Biomedical subjects
Anjali Amarapurkar
Publications and source records attributed to Anjali Amarapurkar.
Non-alcoholic steatohepatitis in type 2 diabetes mellitus.
BACKGROUND AND AIMS: Non-alcoholic steatohepatitis (NASH) is commonly associated with type 2 diabetes mellitus (DM). Prevalence of NASH in type 2 DM has not been well studied and there is an epidemic rise in type 2 DM in Asian and Western populations. Its association with chronic liver disease in the form of NASH makes it an important health problem. Hence we have studied its prevalence and correlation of biochemical parameters with histological grades of non-alcoholic fatty liver disease (NAFLD) in otherwise asymptomatic type 2 DM patients. METHODS: One hundred and forty-eight individuals were screened. Forty-eight individuals were excluded due to history of alcohol intake or liver disease as a result of other causes. One hundred non-alcoholic individuals with type 2 DM underwent abdominal ultrasonography (US abdomen). Forty-nine patients had evidence of fatty liver on US abdomen, and 32 of these 49 patients underwent liver biopsy. RESULTS: Four of 32 (12.5%) individuals had steatosis alone. Mild, moderate and severe NASH was present in 21/32 (65.5%), 4/32 (12.5%) and 3/32 (9.35%), respectively. Fibrosis was present in 7/32 (21.8%) patients (four grade 1 and three grade 3). There was no significant difference in body mass index (BMI), transaminase levels, serum cholesterol and triglyceride levels among patients with non-alcoholic fatty liver disease. CONCLUSION: We conclude that the prevalence of NASH is high in type 2 DM patients and liver biopsy is the only investigation to differentiate between non-alcoholic fatty liver and steatohepatitis.
Helicobacter pylori eradication: efficacy of conventional therapy in India.
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Primary biliary cirrhosis and autoimmune hepatitis switch over: report of 2 cases.
Overlap syndrome in Autoimmune liver disease is not unusual but the switch over from one type of autoimmune liver disease to another is not well recognized. We report 2 cases of primary biliary cirrhosis (PBC) who with time, crossed over to autoimmune hepatitis (AIH). Recognition of such switch over from PBC to AIH is important for appropriate change in management of the patients.
Intestinal amyloidosis presenting as malabsorption syndrome.
Intestinal amyloidosis presenting with small bowel diarrhoea with malabsorption is an infrequent clinical entity. The present case report includes such a case and discusses the diagnostic approach in such a case.
Liver involvement in tuberculosis--an autopsy study.
OBJECTIVE: To study the spectrum of histopathological changes in the liver in cases of tuberculosis. MATERIALS & METHODS: This is an autopsy study consisting of 150 adult cases of tuberculosis over a period of 3 years. The diagnosis of tuberculosis was made on the basis of caseating granulomas or acid fast bacilli in the tissue. Cases showing only healed foci of tuberculosis at autopsy were excluded. Clinical details of all cases were obtained from hospital records. At autopsy, gross examination was done meticulously with special emphasis on the liver and extrahepatic biliary tree. Sections from the liver were processed routinely and histopathological findings were analyzed in detail. RESULTS: Patients were between 21 to 60 years of age with a male: female ratio of 2.1:1. Fever was the commonest symptom (62%). On gross examination, at autopsy, pulmonary and extrapulmonary tuberculosis was seen in 79 (52.6%) and 71 (47.4%) cases respectively. Liver involvement was mainly secondary except in one case. The extrahepatic biliary tree was involved in 18 cases, in the form of external compression of the common bile duct by a group of enlarged caseating, matted lymph nodes. The spectrum of histopathological changes of the liver showed epitheloid cell granulomas in 63 (42%), fatty changes in 49 (32.6%), inflammation in 60 (40%), sinusoidal congestion in 48 (32%) and fibrosis in 24 (16%) cases. Of the 63 cases of liver granulomas, 12 (19%) were cases of extensive pulmonary tuberculosis and the remaining were extrapulmonary tuberculosis. Granulomas were caseating in 58.7%, noncaseating in 23.8% and atypical in 17.5% cases. Fatty change ranged from mild to severe. Inflammation was mainly mild to moderate. Stage I and II fibrosis was seen in 13 (8.6%) and stage III and IV in 11 (7.3%) cases. On comparing the granuloma and non-granuloma cases histological features, it was found that fatty changes and inflammation were more with granuloma formation but there was no difference in the degree of fibrosis in the two groups. CONCLUSION: Liver involvement was mainly in the form of secondary tuberculosis. On histopathology, epitheloid cell granulomas were seen in 42% cases, other changes were non-specific. Significant fibrosis was seen in 7.3% cases however the finding of tuberculosis as a cause of significant fibrosis was not consistent.