- Email: [email protected]
Pancreatic Exocrine Insufficiency in Diabetes
JOURNAL OF CLINICAL AND EXPERIMENTAL HEPATOLOGY
CONFLICTS OF INTEREST
CONFLICTS OF INTEREST
The authors have none to declare.
The authors have none to declare.
Corresponding author: . E-mail: [email protected]
Corresponding author: Syed Afzal. E-mail: [email protected]
http://dx.doi.org/10.1016/j.jceh.2016.06.144
http://dx.doi.org/10.1016/j.jceh.2016.06.145
24
25
PANCREATIC EXOCRINE INSUFFICIENCY IN DIABETES
GRANULOMATOUS HEPATITIS COMPLICATING INTRAVESICAL BACILLE CALMETTE-GUÉRIN (BCG) THERAPY FOR HIGH-RISK SUPERFICIAL BLADDER CANCER
J N Medical College Hospital, Aligarh, India
Background and Aim: PEI is frequently seen in DM. More than 50% of patients have pancreatic fibrosis and atrophy. The present study is designed to evaluate PEI in Type 1 and Type 2 DM. Primary aim: evaluate PEI in DM. Secondary aims: to co-relate degree of PEI with duration of diabetes, PEI with diabetic neuropathy and size of pancreas with duration of diabetes. Methods: 108 patients were taken up for study. It was a hospital based, cross sectional observational analytical study conducted in JNMCH, AMU. Inclusion criteria: patients having Type 1 and Type 2 DM. Exclusion criteria: patients having acute and chronic pancreatitis (various etiologies). Fecal elastase 1 test was used for PEI, Monofilament test for diabetic neuropathy, USG for size of pancreas. Results: 17 (15.74%) patients out of 108 had FEC <100 mg, 22 (20.37%) had FEC between 100 and 200 mg and 69 (63.88%) had FEC >200 mg. 25.71% of Type 1 DM and 10.95% of Type 2 DM had severe PEI (<100 mg). Of 108 patients, 12.03%(13)showed reduced size of pancreas, 5 had Type 1 and 8 had Type 2 DM.4 patients had a duration of disease between 5 and 10 years in Type 1 DM. Whereas in Type 2 DM, 4 had disease between 5 and 10 years and 4 had >10 years of disease. 37 (50.68%) patients had diabetic neuropathy, 13 Type 1 and 24 Type 2 DM. Conclusion: The present study showed PEI is present in both Type 1 and Type 2 DM, its more common in Type 1 DM (59.99% vs 24.65%). Both degree and prevalence of PEI increased with duration of disease (more frequent in Type 1 than Type 2 DM). The prevalence of smaller pancreas increased with duration of disease (more frequent in Type 1 than Type 2 DM). There is a strong co-relation between PEI and diabetic neuropathy (76% of neuropathy patients had PEI).
Arun Iyer, Prasanth Sudheendran, Shanid Sathar, Sreejaya Sreesh, Krishnadas Devadas Government Medical College and Hospital, Thiruvananthapuram, India
Background: Intravesical bacille Calmette-Guérin (BCG) therapy is the most effective treatment for high-risk superficial bladder cancer. Severe systemic complications are rare, but may occur in approximately 1% of cases. Case Report: We report a severe complication of intravesical BCG: a disseminated Mycobacterium bovis infection with biopsy-proven granulomatous hepatitis in a patient with bladder cancer. In our case we did not start the patient on anti tubercular therapy (ATT), as opposed to the previous case reports of disseminated Mycobacterium bovis infection, in which the patient had been put on category I ATT. But in our case, the patient responded to UDCA and symptomatic management alone. This has not been previously described in literature and we want to highlight the fact that selected patients with only granulomatous hepatitis (limited disease, as opposed to more diffuse involvement of lungs and liver reported in earlier cases in literature) due to BCGosis may respond to conservative management alone. This also holds weight in the current scenario in our country as the number of resistant cases of TB has been on the rise and also considering the hepatotoxic profile of ATT drugs it may be prudent to observe the patient in selected cases. CONFLICTS OF INTEREST The authors have none to declare. Corresponding author: Arun Iyer. E-mail: [email protected] http://dx.doi.org/10.1016/j.jceh.2016.06.146
Journal of Clinical and Experimental Hepatology | July 2016 | Vol. 6 | No. S1 | S74–S102
S87
Miscellaneous
Syed Afzal, Masi-ur-Rehman Ajmal, Ashaq Dar, Sheelu Siddiqi
CONFLICTS OF INTEREST
CONFLICTS OF INTEREST
The authors have none to declare.
The authors have none to declare.
Corresponding author: . E-mail: [email protected]
Corresponding author: Syed Afzal. E-mail: [email protected]
http://dx.doi.org/10.1016/j.jceh.2016.06.144
http://dx.doi.org/10.1016/j.jceh.2016.06.145
24
25
PANCREATIC EXOCRINE INSUFFICIENCY IN DIABETES
GRANULOMATOUS HEPATITIS COMPLICATING INTRAVESICAL BACILLE CALMETTE-GUÉRIN (BCG) THERAPY FOR HIGH-RISK SUPERFICIAL BLADDER CANCER
J N Medical College Hospital, Aligarh, India
Background and Aim: PEI is frequently seen in DM. More than 50% of patients have pancreatic fibrosis and atrophy. The present study is designed to evaluate PEI in Type 1 and Type 2 DM. Primary aim: evaluate PEI in DM. Secondary aims: to co-relate degree of PEI with duration of diabetes, PEI with diabetic neuropathy and size of pancreas with duration of diabetes. Methods: 108 patients were taken up for study. It was a hospital based, cross sectional observational analytical study conducted in JNMCH, AMU. Inclusion criteria: patients having Type 1 and Type 2 DM. Exclusion criteria: patients having acute and chronic pancreatitis (various etiologies). Fecal elastase 1 test was used for PEI, Monofilament test for diabetic neuropathy, USG for size of pancreas. Results: 17 (15.74%) patients out of 108 had FEC <100 mg, 22 (20.37%) had FEC between 100 and 200 mg and 69 (63.88%) had FEC >200 mg. 25.71% of Type 1 DM and 10.95% of Type 2 DM had severe PEI (<100 mg). Of 108 patients, 12.03%(13)showed reduced size of pancreas, 5 had Type 1 and 8 had Type 2 DM.4 patients had a duration of disease between 5 and 10 years in Type 1 DM. Whereas in Type 2 DM, 4 had disease between 5 and 10 years and 4 had >10 years of disease. 37 (50.68%) patients had diabetic neuropathy, 13 Type 1 and 24 Type 2 DM. Conclusion: The present study showed PEI is present in both Type 1 and Type 2 DM, its more common in Type 1 DM (59.99% vs 24.65%). Both degree and prevalence of PEI increased with duration of disease (more frequent in Type 1 than Type 2 DM). The prevalence of smaller pancreas increased with duration of disease (more frequent in Type 1 than Type 2 DM). There is a strong co-relation between PEI and diabetic neuropathy (76% of neuropathy patients had PEI).
Arun Iyer, Prasanth Sudheendran, Shanid Sathar, Sreejaya Sreesh, Krishnadas Devadas Government Medical College and Hospital, Thiruvananthapuram, India
Background: Intravesical bacille Calmette-Guérin (BCG) therapy is the most effective treatment for high-risk superficial bladder cancer. Severe systemic complications are rare, but may occur in approximately 1% of cases. Case Report: We report a severe complication of intravesical BCG: a disseminated Mycobacterium bovis infection with biopsy-proven granulomatous hepatitis in a patient with bladder cancer. In our case we did not start the patient on anti tubercular therapy (ATT), as opposed to the previous case reports of disseminated Mycobacterium bovis infection, in which the patient had been put on category I ATT. But in our case, the patient responded to UDCA and symptomatic management alone. This has not been previously described in literature and we want to highlight the fact that selected patients with only granulomatous hepatitis (limited disease, as opposed to more diffuse involvement of lungs and liver reported in earlier cases in literature) due to BCGosis may respond to conservative management alone. This also holds weight in the current scenario in our country as the number of resistant cases of TB has been on the rise and also considering the hepatotoxic profile of ATT drugs it may be prudent to observe the patient in selected cases. CONFLICTS OF INTEREST The authors have none to declare. Corresponding author: Arun Iyer. E-mail: [email protected] http://dx.doi.org/10.1016/j.jceh.2016.06.146
Journal of Clinical and Experimental Hepatology | July 2016 | Vol. 6 | No. S1 | S74–S102
S87
Miscellaneous
Syed Afzal, Masi-ur-Rehman Ajmal, Ashaq Dar, Sheelu Siddiqi