P. Basumani | Fortis Hospital (original) (raw)
Papers by P. Basumani
Postgraduate Medical Journal, 2005
Gut, 2011
Introduction Hp causes peptic ulcer disease (PUD) and is potentially carcinogenic. Hp eradication... more Introduction Hp causes peptic ulcer disease (PUD) and is potentially carcinogenic. Hp eradication is done in conditions like PUD, uncomplicated dyspepsia and persistent iron deficiency anaemia. 'Test and treat' implies testing specifi cally with intent to treat, if positive. CLO test is read in real time and acted on promptly. Hp serology is used in acute upper GI (UGI) bleed or endoscopy on PPI as CLO test is less sensitive. Results take 5-7 days by when in-patients have been discharged and positive Hp serology (Hp+ve) results overlooked. This audit was prompted by two such missed cases of Hp+ve PUD with rebleed in one. Aim To review action taken on Hp+ve results in our hospital, assess factors contributing to inaction, impact on patient care and remedial steps needed. Methods Retrospective study of all patients with Hp+ve requested by hospital clinicians in 12 months (1 April 2009 to 31 March 2010). Serology data from our microbiology department was matched with subsequent urea breath tests (UBT), our standard test to confi rm eradication. Patients with sequential serology and UBT were deemed to have received eradication. Case notes of the others were reviewed for test indication, point of fi rst contact, gastroscopy fi ndings (if
Frontline Gastroenterology, 2014
ABSTRACT Objective To determine the best faecal calprotectin (FCP) cut-off level for differentiat... more ABSTRACT Objective To determine the best faecal calprotectin (FCP) cut-off level for differentiating between irritable bowel syndrome (IBS) and organic disease, particularly inflammatory bowel disease (IBD), in patients presenting with chronic diarrhoea. Design Retrospective analysis of patients who had colonoscopy, histology and FCP completed within 2 months. Setting District general hospital. Patients Consecutive new patients with chronic diarrhoea lasting longer than 4 weeks. Interventions Patients were seen by a single experienced gastroenterologist and listed for colonoscopy with histology. Laboratory investigations included a single faecal specimen for calprotectin assay (lower limit of detection: 8 µg/g), the results used for information only. Main outcome measures Six FCP cut-off levels (range 8–150 µg/g) were compared against the ‘gold standard’ of histology: inflammation ‘present’ or ‘absent’. Results Of 119 patients studied, 98 had normal colonoscopy and histology. The sensitivity of FCP to detect IBD at cut-off levels 8, 25 and 50 µg/g was 100% (with corresponding specificity 51%, 51%, 60%). In contrast, the lowest FCP cut-off, 8 µg/g, had 100% sensitivity to detect colonic inflammation, irrespective of cause (with negative predictive value (NPV) 100%). Importantly, 50/119 patients (42%) with FCP <8 µg/g had normal colonoscopy and histology. Conclusions Our results suggest that using FCP to screen patients newly referred for chronic diarrhoea could exclude all without IBD and, at a lower cut-off, all without colonic inflammation, thus avoiding the need for colonoscopy. Such a major reduction has implications for resource allocation.
Proceedings of the Nutrition Society, 2008
Journal of Hepatology, 2009
Poster Session − Saturday, April 25 cells increases greatly following hepatic injury. The present... more Poster Session − Saturday, April 25 cells increases greatly following hepatic injury. The present study was aimed to provide data to support this hypothesis in humans. Methods: The study included 219 consecutive patients (154 males), median age 55 years (range, 22−68), who underwent liver transplantation for end stage liver disease; 236 blood donors (164 males), served as controls. Genotyping for the IL-6 −174 G>C polymorphism, that is associated with high IL-6 production, was performed on whole blood samples by a PCRrestriction fragment length polymorphism assay. All total hepatectomy specimens were sectioned at intervals of approximately 1 cm in search for suspicious focal hepatic lesions. Results: HCC foci were identified in the native livers of 66/219 patients undergoing liver transplantation. IL-6 −174 G>C allelic frequencies in patients and controls were G = 0.650 and 0.689, C = 0.350 and 0.311, respectively
Journal of Hepatology, 2008
POSTERS immunoglobulin G (IgG) subclasses, and standard autoantibodies were recorded and, when un... more POSTERS immunoglobulin G (IgG) subclasses, and standard autoantibodies were recorded and, when unavailable, determined on archived blood samples. Results: Thirty patients (14 male) with CP were identified. Median age at presentation was 9 years range, 0.4−15. Presentation symptoms included abdominal pain (30), food intolerance (29) and obstructive jaundice (10). Three patients had long common choledocho-pancreatic channel, 1 double outlet pancreatic duct, 8 common bile or pancreatic duct dilatation and/or stricture, 2 pancreatic and 1 gallstones, 4 inflammatory pseudotumour, 1 post-chemotherapy biliary stricture (medulloblastoma), 1 systemic lupus erythematosus, 1 portal vein thrombosis and 8 cryptogenic pancreatitis. Ten patients (33%; 4 male) had raised age-adjusted IgG4 levels, with normal total IgG levels. Median IgG4 was 1.73 g/L range, 0.065−3.3. Autoantibodies were negative in all except in 1 (SMA 1:40). At presentation, median serum amylase was 195 IU/L range, 27-638; normal <100 IU/L and triglycerides 1.7 mmol/L range, 0.9−2.1; normal 0.5−2 mmol/L. All tested patients were negative for common cystic fibrosis mutations. 3/6 patients tested for hereditary pancreatitis had PRSS1 mutation in the cationic trypsinogen gene. Irregularity of the pancreatic duct was documented in 7 children CT = 2, MRCP = 5. ERCP showed a stricture affecting the pancreatic duct in 3 patients, 2 of whom required stent insertion. Subsequently, 2 of them underwent a pancreatico-enterostomy (Puestow procedure). One girl was treated with prednisolone (60 mg) and azathioprine (2 mg/kg/d) and normalized IgG4 within 2 months, but developed diabetes mellitus. In the remaining 9 patients pancreatitic symptoms improved after endoscopic or surgical treatment median follow up: 12 months (range, 4−84). Conclusion: One-third of our patients with CP fulfilled clinical criteria for AIP. Some of them possess PRSS1 mutation and conventional endoscopico-surgical treatment appears to be superior.
Journal of Hepatology, 2009
Gut, 2011
IntroductionThe prevalence of bile acid diarrhoea (BAD) is estimated to be 1%, but the condition ... more IntroductionThe prevalence of bile acid diarrhoea (BAD) is estimated to be 1%, but the condition remains under diagnosed, partly because the selenium homocholic acid taurine (SeHCAT) test is not widely available. Fibroblast Growth Factor 19 (FGF19) produced in the terminal ileum in response to bile acid absorption plays an important role as a negative regulator of bile acid synthesis and
Postgraduate Medical Journal, 2005
Gut, 2011
Introduction Hp causes peptic ulcer disease (PUD) and is potentially carcinogenic. Hp eradication... more Introduction Hp causes peptic ulcer disease (PUD) and is potentially carcinogenic. Hp eradication is done in conditions like PUD, uncomplicated dyspepsia and persistent iron deficiency anaemia. 'Test and treat' implies testing specifi cally with intent to treat, if positive. CLO test is read in real time and acted on promptly. Hp serology is used in acute upper GI (UGI) bleed or endoscopy on PPI as CLO test is less sensitive. Results take 5-7 days by when in-patients have been discharged and positive Hp serology (Hp+ve) results overlooked. This audit was prompted by two such missed cases of Hp+ve PUD with rebleed in one. Aim To review action taken on Hp+ve results in our hospital, assess factors contributing to inaction, impact on patient care and remedial steps needed. Methods Retrospective study of all patients with Hp+ve requested by hospital clinicians in 12 months (1 April 2009 to 31 March 2010). Serology data from our microbiology department was matched with subsequent urea breath tests (UBT), our standard test to confi rm eradication. Patients with sequential serology and UBT were deemed to have received eradication. Case notes of the others were reviewed for test indication, point of fi rst contact, gastroscopy fi ndings (if
Frontline Gastroenterology, 2014
ABSTRACT Objective To determine the best faecal calprotectin (FCP) cut-off level for differentiat... more ABSTRACT Objective To determine the best faecal calprotectin (FCP) cut-off level for differentiating between irritable bowel syndrome (IBS) and organic disease, particularly inflammatory bowel disease (IBD), in patients presenting with chronic diarrhoea. Design Retrospective analysis of patients who had colonoscopy, histology and FCP completed within 2 months. Setting District general hospital. Patients Consecutive new patients with chronic diarrhoea lasting longer than 4 weeks. Interventions Patients were seen by a single experienced gastroenterologist and listed for colonoscopy with histology. Laboratory investigations included a single faecal specimen for calprotectin assay (lower limit of detection: 8 µg/g), the results used for information only. Main outcome measures Six FCP cut-off levels (range 8–150 µg/g) were compared against the ‘gold standard’ of histology: inflammation ‘present’ or ‘absent’. Results Of 119 patients studied, 98 had normal colonoscopy and histology. The sensitivity of FCP to detect IBD at cut-off levels 8, 25 and 50 µg/g was 100% (with corresponding specificity 51%, 51%, 60%). In contrast, the lowest FCP cut-off, 8 µg/g, had 100% sensitivity to detect colonic inflammation, irrespective of cause (with negative predictive value (NPV) 100%). Importantly, 50/119 patients (42%) with FCP <8 µg/g had normal colonoscopy and histology. Conclusions Our results suggest that using FCP to screen patients newly referred for chronic diarrhoea could exclude all without IBD and, at a lower cut-off, all without colonic inflammation, thus avoiding the need for colonoscopy. Such a major reduction has implications for resource allocation.
Proceedings of the Nutrition Society, 2008
Journal of Hepatology, 2009
Poster Session − Saturday, April 25 cells increases greatly following hepatic injury. The present... more Poster Session − Saturday, April 25 cells increases greatly following hepatic injury. The present study was aimed to provide data to support this hypothesis in humans. Methods: The study included 219 consecutive patients (154 males), median age 55 years (range, 22−68), who underwent liver transplantation for end stage liver disease; 236 blood donors (164 males), served as controls. Genotyping for the IL-6 −174 G>C polymorphism, that is associated with high IL-6 production, was performed on whole blood samples by a PCRrestriction fragment length polymorphism assay. All total hepatectomy specimens were sectioned at intervals of approximately 1 cm in search for suspicious focal hepatic lesions. Results: HCC foci were identified in the native livers of 66/219 patients undergoing liver transplantation. IL-6 −174 G>C allelic frequencies in patients and controls were G = 0.650 and 0.689, C = 0.350 and 0.311, respectively
Journal of Hepatology, 2008
POSTERS immunoglobulin G (IgG) subclasses, and standard autoantibodies were recorded and, when un... more POSTERS immunoglobulin G (IgG) subclasses, and standard autoantibodies were recorded and, when unavailable, determined on archived blood samples. Results: Thirty patients (14 male) with CP were identified. Median age at presentation was 9 years range, 0.4−15. Presentation symptoms included abdominal pain (30), food intolerance (29) and obstructive jaundice (10). Three patients had long common choledocho-pancreatic channel, 1 double outlet pancreatic duct, 8 common bile or pancreatic duct dilatation and/or stricture, 2 pancreatic and 1 gallstones, 4 inflammatory pseudotumour, 1 post-chemotherapy biliary stricture (medulloblastoma), 1 systemic lupus erythematosus, 1 portal vein thrombosis and 8 cryptogenic pancreatitis. Ten patients (33%; 4 male) had raised age-adjusted IgG4 levels, with normal total IgG levels. Median IgG4 was 1.73 g/L range, 0.065−3.3. Autoantibodies were negative in all except in 1 (SMA 1:40). At presentation, median serum amylase was 195 IU/L range, 27-638; normal <100 IU/L and triglycerides 1.7 mmol/L range, 0.9−2.1; normal 0.5−2 mmol/L. All tested patients were negative for common cystic fibrosis mutations. 3/6 patients tested for hereditary pancreatitis had PRSS1 mutation in the cationic trypsinogen gene. Irregularity of the pancreatic duct was documented in 7 children CT = 2, MRCP = 5. ERCP showed a stricture affecting the pancreatic duct in 3 patients, 2 of whom required stent insertion. Subsequently, 2 of them underwent a pancreatico-enterostomy (Puestow procedure). One girl was treated with prednisolone (60 mg) and azathioprine (2 mg/kg/d) and normalized IgG4 within 2 months, but developed diabetes mellitus. In the remaining 9 patients pancreatitic symptoms improved after endoscopic or surgical treatment median follow up: 12 months (range, 4−84). Conclusion: One-third of our patients with CP fulfilled clinical criteria for AIP. Some of them possess PRSS1 mutation and conventional endoscopico-surgical treatment appears to be superior.
Journal of Hepatology, 2009
Gut, 2011
IntroductionThe prevalence of bile acid diarrhoea (BAD) is estimated to be 1%, but the condition ... more IntroductionThe prevalence of bile acid diarrhoea (BAD) is estimated to be 1%, but the condition remains under diagnosed, partly because the selenium homocholic acid taurine (SeHCAT) test is not widely available. Fibroblast Growth Factor 19 (FGF19) produced in the terminal ileum in response to bile acid absorption plays an important role as a negative regulator of bile acid synthesis and