Randomised clinical trial: The efficacy and safety of pancreatin enteric-coated minimicrospheres (Creon 40000 MMS) in patients with pancreatic exocrine insufficiency due to chronic pancreatitis - A double-blind, placebo-controlled study
Thorat V.,Poona Hospital and Research Center |
Reddy N.,Asian Medical Institute |
Bhatia S.,KEM Hospital |
Bapaye A.,Deenanath Mangeshkar Hospital |
And 4 more authors.
Alimentary Pharmacology and Therapeutics | Year: 2012
Background Pancreatic exocrine insufficiency (PEI) results in maldigestion, leading to abdominal pain, steatorrhoea, malnutrition and weight loss. Aim To assess the efficacy and safety of pancreatin (Creon 40000 MMS) in treating PEI due to chronic pancreatitis (CP). Methods This was a 1-week, double-blind, randomised, placebo-controlled, parallel-group, multicentre study in India. Men and women ≥18 years of age with proven CP and PEI [defined as a coefficient of fat absorption (CFA) ≤80% during run-in phase] were randomised 1:1 to pancreatin or placebo (two capsules orally per main meal, one with snacks). The primary outcome measure was change in CFA from baseline to end of double-blind treatment (analysis of covariance). Results Of 62 patients randomised (34 pancreatin, 28 placebo), 61 completed treatment; one patient in the placebo arm withdrew consent before completion. Patient characteristics were similar in both groups except for the proportion of men (pancreatin 82% vs. placebo 68%). Patients receiving pancreatin had a statistically significant greater improvement in fat absorption from baseline to the end of double-blind treatment compared with those receiving placebo, with a least squares mean change (95% CI) in CFA of 18.5% (15.8-21.2) vs. 4.1% (1.0-7.2), respectively. This resulted in a treatment difference of 14.4% (10.3-18.5); P = 0.001. Patients receiving pancreatin also had a statistically significant greater improvement in nitrogen absorption and greater reductions in mean stool fat, stool frequency and stool weight compared with those receiving placebo. Treatment-emergent adverse events occurred in 12 patients on pancreatin and in seven on placebo; none led to study discontinuation. Conclusions The results provide evidence for the efficacy of pancreatin (Creon 40000 MMS) in patients with pancreatic exocrine insufficiency due to chronic pancreatitis, and confirm that this formulation is well tolerated, with a good safety profile, at the dose administered. © 2012 Blackwell Publishing Ltd.
Roy P.,Fortis Escorts Hospital and Research Center |
Roy P.,Asian Medical Institute |
De A.,Fortis Escorts Hospital and Research Center |
De A.,Asian Medical Institute
Langenbeck's Archives of Surgery | Year: 2010
Objective: The aim of this pilot study is to assess the safety, feasibility, and short-term outcomes of single-incision laparoscopic trans-abdominal preperitoneal (TAPP) mesh hernioplasty using conventional laparoscopic instruments. Methods: During a 3-month study period, data from all consecutive patients referred for inguinal hernia repair to the general and minimally invasive surgery unit of our institution who agreed to undergo single-incision TAPP mesh hernioplasty were included in the prospective study. Outcome measures included completion rate of the attempted procedure, operative time, length of hospital stay, postoperative pain, and assessment of complications. Follow-up was done for 3 months. Result: Fifteen patients completed our protocol. Two patients had bilateral inguinal hernias while all other patients had unilateral hernia. Two patients had sliding hernia on the left side which had sigmoid colon as content. None of the patients required any additional port. There were no intraoperative complications. Conclusions: The concept of laparoscopic single-incision surgery is an attractive and understandable innovation as laparoscopic surgery has become more commonplace. Based on our experience, we believe that the procedure is feasible without additional risk. Cosmetic benefit is clear; however, beyond the actual outcome with respect to postoperative pain and long-term complications, needs to be evaluated and compared to standard laparoscopic TAPP mesh hernioplasty. © Springer-Verlag 2010.
Neal E.,Asian Medical Institute
Medical Acupuncture | Year: 2015
The practice of physician acupuncture faces unique challenges in its development and inclusion as a recognized medical specialty. Information contained in early Chinese medical texts offers solutions to some of the divides that separate Chinese Medicine from contemporary biomedicine. Recent advances in classical text research - made possible by the establishment of Chinese language databases - provide new hypotheses of disease pathogenesis and new strategies for treating various acute and chronic illnesses. The Vascular Model of Disease Pathogenesis summarizes some theories of early Chinese medicine into language recognizable by modern science. This theory bridges some of the current disparities between ancient and modern practices and offers a new model of human health, illness, and clinical therapeutics. © Mary Ann Liebert, Inc. 2015.
Banerjee R.,Asian Medical Institute |
Reddy D.N.,Asian Medical Institute
Indian Journal of Gastroenterology | Year: 2011
Gastroesophageal reflux disease (GERD) and GERD-related symptoms are common, and affect 25% to 30% of the general population. Upper gastrointestinal endoscopy of the esophagus has been the most widely used modality for the diagnosis and grading of reflux disease. Endoscopic imaging today has evolved beyond the confines of routine white light endoscopy (WLE) to advanced optical imaging with a precise and real time endoscopic diagnosis. These technological advances have helped circumvent the limitation of WLE in reflux disease by a) improved detection of subtle irregularities, b) characterization of anomalies, and c) possible optical biopsies providing real-time diagnosis. This review attempts to define the current status of these newer technologies vis-a-vis the diagnosis and management of gastroesophageal reflux disease. © 2011 Indian Society of Gastroenterology.
Bansal S.,Asian Medical Institute |
Prabhash K.,Tata Memorial Hospital |
Parikh P.,SAARC Federation of Oncology
Indian Journal of Medical and Paediatric Oncology | Year: 2013
In an effort to collaborate the data of chronic myeloid leukemia (CML) patient from all over India,meeting was conceived by ICON ( Indian Cooperative Oncology Network) in 2010. This article presents the summarized picture of the data presented in the meeting. In the meeting 8115 patients data was presented and 18 centres submitted their manuscripts comprising of 6677 patients. This data represents large series of patients from all over the country treated on day to day clinical practice and presents the actual outcomes of CML patients in India. The compilation of data confirms the younger age at presentation, increased incidence of resistance and poor outcomes in patients with late chronic phase. It also addresses the issues like Glivec versus Generic drug outcomes, safety of Imatinib during pregnancy and mutational analysis among resistant patients. It concludes that survival and quality of life of CML patients in India has improved over the years especially when treated in early chronic phase. The generic drug is a good option where original is unable to reach the patient due to various reasons. Hopefully, this effort will provide a platform to conduct systematic studies in learning the best treatment options among CML patients in Indian settings.
Khan T.M.,King Faisal University |
Baig M.R.,Asian Medical Institute
Archives of Medical Science | Year: 2013
Introduction: The current study aims to explore the knowledge, attitude, and perception of hospital pharmacists towards HIV/AIDS and patients living with HIV/AIDS (PLWHA) in the state of Kedah, Malaysia. Material and methods: This was a cross-sectional study conducted among the hospital pharmacists in three government hospitals in Kedah, using a self-administered 43-item questionnaire. Data analysis was done using non-parametric and multinomial regression. Results: A total of 75 respondents participated in this study, resulting in a res ponse rate of 60.8%. The majority were found to be well aware of the causes of HIV/AIDS. However, about 34 (45.3%) believed erroneously that HIV/AIDS cannot be transmitted through tattooing or body piercing. Nearly 25 (33.3%) of the respondents believed that preventing the use of intravenous drugs may not be effective to prevent HIV/AIDS and endorsed social isolation as a measure to prevent HIV/AIDS. The majority (66.6%) had negative attitudes and about 20% held extremely ne - ga tive attitudes. Findings from regression modelling revealed that hospital (-2 log likelihood = 215.182, x2 = 18.060, Df = 8, p = 0.021) and gender (-2 log likelihood = 213.643, x2 = 16.521, Df = 8, p = 0.035) were more likely to affect the attitudes of respondents. Conclusions: Overall, more than one third of the respondents were found to have negative attitudes towards PLWHA. Gender, job experience, and hospitals with more HIV/AIDS patient visits were the main factors affecting attitudes.
Tandan M.,Asian Medical Institute |
Nageshwar Reddy D.,Asian Medical Institute
World Journal of Gastroenterology | Year: 2013
Chronic pancreatitis (CP) is a progressive disease with irreversible changes in the pancreas. Patients commonly present with pain and with exocrine or endocrine insufficiency. All therapeutic efforts in CP are directed towards relief of pain as well as the management of associated complications. Endoscopic therapy offers many advantages in patients with CP who present with ductal calculi, strictures, ductal leaks, pseudocyst or associated biliary strictures. Endotherapy offers a high rate of success with low morbidity in properly selected patients. The procedure can be repeated and failed endotherapy is not a hindrance to subsequent surgery. Endoscopic pancreatic sphincterotomy is helpful in patients with CP with minimal ductal changes while minor papilla sphincterotomy provides relief in patients with pancreas divisum and chronic pancreatitis. Extracorporeal shock wave lithotripsy is the standard of care in patients with large pancreatic ductal calculi. Long term follow up has shown pain relief in over 60% of patients. A transpapillary stent placed across the disruption provides relief in over 90% of patients with ductal leaks. Pancreatic ductal strictures are managed by single large bore stents. Multiple stents are placed for refractory strictures. CP associated benign biliary strictures (BBS) are best treated with multiple plastic stents, as the response to a single plastic stent is poor. Covered self expanding metal stents are increasingly being used in the management of BBS though further long term studies are needed. Pseudocysts are best drained endoscopically with a success rate of 80%-95% at most centers. Endosonography (EUS) has added to the therapeutic armamentarium in the management of patients with CP. Drainage of pseudcysts, cannulation of inaccessible pancreatic ducts and celiac ganglion block in patients with intractable pain are all performed using EUS. Endotherapy should be offered as the first line of therapy in properly selected patients with CP who have failed to respond to medical therapy and require intervention. © 2013 Baishideng. All rights reserved.
Agarwal J.,Asian Medical Institute
Indian Journal of Pediatrics | Year: 2013
The lack of information about management of chronic constipation in children amidst general physicians has necessitated this review. A literature search in PubMed was conducted with regard to epidemiology, clinical features, investigation and management of chronic constipation in children. English language studies published over the last 20 y were considered and relevant information was extracted. Constipation is a common problem among children; the commonest cause is functional (95 %). An elaborate history and thorough physical examination are only essential things required to make a diagnosis of functional constipation. Management consists of disimpaction, followed by maintenance therapy with oral laxative, dietary modification and toilet training. A regular follow-up with slow tapering of laxative is the must for effective treatment. Early withdrawal of laxative is the commonest cause of recurrence. © Dr. K C Chaudhuri Foundation 2013.
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.
Matsuda Z.,Asian Medical Institute
Uirusu | Year: 2013
Recent rapid developments in Asian and African countries bring an opportunity of cross-species transmission of pathogens through unprecedented contacts between people and wild animals. Furthermore, increase of global exchanges of people and products facilitates a rapid spread of infectious diseases worldwide. China has an enormous population with diverse ethnic groups within its wide territory; furthermore, it is experiencing very rapid urbanization. These conditions make China a potential epicenter of emerging infectious diseases. One good example is the SARS incidence in 2003. Therefore, it is essential to include China in a network of research groups of infectious diseases. Here we summarize the ongoing collaborations between the Institute of Medical Science, the University of Tokyo, and its Chinese counterparts.