Gastroenterology Commons^™

Obesity And Metabolic Phenotypes (Metabolically Healthy And Unhealthy Variants) Are Significantly Associated With Prevalence Of Elevated C-Reactive Protein And Hepatic Steatosis In A Large Healthy Brazilian Population, Sameer Shaharyar, Lara Roberson, Omar Jamal, Adnan Younus, Shozab Ali, Arthur Agatston, Khurram Nasir Baptist Health Medical Group

All Publications

BACKGROUND:Among the obese, the so-called metabolically healthy obese (MHO) phenotype is thought to confer a lower CVD risk as compared to obesity with typical associated metabolic changes. The present study aims to determine the relationship of different subtypes of obesity with inflammatory-cardiometabolic abnormalities.METHODS:We evaluated 5,519 healthy, Brazilian subjects (43 ± 10 years, 78% males), free of known cardiovascular disease. Those with (MRF) were considered metabolically healthy, and those with BMI ≥ 25 kg/m(2) and/or waist circumference meeting NCEP criteria for metabolic syndrome as overweight/obese (OW). High sensitivity C reactive protein (hsCRP) was measured to assess underlying inflammation and hepatic steatosis …

Low Dose Albumin For The Prevention Of Renal Impairment Following Large Volume Paracentesis In Cirrhosis., Waqar Hussain, Abdullah Bin Khalid, Tayyab Usmani, Aiman Ghufran, Syed H Shah

Department of Medicine

OBJECTIVES: To evaluate the effect of low dose Albumin i.e. 4 grams per litre of ascitic fluid after large volume paracentesis (LVP) for the prevention of paracentesis induced circulatory dysfunction (PICD) related renal impairment in cirrhosis.

METHODS: Case records of all patients with cirrhosis who underwent LVP from January 12(th), 2011 till December 29(th), 2013 were reviewed. Patients were excluded if they had spontaneous bacterial peritonitis, creatinine >1.5 mg/dl, hepatoma or if volume of ascitic fluid removed was <5 litres. Data including age, gender, cause of cirrhosis, CTP score and volume of ascitic fluid drained were noted. In addition serum creatinine and serum sodium at baseline and one week post paracentesis were recorded.

RESULTS: Two hundred and fourteen patients with cirrhosis underwent LVP during the study period. One hundred and thirty nine patients met the …

Total Pancreatectomy With Islet Autologous Transplantation: The Cure For Chronic Pancreatitis?, Samuel J. Kesseli, Kerrington A. Smith, Timothy B. Gardner

Dartmouth Scholarship

Chronic pancreatitis (CP) is a debilitating disease that leads to varying degrees of pancreatic endocrine and exocrine dysfunction. One of the most difficult symptoms of CP is severe abdominal pain, which is often challenging to control with available analgesics and therapies. In the last decade, total pancreatectomy with autologous islet cell transplantation has emerged as a promising treatment for the refractory pain of CP and is currently performed at approximately a dozen centers in the United States. While total pancreatectomy is not a new procedure, the endocrine function-preserving autologous islet cell isolation and re-implantation have made the prospect of total …

Patient Considerations In The Management Of Ulcerative Colitis - Role Of Vedolizumab, M. Kothari, P. Mudireddy, A. Swaminath

Journal Articles

Ulcerative colitis (UC) is a subtype of inflammatory bowel disease which causes inflammation of the large intestine and affects approximately 7.6-24.6 per 100,000 persons. The therapeutic goal for UC patients is inducing remission, maintaining remission, and ideally, obtaining mucosal healing. Vedolizumab, approved by the US Food and Drug Administration in May 2014 for the treatment of moderate-to-severe UC and Crohn's disease, is a newly developed anti-integrin therapy. This review focuses on the preclinical development of vedolizumab and data from early trials, and details the results of the landmark trails that led to its approval in the USA with a specific …

Hepatic Manifestations Of Non-Steroidal Inflammatory Bowel Disease Therapy, R. Hirten, K. Sultan, A. Thomas, D. E. Bernstein

Journal Articles

Inflammatory bowel disease (IBD) is composed of Crohn's disease and ulcerative colitis and is manifested by both bowel-related and extraintestinal manifestations. Recently the number of therapeutic options available to treat IBD has dramatically increased, with each new medication having its own mechanism of action and side effect profile. A complete understanding of the hepatotoxicity of these medications is important in order to distinguish these complications from the hepatic manifestations of IBD. This review seeks to evaluate the hepatobiliary complications of non-steroid based IBD medications and aide providers in the recognition and management of these side-effects.

Comparison Of The Diagnostic Yield And Outcomes Between Standard 8 H Capsule Endoscopy And The New 12 H Capsule Endoscopy For Investigating Small Bowel Pathology, M. Rahman, S. Akerman, B. Devito, L. Miller, M. Akerman, K. Sultan

Journal Articles

AIM: To evaluate the completion rate and diagnostic yield of the PillCam SB2-ex in comparison to the PillCam SB2. METHODS: Two hundred cases using the 8-h PillCam SB2 were retrospectively compared to 200 cases using the 12 h PillCam SB2-ex at a tertiary academic center. Endoscopically placed capsules were excluded from the study. Demographic information, indications for capsule endoscopy, capsule type, study length, completion of exam, clinically significant findings, timestamp of most distant finding, and significant findings beyond 8 h were recorded. RESULTS: The 8 and 12 h capsule groups were well matched respectively for both age (70.90 +/- 14.19 …

Clinical Markers Of Crohn's Disease Severity And Their Association With Opiate Use, M. Cheung, S. Khan, M. Akerman, C. K. Hung, K. Vennard, N. Hristis, K. Sultan

Journal Articles

BACKGROUND: The safety of opiate use for patients with Crohn's disease (CD) has long been a concern. The recent Crohn's therapy, resource, evaluation, and assessment tool (TREAT) registry update has added to these concerns by demonstrating an association of opiate use with an increased risk of infection and death in CD. While the association is clear, the relationship of opiates to these negative outcomes is not. It is unknown whether opiates are a contributing factor to these negative outcomes or if their use is merely a marker of more severe disease. We hypothesized that opiate use is not harmful in …

Comparison Of Endoscopic Ultrasound Guided 22-Gauge Core Needle With Standard 25-Gauge Fine-Needle Aspiration For Diagnosing Solid Pancreatic Lesions, M. Berzosa, N. Villa, H. B. El-Serag, D. V. Sejpal, K. K. Patel

Journal Articles

Background and Objectives: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the standard modality for diagnosing pancreatic masses. We compared the diagnostic yield of a new EUS-guided 22-gauge core needle biopsy to a standard 25-gauge FNA in sampling the same pancreatic lesions during the same EUS. Patients and Methods: The main outcomes of the study were the sample adequacy of each method to provide a final pathological diagnosis, and the concordance in diagnosis between core and FNA specimens. The secondary outcomes were the sensitivity and specificity of the findings for each needle and the incremental yield of using both needles compared with …

Hemophagocytic Lymphohistiocytosis: A Series Of Five Clinical Cases In Adult Patients At A Single Institution With A Review Of The Literature, David Thomas, Nihar Shah Md, Hiren Patel, Tapan Pandya, Dron Gauchan, Michael Maroules

Gastroenterology

Context: Hemophagocytic Lymphohistiocytosis or the “Hemophagocytic Syndrome” is a spectrum of disorders of regulatory immunomodulatory pathways inciting phagocytosis of hematopoietic cells resulting in end-organ damage. The condition appears in both heritable and non-heritable forms from a multitude of possible environmental triggers, most notably infection. The condition often results in a fatal outcome without prompt diagnosis and treatment. Cases in children have been reported much more frequently and classically than in adult patients.

Case Report: In this case series we examined fi ve such cases in adult patients that were found at our institution in a window as small at 2 …

Enterogenous Cyst Of The Small Bowel Causing Intussusception In An Adult: Case Report And Review Of Literature, Nihar Shah Md, Therese Lizardo-Escaño, Hamid Shaaban, Gautamy Dhadham, Arya Karki, Robert Spira

Gastroenterology

Small bowel intussusception is a rare congenital disease entity, mostly manifesting before the age of two with abdominal pain and acute intestinal obstruction. In adults, colon intussusception is a rare event causing approximately 1% of all acute intestinal obstructions and they can occur idiopathically in adults or due to an intraluminal tumor mass. We report a case of an enterogenous cyst causing intussusception and iron deficiency anemia in an adult treated by surgical excision and resection of the small bowel.

Non-Invasive Parameters For The Detection Of Variceal Bleed In Patients Of Liver Cirrhosis, An Experience Of A Tertiary Care Hospital In Pakistan, Anam Umar, Fakhar Qazi, Rukhsana Abdul Sattar, Beena Umar

Section of Gastroenterology

Objective: Cirrhotic patients commonly undergo screening endoscopy for the existence of esophageal varices. The use of this invasive procedure which is expensive, poorly tolerable and generally not acceptable for the patients is increasing due to increasing number of patients with chronic liver disease and their enriched survival. In this study, our aim is to identify clinical, biochemical, and ultrasonography parameters which might noninvasively predict the presence of esophageal varices and risk of bleeding in patients with liver cirrhosis.

Material and Methods: Total 150 Patientsof chronic liver disease admitted in ward-5, JPMC(Sep 2011-Feb 2012) with a complaint of hematemesis or melena …

Small Intestinal Bacterial Overgrowth In Post Oesophagectomy And Gastrectomy Patients, Melissa Dooley

Masters

A review of patients who underwent a hydrogen breath test for Small Intestinal Bacterial Overgrowth, following an oesophagectomy or gastrectomy was carried out in the Gastrointestinal Function Unit, St. James’s Hospital, Dublin. The aim of this research was to look at the incidence of Small Intestinal Bacterial Overgrowth and create an optimal protocol for Hydrogen Breath Testing with the hope of improving patient compliance and reducing clinic waiting times. Factors such as lifestyle, multimodal therapy, tumour morphology, and gender were analysed in relation to positive Hydrogen Breath Test results in this patient group. Patients were selected following a referral from …

Implementation Of A Helicobacter Pylori Test And Treat Program In Rural Nepal Facilitated By A Nurse Practitioner Doctor Of Nursing Practice Comprehensive Project Report, Shelley Bloom

Doctor of Nursing Practice (DNP) Projects

There are 30 million people in Nepal, 85% live in rural areas and have access to 15% of health care resources. This deficit in health care resources is supplemented by services provided by non-governmental organizations who organize short-term medical missions. At a rural Nepalese health post 45% of the patients complained of abdominal discomfort. As the prevalence of helicobacter pylori is 50-90% in Southeast Asia, the patients believed that they had helicobacter pylori.

In resource-poor communities, there is a gap between best practices and the care delivered. To decrease the gap in one rural Nepalese health post, a Nurse Practitioner …

Biomarker Discovery Of Liver Diseases Using Mass Spectrometry-Based Metabolomics., Xue Shi

Electronic Theses and Dissertations

Metabolomics has emerged as one of the latest of the "-omics" disciplines that can detect metabolite biomarkers in biological samples. The diverse characteristics of metabolites make the analytical platform challenging in metabolomics. Two bioanalytical platforms were developed in this study to investigate metabolite abundance changes under different biological conditions. We first developed a bioanalytical platform that coupled linear trap quadruple - Fourier transform ion cyclotron mass spectrometer (LTQ-FTICR MS) with direct infusion chip-based nano-electrospray ionization (DI-nESI) and applied it to study polychlorinated biphenyls (PCB) effects on non-alcoholic fatty liver disease (NAFLD). We also employed this platform in conjunction with in …

Rare Presentation Of Pancreatitis Secondary To Intussusception Of Duodenal Duplication Cyst, A Pediatric Case Report, Valentina Shakhnovich, Jennifer Colombo, Amita A. Desai, Shawn D. St Peter

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Plasticity In The Contribution Of T Cell Receptor Variable Region Residues To Binding Of Peptide-Hla-A2 Complexes, Sheena N. Smith, Daniel Sommermeyer, Kurt H. Piepenbrink, Sydney J. Blevins, Helga Bernhard, Wolfgang Uckert, Brian M. Baker, David M. Kranz

Food for Health: Publications

One hypothesis to account for MHC-restriction by T cell receptors (TCRs) holds that there are several evolutionary-conserved residues in TCR variable regions that contact MHC. While this ‘germline-codon’ hypothesis is supported by various lines of evidence, it has been difficult to test. The difficulty stems in part from the fact that TCRs exhibit low affinities for pep/MHC, thus limiting the range of binding energies that can be assigned to these key interactions using mutational analyses. To measure the magnitude of binding energies involved, here we used high affinity TCRs engineered by mutagenesis of CDR3. The TCRs included a high-affinity, MART-1/ …

Outcomes Of Splenectomy For Idiopathic Thrombocytopenic Purpura In Adults: A Developing Country Perspective., Amyn Pardhan, Aamir Hameed, Hasnain Zafar, Samia Mazahir, Ghulam Murtaza

Department of Medicine

Objective: to determine the outcome of splenectomy done in adult patients of Idiopathic Thrombocytopenic Purpura over a period of 10 years and, secondarily, to determine the predictors of complete response to therapy.

Methods: The retrospective review comprised of adult patients over 14 years of age who underwent open or laparoscopic splenectomy for Idiopathic Thrombocytopenic Purpura at Aga Khan University Hospital, Karachi, from January 2000 to December 2010. Data was reviewed in January 2011 by a surgical resident. Outcome was the response to splenectomy as per new definition of response set by the American Society of Haematology 2011 evidence based practice …

Unchain My Heart: Constrictive Pericarditis In The Setting Of Chronic Kidney Disease And Monoclonal Gammopathy Of Undetermined Significance, Neiman Ramjattan Do, Justin L. Guthier Do, Stacey Smith Md, Facp

Department of Medicine

No abstract provided.

Isolated Gastroduodenal Crohn’S Disease, Matthew Sullivan Do, Patrick Hickey Do, Saba Ahmad Md, Jeffrey Brodsky Md, Hiral N. Shah Md, Ronald Bross Md

Department of Medicine

No abstract provided.

Rare Presentation Of A Massive Intermittent Upper Gastrointestinal Bleed, Bonnie Patek Do, Matthew Sullivan Do, Shashin Shah Md

Department of Medicine

No abstract provided.