review discusses the clinical conundrum of CMV in ulcerative colitis, approach to discriminate infection from disease, and therapeutic considerations (immunosuppressive and anti-CMV treatment). CMV disease should be considered in corticosteroid refractory- dependent and thiopurine refractory disease. Endoscopy may reveal deep punched out ulcers, irregular ulcers, or cobble-stoning. The diagnosis rests on the presence and abundance of viral inclusion bodies on hematoxylin and eosin stain, positive immunohistochemistry, and/or positive tissue polymerase chain reaction. CMV disease is associated with worse outcomes including increased colectomy rates. The timing and duration of antiviral drugs in CMV disease is debatable but depends on the load of CMV in tissue. In high-grade infection, CMV needs to be treated while increasing immunosuppression may work in the setting of low-grade infection. Ganciclovir is the drug of choice for treatment of CMV disease. Tumor necrosis factor inhibitors may be useful for treating underlying disease activity in the setting of CMV. Other emerging therapies include fecal microbiota transplantation. Randomized studies are necessary to define the best timing and duration of anti-CMV therapy.

To study the upper gastrointestinal bleeding (UGIB) characteristics and to validate the Rockall and Glasgow-Blatchford scores (GBS), Progetto Nazionale Emorragica Digestiva (PNED) and albumin, international normalized ratio (INR), mental status, systolic blood pressure, and age > 65 (AIMS65) risk scores in predicting outcomes in patients with UGIB. Three hundred subjects with hematemesis and/or melena were prospectively enrolled and followed up for 30 days. All patients were assessed by hematological investigations, imaging, and endoscopy and risk scores were calculated. The mean age was 43.5 ± 17.2 years, and 207 (69%) were males. Hematemesis was the most common presentation (94%). Variceal bleeding was the most common etiology (47.7%). Thirty patients died (10%) and 50 had rebleeding (16.7%). On univariate analysis, serum albumin ≤ 2.7 gm% (p = 0.008), Glasgow Coma scale ≤ 13.9 (p = 0.001), serum bilirubin > 3 mg/dL (p = 0.004), serum bicarbonate ≤ 15.7 mEq/L (p = 0.001), systolic blood pressure 0 was significant while score of

Background and Aim The two most common etiologies of acute pancreatitis (AP) are alcohol and gallstone. Whether etiology contributes to the outcome in patients with AP is an unresolved issue, more so in the severe form of the disease. The aim is to study the effects of the etiological factors of alcohol and gallstone on the disease course and the role of etiology in the subgroup of severe AP. Methods Consecutive patients of AP with alcohol or gallstone etiology were included. Various severity parameters and various outcome measures, such as need for organ support, intensive care, surgical or radiological intervention, hospital stay, and mortality, were evaluated between the two groups. Results Of the 759 patients, alcoholic pancreatitis was seen in 368 (48.5%), while gallstone disease was observed in 246 (32.4%). Gallstone pancreatitis occurred in older age (P

Transabdominal ultrasonography, contrast-enhanced computed tomography, and magnetic resonance imaging (MRI) are the common diagnostic tests for the detection of hepatic lesions. Use of enhanced and advanced MRI technique, that is, diffusion weighted MRI and hepatocyte-specific contrast agents, has further improved the accuracy of detection of metastatic liver lesions ≤ 10 mm in diameter. However, even with these advanced imaging modalities sensitivity is low for lesions smaller than 10 mm when compared with standard intraoperative ultrasound. Endoscopic ultrasound (EUS) is an emerging imaging modality with resolution sufficient to detect and sample lesions as small as 5 mm in diameter. In this news and views, we have discussed the role of standard and enhanced EUS for the detection of metastatic liver lesions.

Background : Assessment of liver disease severity in chronic Hepatitis C (CHC) is essential both in pre-treatment and post-treatment period. We assessed the impact of direct-acting antiviral therapy on liver stiffness regression measured by Vibration Controlled Transient Elastography (VCTE) in patients with CHC and evaluated the diagnostic performance of the APRI and FIB-4 scores compared to VCTE in detecting advanced fibrosis and cirrhosis (F3/F4). Methodology : Retrospective analysis of consecutive patients with CHC who underwent VCTE before and after DAA therapy was done. APRI and FIB-4 scores were compared to VCTE. Results : 88 (56.78%) patients-12 (F3) and 76 (F4) according to VCTE, had advanced fibrosis pre-treatment, which reduced to 69 (44.52%) - 10 (F3) and 59 (F4) after 12 weeks DAA therapy. Significant reduction in VCTE value from 14.08 ± 9.05 KPa to 11.84 ± 8.31 KPa (p=0.002) was noted. There is significant reduction in APRI, FIB-4 and GUCI score post-treatment which was not the case with Lok score and Bonacini score. Before therapy, FIB-4 outperformed others to predict advanced fibrosis with score >2.13 (AUC 0.93), having sensitivity 76%, specificity 96% and accuracy 86%. However post-treatment, APRI and GUCI score performed best to predict F3/F4 fibrosis with score >0.63 (AUC 0.97) and >0.64 (AUC 0.96), having sensitivity, specificity and accuracy of 85%, 96.6% and 92% ; 85%, 96.6% and 92% respectively. Conclusion : Before therapy, FIB-4 had the best accuracy in predicting advanced fibrosis whereas APRI and GUCI score were the best indices post-treatment.

Background: Prevalence and impact of thiopurine S-methyltransferase (TPMT) and Nudix hydrolase (NUDT15) minor allele frequencies in South Asian population is unclear. Methods: We searched PubMed and Embase with keywords-TPMT and NUDT15 combined with South Asian countries. We included studies reporting frequency of TPMT and NUDT15 polymorphisms. We estimated the pooled prevalence of TPMT and NUDT15 polymorphisms and their impact on pooled odds ratio of adverse events with thiopurines. Results: We included 26 studies in our analysis. The pooled prevalence of NUDT15 and TPMT polymorphisms was 16.5% (95% CI: 13.09–20.58) and 4.57% (95% CI: 3.66–5.68), respectively. In patients with adverse effects, the pooled prevalence of NUDT15 and TPMT polymorphism was 49.51% (95% C.I. 21.69–77.64) and 9.47% (95% C.I. 5.39–16.11), respectively. The odds ratio (OR) of adverse events with presence of TPMT polymorphisms was 3.65 (95% C.I., 1.43–9.28). The pooled OR for adverse events in presence of NUDT15 polymorphism was 12.63 (95% C.I., 3.68–43.26). Conclusion: NUDT15 were reported more frequently than the TPMT polymorphisms in South Asian population and were more frequently associated with adverse events. These findings may have implications for preemptive testing amongst South Asian population and immigrants prior to starting thiopurines.

Background Antibiotics have a proven role in the induction of remission in Crohn disease and treatment of pouchitis. However, the role of antibiotics for disease activity and remission maintainence in ulcerative colitis (UC) is uncertain. Methods We searched electronic databases (Pubmed, Embase and CENTRAL) for randomised trials using various search terms to identify studies reporting on the use of antibiotics for induction or maintainence of remission in ulcerative colitis. The outcomes assessed were a clinical response, need for second line therapy, colectomy and adverse effects. Subgroup analysis to clarify the mode of administration (oral or intravenous), number of antibiotics (single or combination) or the setting of use (acute severe UC or active non-severe UC) were also done. Results Eventually, 13 trials including 785 patients were included. The pooled odds ratio of achieving clinical response with antibiotic use was 1.74 (95% CI, 1.17- 2.58). No differences were noted in the relapse rates, need for second line therapy, colectomy or adverse effects with the use of antibiotics. Subgroup analysis showed no differences with use of single or combination of antibiotics. The use of oral antibiotics in the setting of non-severe active UC could have some benefit in clinical response. No benefit of intravenous antibiotics in setting of acute severe ulcerative colitis was noted. The included studies were heterogeneous because of different included populations, type and duration of antibiotics use and differences in definitions and time of assessment of clinical response. Conclusions The results suggest a lack of benefit of intravenous antibiotics in the setting of acute severe UC. The use of oral antibiotics for induction of maintenance needs further evaluation

Scalloping of visceral organs like liver and spleen can cause certain peritoneal diseases. It has usually been described with pseudomyxoma peritonei and peritoneal carcinomatosis. Occasionally, it has also been described with certain benign conditions like peritoneal tuberculosis. We describe visceral scalloping in setting of pancreatic diseases. We believe that pancreatic fluid collections exert significant pressure on the visceral organs to result in scalloping of the visceral surfaces.

Although pancreatic tuberculosis (TB) is traditionally considered to be a rare clinical entity, in recent times, an increase in the number of reports of pancreatic TB has been noted. We conducted a systematic review in order to summarise currently available data on pancreatic TB.A comprehensive literature search of Medline, Scopus and ISI Web of Science databases was conducted in order to identify papers reporting cases of pancreatic TB. The eligibility criteria for inclusion in the review required that the studies reported patient(s) affected by pancreatic TB and that individual data on age, sex, clinical presentation and outcome were available.In total, 116 studies reporting data on 166 patients were included in the analysis. The majority of patients were males (62.1%) diagnosed at a mean age of 41.61 ± 13.95 years. Most cases were diagnosed in Asia (50.0%), followed by North America (22.9%), Europe (20.5%), Africa (4.2%) and South America (2.4%). Human immunodeficiency virus (HIV) infection was diagnosed in 25.3% of those affected. Pancreatic TB most frequently presented itself in the form of a pancreatic mass (79.5%) localised mainly in the head (59.0%) and less frequently in the body (18.2%) and tail (13.4%). Extrapancreatic TB involvement most frequently affected the peripancreatic lymph nodes (47.3%). More than half of patients (55.2%) were subjected to laparotomy, while 21.08% underwent endoscopic ultrasound fine-needle aspiration biopsy. The presence of TB was identified most frequently through histological analysis (59.6%), followed by culture (28.9%), staining (27.7%) and, in a smaller number, by polymerase chain reaction (9.6%) and cytology (6.6%). Almost all patients received anti-tubercular pharmacological therapy (98.2%), while 24.1% underwent surgery. Despite treatment, 8.7% of patients died.Increased awareness of pancreatic TB is needed, not only in endemic areas but especially in relation to HIV infection and other clinical conditions associated with immunoincompetence.

Role of chemoprophylaxis for prevention of antitubercular therapy-related drug-induced liver injury (ATT-DILI) is uncertain. Electronic databases were searched for randomized trials reporting on chemoprophylaxis agents for prevention of ATT-DILI. We included studies evaluating the role of a drug in comparison to controls/placebo. The primary outcome was the occurrence of ATT-DILI. We performed a Bayesian random-effects network meta-analysis to calculate odds ratios (ORs) and 95% credible intervals (CrI) for those arms where at least two studies were available. Additional comparative studies for these arms were also identified. Fourteen studies were identified and seven included in the meta-analysis. The agents used for prevention of ATT-DILI were silymarin/silibinin (4 trials), N-acetylcysteine (NAC) (3 studies), herbal preparations (5 studies) and one study each for cholecalciferol and carnitine. Compared with controls/placebo, the odds of occurrence of hepatotoxicity with NAC was 7 * 10���17 (95% CrI: 2.8 * 10���53, 0.0053) and Silymarin was 0.68 (95% CrI: 0.084, 4.6). NAC had the highest probability of rank 1 (0.99) which was followed by Silymarin (0.004). N-acetyl cysteine, but not Silymarin/Silibinin, appears to be beneficial in prevention of ATT-DILI. However, the results were limited by the possible risk of bias in included studies, variable definitions of ATT-DILI and limited number and category of patients.

Background Microscopic colitis (MC) remains an elusive cause of chronic diarrhea. Histopathology is a gold standard with variable yield. The OCTT and concomitant lactose intolerance in these cases may aid to understand the complex symptoms. We used Hydrogen(H2) breath tests (H2BT) for detecting SIBO (Small Intestinal Bacterial Overgrowth), Lactose intolerance and calculation of oro-cecal transit time (OCTT). Methods 43 MC patients [mean age - 45.83(±15.92] and 10 controls were studied. Among these, 37(86%) patients with MC & 9 (90%) controls underwent breath tests. SIBO was diagnosed with glucose H2BT. For confirmation, we took rise ≥12 ppm over fasting value in H2 concentration within 2hours of glucose ingestion Lactulose H2BT was done to calculate OCTT. Time taken for rising in breath hydrogen by ≥12ppm over baseline value in two consecutive readings was considered as OCTT. For lactose breath test, 15 minutes samples were taken up to 4 hours. A ≥20 ppm rise over fasting value in H2concentration in two consecutive readings was considered intolerance Results Four(9.5%) patients of SIBO in Glucose H2BT were enrolled in controls. Mean (+ SD) OCTT in cases of MC vs controls was 130.38±47.95 mins and 97.14±48.55 mins (p= 0.109) respectively. Thus OCTT increased in 73% cases of MC vs 43% controls. Also, in the MC group, 9(28.1%) patients were lactose intolerant while vs 3(42.9%) controls (p= 0.654). Thus a significant 28% MC patients were lactose intolerant possibly aggravating symptoms Conclusions Lactose intolerance has lesser prevalence in cases of microscopic colitis. These patients were also detected to have paradoxically prolonged OCTT excluding the role of small bowel in diarrheal symptoms

Background Chronic diarrhea due to Microscopic colitis (MC) is often overlooked. Restriction of disease to the colon is still unclear, and on drawing analogies from Idiopathic Ulcerative Colitis any proximal disease extension may have bearing on treatment regimes. We evaluated terminal ileum using narrow band imaging (NBI), high definition white light endoscopy (HDWLE) and histopathological findings on biopsy Methods 53 adults with suspected MC were enrolled. All underwent colonoscopy with ileal intubation. Segmental colonic and terminal ileum biopsies were obtained using HDWLE and NBI. Same were analysed by expert gastrointestinal histopathologist Results In 43 patients of confirmed MC, HDWLE of ileum was normal. On NBI, intravillous capillary network was regular unbranched with semi-circular pattern in 41(95.4%) of patients of MC and in all controls. It was sparse and irregular in 2(4.7%) cases. Peyer’s patch domes were indistinct in 5(9.4%), normal in 38(88.4%) cases and normal in all controls (p = 0.570). Peyer’s patch vessels were regular and unbranched in 38(88.4%) cases and all controls. They were sparse and irregular in 5 cases (11.6%) (p = 0.570). Ileal histopathology revealed normal villi in 39 (90.6%) cases, 4 had partial villous atrophy. The crypt villous ratio was grouped as 1:1.5, 1:3, 1:4 and 1:5 in 2 (4.6), 26 (60.4),11 (25.5%) and 4 (9.3) respectively. Lymphoplasmacytic infiltrate was grouped as mild, moderate and severe, and observed in 10 (23.2%), 2 (4.6%) and 1 (2.3%) patient respectively Conclusions Ileal NBI findings in MC are hitherto unreported, with up to 12% showing abnormalities. Histologically up to 23% showed abnormalities in ileal biopsies. Ileal pathology may contribute to certain symptoms in MC

Background & objectives: Resveratrol (trans-3,4,5’ –trihydroxystilbene) is an active compound in food, such as redgrapes, peanuts, and berries. A body of evidence shows that resveratrol is able to inhibit thegrowth of many cancers such as leukemia, breast cancer and primary brain tumors. The objective of the present study was to demonstrate the dose and time dependent apoptotic effect of Resveratrol on Human Caski cell line. Methods: We used cell viability assays like MTT and Trypan blue assays to demonstrate the inhibition of cancer cell proliferation in a dose and time dependent manner. Results: Our results have shown that Resveratrol inhibited proliferation of Caski cells in a concentration and time dependent manner in 48 hr cultures. No significant effect was observed in 24 hour cultures of cell viability assays. Interpretation & conclusions: The results indicated that Resveratrol and NAC inhibited cell growth in Caski cells as a function of dose and time. Keywords: Resveratrol , Cervical cancer, apoptosis

Background: Cardiovascular diseases are emerging as a major cause of mortality and disability in India. Coronary artery Calcium (CAC) has been proposed as an additional tool for risk re-stratification for Primary prevention. However, there is a lack of data for its incremental value assessment in Indian patients. Methods: This study included 150 patients presenting with risk factors for Cardiovascular Diseases or Symptoms. 10-year risk of CVD was calculated using risk assessment models Revised American College of Cardiology/American Heart Association (Risk ACC/AHA) and WHO Risk Prediction Charts. CT Angiography and Coronary Artery Calcium Scoring was done in each patient. Results: 48.2 % (28/57) of patients in Statins recommended category (10 yr ASCVD Risk >7.5 %) and 11/17 (64.7%) in Statin Considered group (ASCVD Risk 5-7.5 %) according to guidelines had CAC Zero. 13/75 (17.3 %) of patients in whom statin was not recommended had a non-zero Coronary artery Calcium. A total of 52/150 (34.6%) (Statin not needed with CAC non-zero -13, Statin considered and recommended with CAC zero - 39) would be risk restratified using CAC. Conclusion: One Third Patients would be risk restratified using Coronary Artery Calcium Score as an additional tool to convention Cardiovascular Risk Scores.

Background CDAI and SDAI have been frequently used to categorize disease activity in patients with rheumatoid arthritis (RA), but have not been comparatively validated in Indian population. Objective To validate CDAI and SDAI in RA, taking DAS-28 as gold standard and to derive new cutoffs for CDAI and SDAI. Methods Patients fulfilling ACR/EULAR criteria for diagnosis of RA were studied. After complete history, physical examination and biochemical tests, patients were grouped into remission, low, moderate and high activity on the basis of pre-defined cut-offs for DAS-28, CDAI, and SDAI. Spearman’s correlation and group wise inter-rater agreement tests were performed. Using DAS-28 as gold standard, the sensitivity and specificity of CDAI and SDAI cut off were determined for predicting levels of disease activity by area under receiver operator characteristics curves. (AUROC) Results We studied 112 patients with RA, there was excellent correlation between DAS-28 and CDAI (r = 0.96 with 95% C.I. = 0.94−0.97), CDAI and SDAI (r=0.99, 95% C.I. 0.98−1), and DAS-28 and SDAI (r = 0.96, 95% C.I. = 0.94−0.97). There was a good inter-rater agreement between the various levels of disease activity as defined by DAS-28 and CDAI (weighed k = 0.598) and DAS-28 and SDAI (weighed k = 0.699) with excellent agreement between SDAI and CDAI categories (weighed k = 0.816). There was no statistically significant difference between AUROC of CDAI and SDAI and both performed equally well. Conclusion CDAI and SDAI are highly correlated with DAS-28 score hence are good markers of disease activity. The cut-off values for CDAI and SDAI used in western literature can be used with minor modifications in Indian scenario.

Background. FEV1/FEV6 has been proposed as a cheap, reproducible and valid alternative to FEV1/FVC in spirometry. No Indian data exists on its utility to diagnose airway obstruction. Aim. we sought to determine a fixed cut off of FEV1/FEV6 to diagnose obstruction corresponding to FEV1/FVC < 0.70 proposed by GOLD guidelines. Method. Spirometry was done on patient referred to a tertiary centre in India. Age, sex, height weight were recorded in addition to spirometric variables like FEV1, FVC, FEV6. The sensitivity, specificity, positive and negative predictive values of FEV1/FEV6 were determined with respect to gold standard of FEV1/FVC < 0.70. Results. 467 spirometries were analysed after meeting the ATS acceptability criteria. Considering FEV1/FVC < 0.7 as being the gold standard for obstruction, ROC curve was used to determine the best corresponding cut-off for FEV1/FEV6. The area under the curve was 99.3% (95% CI: 98.1–99.8%), and the FEV1/FEV6 cut-off, corresponding to the greatest sum of sensitivity and specificity, was 73%. For the total population, the FEV1/FEV6 sensitivity, specificity, PPV, NPV were was 95.7 %, 94.2 %, 87.5 % and 97.9 % respectively. Agreement by Kappa value between two cut offs was excellent 0.89 (0.87–0.91). Conclusion. FEV1/FEV6 < 73% is a new reliable spirometry index to diagnose airway obstruction in Indian population.

Though intravenous (IV) Magnesium Sulphate (MgS04) has additive effect to beta-2 agonists, its additive benefit in face of combination therapy with beta-2-agonists and ipratropium (standard therapy of severe acute exacerbation of asthma) remains unaddressed. The aim of this investigation was to evaluate the role of IV MgSO4 when used as an adjunct to standard therapy of severe exacerbations of asthma. Randomized, single blinded, placebo-controlled study was carried out in Emergency Department (ED). Patients aged 18-60 years presenting with acute asthma and FEV130 % predicted (pred.) were included. All patients received IV Hydrocortisone on arrival. In group1 (controls), patients were nebulised with salbutamol and ipratropium thrice at 20 minutes interval and were given 2g IV MgSO4 at 30 minutes. In group2 patients were nebulised similarly, but were given IV normal saline at 30 minutes for blinding. FEV1 was evaluated at baseline and at 30 minutes intervals. The primary efficacy end point was FEV1%pred. at 120 mins and pooled discharge rate (derived from comparing proportion of groups attaining PEFRor = 60%pred. and relief in dyspnea at 30, 60, 90, 120 minutes). Both groups of 30 patients each, were matched with respect to demographic and pulmonary parameters (Baseline FEV1% :22.0+/-5.1% in group2 vs.22.07+/-5.2% in group1, p=0.87).At 120 minutes, there was a higher mean FEV1 %pred (62.84+/-4.73% vs. 56.7+/-4.5%) and %improvement from baseline of (40.7+/-9.2%vs34.77+/-7.3%), in group 2 as compared to group1 (Mean Difference= 6.07%, C.I.1.87-10.62., p0.01).The pooled discharge rate in group2 with respect to group1 was positive and significant (log rank.=6.8, p0.05). Thus IV MgSO4 improves pulmonary function and discharge rates, when used as an adjunct to standard therapy in severe acute asthma.Magnesium sulfate as an adjunct to standard therapy in patients with severe exacerbation of asthma could cause improvement in pulmonary function and decrease in hospital admission.