Publications by authors named "Gurcharan Avasthi"

8 Publications

  • Page 1 of 1

Methotrexate-induced liver cirrhosis in a patient of psoriasis.

J Assoc Physicians India 2012 May;60:47-8

Department of Medicine, SPS Apollo Hospitals, Ludhiana.

Methotrexate has been used for many years to treat refractory psoriasis. A case of methotrexate induced cirrhosis is being presented to emphasize the importance of strict adherence to published criteria for patient selection, monitoring of cumulative drug dosages, and the performance of serial liver biopsies.
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May 2012

Healing of solitary rectal ulcers with multiple sessions of argon plasma coagulation.

Dig Endosc 2010 Apr;22(2):107-11

Department of Gastroenterology, SPS Apollo Hospitals, Ludhiana, Punjab.

Background: Solitary rectal ulcer syndrome (SRUS) is an uncommon disorder of evacuation. Management of bleeding ulcers is usually unsatisfactory with conventional treatment. Argon plasma coagulation (APC) has been reported to control bleeding; however, it has not been shown to result in ulcer healing. The aim of the present study was to: (i) to investigate the efficacy and safety of APC in controlling bleeding from SRUS; and (ii) to study its efficacy in the healing of ulcer/s.

Methods: Twenty-four patients with bleeding SRUS diagnosed on clinical, colonoscopic, and histological findings were randomized to receive either standard care alone (12 patients) or to undergo multiple sessions of APC in addition (12 patients). All patients were followed up to determine ulcer healing.

Results: Twenty-four patients with a mean duration of symptoms of 12.6 +/- 4.8 months were included. Bleeding was controlled with one (n = 5) or two sessions (n = 7) of APC. Reduction in size and depth of ulcer was noted. Eight out of 12 patients who received APC had complete healing of ulcers after four to eight sessions, carried out 2-4 weeks apart. The remaining four patients had a reduction in size and depth of ulcers compared to their pretreatment appearance. All patients were advised to have a high intake of fluids, fiber and laxatives, and to undergo biofeedback and behavior modification therapy in addition to the treatment.

Conclusions: APC controls bleeding in patients with SRUS and it also improves the healing of these ulcers.
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http://dx.doi.org/10.1111/j.1443-1661.2010.00941.xDOI Listing
April 2010

High pharyngoesophageal strictures after laryngopharyngectomy can also be treated by self-expandable plastic stents.

Gastrointest Endosc 2010 Jun 9;71(7):1304-7. Epub 2010 Apr 9.

Department of Gastroenterology, Sahara Hospital, Lucknow 226010 (UP), India.

Background: Permanent dysphagia occurring after laryngectomy or laryngopharyngectomy can usually be treated by periodic dilation. Occasionally, however, conservative treatment is insufficient, and patients require long-term tube feeding. We describe 4 cases with stricture after laryngopharyngectomy who underwent insertion of self-expandable plastic stents (SEPSs) across the stricture for treatment of dysphagia.

Objective: The aim of this study was to evaluate the role of SEPSs in postlaryngopharyngectomy strictures.

Design: An interventional study of management of 4 patients of dysphagia after laryngopharyngectomy with SEPSs.

Setting: Medical gastroenterology unit in a tertiary care hospital.

Patients: Four patients with dysphagia after laryngopharyngectomy.

Interventions: SEPS placement and removal after 3 months.

Main Outcome Measurements: Improvement in dysphagia.

Methods: Four patients with dysphagia after laryngopharyngectomy underwent dilation of stricture followed by SEPS placement for 3 months.

Results: Three patients had grade IV, and 1 grade III dysphagia. Endoscopy showed stricture at 10 to 14 cm from the incisors. Stricture was dilated up to 15 mm on 3 occasions, 2 weeks apart. A silicone Polyflex stent was placed across the stricture and removed after 3 months. No dysphagia recurred after 2 months. No significant complications were noted.

Limitations: Small sample size.

Conclusions: SEPSs dilate postlaryngopharyngectomy strictures and prevent restenosis even after removal.
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http://dx.doi.org/10.1016/j.gie.2009.12.050DOI Listing
June 2010

Healing of a bleeding solitary rectal ulcer with multiple sessions of argon plasma.

Gastrointest Endosc 2010 Mar;71(3):578-82

Department of Gastroenterology, SPS Apollo Hospitals, Punjab, India.

Background: Solitary rectal ulcer syndrome (SRUS) is an uncommon disorder of evacuation. Management of bleeding ulcers is usually unsatisfactory with conventional treatments. Argon plasma coagulation (APC) has been reported in case reports to control bleeding; however, it has not been shown to result in ulcer healing.

Objective: To investigate the efficacy and safety of APC in controlling bleeding from SRUS and to study its efficacy in eventual healing of ulcers.

Design: A randomized, controlled trial of the management of 24 consecutive patients with SRUS.

Setting: The gastroenterology unit at 2 tertiary care hospitals.

Patients: Twenty-four patients with bleeding SRUS.

Main Outcome Measurements: Control of bleeding and endoscopic healing of SRUS.

Methods: Twenty-four patients with bleeding SRUS, whose diagnoses were based on clinical, colonoscopic, and histologic findings, were randomized to receive either standard care only (12 patients, biofeedback therapy [BT] group) or multiple sessions of APC in addition to BT (12 patients, APC group). All patients were advised to intake a high level of fluids and fibers, laxatives, biofeedback, and behavior modification therapy in addition to the treatment. Patients were followed to determine whether ulcers healed.

Results: Twenty-four patients with symptoms that lasted 12.6 +/- 4.8 months were included. Bleeding was controlled in all 12 patients in the APC group, but only in 5 of 12 patients in BT group. We also made the following observations about healing of the ulcers: 8 of 12 patients in the APC group had complete healing of their ulcers after 4 to 8 sessions, whereas in the BT group, ulcers healed in only 2 of 12 patients.

Conclusions: APC controls the bleeding in patients with SRUS and also improves the healing of these ulcers.
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http://dx.doi.org/10.1016/j.gie.2009.10.038DOI Listing
March 2010

Prevalence of celiac disease among school children in Punjab, North India.

J Gastroenterol Hepatol 2006 Oct;21(10):1622-5

Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Background: Celiac disease, as of today, is said to exist in almost all parts of the world, although it is rare among people of purely African-Caribbean, Japanese and Chinese background. The disease has also been considered uncommon in India until recently. Hospital records have revealed an increasing trend of the disease in predominantly wheat-eating areas of North India. The aim of the present study was to determine the prevalence of celiac disease among school children in Punjab, North India.

Methods: The study was carried out in the Ludhiana district of Punjab, Northern India. A total of 4347 children aged 3-17 years attending different schools were enrolled. A structured questionnaire was used to collect sociodemographic data and symptoms and signs related to celiac disease and various sociodemographic factors. The screening for celiac disease for the suspected celiacs was done by testing for antitissue transglutaminase (anti-tTG) by indirect solid-phase immunometric assay (ELISA). All children with high anti-tTG whose parents consented underwent upper gastrointestinal endoscopy for small bowel biopsy from the second part of the duodenum. Histopathology was expressed according to the Marsh classification of 1992. Follow up was carried out among children who were put on a gluten-restricted diet, at monthly intervals for 3 months and every 3 months thereafter. The diagnosis of celiac disease was established on the basis of the revised European Society of Paediatric Gastroenterologists and Nutritionists (ESPGAN) criteria (confirmed cases).

Results: A total of 4347 school children (1967 girls, 2380 boys, age range 3-17 years) were screened for celiac disease. Out of these, 198 suspected children were identified for further evaluation. Twenty-one children tested positive for anti-tTG assay (10.6%, 95% confidence interval: 16.91-34.79). Seventeen of these 21 children agreed to undergo biopsy; of these, 14 had histological changes consistent with celiac disease and all these 14 children had clinical response to gluten restriction. Three children with high anti-tTG had normal mucosa on duodenal biopsy and were not labelled as being in the celiac disease group. In the final analysis the disease prevalence was one in 310 children.

Conclusions: This is the first study on celiac disease prevalence among school children from India. Although this disease frequency of one in 310 is thought to be an under-assessment, it clearly shows that celiac disease is not rare in wheat-eating areas of North India.
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http://dx.doi.org/10.1111/j.1440-1746.2006.04281.xDOI Listing
October 2006

An unusual case of complete heart block with triplet pregnancy.

Indian Heart J 2003 Nov-Dec;55(6):641-2

Dayanand Medical College and Hospital, Ludhiana.

A young primigravida presented at 36 weeks of gestation with complete heart block and triplet pregnancy. She underwent a lower segment cesarean section, and was managed successfully. The patient remained asymptomatic and did not require antiarrhythmic drugs or pacing.
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April 2004

Azathioprine versus sulfasalazine in maintenance of remission in severe ulcerative colitis.

Indian J Gastroenterol 2003 May-Jun;22(3):79-81

Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab.

Background: Azathioprine is useful as a steroid-sparing drug in patients with ulcerative colitis. Its role as monotherapy in the maintenance of disease remission has not been evaluated.

Methods: In this prospective, randomized, open-label study, 25 patients with severe ulcerative colitis received either azathioprine (2.5 mg/Kg/day; Group A, n = 12) or sulfasalazine (6 g/day; Group B, n = 13). All patients received oral corticosteroids in a tapering dosage schedule initially. Treatment failure was defined as either disease relapse or drug withdrawal because of adverse effects.

Results: Five of 12 patients in Group A and 8 of 13 patients in Group B had sustained remission during the stipulated study period of 18 months (p = ns). Two patients in Group A had to stop azathioprine because of adverse effects (bone marrow suppression and acute pancreatitis). In Group A, all patients who had treatment failure developed it in the first half of the study while in Group B treatment failure occurred in both halves.

Conclusions: The relapse rate of ulcerative colitis on maintenance therapy with azathioprine or sulfasalazine is comparable; there was a trend towards earlier treatment failure with azathioprine.
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September 2003

Acute renal failure in medical and surgical intensive care units--a one year prospective study.

Ren Fail 2003 Jan;25(1):105-13

Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

The spectrum of acute renal failure is different in intensive care unit (ICU) vs. non-ICU population. This one year prospective study carried out in medical and surgical intensive care units showed an incidence of 8.6% of acute renal failure. The incidence of acute renal failure was highest in medical ICU (17.2%) followed by burns ICU (5.3%), pulmonary ICU (5.2%), stroke ICU (4.4%), surgical ICU (3.1%) and least in coronary ICU (1.3%). The acute renal failure was attributable to medical causes in 68% followed by surgery and trauma in 21.2%, burns in 5.6% and pregnancy related in 5.1%. In majority, acute renal failure was multifactorial. Septicemia was the commonest cause in both medical (50%) and surgical (86%) ICUs. Multi organ system failure was present in 77.3% of patients with acute renal failure. Approximately 40% required dialysis. The mortality of acute renal failure was 62% and the mortality was correlated with the number of organ system failures, presence of oliguria and septicemia. The mean ICU stay was significantly shorter in the non-survivors.
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http://dx.doi.org/10.1081/jdi-120017473DOI Listing
January 2003
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