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ABSTRACTS OF PAPERS AT THE 82ND RESEARCH MEETING OF THE MEDICAL RESEARCH CENTRE OF BOMBAY HOSPITAL ON MONDAY, 11TH DECEMBER 2000, 2.30 PM, SP JAIN CAFETERIA (CONVENOR DR. HL DHAR)
1. PROFILE OF MESENTERIC VENOUS THROMBOSIS
Deepak Amarapurkar, Sandeep Punamiya, Jignesh Jatania, T Satyendra
Mesenteric venous thrombosis is an infrequent form of mesenteric ischaemia and accounts for 5 to 10% cases of acute mesenteric ischaemia. Due to improved noninvasive imaging it is possible to recognize this entity which can present in acute, subacute or chronic forms.
Objective : To study the profile of patients with mesenteric venous thrombosis.
Profile of patients presenting with mesenteric venous thrombosis was studied.
Over a period of 5 years from Jan. 1995 to Jan. 2000 we encountered 16 patients with mesenteric vein thrombosis (male 1, female 12:4, age range 22 years to 64 years mean age 44 years). Presentation was acute in 11/16, subacute 3/16 and chronic 2/16. All patients had abdominal pain. Gastrointestinal bleeding, nausea, vomiting and altered bowel habits were seen in 10, 14 and 7 patients respectively. Detailed coagulation work up showed protein C deficiency in one patient, protein C and S deficiency in 2, thrombophilia in 2, myeloproliferative disorders in 2 and no identifiable cause in 9 patients. Five out of 11 patients presenting as acute abdomen died. 8 required surgery for intestinal stricture after recovery. Associated portal and splenic thrombosis was seen in 13/16 patients while arterial thrombosis was seen in 3/16 patients. Ten out of 16 patients are doing well on anticoagulation.
Mesenteric venous thrombosis in an uncommon cause of abdominal pain. Early recognition of this entity and treatment with anticoagulation improves survival substantially.
2. HELICOBACTER PYLORI ERADICATION - DO SHORT TERM TREATMENTS ARE RELIABLE?
Deepak Amarapurkar, Madhavi Makesar, Anjali Amarapurkar
Short courses of treatment regimens consisting of proton pump inhibitors (PPI) and antibiotics including nitro imidazole are prescribed routinely for eradication of H. pylori infection in India.Double blind non randomized study to assess the efficacy of 3 different treatment regimen for H. pylori eradication.
Forty consecutive patients undergoing upper GI endoscopy who were H. pylori positive were selected for this study. At index endoscopic biopsies were taken for urease test, histology, culture and PCR. Patients were treated with 3 different regimens (1) Lansoprazole 20 mg bid, clarithromycin 250 mg bid, amoxycillin 750 mg bid, for 15 days (n=13) (2) Omeprazole 20 mg bid, amoxycillin 750 mg bid, tinidazole 500 mg bid for 15 days (n=16), (3) Omeprazole 20 mg bid, tinidazole 500 mg bid and amoxycillin 750 mg bid for 7 days (n=11). All patients were subjected for repeat endoscopy and biopsies after one month of stopping treatment. H. pylori positivity by at least 2 out of 4 modalities (i.e. urease test, histology, PCR, culture) was seen in 46%, 56% and 81% in 3 groups respectively.
None of the treatment regimen available in kit forms are satisfactory for eradication of H. pylori infection in India.
3. PRIMARY ANTI PHOSPHOLIPID ANTIBODY SYNDROME
Sanjay Porwal, K Ramamoorthy
58 year old male presented with fever, cough, haemoptysis with big spleen, found out to be having pulmonary infarct and splenic infarct on CT chest and abdomen. Also he had thrombocytopenia work up for the same was done showed false positive VDRL and as PTT more than 120 second. As a result of above clinical and lab data, lupus anticoagulant and anticardiolipid antibody was send turned out to be strongly positive proving diagnosis of primary antiphospholipid antibody syndrome as both (clinical data - vascular thrombosis - pulmonary and splenic infarct and Lab data-lupus anticoagulant and anticardiolipin antibody) has fitted in this case. It is a thrombophilic disorder in which arterial or venous thrombosis or both occur in a patient having antibodies against negatively charged phospholipids important for coagulation especially b2 microglobulin and prothrombin. Syndrome is primary if there is no accompanying autoimmune diseases and secondary if the patient has a known connective tissue diseases especially SLE - approximately half of all have primary variant of the disease. Primary and secondary has similar clinical presentation 1) arterial venous thrombosis 2) thrombocytopenia or 3) Recurrent foetal loss.Tests are false positive VDRL and prolonged PTT. If they are positive with clinical setting lupus anticoagulant and anticardiolipin antibody are done as diagnostic test. Management of this syndrome is according to the clinical syndrome for DVT/arterial and venous thrombosis. Life long warfarin as anticoagulant maintaining INR ~ 3.0 initiated by heparin. For recurrent abortion - heparin during antenatal period 5000 s/c BD and for retinal artery and venous thrombosis - pentoxyphyllin or hydroxy chloroquin are used. For life threatening thrombocytopenia gamma globulins are used. Steroids used only if associated with any connective tissue disorders.
4. SIGNIFICANCE OF ALLERGEN SPECIFIC IgE TO HDM IN EXERCISE INDUCED ASTHMA
SV Joshi, DM Tripathi, SY Bhave, HL Dhar
Most allergic diseases are caused by IgE mediated hypersensitivity reactions. This study was an attempt to correlate allergen specific IgE for house dust mite (HDM) in causation of exercise induced asthma. Study included 250 children and 200 adult asthmatics.To detect the presence of specific IgE to HDM, a modified skin prick test was performed which is more sensitive and specific than in-vitro methods. It is a better predictor of clinical allergy than total serum IgE and eosinophil counts.
Positive skin tests to housedust mites was observed in 60% asthmatic children and 60.1% in adults. However, in adults strong sensitivity to HDM was seen in 84%. Amongst other aeroallergens, pollen sensitivity was observed in 49.2% children and about 50% in adults. Pulmonary functions, especially peak expiratory flow rate (PEFR) and EFV1 which reflect on primarily large airway caliber and in both large and medium size airways were reduced significantly along with the other functions viz. VC etc in mite sensitive children and adults.
Forty per cent children and 64% adults with high sensitivity to HDM developed exercise induced asthma, indicating the role of allergen specific IgE to HDM in causing exercise induced asthma in both groups. As such screening of specific IgE levels can be helpful in diagnosis of EIB and further management.
5. COMPARISON OF THYROID FUNCTIONS IN HYPERTENSION AND DIABETIC PATIENTS
DM Sharma, DR Jangid, SV Joshi, HL Dhar
The aim of this study was to compare thyroid functions in hypertension and diabetic patients. Out of 100 patients referred to Nuclear Medicine Department of Bombay Hospital Trust for thyroid function tests during Dec. 1996-Oct. 1999. 252 cases either hypertension, diabetes or both were included in the study.Routine thyroid functions viz. T3, T4 TSH were evaluated using radioimmunoassay (RIA) along with relevant biochemical parameters including plasma glucose, serum creatinine, serum cholesterol and blood urea.
Results show that among the hypertensive N=100 patients 42% were euthyroid, 36% were hyperthyroid, 22% were hypothyroid. In hypertensive hypothyroid patients T3 was low in 22.72%. However, in 23.8% euthyroid cases T3 was reduced with no alteration in either T4 or TSH.
In diabetics, incidence of hypothyroidism (48%) and euthyroidism (48%) was higher than hyperthyroidism. Serum T3 levels were low in 29.16% hypothyroid and 18.60% euthyroid cases with no changes in T4 and TSH levels. Hypercholesterolaemia was observed in (25%) hypothyroid individuals. Hypothyroidism (42.3%), hyperthyroidism (28.2%) and euthyroidism (28.84%) were associated with both hypertension and diabetes. Decreased T3 and T4 levels were found in 18.18% each in hypothyroid patients.
Study suggests that hyperthyroidism is commonly associated with hypertension and hypothyroidism is more in diabetic patients. Both diabetes and hypertension were associated with primary hypothyroidism.
6. EFFECT OF MEDITATION ON INTELLIGENCE AND PERFORMANCE IN NURSING STUDENTS
AH Shah, SV Joshi, PP Mehrotra, UD Mahadik, Naina Potdar, HL Dhar
Meditation is a mental exercise which can be used as a powerful instrument to restrain sense organ and control autonomic nervous system.42 second year students of Nursing College were included in the study. Following parameters were studied in Jan. 1999.
i) Cardio pulmonary function (viz. pulse, BP PEFR)
ii) Psychomotor Test including reaction time
iii) Maze
iv) Arithmatic ability
v) Mental status questionnaire
vi) Examination Results
Training of Meditation was imparted for three days and then were asked to practice. All the above parameters were repeated in July 2000 (After 1 1/2 year).
There was some change in cardiopulmonary function, Maze, arithmatic abilities and reaction time. However, performance in examination results and mental status questionnaire improved significantly. Regular practice of meditation caused significant improvement in intelligence and performance.
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