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The use of acid suppression therapy (AST) is a common approach for managing a wide spectrum of acid peptic disorders. Histamine type 2-receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) are the most widely prescribed AST in routine clinical practice. However, an exponential surge in the prescriptions of PPIs, such as Omeprazole, Esomeprazole, Pantoprazole, Lansoprazole in recent years and their associated adverse effects have raised concern about their inappropriate and overuse, both in children and adults. To address these issues, a three-step modified Delphi polling process was employed to establish best practice consensus statements for rationalizing the use of acid suppressants. A multidisciplinary expert panel of 13 health professionals across medical specialties, including gastroenterologists, hepatologists, pediatric gastroenterologists, pediatricians, otolaryngologists, cardiologists, nephrologists, gynecologist and orthopedists actively contributed to this collaborative process of consensus development. The expert panel proposed 21 consensus statements providing best practice points on the general use and safety of acid suppressants based on a comprehensive review of scientific literature and clinical expertise. The panel also collaboratively developed a PPI deprescribing algorithm. Altogether, this consensus paper offers evidence-based recommendations and guidance for the rational use of acid suppressants with a blueprint for deprescribing PPIs. This consensus paper contributes to aiding primary care practitioners in improving patient outcomes and minimizing healthcare costs. Additionally, it enhances patient safety and curtail inappropriate usage. How to cite this article: Prabhoo RY, Pai UA, Wadhwa A, et al. Multidisciplinary Consensus for Rationalizing the Use of Acid Suppressants in Children and Adults: CONFOR. Euroasian J Hepato-Gastroenterol 2024;14(1):99-119.
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OBJECTIVE: This retrospective study was conducted to evaluate the behaviour of AIDS associated cancers treated with comprehensive cancer treatment along with highly active anti-retroviral therapy (HAART). METHODS: 172 AIDS-associated cancers were diagnosed and treated during 2003 to 2021. HIV status was evaluated by ELISA, viral load and CD4/CD8 counts. They were treated with different cancer treatment modalities for cancers, HAART for HIV infection and followed up periodically. RESULTS: Of 172 cases of AIDS associated cancers, AIDS-Defining Cancers (ADCs) were seen in 84 (48.84%) and non-AIDS-Defining Cancers (NADC) in 88 patients (51.16%). Non-Hodgkin Lymphoma was the commonest AIDS-defining cancer in 58 (69.05%) patients. Extranodal presentations of ARLs was seen in 28 cases (19.86%) followed by cervical cancers in 26 (30.95%) women with HIV infection. Kaposi's sarcoma was not found. Head and neck cancers were the most common cancers in NADCs, followed by breast cancers and other types of cancers. Only two patients had HIV-2 associated cancers. One patient had immune reconstitution syndrome (IRIS).Long-term non-progressor HIV infection with cancer was seen in one patient. 49 patients (28.49%) were receiving HAART. CONCLUSIONS: AIDS-associated cancers are seen in advanced stage of HIV infection. Concurrent chemotherapy and anti-retroviral therapy for ADCs show good control of both diseases. Non-AIDS-defining cancers do not show predictable response to anti-retroviral therapy. KS is not seen in our study.
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Síndrome de Inmunodeficiencia Adquirida , Infecciones por VIH , Neoplasias , Sarcoma de Kaposi , Neoplasias del Cuello Uterino , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Terapia Antirretroviral Altamente Activa , Controladores de Élite , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Neoplasias/complicaciones , Neoplasias/epidemiología , Estudios Retrospectivos , Sarcoma de Kaposi/tratamiento farmacológico , Sarcoma de Kaposi/epidemiologíaRESUMEN
Netherton syndrome (NS) is an autosomal recessive primary immunodeficiency. It is characterised by substantial skin barrier defects and is often misdiagnosed as severe atopic dermatitis or hyper-immunoglobulin E syndrome. Although more than 80 NS-associated pathogenic mutations in the serine peptidase inhibitor kazal type 5 (SPINK5) gene have been reported worldwide, only one has been reported in the Arab population to date. We report the case of a novel association between the c.1887+1G>A mutation in the SPINK5 gene and NS in an Omani-Arab patient born in 2014 who was managed at a paediatric immunology clinic in Muscat, Oman. Accurate genetic diagnosis facilitated tailored clinical management of the index patient and enabled the provision of genetic counselling and offering of future reproductive options to the individuals related to the index patient.
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Síndrome de Netherton , Niño , Humanos , Mutación , Síndrome de Netherton/diagnóstico , Síndrome de Netherton/genética , Omán , Proteínas Inhibidoras de Proteinasas Secretoras/genética , Inhibidor de Serinpeptidasas Tipo Kazal-5/genéticaRESUMEN
Rebleeding after initially successful endoscopic variceal ligation (EVL) occurs in 20-60% of patients, most commonly from band ulcers, and is associated with 20-50% mortality. Although band ulcer bleeding has been treated in a number of different ways, no single therapeutic intervention has shown a clear benefit. Hemospray (Cook Medical, Winston-Salem, North Carolina, USA) is a relatively new non-contact hemostatic modality used in the management of bleeding peptic ulcers. It is a nano-powder that can be sprayed over a larger mucosal area. Here we describe a patient with end stage liver disease who presented with recurrent bleeding from a deep esophageal ulcer following band ligation and sclerotherapy, effectively managed with multiple sessions of Hemospray.
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BACKGROUND: Prediction equations for diffusing capacity of lung for carbon monoxide (DLCO), alveolar volume (VA), and DLCO/VA using the current standardization guidelines are not available for Indian population. The present study was carried out to develop equations for these parameters for North Indian adults and examine the ethnic diversity in predictions. MATERIALS AND METHODS: DLCO was measured by single-breath technique and VA by single-breath helium dilution using standardized methodology in 357 (258 males, 99 females) normal nonsmoker adult North Indians and DLCO/VA was computed. The subjects were randomized into training and test datasets for development of prediction equations by multiple linear regressions and for validation, respectively. RESULTS: For males, the following equations were developed: DLCO, -7.813 + 0.318 × ht -0.624 × age + 0.00552 × age(2); VA, -8.152 + 0.087 × ht -0.019 × wt; DLCO/VA, 7.315 - 0.037 × age. For females, the equations were: DLCO, -44.15 + 0.449 × ht -0.099 × age; VA, -6.893 + 0.068 × ht. A statistically acceptable prediction equation was not obtained for DLCO/VA in females. It was therefore computed from predicted DLCO and predicted VA. All equations were internally valid. Predictions of DLCO by Indian equations were lower than most Caucasian predictions in both males and females and greater than the Chinese predictions for males. CONCLUSION: This study has developed validated prediction equations for DLCO, VA, and DLCO/VA in North Indians. Substantial ethnic diversity exists in predictions for DLCO and VA with Caucasian equations generally yielding higher values than the Indian or Chinese equations. However, DLCO/VA predicted by the Indian equations is slightly higher than that by other equations.
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Long-term non-progressor HIV infection (LTNP-HIV) is seen in <1 percent of HIV-afflicted population. There are definite criteria for the diagnosis of LTNP-HIV. Malignancies either solid tumors or haematological cancers have not been reported in such population. We report here a rare case of follicular thyroid carcinoma in LTNP-HIV infection. She never had any opportunistic infections. She did not receive anti-retroviral therapy in the entire course of illness and continued to have good quality of life. Treatment of follicular thyroid cancer was similar to other patients without HIV infection. This could be the first case study from India.
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This is the first-case report of isolated human immunodeficiency virus-2 (HIV-2) infection that developed squamous cell carcinoma (SCC) of the buccal mucosa. She was treated with radiotherapy 66 Gy in 30 fractions. HIV-2 infection was diagnosed with Tridot test, and quantitative estimation was done with polymerase chain reaction. Viral load is usually low in HIV-2 patients; similarly tempo of disease progression is also slow. Treatment of SCC of buccal mucosa with or without HIV infection is not different. Protease inhibitor-based anti-retroviral therapy is an appropriate treatment for HIV-2 infection.
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Carcinoma de Células Escamosas/diagnóstico por imagen , Infecciones por VIH/diagnóstico , VIH-2 , Neoplasias de la Boca/diagnóstico por imagen , Femenino , Infecciones por VIH/virología , Humanos , Persona de Mediana Edad , Mucosa Bucal/diagnóstico por imagen , Mucosa Bucal/patología , RadiografíaRESUMEN
Pregnancy luteoma is a non-neoplastic lesion of the ovary occurring during pregnancy and is usually discovered incidentally at the time of a cesarean section or during postpartum tubal ligation. An accurate diagnosis is important for the mother and the fetus as it can be confused with ovarian malignancy leading to unnecessary surgery. We report a case of a pregnant female who was discovered to have bilateral enlarged ovaries at the time of emergency cesarean section.
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Collagenous spherulosis is a rare entity usually seen in association with benign breast lesions. It is often picked up incidentally with a reported incidence of about 0.2% in cytological material. There are very few reports describing cytomorphological features of collagenous spherulosis. To the best of our knowledge this is the only case reported from the middle-east region. The presence of hyaline spherules surrounded by a single layer of benign myoepithelial cells is the hallmark of collagenous spherulosis on FNA. However, due to close cytological resemblance, it can be misdiagnosed as adenoid cystic carcinoma of the breast. A 40-year-old woman presented with a history of a painless lump in the infraareolar region of left breast for a year. Fine needle aspiration was performed. The smears showed scanty cellularity comprising of cohesive clusters and a few branching fragments of benign ductal epithelial cells closely intermingled with many spherical, acellular homogenous hyaline globules. Few bare bipolar nuclei were noted in the background. A diagnosis of collagenous spherulosis associated with benign proliferative breast disease was made. Cytopathologists need to be aware of this entity in order to differentiate it from adenoid cystic carcinoma of the breast which requires radical treatment.
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Association of Cancer and HIV infection is seen in practice. Commonly observed cancer in HIV infected patients are Non-Hodgkin's Lymphoma, cervical cancer and Kaposi Sarcoma, Coexistent Chronic Myelogenous Leukemia (CML) and HIV infection are rare. We report a case where these two diseases were found in a patient and were treated with a single agent Hydroxyurea.
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Acute decompression syndrome (Caisson's disease) is an acute neurological emergency in divers. It is caused due to release of nitrogen gas bubbles that impinge the blood vessels of the spinal cord and brain and result in severe neurodeficit. There are very few case reports in Indian literature. There are multiple factors in the pathogenesis of Acute decompression syndrome (Caisson's disease) such as health problems in divers (respiratory problems or congenital heart diseases like atrial septal defect, patent ductus arteriosus etc), speed of ascent from the depth and habits like smoking that render divers susceptible for such neurological emergency. Usually, immediate diagnosis of such a condition with MRI is not possible in hospitals in the Coastal border. Even though, MRI is performed, it has very low specificity and sensitivity. Facilities like hyperbaric oxygen treatment are virtually non-existent in these hospitals. Therefore, proper education of the divers and appropriate preventive measures in professional or recreational divers is recommended.
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OBJECTIVES: To study the incidence and effects of anti-retroviral therapy along with cancer chemotherapy on outcome of AIDS associated Cancers in Indian patients. METHOD: 3832 cancers patients were investigated over a period of 5 years. 46 AIDS-associated cancers were identified. HIV status was evaluated by ELISA, Western Blot, viral load and CD4/CD8 counts. Patients were treated with different modalities of cancer management and anti-retroviral therapy was discussed with the patient and relatives. Patients were followed up 6 monthly. RESULTS: Incidence of AIDS-associated cancers was 1.2 percent. AIDS-Defining Cancers (ADC) were seen in 26 (54.35%) while non-AIDS-Defining Cancers (NADC) were observed in 21 (45.65%). Non Hodgkin Lymphoma was the commonest form of AIDS-defining cancers in 21 (84%) patients, cervical cancers in 4 (16%) women while there was not a single case of Kaposi's Sarcoma. AIDS associated cancers were common in males. Mean age was 38.5 years. Only 33.5% patients received treatment for HIV and cancers. Development of immune reconstitution syndrome was observed in 9.09% patients. Hepatitis B infection was seen in only one patient (2.17%). CONCLUSIONS: AIDS-associated cancers are seen in advanced stage of HIV infection. Concurrent chemotherapy and anti-retroviral therapy for ARL is significantly effective. Cervical cancers and non-AIDS-defining cancers do not show predictable response to anti-retroviral therapy. Mortality in non-AIDS related cancers was significantly higher than AIDS related cancers.
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Antirretrovirales/uso terapéutico , Terapia Antirretroviral Altamente Activa , Infecciones por VIH/tratamiento farmacológico , Neoplasias/tratamiento farmacológico , Adulto , Factores de Edad , Ensayo de Inmunoadsorción Enzimática , Femenino , Estudios de Seguimiento , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Infecciones por VIH/virología , Humanos , Incidencia , India/epidemiología , Linfoma no Hodgkin/complicaciones , Linfoma no Hodgkin/tratamiento farmacológico , Linfoma no Hodgkin/epidemiología , Linfoma no Hodgkin/virología , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Neoplasias/epidemiología , Neoplasias/virología , Distribución por Sexo , Resultado del Tratamiento , Neoplasias del Cuello Uterino/complicaciones , Neoplasias del Cuello Uterino/tratamiento farmacológico , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/virología , Adulto JovenRESUMEN
Using a physiological model of acutely increasing venous return into the lungs, i.e. by applying and then releasing lower body negative pressure (LBNP) to mimic the natural stimulus of juxtapulmonary capillary (J) or pulmonary C fibre receptors, produced an immediate and significant reduction in the amplitude of the Hoffman (H) reflex by 81±4% (P=0.001) in a majority of subjects 70% (n=5). Accompanying this was a notable change in the respiratory pattern with tidal volume (V(T)) increasing in all subjects from (mean) 0.462±.038 to 0.777±.061l/min (P=0.001) and the respiratory rate (F(R)) in 40% from 14±1 to 24±0.8 breaths/min. A feeling of pressure in throat, upper chest was reported by all and a shortness of breath-by 70% of the subjects. These were similar in nature to the respiratory sensations felt with threshold doses of intravenous lobeline, a well-established chemical stimulant of J receptors. All effects lasted for 15-20s and within a minute the parameters resumed their earlier control values. In animals, respiratory augmentation and locomotion inhibition are well-established reflexes of J receptors - this simultaneous though transitory reduction in H reflex amplitude reflecting change in the excitability of the motoneurone pool and appearance of respiratory effects, is the first demonstration in human subjects of the two reflexes appearing in response to a sudden increase in pulmonary blood flow that mimics the natural stimulus of these receptors.
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Presión Negativa de la Región Corporal Inferior/métodos , Músculo Esquelético/fisiología , Reflejo Anormal/fisiología , Respiración , Sensación/fisiología , Adulto , Relación Dosis-Respuesta a Droga , Electromiografía , Femenino , Humanos , Lobelina/farmacología , Masculino , Persona de Mediana Edad , Músculo Esquelético/efectos de los fármacos , Reflejo Anormal/efectos de los fármacos , Respiración/efectos de los fármacos , Fármacos del Sistema Respiratorio/farmacología , Sensación/efectos de los fármacos , Umbral Sensorial/efectos de los fármacos , Factores de Tiempo , Adulto JovenRESUMEN
CONTEXT: Heterotopic pancreas is the presence of pancreatic tissue found outside the usual anatomical location of the pancreas. It is a rare condition and can occur anywhere in the gastrointestinal tract with the stomach and the small bowel being the most common sites. It is usually asymptomatic and often discovered incidentally. CASE REPORT: We report the case of a 48-year-old Omani female who presented with recurrent epigastric pain. Endoscopy revealed a sessile mass in the antrum which was snared and showed heterotopic pancreatic tissue in the submucosa on histopathology. CONCLUSION: Heterotopic pancreas should be considered in the differential diagnosis of gastric mass lesions.
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Coristoma/patología , Páncreas , Gastropatías/patología , Diagnóstico Diferencial , Endoscopía , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Immune Reconstitution syndrome following antiretroviral therapy is common in HIV/AIDS patients due to boosting of immunity. A case is reported here wherein AIDS-related Non-Hodgkin's lymphoma patient received CHOP regimen and antiretroviral therapy. Patient developed tubercular lymphadenopathy paradoxically as a manifestation of IRIS.
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BACKGROUND: In spite of leprosy being a disease of nerves, ROM therapy for single skin lesion leprosy was based on clinical trials without much evidence-based studies of nerve pathology. The present study was undertaken to compare the histology of skin and nerve in single skin lesion leprosy, and to assess the scientific rationale and justification of single dose ROM therapy. METHODS: Twenty-seven untreated patients with single skin lesion without significantly thickened peripheral nerves were selected. Skin and nearby pure cutaneous nerve biopsies were studied under both H&E and Fite's stain. RESULTS: All the skin biopsies were negative for AFB and clinico-pathological correlation was positive in 51.85% of skin biopsy specimens. Histopathological diagnosis of leprosy was evident in 55.5% of clinically normal looking nerves, with AFB positivity in 29.6% of nerve biopsy specimens. Correlation between clinical diagnosis and nerve histopathology was poor (26%). CONCLUSIONS: Single skin lesion without thickened peripheral nerves as criteria for single dose ROM therapy is not logical, since the histological diagnosis of leprosy in normal looking nerves with presence of AFB is revealed in this study. Pure cutaneous nerve biopsy is a simple outpatient procedure, without complications. This study emphasizes the need to consider nerve pathology as an important tool for further therapeutic recommendations, than just clinical trials and skin pathology alone. Though single dose ROM therapy has been withdrawn recently, the principle holds good for any future therapeutic recommendations.
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Antibacterianos/administración & dosificación , Leprostáticos/administración & dosificación , Lepra/tratamiento farmacológico , Lepra/patología , Minociclina/administración & dosificación , Ofloxacino/administración & dosificación , Rifampin/administración & dosificación , Adolescente , Adulto , Anciano , Niño , Quimioterapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Nail disorders are frequent among the geriatric population. This is due in part to the impaired circulation and in particular, susceptibility of the senile nail to fungal infections, faulty biomechanics, neoplasms, concurrent dermatological or systemic diseases, and related treatments. With aging, the rate of growth, color, contour, surface, thickness, chemical composition and histology of the nail unit change. Age associated disorders include brittle nails, trachyonychia, onychauxis, pachyonychia, onychogryphosis, onychophosis, onychoclavus, onychocryptosis, onycholysis, infections, infestations, splinter hemorrhages, subungual hematoma, subungual exostosis and malignancies. Awareness of the symptoms, signs and treatment options for these changes and disorders will enable us to assess and manage the conditions involving the nails of this large and growing segment of the population in a better way.
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Enfermedades de la Uña/fisiopatología , Uñas/fisiopatología , Anciano , Antifúngicos/uso terapéutico , Humanos , Enfermedades de la Uña/etiología , Enfermedades de la Uña/patología , Uñas/patología , Onicomicosis/tratamiento farmacológico , Onicomicosis/fisiopatologíaRESUMEN
We studied whether the occurrence of Parkinson's disease (PD) in the Anglo-Indians, an admixed population of European and Asian Indian origin, differs from Indians living in the same environment. Epidemiological studies show considerably higher prevalence of PD amongst white compared to non-white populations. Normal Indians contain a approximately 40% lower number of melanized nigral neurons compared to Caucasians from the UK. Anglo-Indians are an admixed population of European and Indian origin. We used the UK Parkinson's Disease Society Brain Bank clinical diagnostic criteria (steps 1 and 2) to diagnose PD in 84 of 493 residents (Indians, 409; Anglo-Indians, 84) living in elderly homes in Bangalore, India. Of these 84, 80 were Indians (19.5%) and 4 were Anglo-Indians (4.8%). Occurrence of PD is nearly five times higher amongst Indians compared to the Anglo-Indians (odds ratio, 3.9; 95% confidence interval, 1.3-12.9). We conclude that an admixture population of European and Indian origins, rather than averaging, might result in reduced occurrences of PD. Hence, studying an admixed population could provide crucial insights into understanding genetic mechanisms in the etiopathogenesis of PD.