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OBJECTIVES: Chronic constipation (CC), a common functional gastrointestinal disorder, has laxatives as its mainstay of treatment. Refractoriness to laxatives calls for better treatment options. Prucalopride is a novel, well-tolerated enterokinetic with high 5-hydroxytryptamine 4 receptor selectivity. This study was undertaken with the intention to establish the efficacy and safety of prucalopride with placebo in adults with refractory CC. MATERIALS AND METHODS: Patients were screened and 180 patients fulfilling the inclusion criteria were simply randomized into 2 groups either to receive prucalopride 2 mg (n = 90) or placebo (n = 90) once daily for a duration of 12 weeks. The efficacy endpoints (primary) were intended to measure the proportion of patients with three or more spontaneous complete bowel movements (SCBMs) per week over 12 weeks. Secondary endpoints were assessed via the validated questionnaires. Adverse events, electrocardiogram, and other laboratory parameters were monitored at different time intervals. RESULTS: Efficacy and safety were analyzed in 180 patients simply randomized (1:1) into group A (prucalopride arm, n = 90) and group B (placebo arm, n = 90). Patients having three or more SCBMs per week in the prucalopride arm (2 mg) were 41% as against to 12% in the placebo arm (P < 0.001). A significant increase (P < 0.001) in the number of spontaneous bowel movements per week plus an increase of average bowel movement by 1 point per week was seen in the prucalopride arm. Secondary efficacy endpoints which included patients' treatment satisfaction, improvement in the perception of constipation symptoms using the patient assessment of constipation -symptoms and stool consistency score changes were more pronounced in the prucalopride arm than the placebo. The most common adverse events reported from both the groups were headache, nausea, bloating, and diarrhea. No significant cardiovascular changes or laboratory abnormality was detected throughout the study period. CONCLUSION: Prucalopride is effective in laxative refractory CC cases with a good safety profile.
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Estreñimiento , Laxativos , Adulto , Humanos , Laxativos/efectos adversos , Método Simple Ciego , Centros de Atención Terciaria , Enfermedad Crónica , Método Doble Ciego , Estreñimiento/tratamiento farmacológico , Resultado del TratamientoRESUMEN
BACKGROUND: The study was designed to assess cardiovascular risk factors flow-mediated dilatation % (FMD%) and carotid intima-media thickness (CIMT) in NAFLD. METHODS: 126 NAFLD subjects and 31 chronic hepatitis B (CHB) controls were studied. Measuring carotid intima-media thickness (CIMT) and the flow-mediated dilatation % (FMD%) by brachial artery Doppler ultrasound were used to assess atherosclerosis. The risk of cardiac events at 10 years (ROCE 10) was estimated by the Prospective Cardiovascular Munster Study (PROCAM) score. RESULTS: 58 of 126 NAFLD have coexistent metabolic syndrome. Mean CIMT was 0.73 ± 0.041 mm among NAFLD with MS, 0.66 ± 0.016 mm among NAFLD without MS, and 0.66 ± 0.037 in controls CHB patients. FMD% in NAFLD with MS was 10.43 ± 3.134%, but was 8.56 ± 3.581% in NAFLD without MS and 17.78 ± 6.051% in controls. PROCAM score of NAFLD with MS was 46.95 ± 6.509 while in NAFLD without MS was 38.2 ± 3.738. Controls had a PROCAM score of 38.13 ± 5.755. ROCE 10 in NAFLD with MS was 13.64 ± 8.568 while NAFLD without MS was 5.55 ± 1.949. Controls have a ROCE 10 of 5.95 ± 3.973. Post hoc analysis showed CIMT was dependent upon MS while FMD% was different between all subgroups hence independent of metabolic syndrome. CONCLUSION: The markers of endothelial dysfunction are significantly higher in patients with NAFLD than controls.
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BACKGROUND AND OBJECTIVES: Acute-On-Chronic liver failure (ACLF) is an emerging entity. The present study was undertaken to analyze the clinical profile and natural course of ACLF patients. PATIENTS AND METHODS: ACLF was defined as per Asia Pacific Association for the Study of Liver consensus criteria 2009. Patients fulfilling these criteria with some deviations were included and prospectively evaluated for clinical profile, etiologies of acute decompensation (AD) and underlying chronic liver disease, and short-term natural course [3 months]. RESULTS: Out of 123 patients with ACLF (mean age: 45.83 ± 12.05 years; male:female 109:14), 45.53% cases had prior history of AD, and 54.47% presented for the first time as ACLF. Etiologies of cirrhosis were alcohol, cryptogenic, and chronic hepatitis B virus infection in 65.04%, 23.57%, and 11.38% cases, respectively. Recent history of alcohol intake (within 4 weeks) [42.27%] followed by bacterial infections [36.58%] were the common etiologic precipitants for AD. Only 87 (70.73%) out of 123 cases could be followed up for a duration of 3 months; 62 (71.26%) cases died by 3 months. Most deaths occurred in the alcoholics compared to nonalcoholics [(43/53) 81.13% vs. (19/34) 55.88%; P = 0.01]. No significant difference in mortality rate was observed between ACLF cases with history of prior AD compared to newly diagnosed ACLF cases [30/40 (75%) vs. 32/47 (68.09%); P = 0.477]. The prognostic markers [MELD, MELD-Na, CTP] were not significantly different between survivors and nonsurvivors. CONCLUSION: ACLF patients in our population had high short-term mortality rates with majority of deaths in alcoholics. Alcohol intake and bacterial infections were mainly responsible for AD in our study.
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Sulfato de Bario , Fístula Biliar/diagnóstico por imagen , Medios de Contraste , Fístula Gástrica/diagnóstico por imagen , Fístula Intestinal/diagnóstico por imagen , Enfermedades del Yeyuno/diagnóstico por imagen , Anciano , Anastomosis en-Y de Roux , Fístula Biliar/cirugía , Enema , Gastrectomía , Fístula Gástrica/cirugía , Humanos , Fístula Intestinal/cirugía , Enfermedades del Yeyuno/cirugía , Masculino , Radiografía , VómitosRESUMEN
The study was undertaken to investigate the clinical implications of hepatitis B virus (HBV) genotypes, basal core promoter (BCP), precore (PC) and surface gene mutations in HBV infected patients from Orissa, southeastern India. HBV infections were identified by serology testing and HBV DNA amplification by polymerase chain reaction among the 152 patients. After sequencing, surface gene mutation were studied by sequence analysis as well as by using BLOSUM scores and BCP mutations were studied only by sequence analysis. A high proportion of HBV/D5 (66.0%) was found among the study samples having significant relation with liver cirrhosis (LC) and hepatocellular carcinoma (HCC) patients (p<0.05). The BCP mutation, TA (81.4%) and C1753/TA (75.0%) was found in significant proportion (p<0.05) among HCC cases and in fact a gradual increase in these mutations were noted between inactive carriers (IC) to HCC group and also showed higher viral load. An increasing trend of major hydrophilic region (MHR) mutations in S gene was also observed from IC (56.0%) to chronic liver disease (CLD) (60.4%) to LC (72.4%) to HCC (95.0%) patients. In conclusion, our study suggests that the predominant HBV subgenotype HBV/D5 with high viral load and BCP mutations (double and triple) and high mutations in MHR region was significantly associated with advanced liver disease (LC and HCC) and might act as predictor of severe hepatic complications.
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Virus de la Hepatitis B/genética , Hepatitis B/virología , Adulto , Anciano , Secuencia de Aminoácidos , Carcinoma Hepatocelular/virología , Distribución de Chi-Cuadrado , Secuencia de Consenso , ADN Viral/genética , Femenino , Genes Virales , Genotipo , Hepatitis B/complicaciones , Hepatitis B/epidemiología , Humanos , Interacciones Hidrofóbicas e Hidrofílicas , India/epidemiología , Cirrosis Hepática/complicaciones , Cirrosis Hepática/virología , Neoplasias Hepáticas/virología , Masculino , Persona de Mediana Edad , Datos de Secuencia Molecular , Mutación , Filogenia , Carga Viral , Proteínas Virales/química , Proteínas Virales/genéticaAsunto(s)
Fármacos Gastrointestinales/administración & dosificación , Infecciones por Helicobacter/tratamiento farmacológico , Omeprazol/análogos & derivados , 2-Piridinilmetilsulfinilbencimidazoles , Adolescente , Adulto , Amoxicilina/administración & dosificación , Claritromicina/administración & dosificación , Método Doble Ciego , Esquema de Medicación , Quimioterapia Combinada , Femenino , Gastroscopía , Infecciones por Helicobacter/patología , Helicobacter pylori/genética , Helicobacter pylori/aislamiento & purificación , Humanos , Lansoprazol , Masculino , Persona de Mediana Edad , Omeprazol/administración & dosificación , Reacción en Cadena de la Polimerasa , Tinidazol/administración & dosificación , Resultado del TratamientoRESUMEN
We report a 22-year-old woman who presented with an abdominal wall lump in the right upper quadrant 15 days after starting antitubercular treatment for right pleural effusion. CT scan revealed a right liver lobe subcapsular abscess communicating vith subcutaneous tissue. Aspiration of pus revealed acid-fast bacilli. She responded to 9 months of antitubercular treatment.
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Absceso Abdominal/etiología , Tuberculosis Hepática/complicaciones , Adulto , Femenino , Humanos , Tomografía Computarizada por Rayos X , Tuberculosis Hepática/diagnóstico por imagen , Tuberculosis Pleural/complicacionesRESUMEN
A 2-year-old male child, who was operated on 18 months earlier for tuberculous meningitis with hydrocephalus by placement of a ventriculo-peritoneal shunt, presented with the lower end of the shunt tube coming out through the anus. Colonoscopy showed the shunt tube coming out through the colon 22 cm from the anal opening. The cranial end, along with a malfunctioning valve, were disconnected surgically, and the shunt was removed endoscopically using a pediatric flexible colonoscope.
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Perforación Intestinal/etiología , Derivación Ventriculoperitoneal/efectos adversos , Preescolar , Endoscopía del Sistema Digestivo , Humanos , MasculinoAsunto(s)
Cuerpos Extraños , Cepillado Dental , Adulto , Endoscopía , Cuerpos Extraños/cirugía , Humanos , MasculinoRESUMEN
BACKGROUND: Color Doppler is a noninvasive method for assessing portal hemodynamics. Laser Doppler velocimetry is useful in assessment of microcirculatory abnormalities in portal hypertensive gastropathy (PHG). AIMS: To study portal hemodynamics by color Doppler and gastric mucosal blood flow (GMBF) by laser Doppler velocimetry in patients with cirrhosis. METHODS: Twenty-eight patients with cirrhosis of liver (24 men) and 10 healthy subjects (7 men) were studied. Portal venous blood flow (PVBF) and portal flow velocity (PFV) were assessed by color Doppler at the level where the hepatic artery crosses the portal vein, and GMBF was measured by laser Doppler velocimetry. RESULTS: PVBF (379.5 [102.9] mL/min), PFV (5.3 [1.1] cm/sec) and GMBF (3.5 [0.8] volts) were significantly lower in patients with cirrhosis than in controls. PVBF and PFV were significantly lower in patients in Child class B and C than those in class A. Patients with ascites had significantly lower PVBF, PFV and GMBF than those without; values were also lower in patients with PHG than in those without. History of bleeding had no relation with PVBF and PFV. GMBF showed good correlation with PVBF (r=0.58, p<0.001) and with PFV (r=0.48, p<0.01). CONCLUSIONS: In cirrhosis of liver, PVBF, PFV and GMBF are significantly lower, and the changes increase with increasing severity of liver disease.
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Flujometría por Láser-Doppler/métodos , Cirrosis Hepática/fisiopatología , Presión Portal/fisiología , Vena Porta/fisiología , Ultrasonografía Doppler en Color/métodos , Adulto , Velocidad del Flujo Sanguíneo , Femenino , Mucosa Gástrica/irrigación sanguínea , Humanos , Masculino , Estudios ProspectivosRESUMEN
BACKGROUND: Interferon treatment for chronic hepatitis B has low efficacy and is associated with serious side effects. It is therefore important to assess the role of other drugs in the treatment of this condition. AIMS: To assess the efficacy and safety of thymosin alpha in 20 patients with hepatitis B-related liver disease. METHODS: Patients with chronic hepatitis B, HBV DNA positivity, ALT more than 1.5 times the upper limit of normal and liver biopsy showing chronic hepatitis or cirrhosis were treated with thymosin alpha 1.6 mg subcutaneously twice a week for 6 months. Biochemical and serological markers were assessed pre-treatment, immediately post treatment, and 6 months and 1 year after end of treatment. RESULTS: Of 20 patients, 15 had chronic hepatitis and 5 had cirrhosis on histology; 17 were HBeAg-positive and 3 were HBeAg-negative. Eight patients were interferon non-responders and 12 were naïve patients. Four patients had end-of-treatment response and two additional patients had a delayed response within 6 months of treatment; one responder had a relapse within 1 year of treatment. Overall sustained response rate was 25% (5 of 20). No patient cleared HBsAg. Reduction in ALT levels was observed after treatment and persisted one year later. No significant side effects were observed. CONCLUSION: Thymosin alpha is a safe and effective alternative treatment modality in chronic hepatitis B.