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Intestinal lymphangiectasia:Understanding the bigger picture

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World Journal of Clinical Cases 2024年第18期12卷 3298-3303页

作者： sudheer Marrapu Ramesh kumar Department of Gastroenterology All India Institute of Medical SciencesPatna 801507India

Intestinal lymphangiectasia(IL)is characterized by the dilation of intestinal lymphatic vessels,which can rupture and cause loss of lymph into the intestine.Due to the high content of proteins,lipoproteins,and lymphocytes in the intestinal lymph,loss of lymph might result in hypoproteinemia,hypoalbuminemia,hypogammaglobulinemia,and lymphocytopenia.In addition,there may be a depletion of minerals,lipids,and fat-soluble vitamins.IL can be primary due to inherent malfunctioning of the lymphatic system,or secondly,a result of various factors that may hinder lymphatic drainage either directly or indirectly.This condition has emerged as a subject of significant clinical interest.Given that the intestinal lymphatic system plays an important role in the body’s fluid homeostasis,adaptive immunity,nutrient and drug absorption,intestinal transport,and systemic metabolism,its dysfunction may have wider implications.Although primary IL is rare,with varied clinical features,complications,treatment response,and outcomes,secondary IL is more common than previously believed.The definitive diagnosis of IL requires endoscopic demonstration of whitish villi(which frequently resemble snowflakes)and histological confirmation of dilated lacteals in the small intestinal mucosa.Treatment of IL is challenging and involves dietary modifications,managing underlying medical conditions,and using medications such as sirolimus and octreotide.Recognizing its prevalence and diverse etiology is crucial for targeted management of this challenging medical condition.This article provides a comprehensive exploration of the clinical implications associated with IL.In addition,it offers valuable insights into critical knowledge gaps in the existing diagnostic and management landscape.

关键词： Intestinal lymphatics Lymphangiectasia Waldman's disease Lacteals Lymph

Dietary salt in liver cirrhosis:With a pinch of salt!

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World Journal of Hepatology 2023年第10期15卷 1084-1090页

作者： Ramesh kumar sudheer Marrapu Department of Gastroenterology All India Institute of Medical SciencesPatna 801507India

Patients with liver cirrhosis are advised to limit their sodium consumption to control excessive fluid accumulation.Salt is the most common form in which sodium is consumed daily.Consequently,various recommendations urge patients to limit salt intake.However,there is a lack of consistency regarding salt restriction across the guidelines.Moreover,there is conflicting evidence regarding the efficacy of salt restriction in the treatment of ascites.Numerous studies have shown that there is no difference in ascites control between patients with restriction of salt intake and those without restriction.Moreover,patients with cirrhosis may have several negative effects from consuming too little salt,although there are no recommendations on the lower limit of salt intake.Sodium is necessary to maintain the extracellular fluid volume;hence,excessive salt restriction can result in volume contraction,which could negatively impact kidney function in a cirrhotic patient.Salt restriction in cirrhotic patients can also compromise nutrient intake,which can have a negative impact on the overall outcome.There is insufficient evidence to recommend restricted salt intake for all patients with cirrhosis,including those with severe hyponatremia.The existing guidelines on salt restriction do not consider the salt sensitivity of patients;their nutritional state,volume status and sodium storage sites;and the risk of hypochloremia.This opinion article aims to critically analyze the existing literature with regard to salt recommendations for patients with liver cirrhosis and identify potential knowledge gaps that call for further research.

关键词： Salt Cirrhosis Sodium Hyponatremia Ascites Malnutrition

Molecular approaches for the detection and monitoring of microbial communities in bioaerosols:A review

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Journal of Environmental Sciences 2017年第1期29卷 234-247页

作者： Keunje Yoo Tae Kwon Lee Eun Joo Choi Jihoon Yang sudheer kumar Shukla Sang-il Hwang Joonhong Park Department of Civil and Environmental Engineering Yonsei UniversitySeoul 03722South Korea Department of Environmental Engineering Yonsei UniversityWonju 26493South Korea Department of Systems Biology Yonsei UniversitySeoul 03722South Korea Department of Built and Natural Environment Caledonian College of EngineeringSultanate of Oman Division of Natural Resources Conservation Korea Environment InstituteSejong-si 30147South Korea

Bioaerosols significantly affect atmospheric processes while they undergo long-range vertical and horizontal transport and influence atmospheric chemistry and physics and climate change.Accumulating evidence suggests that exposure to bioaerosols may cause adverse health effects,including severe disease.Studies of bioaerosols have primarily focused on their chemical composition and largely neglected their biological composition and the negative effects of biological composition on ecosystems and human health.Here,current molecular methods for the identification,quantification,and distribution of bioaerosol agents are reviewed.Modern developments in environmental microbiology technology would be favorable in elucidation of microbial temporal and spatial distribution in the atmosphere at high resolution.In addition,these provide additional supports for growing evidence that microbial diversity or composition in the bioaerosol is an indispensable environmental aspect linking with public health.

关键词： Bioaerosol Airborne microbial community Molecular methods Metagenomics

A randomized trial of a 4- vs 12-week daily interferon dose regimen combined with ribavirin in treatment of patients with chronic hepatitis C

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Hepatobiliary & Pancreatic Diseases International 2004年第1期3卷 42-48页

作者： Shiv K. Sarin Ankur Goyal sudheer kumar Rajkumar C. Guptan Abid Zaffar Hashmi Pooja Sakhuja Veena Malhotra Departments of Gastroenterology G. 13. Pant Hospital New Delhi 110002 India Departments of Pathology G. 13. Pant Hospital New Delhi 110002 India

BACKGROUND: Standard combination-therapy of ribavi- rin with alternate day interferon (IFN) in patients with chronic hepatitis C ( CHC) has been reported to achieve 30%-55% sustained viral response. Early reduction of viral load by daily dosage of IFN could enhance viral clearance. However, the duration of daily dosage protocol and the likely side-effects have not been well studied. We compared the efficacy and safety of a 4- vs 12-week daily IFN dosage in patients with CHC. METHODS: Fifty-nine, histologically proven CHC patients having ALT levels >1.5 ×ULN were divided randomly into 2 groups, group I was given IFN 3 MIU daily for 4 weeks, followed by tiw up to 12 months and group was given IFN 3 MIU daily for 12 weeks, followed by tiw up to 12 months. Ribavirin was given in a dose of 800-1200 mg/d for 12 months. RESULTS: Fifty-two of the 59 patients (group group completed the study. The pretreatment vari- ables and the prevalence of HCV genotype 1 were compara- ble between the groups. Nine patients (29%) in group and 6 (25%) in group had stage 3, 4 fibrosis. At the end of 4, 12, 24 and 52 weeks, HCV RNA negativity was ob- served in 27%, 54%, 65% and 71% in group I and 38%, 54%, 71% and 75% in group respectively (P =ns). Four of the eight (50%) patients with genotype 1 and 30 (69.8%) of 43 patients with genotype non-1 responded to therapy (P =ns). Sustained viral response was achieved in 61% and 71% in groups respectively. None of the variables predicted non-response precisely. No serious adverse effects were observed and they were comparable between the two groups. CONCLUSION: Daily IFN dosage with ribavirin is safe and can achieve response in up to 65% patients. Since the effica- cy of a 4-week daily dosage of IFN is comparable to a 12- week schedule, we recommend the former regimen.

关键词： hepatitis C virus hepatitis C interferon ribavirin induction dosage sustained viral response chronic hepatitis combination therapy

In vitro antioxidant activity and in vivo hepatoprotective activity of aqueous extract of Allium cepa bulb in ethanol induced liver damage in Wistar rats

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Food Science and Human Wellness 2013年第3期2卷 132-138页

作者： K.Eswar kumar K.N.Harsha V.sudheer Nelli Giri babu Pharmacology Division A.U.College of Pharmaceutical SciencesAndhra UniversityVisakhapatnam 530003Andhra PradeshIndia

The in vitro antioxidant and in vivo hepatoprotective effects of aqueous extract of Allium cepa(A.cepa)bulb were evaluated in male rats against ethanol induced liver damage in preventive and curative models.The antioxidant activity of A.cepa was assayed and activities were compared to standard antioxidant,ascorbic acid.The results revealed that the IC50 values of A.cepa bulb extract for DPPH,hydroxyl,superoxide radical scavenging activities were 195.2±0.2,374.7±0.4 and 182.5±1.7g/mL,respectively.Liver injury was induced by 40%ethanol administration(3.76 g/kg bw,orally)for 25 days.In two different sets of experiments,the A.cepa extracts(100,300 and 600 mg/kg bw)and silymarin(100 mg/kg bw)were administered orally in preventive and curative models.Ethanol administration caused severe hepatic damage in rats as evidenced by elevated serum aspartate aminotransferase(AST),alanine aminotransferase(ALT),alkaline phosphatase(ALP)and total bilirubin levels.The A.cepa and silymarin administration prevented the toxic effect of ethanol on the above serum parameters in both preventive and curative models.The present study concludes that aqueous extract of A.cepa bulb has significant antioxidant and hepatoprotective activity against ethanol induced hepatotoxicity.©2013 Beijing Academy of Food Sciences.Production and hosting by Elsevier B.V.All rights reserved.

关键词： Allium cepa Antioxidant Ethanol Hepatoprotective Rat

Prediction Modeling and Mapping of Soil Carbon Content Using Artificial Neural Network, Hyperspectral Satellite Data and Field Spectroscopy

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Advances in Remote Sensing 2015年第1期4卷 63-72页

作者： sudheer kumar Tiwari Sudip kumar Saha Suresh kumar Agriculture and Soils Indiana Institute of Remote Sensing Dehradun India

Soil organic carbon (SOC) is an important and reliable indicator of soil quality. In this study, soil spectra were characterized and analysed to predict the spatial soil organic carbon (SOC) content using multivariate predictive modeling technique-artificial neural network (ANN). EO1-Hyperion (400 - 2500 nm) hyperspectral image, field and laboratory scale data sets (350 - 2500 nm) were generated which consisted of laboratory estimated SOC content of collected soil samples (dependent variable) and their corresponding reflectance data of SOC sensitive spectral bands (predictive variables). For each data set, ANN predictive models were developed and all three datasets (image-scale, field-scale and lab-scale) revealed significant network performances for training, testing and validation indicating a good network generalization for SOC content. ANN based analysis showed high prediction of SOC content at image (R2 = 0.93, and RPD = 3.19), field (R2 = 0.92 and RPD = 3.17), and lab scale (R2 = 0.95 and RPD = 3.16). Validation results of ANN indicated that predictive models performed well (R2 = 0.90) with RMSE 0.070. The result showed that ANN methods had a great potential for estimating and mapping spatial SOC content. The study concluded that ANN model was potential tools in predicting SOC distribution in agricultural field using hyper-spectral remote sensing data at image-scale, field-scale and lab-scale.

关键词： Soil Carbon Artificial Neural Network Hyperspectral Imagine Spectroscopy Hyperion

Genetic Association of Interferon Gamma Induced Protein-10 (IP-10), <i>CXCL-</i>10 Gene Polymorphisms with TB Pleurisy Susceptibility in South Indian Population

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Open Journal of Immunology 2015年第2期5卷 72-78页

作者： Ghousunnissa Sheikh Venkata Sanjeev kumar Neela Satya sudheer Pydi Naveen Chandra Suryadevara Ramulu Gaddam Suman Latha Gaddam Sai kumar Auzumeedi Vijaya Lakshmi Valluri LEPRA-India Blue Peter Public Health & Research Centre Hyderabad India Government Chest & General Hospital Hyderabad India Bhagwan Mahavir Medical Research Centre Hyderabad India Osmania University Hyderabad India

CXCL-10 known as Interferon gamma-induced protein 10 (IP-10) or small-inducible cytokine 10 is a 8.7 kDa protein, which is secreted in response to IFN-γ by monocytes, endothelial cells and fi-broblasts. It has chemo-attraction for monocytes/macrophages, T cells, NK cells and dendritic cells in promotion of T cell adhesion to endothelial cells. In the present study, we investigated whether polymorphisms in CXCL-10 gene have any role in the manifestation of Tuberculous (TB) pleurisy. Two SNPs in CXCL-10 promoter region (﹣1447A > G and ﹣135G > A) were genotyped in patients with TB Pleurisy (n = 186), Pulmonary TB patients (n = 159) and healthy controls (n = 205) by PCR-RFLP. Disease associations were statistically analyzed by Fisher exact test. At the ﹣135G > A position, the frequencies of genotype GA and allele G were significantly high in TB pleurisy patients compared to healthy controls. While the frequencies of genotype AA and allele A were significantly low in TB pleurisy patients compared to healthy controls. The frequency of haplotype A-G with the combination of 1447A > G and ﹣135G > A was significantly high in TB pleurisy. Our results reveal that genotype GA and allele G at ﹣135G > A position were strongly associated with susceptibility to tuberculous pleurisy. The GA genotype may be a useful genetic marker for early detection of the disease in high risk individuals.

关键词： CXCL-10 Polymorphism Haplotype Susceptibility Tuberculous Pleurisy

Cavitary lung lesion 6 years after renal transplantation

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World Journal of Transplantation 2016年第2期6卷 447-450页

作者： Arun kumar Subbiah sudheer Arava Soumita Bagchi Karan Madan Chandan J Das Sanjay kumar Agarwal Department of Nephrology All India Institute of Medical Sciences Department of Pathology All India Institute of Medical Sciences Department of Pulmonary medicine and sleep disorders All India Institute of Medical Sciences Department of Radiology All India Institute of Medical Sciences

The differential diagnoses of a cavitary lung lesion in renal transplant recipients would include infection, malignancy and less commonly inflammatory diseases. Bacterial infection, Tuberculosis, Nocardiosis, fungal infections like Aspergillosis and Cryptococcosis need to be considered in these patients. Pulmonary cryptococcosis usually presents 16-21 mo after transplantation, more frequently in patients who have a high level of cumulative immunosuppression. Here we discuss an interesting patient who never received any induction/anti-rejection therapy but developed both BK virus nephropathy as well as severe pulmonary Cryptococcal infection after remaining stable for 6 years after transplantation. This case highlights the risk of serious opportunistic infections even in apparently low immunologic risk transplant recipients many years after transplantation.

关键词： Lung cavity Immunosuppression Renal transplantation