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Minimal Hepatic Encephalopathy in Indians:Psychometric Hepatic Encephalopathy Score and Inhibitory Control Test for Diagnosis and Rifaximin or Lactulose for Its Reversal

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Journal of Clinical and Translational Hepatology 2019年第4期7卷 304-312页

作者： Vinay B.Pawar Ravindra G.Surude nikhil sonthalia Vinay Zanwar Samit Jain Qais Contractor Pravin M.Rathi Department of Gastroenterology Topiwala National Medical College and BYL Ch HospitalMumbaiMaharashtraIndia

Background and Aims: Psychometric hepatic encephalop-athy score(PHES)is used widely for diagnosis of minimal hepatic encephalopathy(MHE).This prospective study aimed to determine the utility of the inhibitory control test(ICT)for the diagnosis of ***,the efficacy of rifaximin and lactulose for reversal of MHE was ***:A total of 180 eligible cirrhotic patients underwent testing for *** PHES was ≤ ?5 and ICT lures were ≥ 14,MHE was *** 108 patients with MHE were randomized to three groups for treatment with either lactulose,rifaximin,or *** outcomes were measured at the end of 3 ***: The 108 patients with MHE diagnosed by PHES and/or ICT accounted for 60%.The diagnosis of MHE was made by both ICT and PHES positivity in 56 patients,by abnormal ICT and normal PHES in 37 patients,and by abnor-mal PHES and normal ICT in 15 *** diagnosis of MHE,ICT had sensitivity of 78.87%,specificity of 66.06%with 60.22%positive predictive value and 82.76%negative predictive *** area under the curve value of 0.724(95%CI: 0.653–0.788)was obtained for diagnosis of *** of MHE was seen in 71.42%,70.27%and 11.11%of patients in the rifaximin,lactulose and placebo arms(p < 0.001).Rifaximin showed better tolerability compared to ***: For the diagnosis of MHE,ICT is a simple tool but has lower sensitivity and better specificity than *** is as efficacious as lactulose in the treat-ment of MHE and better tolerated.

关键词： Minimal hepatic encephalopathy ICT PHES Indians Lactulose Rifaximin

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Fine needle aspiration diagnosis of isolated pancreatic tuberculosis: A case report

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World Journal of Clinical Cases 2013年第5期1卷 181-186页

作者： nikhil sonthalia Sayantan Ray Partha Pal Avishek Saha Arunansu Talukdar Department of General Medicine Medical College and HospitalKolkata 700073 India Department of General Medicine Calcutta National Medical College and HospitalKolkata 700014 India Department of General Medicine NRS Medical College and HospitalKolkata 700014 India

Tuberculosis(TB) involving the pancreas are uncommon, especially when present in immunocompetent hosts. Pancreatic TB is more frequently associated with miliary TB or widely disseminated disease. Pancreatic TB may present as cystic or solid pancreatic masses, pancreatic abscess or acute or chronic pancreatitis. Majority of the cases are diagnosed after surgical exploration for presumed pancreatic malignancy and preoperative diagnosis is quite difficult. However, improvement in imaging techniques and the resulting imageguided interventions gradually can obviate the need for more invasive diagnostic surgical procedures and expedite the planning of therapy. Herein, we report a rare case of isolated pancreatic TB which presented with pancreatic mass lesion in an immunocompetent host. Diagnosis was made by contrast enhanced computed tomography and guided fine needle aspiration of the pancreatic mass which revealed acid-fast bacillion Ziehl-Neelsen stain. The case was treated successfully with antituberculous drugs. Pancreatic tuberculosis should be considered in the differential diagnosis of a pancreatic mass when the patient is young, residing in the endemic zone of tuberculosis. Every attempt should be made to diagnose the cases to prevent unnecessary operation.

关键词： Pancreatic tuberculosis Pancreatic mass Pre-operative diagnosis Computed tomography Fine needle aspiration Antituberculous drugs

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Primary hepatic amyloidosis:A case report and review ofliterature

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World Journal of Hepatology 2016年第6期8卷 340-344页

作者： nikhil sonthalia Samit Jain Sunil Pawar Vinay Zanwar Ravindra Surude Praveen M Rathi Department of Gastroenterology Topiwala National Medical College and BYL Ch HospitalMumbai 400008MaharashtraIndia

We describe a case of 42-year-old female presenting with abdominal pain associated with loss of weight and fever for 8 mo. On evaluation she had gross hepatomegaly with raised alkaline phosphatase and raised GGT levels with normal transaminases and bilirubin. On imaging she had diffuse enlargement of liver with heterogeneous contrast uptake in liver. Her viral marker and autoimmune markers were negative. Liver biopsy depicted massive deposition of amyloid in peri-sinusoidal spaces which revealed apple green birefringence on polarizing microscopy after Congo red staining. Cardiac and renal evaluation was unremarkable. Abdominal fat pad and rectum biopsy was negative for amyloid deposit. There was no evidence of primary amyloidosis as bone marrow examination was normal. Serum and urine immunofixation electrophoresis were normal. Immunoperoxidase staining for serum amyloid associated protein for secondary amyloidosis was negative from liver biopsy. We present this rare case of primary hepatic amyloidosis and review the literature regarding varied presentations of hepatic involvement in amyloidosis.

关键词： Amyloidosis Congo red staining Isolatedhepatic amyloidosis Amyloid associated protein Immunofixation electrophoresis

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