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Extra-hepatic manifestations associated with hepatitis E virus infection:a comprehensive review of the literature

Gastroenterology Report 2016年第1期4卷 1-15,I0001页

作者： Fateh Bazerbachi Samir Haffar sushil k.garg John R Lake Division of Gastroenterology and Hepatology University of MinnesotaMinneapolisMN 55455USA Department of Gastroenterology and Hepatology University of DamascusDamascusSyrian Arab Republic

Background and aims:Hepatitis E virus(HEV)infection is a significant public health problem that afflicts almost 20 million individuals annually and causes acute liver injury in 3.5 million,with approximately 56000 *** with other viral hepatitides,extra-hepatic manifestations could represent an important aspect of this *** spectrum of these manifestations is still *** pancreatitis and neurological,musculoskeletal,hematological,renal,and other immune-mediated manifestations have been *** aim of this article is to comprehensively review the published literature of extra-hepatic manifestations associated with HEV *** sources:We searched the PubMed database using the MeSH term“hepatitis E”and each of the extra-hepaticmanifestations associated with HEV *** language or date restrictions were set in these *** retrieving articles with non-A,non-B hepatitis were *** articles were identified through the reference lists of included ***:Several extra-hepatic manifestations associated with HEV infection have been *** temporal association between some extra-hepatic manifestations and HEV infection and the exclusion of other possible etiologies suggests that HEV infection could have caused some of *** to the available data,HEV infection appears to be strongly associated with acute pancreatitis,neurological disorders(with primarily dominant peripheral nerve involvement,most commonly manifested as Guillain-Barre´syndrome,followed by neuralgic amyotrophy),hematological diseases(hemolytic anemia due to glucose phosphate dehydrogenase deficiency,and severe thrombocytopenia),glomerulonephritis,and mixed *** data are needed to clarify whether an association exists with musculoskeletal or other immunemediated ***:HEV infection should be considered in patients with acute pancreatitis,Guillain-Barre´syndrome,neuralgic amyotrophy,hem

关键词： hepatitis E virus viral hepatitis extra-hepatic manifestations vaccine primary prevention

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Fecal diversion in complex anal fistulas:Is there a way to avoid it?

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World Journal of Clinical Cases 2021年第25期9卷 7306-7310页

作者： Pankaj garg Vipul D Yagnik sushil Dawka Colorectal Surgery Garg Fistula Research InstitutePanchkula 134113HaryanaIndia Colorectal Surgery Indus International HospitalMohali 140201PunjabIndia Surgical Gastroenterology Nishtha Surgical Hospital and Research CenterPatan 384265GujaratIndia Surgery SSR Medical CollegeBelle Rive 744101Mauritius

Temporary fecal diversion by a diverting colostomy or ileostomy is occasionally performed for serious complex *** main indications are highly complex and extensive cryptoglandular anal fistula,anal fistula associated with severe anorectal Crohn’s disease,recurrent rectovaginal fistula,radiation-induced fistula and anal fistula with associated necrotizing *** purpose of stoma formation is to divert the fecal stream away from the anorectum and the perianal region so as to control the infective process and prevent trauma to the operated repaired *** the fistula has healed,the diverting stoma is ***,two questions are ***,is it certain that the same disease would not relapse(or the fistula would not recur)once the colostomy is closed?Second,is there a non-surgical method which can obviate the need for a diverting colostomy?An attempt is made to answer both these questions in this review.

关键词： Anal fistula Fecal diversion Diverting stoma Colostomy Crohn’s disease Rectovaginal fistula

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Nationwide trends of hospital admissions for acute cholecystitis in the United States

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Gastroenterology Report 2017年第1期5卷 36-42,I0002页

作者： Vaibhav Wadhwa Yash Jobanputra sushil k.garg Soumil Patwardhan Dhruv Mehta Madhusudhan R.Sanaka Department of Internal Medicine Fairview HospitalCleveland ClinicOHUSA Department of Gastroenterology and Hepatology Digestive Disease InstituteCleveland ClinicClevelandOHUSA Department of Internal Medicine University of MinnesotaMinneapolisMNUSA Department of Internal Medicine University of MassachusettsWorcesterMAUSA Department of Internal Medicine Westchester Medical CenterValhallaNYUSA

Background and aims:Acute cholecystitis is a fairly common inpatient diagnosis among the gastrointestinal *** aim of this study was to use a national database of US hospitals to evaluate the incidence and costs of hospital admissions associated with acute ***:We analyzed the National Inpatient Sample Database(NIS)for all patients in which acute cholecystitis(ICD-9 codes:574.00,574.01,574.30,574.31,574.60,574.61 or 575.0)was the principal discharge diagnosis from 1997 to *** NIS is the largest all-payer inpatient database in the United States and contains data from approximately 8 million hospital stays each *** statistical significance of the difference in the number of hospital discharges,lengths of stay and associated hospital costs over the study period was determined by using the Chi-square test for ***:In 1997,there were 149661 hospital admissions with a principal discharge diagnosis of acute cholecystitis,which increased to 215995 in 2012(P<0.001).The mean length of stay for acute cholecystitis decreased by 17% between 1997 and 2012(*** 4.7 days to 3.9 days);(P<0.05).During the same time period,however,mean hospital charges have increased by 195.4% from US$14608 per patient in 1997 to US$43152 per patient in 2012(P<0.001).Conclusion:The number of inpatient discharges related to acute cholecystitis has increased significantly in the United States over the last 16 years,along with a great increase in the associated hospital ***,there has been a gradual decline in the mean length of *** costs associated with acute cholecystitis contribute significantly to the total healthcare *** research on cost-effective evaluation and management of acute cholecystitis is required.

关键词： inpatient admission rates acute cholecystitis epidemiology trends

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Including video and novel parameter-height of penetration of external anal sphincter-in magnetic resonance imaging reporting of anal fistula

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World Journal of Gastrointestinal Surgery 2022年第4期14卷 271-275页

作者： Pankaj garg Baljit kaur Vipul D Yagnik sushil Dawka Department of Colorectal Surgery Garg Fistula Research InstitutePanchkula 134113HaryanaIndia Department of Colorectal Surgery Indus International HospitalMohali 140507PunjabIndia Department of Radiology SSRD Magnetic Resonance Imaging InstituteChandigarh 160011ChandigarhIndia Department of Surgical Gastroenterology Nishtha Surgical Hospital and Research CenterPatan 384265GujaratIndia Department of Surgery SSR Medical CollegeBelle Rive 744101Belle RiveMauritius

The main purpose of a radiologist’s expertise in evaluation of anal fistula magnetic resonance imaging(MRI)is to benefit patients by decreasing the incontinence rate and increasing the healing *** loss of vital information during the transfer of this data from the radiologist to the operating surgeon is unwarranted and is best *** this regard,two methods are ***,a short video to be attached with the standardized written report highlighting the vital parameters of the *** would ensure minimum loss of information when it is conveyed from the radiologist to the operating ***,inclusion of a new parameter,the amount of external sphincter involvement by the anal *** parameter is usually not included in the MRI *** can be evaluated as the height of penetration of the external anal sphincter(HOPE)by the *** external anal sphincter plays a pivotal role in maintaining *** parameter(HOPE)is distinct from the‘height of internal opening’and assumes immense importance as its knowledge is paramount to prevent damage to the external anal sphincter by the surgeon during surgery.

关键词： Magnetic resonance imaging Anal fistula External anal sphincter Video reporting Incontinence

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Guidelines to diagnose and treat peri-levator high-5 anal fistulas: Supralevator, suprasphincteric, extrasphincteric, high outersphincteric, and high intrarectal fistulas

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World Journal of Gastroenterology 2022年第16期28卷 1608-1624页

作者： Pankaj garg Vipul D Yagnik sushil Dawka Baljit kaur Geetha R Menon Department of Colorectal Surgery Garg Fistula Research InstitutePanchkula 134113HaryanaIndia Department of Colorectal Surgery Indus International HospitalMohali 140201PunjabIndia Department of Surgical Gastroenterology Nishtha Surgical Hospital and Research CenterPatan 384265GujaratIndia Department of Surgery SSR Medical CollegeBelle Rive 744101Mauritius Department of Radiology SSRD Magnetic Resonance Imaging InstituteChandigarh 160011India Department of Statistics Indian Council of Medical ResearchNew Delhi 110029India

Supralevator,suprasphincteric,extrasphincteric,and high intrarectal fistulas(high fistulas in muscle layers of the rectal wall)are well-known high anal fistulas which are considered the most complex and extremely challenging fistulas to *** resonance imaging has brought more clarity to the pathophysiology of these *** with these fistulas,a new type of complex fistula in high outersphincteric space,a fistula at the roof of ischiorectal fossa inside the levator ani muscle(RIFIL),has been *** diagnosis,management,and prognosis of RIFIL fistulas is reported to be even worse than supralevator and suprasphincteric *** is a lot of confusion regarding the anatomy,diagnosis,and management of these five types of *** main reason for this is the paucity of literature about these *** common feature of all these fistulas is their complete involvement of the external anal ***,fistulotomy,the simplest and most commonly performed procedure,is practically ruled out in these fistulas and a sphincter-saving procedure needs to be *** advances have provided new insights into the anatomy,radiological modalities,diagnosis,and management of these five types of high *** have been discussed and guidelines formulated for the diagnosis and treatment of these fistulas for the first time in this paper.

关键词： Anal fistula Supralevator Suprasphincteric Extrasphincteric Magnetic resonance imaging

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Efficacy of kegel exercises in preventing incontinence after partial division of internal anal sphincter during anal fistula surgery

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World Journal of Clinical Cases 2022年第20期10卷 6845-6854页

作者： Pankaj garg Vipul D Yagnik Baljit kaur Geetha R Menon sushil Dawka Department of Colorectal Surgery Garg Fistula Research InstitutePanchkula 134113HaryanaIndia Department of Colorectal Surgery Indus International HospitalMohali 140507PunjabIndia Department of Surgical Gastroenterology Nishtha Surgical Hospital and Research CenterPatan 384265GujaratIndia Department of Radiology SSRD Magnetic Resonance Imaging InstituteChandigarh 160011India Department of Statistics Indian Council of Medical ResearchNew Delhi 110029India Department of Surgery SSR Medical CollegeBelle Rive 744101Mauritius

BACkGROUND The transanal opening of intersphincteric space(TROPIS)procedure,performed to treat complex anal fistulas,preserves the external anal sphincter(EAS)but involves partial incision of the internal anal sphincter(IAS).AIM To ascertain the incidence of incontinence after the division of the IAS as is done in TROPIS and to evaluate whether regular kegel exercises(kE)in the postoperative period can prevent incontinence due to IAS *** Patients operated on for high complex fistulas and having no preoperative continence problem(score=0)were included in the *** patients were operated on by the TROPIS procedure and were recommended kE(pelvic contraction exercises)50 times/*** were commenced on the 10^(th)postoperative day and continued for 1 *** was evaluated objectively(by modified Vaizey’s scores)in the immediate postoperative period(Pre-kE group)and on long-term follow-up(Post-kE group).The incontinence scores in both groups were compared to evaluate the efficacy of *** Of 102 anal fistula patients operated on between July 2018 and July 2020 were included in this *** were 90 males,the mean age was 42.3±12.8,and the median follow-up was 30 mo(18-42 mo).Three patients were lost to *** were 65 recurrent fistulas,92 had multiple tracts,42 had associated abscess,46 had horseshoe fistula and 34 were supralevator *** were magnetic resonance imaging-documented high fistulas(>1/3 EAS involved).Overall incontinence occurred in 31%patients(Pre-kE group)with urge and gas incontinence accounting for the majority of cases(28.3%).The mean incontinence scores in the Pre-kE group were 1.19±1.96(in 31 patients,solid=0,liquid=7,gas=8,urge=24)and in the Post-kE group were 0.26±0.77(in 13 patients,solid=0,liquid=2,gas=3,urge=10)(P=0.00001,t-test).CONCLUSION Division of the IAS led to incontinence,mainly urge incontinence,and also to a mild degree of gas and liquid ***,regular kE led to a significa

关键词： Anal fistula Incontinence Urge Transanal opening of intersphincteric space kegel exercises Manometry

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Why are we performing fewer cholecystectomies for mild acute biliary pancreatitis?Trends and predictors of cholecystectomy from the National Readmissions Database(2010–2014)

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Gastroenterology Report 2019年第5期7卷 331-337,I0002页

作者： sushil kumar garg Fateh Bazerbachi Shashank Sarvepalli Shounak Majumder Shanthi Swaroop Vege Division of Gastroenterology and Hepatology Mayo ClinicRochesterMNUSA Division of Gastroenterology Massachusetts General HospitalBostonMAUSA Department of Hospital Medicine Cleveland ClinicClevelandOHUSA

Background:Current guidelines recommend cholecystectomy for patients with mild acute biliary pancreatitis(MABP)during the index admission because it is associated with better *** this study,we aimed to assess national trends in cholecystectomy during index admissions for MABP and to identify factors associated with cholecystectomy completion and 30-day ***:Using diagnostic codes and the National Readmissions Database,we identified patients admitted with MABP between 2010 and *** in cholecystectomy rates were computed on the basis of various *** conducted a multivariable analysis to identify factors associated with 30-day readmission and cholecystectomy during the same ***:We identified 255,695 unique index MABP cases(41.3%male)and the 30-day readmission rate was 12.6%.Overall,43.8%underwent cholecystectomy and 25%underwent endoscopic retrograde cholangiopancreatography(ERCP)with *** observed a decreasing trend in both procedures during the study period(Pk of 30-day *** this benefit and national guidelines recommending cholecystectomy during the index MABP admission,the rate of cholecystectomies performed nationally decreased during the study *** research is needed to understand the implications and reasons underlying this deviation from guidelines.

关键词： cholecystectomy mild acute biliary pancreatitis National Readmissions Database endoscopic retrograde cholangiopancreatography

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Guidelines on postoperative magnetic resonance imaging in patients operated for cryptoglandular anal fistula:Experience from 2404 scans

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World Journal of Gastroenterology 2021年第33期27卷 5460-5473页

作者： Pankaj garg Baljit kaur Vipul D Yagnik sushil Dawka Geetha R Menon Department of Colorectal Surgery Garg Fistula Research InstitutePanchkula 134113HaryanaIndia Department of Colorectal Surgery Indus International HospitalMohali 140201PunjabIndia Department of Radiology SSRD Magnetic Resonance Imaging InstituteChandigarh 160011ChandigarhIndia Department of Surgical Gastroenterology Nishtha Surgical Hospital and Research CenterPatan 384265GujaratIndia Department of Surgery SSR Medical CollegeBelle RiveMauritius Department of Statistics Indian Council of Medical ResearchNew Delhi 110029New DelhiIndia

Magnetic resonance imaging(MRI)is considered the gold standard for the evaluation of anal *** is sufficient literature available outlining the interpretation of fistula MRI before performing ***,the interpretation of MRI becomes quite challenging in the postoperative period after the surgery of fistula has been ***,there are scarce data and no set guidelines regarding analysis of fistula MRI in the postoperative *** this article,we discuss the challenges faced while interpreting the postoperative MRI,the timing of the postoperative MRI,the utility of MRI in the postoperative period for the management of anal fistulas,the importance of the active involvement and experience of the treating clinician in interpreting MRI scans,and the latest advancements in the field.

关键词： Anal fistula Magnetic resonance imaging Postoperative Hyperintensity Internal opening

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Diagnosis of anorectal tuberculosis by polymerase chain reaction,GeneXpert and histopathology in 1336 samples in 776 anal fistula patients

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World Journal of Gastrointestinal Surgery 2021年第4期13卷 355-365页

作者： Pankaj garg Ankita Goyal Vipul D Yagnik sushil Dawka Geetha R Menon Department of Colorectal Surgery Indus International HospitalMohali 140507PunjabIndia Department of Colorectal Surgery Garg Fistula Research InstitutePanchkula 134113HaryanaIndia Department of Pathology Gian Sagar Medical College and HospitalPatiala 140506PunjabIndia Department of Surgery Nishtha Surgical Hospital and Research CentrePatan 384265GujaratIndia Department of Surgery SSR Medical CollegeBelle RiveMauritius Department of Statistics Indian Council of Medical ResearchNew Delhi 110029India

BACkGROUND The association of tuberculosis(TB)with anal fistulas can make its treatment quite *** main challenge is timely detection of TB in anal fistulas and its proper *** is little data available on diagnosis and management of TB in anal *** To detect TB in fistula-in-ano patients were analyzed in different methods *** A retrospective analysis of different methods,polymerase chain-reaction(PCR),GeneXpert and histopathology(HPE),utilized to detect tuberculosis in fistula-inano patients,treated between 2014-2020,was *** sampling was done for tissue(fistula tract lining)and pus(when available).The detection rate of various tests to detect TB and prevalence rate of TB in simple vs complex fistulae were *** In 1336 samples(776 patients)tested,TB was detected in 133 samples(122 patients).TB was detected in 52/703(7.4%)samples tested by PCR-tissue,in 77/331(23.2%)samples tested by PCR-pus,3/197(1.5%)samples tested with HPE-tissue and 1/105(0.9%)samples tested by *** detect TB,PCRtissue was significantly better than HPE-tissue(52/703 vs 3/197 respectively)(P=0.0012,significant,Fisher’s exact test)and PCR-pus was significantly better than PCR-tissue(77/331 vs 52/703 respectively)(P<0.00001,significant,Fisher’s exact test).TB fistulas were more complex than non-tuberculous fistulas[78/113(69%)vs 278/727(44.3%)respectively](P<0.00001,significant,Fisher’s exact test)but the overall healing rate was similar in tuberculous and non-tuberculous fistula groups[90/102(88.2%)vs 518/556(93.2%)respectively](P=0.10,not significant,Fisher’s exact test).CONCLUSION This is the largest study of anorectal TB to be *** detection of TB by polymerase chain-reaction was significantly higher than by histopathology and *** polymerase chain-reaction,pus had a higher detection rate than *** fistulas were more complex than non-tuberculous fistulas but aggressive diagnosis and meticulous treatm

关键词： Anal fistula Fistula-in-ano Tuberculosis,Histopathology,Polymerase chainreaction,GeneXpert

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Acute pancreatitis associated with intravenous administration of propofol:evaluation of causality in a systematic review of the literature

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Gastroenterology Report 2019年第1期7卷 13-23,I0001页

作者： Samir Haffar Ravinder Jeet kaur sushil kumar garg Joseph A.Hyder M.Hassan Murad Barham k.Abu Dayyeh Fateh Bazerbachi Digestive Center for Diagnosis&Treatment 29 Ayar StreetDamascusSyrian Arab Republic Division of Gastroenterology and Hepatology Mayo Clinic200 First Street SWRochesterMN 55905USA Division of Anesthesiology and Perioperative Medicine Mayo Clinic200 First Street SWRochesterMN 55905USA Division of Health Care Policy and Research Mayo Clinic200 First Street SWRochesterMN 55905USA

Acute pancreatitis(AP)associated with intravenous administration of propofol has been described with unknown causal *** therefore assessed this causality in a systematic *** databases were searched on 16 August 2017;studies were appraised and selected by two reviewers based on a priori *** causality was evaluated with the Naranjo scale and Badalov *** identified 18 studies from 11 countries with a total of 21 patients,and the majority had adequate methodological *** median age was 35 years(range,4–77)and 10(48%)were ***,propofol was administrated in 8 patients as sedative along with induction/maintenance of anesthesia in 13 patients;median dose was 200 mg,with intermediate latency(1–30 days)in 14(67%).Serum triglycerides were>1000 mg/dL in four *** AP was observed in four patients(19%).AP recurrence occurred in one out of two patients who underwent *** related to AP was 3/21(14%).Propofol was the probable cause of AP according to the Naranjo scale in 19 patients(89%).Propofol-induced AP has a probable causal relation and evidence supports Badalov class *** is not the only mechanism by which propofol illicit ***-induced AP was severe in 19%of patients with a mortality rate related to AP of 14%.Future research is needed to delineate whether this risk is higher if combined with other procedures that portend inherent risk of pancreatitis such as endoscopic retrograde cholangiopancreatography.

关键词： Acute pancreatitis drug-induced pancreatitis propofol systematic review

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