Asian Healthcare Foundation

Hyderabad, India

Asian Healthcare Foundation

Hyderabad, India
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Banerjee R.,Asian Medical Institute | Balaji M.,Asian Healthcare Foundation | Sasikala M.,Asian Healthcare Foundation | Anuradha S.,Asian Institute of Gastroenterology Somajiguda | And 2 more authors.
Digestive Diseases and Sciences | Year: 2013

Background: Intestinal tuberculosis (ITB) and Crohn's disease are similar granulomatous disorders. Granulomas are present in both and difficult to differentiate on histopathology alone. A recent study demonstrated recruitment of mesenchymal cells (MSCs) at the periphery of granulomas in lymph node tuberculosis which suppressed T cell responses. We hypothesized that granulomas of ITB would also recruit MSCs to evade host immune response. Aim: The purpose of this study was to demonstrate MSC markers in granulomas of ITB and evaluate whether distribution of MSC markers could differentiate between granulomas of Crohn's and ITB. Methods: We initially retrospectively enrolled 17 patients with confirmed ITB (8) or Crohn's (9) with granulomas on histopathology. Tissues were evaluated by immunofluorescence for MSC markers CD29, CD90, CD73 and absence of haematopoietic markers CD31, CD34, CD45 and CD14. Double-staining was done to confirm presence of MSCs. Subsequently, 23 postoperative specimens of Crohn's (18) and ITB (5) were analyzed for validation. Results: Overall, 27 Crohn's and 13 ITB cases were assessed. CD29 and CD90 positive cells were noted around both ITB and Crohn's granulomas. MSC marker CD73 was expressed around the granulomas of ITB alone and was completely absent in the Crohn's. The subsequent assessment of granulomas in postoperative specimens of Crohn's and ITB also showed similar results. Conclusion: Granulomas of ITB and Crohn's disease can be differentiated by CD73 MSC surface marker expression. The differential CD73 expression around ITB granuloma indicates that Mycobacterium tuberculosis evades host immunity by recruiting MSCs with CD73 expression. MSCs with increased CD73 expression could be the future for therapeutic intervention in Crohn's. © 2013 Springer Science+Business Media New York.

Talukdar R.,Asian Medical Institute | Talukdar R.,Asian Healthcare Foundation | Reddy D.N.,Asian Medical Institute
World Journal of Gastroenterology | Year: 2013

Chronic pancreatitis (CP) continues to be a clinical challenge. Persistent or recurrent abdominal pain is the most compelling symptom that drives patients to seek medical care. Unfortunately, in spite of using several treatment approaches in the clinical setting, there is no single specific treatment modality that can be earmarked as a cure for this disease. Traditionally, ductal hypertension has been associated with causation of pain in CP; and patients are often subjected to endotherapy and surgery with a goal to decompress the pancreatic duct. Recent studies on humans (clinical and laboratory based) and experimental models have put forward several mechanisms, including neuroimmune alterations, which could be responsible for pain. This might explain the partial or no response to single modality treatment in a significant proportion of patients. The current review discusses the recent concepts of pain generation in CP and evidence based therapeutic approaches (other than ductal decompression) to handle persistent or recurrent pain. We focus primarily on parenchymal and neural components; and discuss the role of antioxidants and the existing controversies, drugs that interfere with neural transmission, pancreatic enzyme supplementation, celiac neurolysis, and pancreatic resection procedures. The review concludes with the treatment approach that we follow at our institute. © 2013 Baishideng. All rights reserved.

PubMed | Asian Medical Institute and Asian Healthcare Foundation
Type: Journal Article | Journal: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] | Year: 2016

The incidence of acute pancreatitis (AP) is increasing globally and mortality could be high among patients with organ failure and infected necrosis. The predominant factors responsible for the morbidity and mortality of AP are systemic inflammatory response syndrome and multiorgan dysfunction. Even though preclinical studies have shown antisecretory agents (somatostatin), antioxidants (S-adenosyl methionine [SAM], selenium), protease inhibitors, platelet activating factor inhibitor (Lexipafant), and anti-inflammatory immunomodulators (eg. prostaglandin E, indomethacin) to benefit AP in terms of reducing the severity and/or mortality, most of these agents have shown heterogeneous results in clinical studies. Several years of experimental studies have implicated nuclear factor-kappa B (NF-B) activation as an early and central event in the progression of inflammation in AP. In this manuscript, we review the literature on the role of NF-B in the pathogenesis of AP, its early intraacinar activation, and how it results in progression of the disease. We also discuss why anti-protease, antisecretory, and anti-inflammatory agents are unlikely to be effective in clinical acute pancreatitis. NF-B, being a central molecule that links the initial acinar injury to systemic inflammation and perpetuate the inflammation, we propose that more studies be focussed towards targeted inhibition of NF-B activity. Direct NF-B inhibition strategies have already been attempted in patients with various cancers. So far, peroxisome proliferator activator receptor gamma (PPAR-) ligand, pyrrolidine dithiocarbamate (PDTC), proteasome inhibitor and calpain I inhibitor have been shown to have direct inhibitory effects on NF-B activation in experimental AP.

Talukdar R.,Asian Institute of Gastroenterology | Talukdar R.,Asian Healthcare Foundation | Reddy D.N.,Asian Institute of Gastroenterology
Clinical Gastroenterology and Hepatology | Year: 2014

Pancreatic cystic neoplasms (PCNs) are a heterogeneous group of tumors with distinct biological features. These neoplasms are now being recognized more frequently owing to advances in cross-sectional imaging and increasing awareness. Guidelines for treatment of the common and clinically important PCNs frequently have been revised in view of the continuing controversies and evolving clinical data. This review summarizes the management approaches of the common and clinically important PCNs based on current evidence and guidelines. © 2014 AGA Institute.

Talukdar R.,Asian Institute of Gastroenterology | Talukdar R.,Asian Healthcare Foundation | Bhattacharrya A.,Asian Institute of Gastroenterology | Rao B.,Asian Institute of Gastroenterology | And 2 more authors.
Pancreatology | Year: 2014

Background and aim Revision of the Atlanta classification for acute pancreatitis (AP) was long awaited. The Revised Atlanta Classification has been recently proposed. In this study, we aim to prospectively evaluate and validate the clinical utility of the new definitions. Patient and methods 163 consecutive patients with AP were followed till death/6 mths after discharge. AP was categorized as mild (MAP) (no local complication[LC] and organ failure[OF]), moderate (MSAP)(transient OF and/or local/systemic complication but no persistent OF) and severe (SAP) AP (persistent OF). LC included acute peripancreatic fluid collections, pseudocyst, acute necrotic collection, walled-off necrosis, gastric outlet dysfunction, splenic/portal vein thrombosis, and colonic necrosis. Baseline characteristics (age/gender/hematocrit/BUN/SIRS/ BISAP) and outcomes (total hospital stay/need for ICU care/ICU days/primary infected (peri)pancreatic necrosis[IN]/in-hospital death) were compared. Results 43 (26.4%) patients had ANP, 87 (53.4%) patients had MAP, 58 (35.6%) MSAP and 18 (11.04%) SAP. Among the baseline characteristics, BISAP score was significantly higher in MSAP compared to MAP [1.6 (1.5-2.01) vs 1.2 (1.9-2.4); p = 0.002]; and BUN was significantly higher in SAP compared to MSAP[64.9 (50.7-79.1) vs 24.9 (20.7-29.1); p < 0.0001]. All outcomes except mortality were significantly higher in MSAP compared to MAP. Need for ICU care (83.3%vs43.1%; p = 0.01), total ICU days[7.9 (4.8-10.9) vs 3.5 (2.7-5.1); p = 0.04] and mortality (38.9%vs1.7%; p = 0.0002) was significantly more in SAP compared to MSAP. 8/18 (44.4%) patients had POF within seven days of disease onset (early OF). This was associated with 37.5% of total in-hospital mortality. Patients with MSAP who had primary IN (n = 10) had similar outcomes as SAP. Conclusions This study prospectively validates the clinical utility of the Revised Atlanta definitions of AP. However, MSAP patients with primary infected necrosis may behave as SAP. Furthermore, patients with early severe acute pancreatitis (early OF) could represent a subgroup that needs to be dealt with separately in classification systems. © 2014, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. All right reserved.

Talukdar R.,Asian Institute of Gastroenterology | Talukdar R.,Asian Healthcare Foundation | Nageshwar Reddy D.,Asian Institute of Gastroenterology
Endoscopy | Year: 2012

Public healthcare has progressed immensely in the past few decades. However, the rural masses in the developing and underdeveloped countries very often have limited access to the advanced healthcare technology. At the Asian Institute of Gastroenterology, Hyderabad, India, the Rural Health Care Project has been initiated in an attempt to provide cost-effective gastrointestinal care to the rural population. The Project was implemented by traveling to remote rural areas in a bus that had been converted into a mobile hospital and equipped with basic diagnostic facilities including a custom-made endoscopy unit. The mobile hospital and endoscopy unit is accompanied by a telemedicine vehicle that transmits all procedures and data to the main telemedicine center at the parent institute in Hyderabad. Our efforts have resulted in cost-effective management and robust data collection of several common gastrointestinal illnesses in remote rural areas of the Indian state of Andhra Pradesh. To date, 32756 endoscopic procedures have been carried out in a population of over 10 million people spanning 4837 villages. Overall, 72% of the population has had a positive finding on upper gastrointestinal endoscopy (primarily related to acid peptic diseases). Interestingly, <1% of the population have had colonic polyps on screening colonoscopy, whereas the prevalence of infective colitis has been high. This whole exercise has produced a high level of satisfaction among both beneficiaries and care-givers; it has also offered doctors in training the opportunity to encounter and manage common public health-related problems. This program is funded by philanthropic donations. © Georg Thieme Verlag KG Stuttgart New York.

Talukdar R.,Asian Institute of Gastroenterology | Talukdar R.,Asian Healthcare Foundation | Inoue H.,Showa University | Reddy D.N.,Asian Institute of Gastroenterology
Surgical Endoscopy and Other Interventional Techniques | Year: 2015

Background: Peroral endoscopic myotomy (POEM) is an evolving therapeutic modality for achalasia. We aim to determine efficacy of POEM for the treatment of achalasia and compare it with laparoscopic Heller’s myotomy (LHM). Materials and methods: Systematic review and meta-analyses was conducted on 19 studies using POEM for achalasia. Pubmed, Medline, Cochrane, and Ovid databases, were searched using the terms ‘achalasia’, ‘POEM’, ‘peroral endoscopic myotomy’, ‘per oral endoscopic myotomy’, and ‘per-oral endoscopic myotomy’. Reduction in Eckhart’s score and lower esophageal sphincter (LES) pressure were the main outcome measures. Results: A total of 1,045 patients underwent POEM in 29 studies. Ninety patients undergoing POEM was compared with 160 undergoing LHM in five studies. Nineteen and 14 studies, respectively, evaluated for Eckhart’s score and LES pressure. There was significant reduction in Eckhart’s score and LES pressure with effect sizes of −7.95 (p < 0.0001) and −7.28 (p < 0.0001), respectively. There was significant heterogeneity among the studies [(Q = 83.06; I2 = 78.33 %; p < 0.0001) for Eckhart’s score and (Q = 61.44; I2 = 75.68 %; p < 0.0001) for LES pressure]. There were no differences between POEM and LHM in reduction in Eckhart’s score, post-operative pain scores and analgesic requirements, length of hospital stay, adverse events, and symptomatic gastroesophageal reflux/reflux esophagitis. Operative time was significantly lower for POEM. Conclusions: POEM is effective for achalasia and has similar outcomes as LHM. Multicenter randomized trials need to be conducted to further compare the efficacy and safety of POEM between treatment naïve achalasia patients and those who failed treatment. © 2014, Springer Science+Business Media New York.

Sasikala M.,Asian Healthcare Foundation | Talukdar R.,Asian Healthcare Foundation | Talukdar R.,Asian Institute of Gastroenterology | Pavan Kumar P.,Asian Healthcare Foundation | And 5 more authors.
Digestive Diseases and Sciences | Year: 2012

Chronic pancreatitis (CP) is a progressive inflammatory disease characterized by irreversible destruction of pancreatic secretory parenchyma, fibrosis, exocrine atrophy, and endocrine insufficiency leading to diabetes. Secondary diabetes occurring in CP subsequent to destruction of pancreatic β-cells is distinct, since it involves β-cell dysfunction amidst an inflammatory milieu. Even though considerable knowledge is available on the pathophysiology and clinical management of CP, relatively much less is known about the molecular events leading to β-cell dysfunction. Investigators have demonstrated that altered morphology, reduced β-cell mass, and β-cell numbers result in endocrine insufficiency. However, recent reports and our observations suggest that β-cell dysfunction develops in the early stages of CP while clinical diabetes manifests later, when there is profound fibrosis. In the early stages, altered internal milieu and physiology arising due to inflammation and release of cytokines might lead to deranged signaling pathways and islet dysfunction. Subsequently, development of fibrosis causes islet destruction. This suggests that endocrine deficiency in CP is multifactorial. Although the role of transcription factors (Pdx-1, MafA, NeuroD) on β-cell functions is understood, alterations in internal milieu of pancreatic tissue that affects β-cell functions in CP has not been elucidated. In this review, we summarize the factors that have an effect on islet functions. Understanding molecular events of β-cell dysfunction in CP can lead to the development of targeted preventive and therapeutic modalities. © Springer Science+Business Media, LLC 2012.

Talukdar R.,Asian Institute of Gastroenterology | Talukdar R.,Asian Healthcare Foundation | Reddy D.N.,Asian Institute of Gastroenterology
Current Opinion in Gastroenterology | Year: 2014

PURPOSE OF REVIEW: To summarize recent data on techniques, efficacy and complications of endoscopic management of chronic pancreatitis. RECENT FINDINGS: Extracorporeal shock wave lithotripsy with or without endoscopic retrograde cholangiopancreatography is the first-line treatment for large painful obstructive pancreatic duct calculi. Use of preextracorporeal shock wave lithotripsy secretin could result in better stone clearance. The first-line treatment for dominant pancreatic duct strictures is placement of a single 10-Fr polyethylene stent with planned exchanges every 3 months until 1 year. Other endoscopic approaches that have shown good efficacy include placement of simultaneous multiple plastic stents and fully covered self-expanding metallic stents. Endoscopic options to treat chronic pancreatitis-associated benign biliary strictures include single and simultaneous multiple plastic stenting and fully covered self-expanding metallic stents. The European Society of Gastrointestinal Endoscopy recommends multiple plastic stenting for such strictures, although fully covered self-expanding metallic stents should be currently used under research settings. Endoscopic ultrasonography-guided cholangiopancreatography and pancreatobiliary drainage is an evolving option for chronic pancreatitis-related ductal obstruction after failed endoscopic retrograde cholangiopancreatography. Recent data have supported the safety and efficacy of endotherapy for chronic pancreatitis in children. SUMMARY: Endotherapy is the first line of management in chronic pancreatitis with symptomatic pancreatobiliary ductal obstruction. Further studies are required in certain key areas such as use of fully covered self-expanding metallic stents for pancreatic ductal and biliary strictures and endoscopic ultrasonography- guided pancreatobiliary drainage after failed endoscopic retrograde cholangiopancreatography. © 2014 Wolters Kluwer Health.

Siddapuram S.P.,Asian Healthcare Foundation
The Journal of the Association of Physicians of India | Year: 2011

To study allelic variants of CYP2C19 gene in South Indians. A total of 220 individuals (167 Males and 53 Females) confirmed to be healthy on the basis of their physical examination and laboratory studies were recruited in the study. Genotyping of CYP2C19*2 and *3 polymorphisms was performed by a Polymerase chain reaction-Restriction fragment length polymorphism method. The genotypic results of both CYP2C19*2 and CYP2C19*3 are considered to establish the frequency of poor metabolisers related to monooxygenase mediated drug metabolism. Individuals who were homozygous mutants for both m1 (m1/m1) and m2 (m2/m2) and heterozygous for both m1 and m2 (ml/m2) mutations were categorized as poor metabolisers. In the present study the frequency of Homozygous Extensive Metabolizers (HomoEM), Heterozygous Extensive Metabolizers (HetEM) and Poor Metabolizers (PM) are 32.2% (n = 71), 52.8% (n = 116) and 15.0% (n = 33) respectively. Since inter individual genetic variations play crucial role in variety of drugs, the identification of intermediate and poor drug metabolizers based on CYP2C19 polymorphism can be a basis for the standardization of personalized therapy.

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