Biomedical subjects
Publications and source records attributed to Rajesh Gupta.
An 84-year-old man was diagnosed with esophageal perforation following ingestion of a blister-wrapped tablet. His condition improved after 2 weeks of conservative treatment using antibiotics and high-protein enteral nutrition.
OBJECTIVE: To study the effects of cord clamping on iron stores of infants born to anemic mothers at 3 months of age. DESIGN: Randomized controlled trial. SETTING: Teaching hospital. METHODS: Infants born to mothers with hemoglobin (Hb)<100 g/L were randomized at delivery to either immediate cord clamping (early group) or cord clamping delayed till descent of placenta into vagina (delayed group). The outcome measures were infant's hemoglobin and serum ferritin 3 months after delivery. RESULTS: There were 102 neonates randomized to early (n = 43) or delayed cord clamping (n = 59). The groups were comparable for maternal age, parity, weight and supplemental iron intake, infant s birth weight, gestation and sex. The mean infant ferritin and Hb at 3 months were significantly higher in the delayed clamping group (118.4 microg/L and 99 g/L) than in the early clamping group (73 microg/L and 88 g/L). The mean decrease in Hb (g/L) at 3 months adjusted for co-variates was significantly less in the delayed clamping group compared to the early clamping group (-1.09, 95% CI-1.58 to -0.62, p >0.001). The odds for anemia (<100 g/L) at 3 months was 7.7 (95% CI 1.84-34.9) times higher in the early compared to the delayed clamping group. CONCLUSION: Iron stores and Hb in infancy can be improved in neonates born to anemic mothers by delaying cord clamping at birth.
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INTRODUCTION: Only limited data are available regarding the safety of therapeutic ERCP in pregnancy. We report our experience with therapeutic ERCP in pregnant women. METHODS: Medical records of 18 pregnant women (first trimester 4, second 6, third 8) who underwent ERCP between July 1994 and December 2004 were reviewed. Patients and their families were contacted to assess the well being of mother and baby. RESULTS: All the women underwent therapeutic ERCP and biliary sphincterotomy for common bile duct (CBD) stones. In 4 patients, 10-Fr CBD stents were inserted; three of these four cases required mechanical lithotripsy after delivery. Median procedure time was 17 min and median fluoroscopy time was 8 seconds. One patient each developed mild post ERCP pancreatitis and post sphincterotomy bleed. One woman had a preterm delivery. At follow up after a median of 6 years, all the babies were healthy. CONCLUSION: Therapeutic ERCP can be performed safely in all the trimesters of pregnancy provided appropriate precautions are taken.
AIM: To assess the utility and efficacy of Rome I and Rome II criteria for the diagnosis of irritable bowel syndrome (IBS) in India. METHODS: Patients referred with a diagnosis of IBS by general practitioners answered a questionnaire about clinical features, including those listed in the Rome I and Rome II criteria. All patients underwent investigations to determine the cause of their symptoms. Sensitivity, positive predictive value and percent agreement of final diagnosis with Rome I and II criteria were calculated. RESULTS: Among 138 patients studied, 6 patients had organic disease . Amongst 132 patients with functional bowel disease, Rome I criteria diagnosed more patients as IBS than Rome II criteria (110 [83.3%] vs. 41 [31.1%]); 36 patients fulfilled both the criteria. Of the patients positive by Rome I, 32.7% fulfilled Rome II criteria, and of those diagnosed by Rome II criteria, 87.8% fulfilled Rome I criteria. Seventeen patients did not fulfill either Rome I or Rome II criteria, and were classified as functional abdominal bloating, functional diarrhea or functional constipation. CONCLUSION: Rome I criteria are more sensitive than Rome II criteria for the diagnosis of IBS in the Indian population.
BACKGROUND: Obscure gastrointestinal bleeding (OGIB) is a common indication for capsule endoscopy (CE). Reports on diagnostic yield of CE in this situation show a wide variation. We evaluated the diagnostic yield and clinical impact of CE in patients with OGIB. METHODS: We reviewed the medical records of patients with OGIB who underwent CE at our institution between June 2002 and October 2005. RESULTS: 154 patients (mean age 47 [SD 17] years; 117 men), including 74 with overt OGIB and 80 with occult OGIB, underwent CE. CE yielded positive findings in 57 of 74 patients (77%) with overt OGIB and 22 of 80 (27%) of those with occult OGIB (p < 0.0001); the overall positive diagnostic yield was 52%. NSAID-induced lesions (15%), angiodysplasias (14%) and aphthous ulcers (12%) were the most frequent findings. CE helped in planning further management in 79% of patients with overt OGIB and 26% of those with occult OGIB. CONCLUSION: CE is a useful diagnostic technique in patients with OGIB, especially those with overt OGIB.
Management of benign biliary stricture remains a challenge for both surgeons and therapeutic endoscopists. Traditionally, surgery is considered the mainstay of treatment, but it is associated with significant morbidity and variable long-term outcome. With advances in endoscopic techniques and accessories, endoscopic management is emerging as an effective option. Outcome of endoscopic management depends on both the etiology and location of stricture. Current data suggest that long-term results with multiple plastic stents are superior to those with single plastic stent. Removable covered metal stents are a good alternative. The role of bio-absorbable self-expanding stents needs to be evaluated further.