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Article ; Online: Predictors of 1-month and 3-months Hospital Readmissions in Decompensated Cirrhosis

Ruchir Patel / Prateik Poddar / Dhaval Choksi / Vikas Pandey / Meghraj Ingle / Harshad Khairnar / Prabha Sawant

Annals of Hepatology, Vol 18, Iss 1, Pp 30-

A Prospective Study in a Large Asian Cohort

2019 Volume 39

Abstract: Introduction and aim: Considered as a healthcare quality indicator, hospital readmissions in decompensated cirrhosis predispose the patients and the society to physical, social and economic distresses. Few studies involving North American cohorts have ... ...

Abstract	Introduction and aim: Considered as a healthcare quality indicator, hospital readmissions in decompensated cirrhosis predispose the patients and the society to physical, social and economic distresses. Few studies involving North American cohorts have identified different predictors. The aim of this study was to determine and validate the predictors of 1-month and 3-months readmission in an Asian cohort. Material and methods.: We prospectively studied 281 hospitalised patients with decompensated cirrhosis at a large tertiary care public hospital in India between August 2014 and August 2016 and followed them for 3 months. Data regarding demographic, laboratory and disease related risk factors were compiled. We used multivariate logistic regression to determine predictors of readmission at 1-month and 3-months and receiver operating curves (ROC) for significant predictors to obtain the best cut-offs. Results: 1-month and 3-months readmission rates in our study were 27.8% and 42.3%, respectively. Model for End stage Liver Disease (MELD) score at discharge (OR:1.24, p < 0.001) and serum sodium (OR:0.94, p-0.039) independently predicted 1-month and MELD score (OR:1.11, p-0.003), serum sodium (OR:0.94, p-0.027) and male gender (OR:2.19, p-0.008) independently predicted 3-months readmissions. Neither aetiology nor complications of cirrhosis emerged as risk factors. MELD score >14 at discharge and serum sodium < 133 mEq/L best predicted readmissions; MELD score being a better predictor than serum sodium (p - 0.0001). Conclusions: High rates of early and late readmissions were found in our study. Further, this study validated readmission predictors in Asian patients. Structured interventions targeting this risk factors may diminish readmissions in decompensated cirrhosis.
Keywords	Early readmissions ; Decompensated chronic liver disease ; Model for End stage Liver Disease score ; Advanced liver disease ; Specialties of internal medicine ; RC581-951
Subject code	610
Language	English
Publishing date	2019-01-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Accuracy of Leukocyte Esterase Reagent Strip (LERS) test for rapid bedside screening of spontaneous bacterial peritonitis

Harshad Khairnar / Meghraj Ingle / Vikas Pandey / Kailash Kolhe / Shamsher Chauhan / Prabha Sawant / Swapnil Walke / Vipul Chaudhary

Journal of Family Medicine and Primary Care, Vol 9, Iss 11, Pp 5542-

An observational study

2020 Volume 5546

Abstract: Introduction: Spontaneous bacterial peritonitis (SBP) is a frequent and severe complication in cirrhotic patients with ascites. SBP is generally diagnosed based on an increased number of polymorphonuclear neutrophils in the ascitic fluid (>250/mm3) and ... ...

Abstract	Introduction: Spontaneous bacterial peritonitis (SBP) is a frequent and severe complication in cirrhotic patients with ascites. SBP is generally diagnosed based on an increased number of polymorphonuclear neutrophils in the ascitic fluid (>250/mm3) and positive culture. Usually fluid analysis and culture take time and precious hours are lost in starting therapy. Leukocyte Esterase Reagent Strips (LERS) have consistently given a high negative predictive value (>95% in the majority of the studies). Aims and Objectives: Aim was to evaluate the diagnostic utility of leukocyte esterase reagent strip for rapid diagnosis of SBP in patients who underwent abdominal paracentesis and to calculate the sensitivity, specificity, positive, and negative predictive values. Methodology: The study was carried out on 64 patients with ascites. Cell count of AF as determined by colorimetric scale of Multistix 10 SG reagent strip was compared with counting chamber method (PMNL count ≥250 cells/mm3 was considered positive). Results: Of the 64 patients SBP was diagnosed in 17 patients, 47 patients were negative for SBP by manual cell count. At cut off of 2+; sensitivity to diagnose SBP was 100%; specificity of 94%; PPV being 57% and NPV of 94%. at the cut off level of 3+; sensitivity decreased down to 76%; specificity increased to 100%; PPV of 100% and NPV of 93.75%. Overall accuracy at 2 + and 3 + was respectively 94.5% and 93.75%. Conclusion: In this study we have found good sensitivity and specificity for the prompt detection of elevated polymorphonuclear neutrophil count. A negative test result excludes SBP with a high degree of certainty. Thus, it represents a convenient, inexpensive, simple bedside screening tool for SBP diagnosis.
Keywords	cnna-culture negative neutrocytic ascites ; npv-negative predictive value ; ppv-positive predictive value ; Medicine ; R
Subject code	610
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Wolters Kluwer Medknow Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Difficult colonoscopy

Alisha Chaubal / Vikas Pandey / Ruchir Patel / Prateik Poddar / Aniruddha Phadke / Meghraj Ingle / Prabha Sawant

Intestinal Research, Vol 16, Iss 2, Pp 299-

air, carbon dioxide, or water insufflation?

2018 Volume 305

Abstract: Background/AimsThis study aimed to compare tolerance to air, carbon dioxide, or water insufflation in patients with anticipated difficult colonoscopy (young, thin, obese individuals, and patients with prior abdominal surgery or irradiation) ... ...

Abstract	Background/AimsThis study aimed to compare tolerance to air, carbon dioxide, or water insufflation in patients with anticipated difficult colonoscopy (young, thin, obese individuals, and patients with prior abdominal surgery or irradiation).MethodsPatients with body mass index (BMI) less than 18 kg/m2 or more than 30 kg/m2, or who had undergone previous abdominal or pelvic surgeries were randomized to air, carbon dioxide, or water insufflation during colonoscopy. The primary endpoint was cecal intubation with mild pain (less than 5 on visual analogue scale [VAS]), without use of sedation.ResultsThe primary end point was achieved in 32.7%, 43.8%, and 84.9% of cases with air, carbon dioxide and water insufflation (P<0.001). The mean pain scores were 5.17, 4.72, and 3.93 on the VAS for air, carbon dioxide, and water insufflation (P<0.001). The cecal intubation rate or procedure time did not differ significantly between the 3 groups.ConclusionsWater insufflation was superior to air or carbon dioxide for pain tolerance. This was seen in the subgroups with BMI <18 kg/m2 and the post-surgical group, but not in the group with BMI >30 kg/m2.
Keywords	Colonoscopy ; Insufflation ; Carbon dioxide insufflation ; Water immersion ; Medicine ; R ; Diseases of the digestive system. Gastroenterology ; RC799-869
Subject code	333
Language	English
Publishing date	2018-04-01T00:00:00Z
Publisher	Korean Association for the Study of Intestinal Diseases
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Endoscopic Ultrasonography Can Prevent Unnecessary Diagnostic Endoscopic Retrograde Cholangiopancreatography Even in Patients with High Likelihood of Choledocholithiasis and Inconclusive Ultrasonography

Ruchir Patel / Meghraj Ingle / Dhaval Choksi / Prateik Poddar / Vikas Pandey / Prabha Sawant

Clinical Endoscopy, Vol 50, Iss 6, Pp 592-

Results of a Prospective Study

2017 Volume 597

Abstract: Background/Aims Endoscopic retrograde cholangiopancreatography (ERCP) is the initial therapy recommended for patients with high likelihood of choledocholithiasis. To determine whether endoscopic ultrasonography (EUS) can prevent diagnostic ERCPs in ... ...

Abstract	Background/Aims Endoscopic retrograde cholangiopancreatography (ERCP) is the initial therapy recommended for patients with high likelihood of choledocholithiasis. To determine whether endoscopic ultrasonography (EUS) can prevent diagnostic ERCPs in patients with high probability of choledocholithiasis and inconclusive ultrasonography (US). Methods All patients with high likelihood of choledocholithiasis and negative US underwent EUS. ERCP was performed for the patients who showed a definite stone/sludge on EUS. Patients without choledocholithiasis were followed up for 3 months. The primary outcome was avoidance of diagnostic ERCP. Results We included 78 patients (51 women; 27 men). Of these, 25 and 7 (total 41%) were diagnosed with choledocholithiasis and sludge, respectively; stone/sludge was removed in 96.9% of the patients. EUS ruled out choledocholithiasis in 38 patients (48.7%). Two of them were found to have choledocholithiasis on follow-up. The sensitivity, specificity, positive and negative predictive value of EUS for detecting choledocholithiasis were 93.9%, 97.3%, 96.9%, and 94.7%, respectively. Unnecessary ERCP was avoided in 57.7% of the patients by using the EUS-first approach. Conclusions EUS is a highly accurate and safe procedure. EUS can replace ERCP as the initial investigation in patients with a high probability of choledocholithiasis. It avoids unnecessary ERCP; hence, decreasing related costs and complications.
Keywords	Endosonography ; High likelihood ; Choledocholithiasis ; Unnecessary endoscopic retrograde cholangiopancreatography ; Inconclusive imaging ; Internal medicine ; RC31-1245 ; Diseases of the digestive system. Gastroenterology ; RC799-869
Subject code	610 ; 616
Language	English
Publishing date	2017-11-01T00:00:00Z
Publisher	Hoon Jai Chun
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Drug Induced Liver Injury at a Tertiary Hospital in India

Chetan Rathi / Nirav Pipaliya / Ruchir Patel / Meghraj Ingle / Aniruddha Phadke / Prabha Sawant

Annals of Hepatology, Vol 16, Iss 3, Pp 442-

Etiology, Clinical Features and Predictors of Mortality

2017 Volume 450

Abstract: Introduction and aims: Drug-induced liver injury (DILI) is rare; however, it is one of the important causes of acute liver failure which results in significant morbidity or mortality. Material and Methods: Patients with suspected DILI were enrolled based ...

Abstract	Introduction and aims: Drug-induced liver injury (DILI) is rare; however, it is one of the important causes of acute liver failure which results in significant morbidity or mortality. Material and Methods: Patients with suspected DILI were enrolled based on predefined criteria and followed up for at least 6 months or until normalization of liver tests. Causality assessment was done by applying the Roussel Uclaf Causality Assessment Method model. Results: We collected data from 82 individuals diagnosed with DILI at our hospital from 2014 through 2015 (41 men; median age, 38 years). The most commonly implicated drugs were antitubercular therapy (ATT) (49%), antiepileptic drugs (12%), complementary and alternative medicine (CAM) in 10%, antiretroviral drugs (9%) and non-steroidal anti-inflammatory drugs (6%). 8 out of 13 deaths were liver related. Also, liver related mortality was significantly higher for ATT DILI (17.5%) vs. those without (2.4%) (P = 0.02). There was no significant difference in overall as well as liver related mortality in hepatocellular, cholestatic or mixed pattern of injury. Laboratory parameters at one week after discontinuation of drug predicted mortality better than those at the time of DILI recognition. On multivariate logistic regression analysis, jaundice, encephalopathy, MELD (Model for end stage liver disease) score and alkaline phosphatase at one week, independently predicted mortality. Conclusion: DILI results in significant overall mortality (15.85%). ATT, anti-epileptic drugs, CAM and antiretroviral drugs are leading causes of DILI in India. Presence of jaundice, encephalopathy, MELD score and alkaline phosphatase at one week are independent predictors of mortality.
Keywords	Acute Liver Failure ; Anti-tubercular therapy ; Model for End Stage Liver Disease ; Specialties of internal medicine ; RC581-951
Subject code	310 ; 610
Language	English
Publishing date	2017-05-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Gastrointestinal Bleeding Due To Visceral Artery Pseudoaneurysms Complicating Chronic Pancreatitis

Dattatray Solanke / Chetan Rathi / Nirav Pipaliya / Prateik Poddar / Vikas Pandey / Meghraj Ingle / Prabha Sawant

JOP Journal of the Pancreas, Vol 17, Iss 2, Pp 204-

A Case Series

2016 Volume 208

Abstract: Objectives Gastrointestinal visceral artery pseudoaneurysms are rare. This study was carried out in a tertiary health care center in Mumbai to study the patients with gastrointestinal visceral artery pseudoaneurysms due to chronic pancreatitis presenting ...

Abstract	Objectives Gastrointestinal visceral artery pseudoaneurysms are rare. This study was carried out in a tertiary health care center in Mumbai to study the patients with gastrointestinal visceral artery pseudoaneurysms due to chronic pancreatitis presenting as gastrointestinal bleed. Methods Patients with chronic pancreatitis presenting with gastrointestinal bleeding due to visceral artery pseudoaneurysms were studied in this prospective study for a period of two years from August 2013 to July 2015. Patients’ demographic data, symptoms at presentation, risk factors, comorbid conditions, laboratory investigations, imaging characteristics were studied. The patients underwent interventions either radiological or surgical. All patients were followed up for three months post-procedure. Results The incidence of pseudoaneurysms in chronic pancreatitis was 7.7%. Twelve patients with chronic pancreatitis had gastrointestinal visceral artery pseudoaneurysms who presented as gastrointestinal bleed. Splenic artery was the most common artery involved (six of twelve patients), followed by gastroduodenal artery (four patients), right gastroepiploic artery (two patients) and short gastric artery (one patient). The size of pseudoaneurysm ranged from 6 mm to 6.3 cm. All patients underwent interventions; transcatheter embolization of pseudoaneurysms in 11 patients and surgical management in the form of splenectomy in one patient. All patients tolerated radiological interventions well without major complications and did not have recurrent bleeding in three months of follow up. Conclusions Pseudoaneurysms of gastrointestinal visceral arteries due to chronic pancreatitis are rare and need prompt intervention either surgical or endovascular. Endovascular therapy in the form of transcatheter embolization is effective in achieving hemostasis. More prospective studies are needed to compare endovascular therapy versus surgical therapy as the treatment modality of gastrointestinal visceral artery pseudoaneurysms.
Keywords	Endoscopy ; Pancreatitis ; Chronic ; Medicine ; R ; Internal medicine ; RC31-1245 ; Specialties of internal medicine ; RC581-951 ; Diseases of the digestive system. Gastroenterology ; RC799-869
Subject code	610
Publishing date	2016-03-01T00:00:00Z
Publisher	E S Burioni Ricerche Bibliografiche
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: An open-label randomized control study to compare the efficacy of vitamin e versus ursodeoxycholic acid in nondiabetic and noncirrhotic Indian NAFLD patients

Pathik Parikh / Meghraj Ingle / Jatin Patel / Prasad Bhate / Vikas Pandey / Prabha Sawant

Saudi Journal of Gastroenterology, Vol 22, Iss 3, Pp 192-

2016 Volume 197

Abstract: Background/Aim: The study was carried out to compare the efficacy of Vitamin E versus Ursodeoxycholic acid (UDCA) in nondiabetic nonalcoholic fatty liver disease (NAFLD) patients. Patients and Methods: We randomized 250 non cirrhotic and non diabetic ... ...

Abstract	Background/Aim: The study was carried out to compare the efficacy of Vitamin E versus Ursodeoxycholic acid (UDCA) in nondiabetic nonalcoholic fatty liver disease (NAFLD) patients. Patients and Methods: We randomized 250 non cirrhotic and non diabetic NAFLD patients diagnosed on ultrasound, with raised alanine aminotransferase (ALT) level. (>40 IU/L), to receive Vitamin E 400 mg twice a day (Group A) or UDCA 300 mg twice a day (Group B) for 52 weeks. Lifestyle modification to achieve at least 5% weight reduction and subsequent weight control and regular exercise was advised to both groups. The primary study endpoint was normalization of ALT. Secondary endpoints were the proportion of patients with reduction in ALT, relative reduction in the NAFLD Fibrosis score (NFS), symptomatic improvement and tolerability. Results: One hundred and fifty patients received UDCA as compared to 100 patients receiving Vitamin E. The treatment groups were comparable at entry with regard to age (44.1 vs 42.4 years), gender (67% vs 63% female), risk factors for nonalcoholic steatohepatitis, hypochondriac pain, serum liver biochemistries, and NAFLD Fibrosis score. The primary endpoint was achieved in 21 (14%) and 19 (19%) of patients in Group A and Group B, respectively (P = 0.2). The proportion of patients with reduction in ALT (56% vs 63%, P = 0.2), symptomatic improvement (78% vs 67%, P= 0.058), reduction in the NFS (44% vs 47%, P= 0.69), and tolerability (98% vs 95%, P= 0.2) were similar between Group A and Group B, respectively. Conclusion: UDCA is an effective and safe alternative to Vitamin E in nondiabetic–noncirrhotic Indian NAFLD patients.
Keywords	Fatty liver ; nonalcoholic steatohepatitis ; steatohepatitis ; Ursodeoxycholic acid ; Diseases of the digestive system. Gastroenterology ; RC799-869 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R
Subject code	610
Language	English
Publishing date	2016-01-01T00:00:00Z
Publisher	Medknow Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Pulmonary Thromboembolism Complicating Acute Pancreatitis With Pancreatic Ascites

Ruchir Patel / Nirav Pipaliya / Prateik Poddar / Vikas Pandey / Meghraj Ingle / Prabha Sawant

JOP Journal of the Pancreas, Vol 17, Iss 3, Pp 308-

A Series of 4 cases

2016 Volume 312

Abstract: Acute pancreatitis is an inflammatory disease often associated with local and systemic complications. Portosplenic and splanchnic vascular complications of acute pancreatitis are common, but extrasplanchnic vessel thrombosis is less commonly seen. Among ... ...

Abstract	Acute pancreatitis is an inflammatory disease often associated with local and systemic complications. Portosplenic and splanchnic vascular complications of acute pancreatitis are common, but extrasplanchnic vessel thrombosis is less commonly seen. Among them, pulmonary thromboembolism is a very rare complication to be encountered with. We report four cases of acute pulmonary thromboembolism in patients with acute pancreatitis superimposed on chronic pancreatitis. All the patients had abdominal pain on presentation and distention of abdomen during the course. Dyspnea was present in all the patients. All patients were found to have pancreatic ascites, whose association with pulmonary thromboembolism is reported only in two patients till date upto our knowledge. Two of them had deep vein thrombosis and rest two had no venous thrombosis. All of them were managed conservatively using subcutaneous heparin, intravenous fluids and analgesics. We provide the causative mechanism for occurrence of pulmonary thromboembolism in acute on chronic pancreatitis. We have also hypothesized pancreatic ascites as the possible cause for pulmonary thromboembolism and provide explanation for it. We conclude that pulmonary thromboembolism in acute pancreatitis has good prognosis if diagnosed timely. Whenever patient with pancreatic ascites presents with dyspnea, pulmonary thromboembolism must be ruled out.
Keywords	Pancreatitis ; Pulmonary Embolism ; Medicine ; R ; Internal medicine ; RC31-1245 ; Specialties of internal medicine ; RC581-951 ; Diseases of the digestive system. Gastroenterology ; RC799-869
Subject code	610
Publishing date	2016-05-01T00:00:00Z
Publisher	E S Burioni Ricerche Bibliografiche
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Intrahepatic Pancreatic Pseudocyst

Dhaval Gupta / Nirav Pipaliya / Nilesh Pandav / Kaivan Shah / Meghraj Ingle / Prabha Sawant

JOP Journal of the Pancreas, Vol 17, Iss 4, Pp 410-

Case Series

2016 Volume 413

Abstract: Intrahepatic pseudocyst is a very rare complication of pancreatitis. Lack of experience and literature makes diagnosis and management of intrahepatic pseudocyst very difficult. Majority of published cases were managed by either percutaneous or surgical ... ...

Abstract	Intrahepatic pseudocyst is a very rare complication of pancreatitis. Lack of experience and literature makes diagnosis and management of intrahepatic pseudocyst very difficult. Majority of published cases were managed by either percutaneous or surgical drainage. Less than 30 cases of intrahepatic pseudocysts have been reported in the literature and there is not a single report of endoscopic ultrasound guided management of intrahepatic pseudocysts. Here we report a case series of 2 patients who presented with intrahepatic pseudocysts and out of which first case was successfully managed by EUS guided drainage. Our second case is also the youngest patient presented with intrahepatic pseudocyst till now.
Keywords	Endosonography ; Pancreatic Pseudocyst ; Medicine ; R ; Internal medicine ; RC31-1245 ; Specialties of internal medicine ; RC581-951 ; Diseases of the digestive system. Gastroenterology ; RC799-869
Publishing date	2016-07-01T00:00:00Z
Publisher	E S Burioni Ricerche Bibliografiche
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The role of capsule endoscopy in etiological diagnosis and management of obscure gastrointestinal bleeding

Vikas Pandey / Meghraj Ingle / Nilesh Pandav / Pathik Parikh / Jignesh Patel / Aniruddha Phadke / Prabha Sawant

Intestinal Research, Vol 14, Iss 1, Pp 69-

2016 Volume 74

Abstract: Background/AimsTo investigate the various etiologies, yields, and effects of capsule endoscopy (CE) on management and complications, along with follow up of patients with obscure gastrointestinal (GI) bleeding.MethodsThe study group of patients included ... ...

Abstract	Background/AimsTo investigate the various etiologies, yields, and effects of capsule endoscopy (CE) on management and complications, along with follow up of patients with obscure gastrointestinal (GI) bleeding.MethodsThe study group of patients included those having obscure, overt, or occult GI bleeding. The findings were categorized as (A) obvious/definitive, (B) equivocal, or (C) negative. Any significant alteration in patient management post CE in the form of drug or surgical intervention was noted.ResultsTotal patients included in the study were 68 (48 males and 20 females). The ratio of male:female was 2.4:1. The age ranged between 16 years to 77 years. Mean age for males was 62±14 years, for females 58±16 years. The total yield of CE with definitive lesions was in 44/68 (65.0%) of patients. In descending order (A) angiodysplasia 16/68 (23.53%), (B) Crohn's disease 10/68 (14.70%), (C) non-steroidal anti-inflammatory drug enteropathy 8/68 (11.76%), (D) small bowel ulcers 4/68 (5.88%), (E) jejunal and ileal polyps 2/68 (2.94%), (F) intestinal lymphangiectasis 2/68 (2.94%), and (G) ileal hemangiomas 2/68 (2.94%) were followed. Equivocal findings 12/68 (17.65%) and negative study 12/68 (17.65%) was found. Complications in the form of capsule retention in the distal ileum were noted in 2/68 (2.94%) subjects. Statistically, there was a higher probability of finding the etiology if the CE was done during an episode of bleeding.ConclusionsCE plays an important role in diagnosing etiologies of obscure GI bleeding. Its role in influencing the management outcome is vital.
Keywords	Etiology ; Gastrointestinal bleeding ; Capsule endoscopy ; Angiodysplasia ; Small bowel ulcer ; Medicine ; R ; Diseases of the digestive system. Gastroenterology ; RC799-869
Subject code	610
Language	English
Publishing date	2016-01-01T00:00:00Z
Publisher	Korean Association for the Study of Intestinal Diseases
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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