The role of capsule endoscopy in etiological diagnosis and management of obscure gastrointestinal bleeding

( Vikas Pandey ),( Meghraj Ingle ),( Nilesh Pandav ),( Pathik Parikh ),( Jignesh Patel ),( Aniruddha Phadke ),( Prabha Sawant ) 대한장연구학회 2016 Intestinal Research Vol.14 No.1

To investigate the various etiologies, yields, and effects of capsule endoscopy (CE) on management and complications, along with follow up of patients with obscure gastrointestinal (GI) bleeding. Methods: The study group of patients included those having obscure, overt, or occult GI bleeding. The findings were categorized as (A) obvious/definitive, (B) equivocal, or (C) negative. Any significant alteration in patient management post CE in the form of drug or surgical intervention was noted. Results: Total patients included in the study were 68 (48 males and 20 females). The ratio of male:female was 2.4:1. The age ranged between 16 years to 77 years. Mean age for males was 62±14 years, for females 58±16 years. The total yield of CE with definitive lesions was in 44/68 (65.0%) of patients. In descending order (A) angiodysplasia 16/68 (23.53%), (B) Crohn’s disease 10/68 (14.70%), (C) non-steroidal anti-inflammatory drug enteropathy 8/68 (11.76%), (D) small bowel ulcers 4/68 (5.88%), (E) jejunal and ileal polyps 2/68 (2.94%), (F) intestinal lymphangiectasis 2/68 (2.94%), and (G) ileal hemangiomas 2/68 (2.94%) were followed. Equivocal findings 12/68 (17.65%) and negative study 12/68 (17.65%) was found. Complications in the form of capsule retention in the distal ileum were noted in 2/68 (2.94%) subjects. Statistically, there was a higher probability of finding the etiology if the CE was done during an episode of bleeding. Conclusions: CE plays an important role in diagnosing etiologies of obscure GI bleeding. Its role in influencing the management outcome is vital. (Intest Res 2016;14:69-74)

Poster Session : PS 0609 ; Pulmonology ; Reversible Cerebellar Ataxia Following Prolonged Treatment with Metronidazole

( Vikas Asati ),( Girish Bhageshwar Ramteke ),( Ved Prakesh Pandey ),( Ajay Deep Bhatnagar ),( Atul Shende ),( Karuna Mujalda ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Metronidazole, a 5-nitroimidazole is widely used for treatment of anaerobic bacterial, protozoal infections, adverse reactions include nausea, dry-mouth, vomiting, diarrhoea. Neurologic toxicity is rare. We report a rare case of ataxia & cerebellar lesions following therapy with metronidazole, which resolved rapidly after discontinuation of drug. 50- year old male presented with fever, right-hypochondriac pain, diagnosed as multiple liver abscesses, managed initially by drainage-of abscess, intravenous ciprofioxacin, metronidazole for 7 days. He improved, was discharged on oral metronidazole800mg thrice-a-day for 7days. He did not return for followup, but continued medication for next 20 days when he presented with slurring of speech, in-coordination, progressive unsteadiness of gait, subsequent inability to walk. He was alert, oriented, speech dysarthric, horizontal nystagmus 2-3 beats on lateralgaze; no vertical nystagmus, heelto- shin, fi nger-to-nose tests abnormal, power normal. Tone decreased. Refi exes equal. Stance wide-based, felt unsteady, unable to walk without support, sensory normal. MRI Brain-abnormal T2 as well as fiAIR hyperintensities in Dentate nuclei, deep cerebellar parenchyma, splenium of corpus callosum. Serum Metronidazole levels were normal. After discontinuation of metronidazole, patient started regaining ambulatory function was able to walk with-support in 4 days, without-support in 10days. Follow-up MRI at 8 weeks was normal with resolution of hyperintensities of dentatenuclei, cerebellum. Discussion: Cerebellar toxicity is rare adverse-event in patients treated with metronidazole. While proposed mechanism was high cumulative dose in most patients (25-1080 grams), our patient inspite of taking about 75 grams had normal serum Metronidazole levels. Exact mechanism by which Metronidazole causes reversible cerebellar ataxia and Dentate nuclei changes is unclear. Cerebellar toxicity should be considered in any patient who presents with ataxia-dysarthria and is receiving prolonged therapy with metronidazole. MRI should be performed for defi nitive diagnosis and metronidazole withdrawn. Further studies are needed to defi ne the pathogenesis of this unusual event.

Poster Session : PS 0151 ; Neurology : Arnold Chiari with Hemiparesis, Hemisensory Loss with Lower Cranial Nerve Palsy

( Vikas Asatl ),( Girish Bhageshwar Ramteke ),( Vinatak Jatale ),( Vep Prakash Pandey ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

The Chiari I malformation (CMI) is caudal displacement of cerebellar tonsils into cervical spinal-canal. CMI is defi ned by tonsillar herniation more than 5 mm below foramen-magnum, may be congenital or acquired. We are presenting case of Arnold chiari with hemiparesis, hemisensory loss with lower cranial nerve palsy. 50 year male, complaints of tingling, numbness left LL, UL since 7 months, Weakness left LL, UL 6 months, drycough, diffi culty in swallowing, regurgitation of food, headache 3 months. Decubitus -supine position left leg extended laterally rotated, higher functions normal. Trigeminal- there is loss of all sensation modalities on left side of face, Gag refl ex is normal with normal palatal movement, Left side shoulder cannot be raised, power of tongue is slightly decreased on left, resting nystagmus with fast component toward right side. On attempting to see right side nystagmus increases while on seeing to left decreases. Heel-knee, fi nger-nose-test on right side is normal, on left side unable to do due to motor weakness. MRI Brain parenchyma normal. Inferior cerebellar tonsillar herniation in dorsal subarachnoid space extending about 6-7 mm below the posterior arch of atlas-Chiari Malformation type I, Mild indentation is seen on the dorsal surface of upper cervical cord. Minimal inferior displacement of 4th ventricle, no hydrocephalus, no syrinx. Discussion: Chiari malformations consist of varying degree of ectopia of cerebellum. Incidence in MRI is between 0.56% and 0.77%.Type I: Elongation of tonsils and medial parts of the inferior lobes of cerebellum into cone-shaped projections, which accompany medulla oblongata into spinal canal. Type II Displacement of parts of inferior vermis, pons, medulla-oblongata together with elongation of fourth ventricle (most cases with spina bifi da). Type III The entire cerebellum herniates into the cervical canal. Type IV is with Cerebellar hypoplasia.

V-REP-based navigation of automated wheeled robot between obstacles using PSO-tuned feedforward neural network

Anish Pandey,Vikas Singh Panwar,Md. Ehtesham Hasan,Dayal R. Parhi 한국CDE학회 2020 Journal of computational design and engineering Vol.7 No.4

This paper describes the navigation of an automated Pioneer P3-DX wheeled robot between obstacles using particle swarm optimization (PSO) algorithm tuned feedforward neural network (FNN). This PSO algorithm minimizes the mean square error between the actual and predicted values of the FNN. In this work, 2 separate DC motors and 16 ultrasonic sensors have been used for making differential drive steering angle and for collecting the distance from obstacles, respectively. The proposed without tuned FNN and PSO-tuned FNN receives obstacle’s distance as inputs form ultrasonic sensors and control the steering angle of a differential drive of automated Pioneer P3-DX wheeled robot as output. We have compared the results between without tuned FNN and PSO-tuned FNN, and it has been found that PSO-tuned FNN gives a better trajectory and takes less distance to reach the target. Virtual Robot Experimentation Platform software has been used to design the real-time simulation results. A comparative study between without tuned FNN and PSO-tuned FNN verifies the effectiveness of PSO-tuned FNN for automated Pioneer P3-DX wheeled robot navigation. Also, we have compared this winner PSO-tuned FNN to the previously developed PSO-optimized Fuzzy Logic Controller navigational technique to show the authenticity and real-time implementation of PSO-tuned FNN.

Difficult colonoscopy: air, carbon dioxide, or water insufflation?

( Alisha Chaubal ),( Vikas Pandey ),( Ruchir Patel ),( Prateik Poddar ),( Aniruddha Phadke ),( Meghraj Ingle ),( Prabha Sawant ) 대한장연구학회 2018 Intestinal Research Vol.16 No.2

Background/Aims: This study aimed to compare tolerance to air, carbon dioxide, or water insufflation in patients with anticipated difficult colonoscopy (young, thin, obese individuals, and patients with prior abdominal surgery or irradiation). Methods: Patients with body mass index (BMI) less than 18 kg/㎡ or more than 30 kg/㎡, or who had undergone previous abdominal or pelvic surgeries were randomized to air, carbon dioxide, or water insufflation during colonoscopy. The primary endpoint was cecal intubation with mild pain (less than 5 on visual analogue scale [VAS]), without use of sedation. Results: The primary end point was achieved in 32.7%, 43.8%, and 84.9% of cases with air, carbon dioxide and water insufflation (P<0.001). The mean pain scores were 5.17, 4.72, and 3.93 on the VAS for air, carbon dioxide, and water insufflation (P<0.001). The cecal intubation rate or procedure time did not differ significantly between the 3 groups. Conclusions: Water insufflation was superior to air or carbon dioxide for pain tolerance. This was seen in the subgroups with BMI < 18 kg/m2 and the post-surgical group, but not in the group with BMI >30 kg/㎡. (Intest Res 2018;16:299-305)

Nicotine Addiction: Neurobiology and Mechanism

Raj Kumar Tiwari,Vikas Sharma,Ravindra Kumar Pandey,Shiv Shankar Shukla 대한약침학회 2020 Journal of pharmacopuncture Vol.23 No.1

Nicotine, primary component of tobaco produces craving and withdrawal effect both in humans and animals. Nicotine shows a close resemblance to other addictive drugs in molecular, neuroanatomical and pharmacological, particularly the drugs which enhances the cognitive functions. Nicotine mainly shows its action through specific nicotinic acetylcholine receptors located in brain. It stimulates presynaptic acetylcholine receptors thereby enhancing Ach release and metabolism. Dopaminergic system is also stimulated by it, thus increasing the concentration of dopamine in nuclear accumbens. This property of nicotine according to various researchers is responsible for reinforcing behavioral change and dependence of nicotine. Various researchers have also depicted that some non dopaminergic systems are also involved for rewarding effect of nicotinic withdrawal. Neurological systems such as GABAergic, serotonergic, noradrenergic, and brain stem cholinergic may also be involved to mediate the actions of nicotine. Further, the neurobiological pathway to nicotine dependence might perhaps be appropriate to the attachment of nicotine to nicotinic acetylcholine receptors, peruse by stimulation of dopaminergic system and activation of general pharmacological changes that might be responsible for nicotine addiction. It is also suggested that MAO A and B both are restrained by nicotine. This enzyme helps in degradation dopamine, which is mainly responsible for nicotinic actions and dependence. Various questions remain uninsurable to nicotine mechanism and require more research. Also, various genetic methods united with modern instrumental analysis might result for more authentic information for nicotine addiction.

Nicotine Addiction: Neurobiology and Mechanism

Tiwari, Raj Kumar,Sharma, Vikas,Pandey, Ravindra Kumar,Shukla, Shiv Shankar KOREAN PHARMACOPUNCTURE INSTITUTE 2020 Journal of pharmacopuncture Vol.23 No.1

Nicotine, primary component of tobaco produces craving and withdrawal effect both in humans and animals. Nicotine shows a close resemblance to other addictive drugs in molecular, neuroanatomical and pharmacological, particularly the drugs which enhances the cognitive functions. Nicotine mainly shows its action through specific nicotinic acetylcholine receptors located in brain. It stimulates presynaptic acetylcholine receptors thereby enhancing Ach release and metabolism. Dopaminergic system is also stimulated by it, thus increasing the concentration of dopamine in nuclear accumbens. This property of nicotine according to various researchers is responsible for reinforcing behavioral change and dependence of nicotine. Various researchers have also depicted that some non dopaminergic systems are also involved for rewarding effect of nicotinic withdrawal. Neurological systems such as GABAergic, serotonergic, noradrenergic, and brain stem cholinergic may also be involved to mediate the actions of nicotine. Further, the neurobiological pathway to nicotine dependence might perhaps be appropriate to the attachment of nicotine to nicotinic acetylcholine receptors, peruse by stimulation of dopaminergic system and activation of general pharmacological changes that might be responsible for nicotine addiction. It is also suggested that MAO A and B both are restrained by nicotine. This enzyme helps in degradation dopamine, which is mainly responsible for nicotinic actions and dependence. Various questions remain uninsurable to nicotine mechanism and require more research. Also, various genetic methods united with modern instrumental analysis might result for more authentic information for nicotine addiction.

CASE REPORT : A Rare Case of Hypermobile Mesentery With Segmental Small Bowel Pneumatosis Cystoides Intestinalis

( Chetan Rathi ),( Nirav Pipaliya ),( Prateik Poddar ),( Vikas Pandey ),( Meghraj Ingle ),( Prabha Sawant ) 대한장연구학회 2015 Intestinal Research Vol.13 No.4

Pneumatosis intestinalis is a rare condition that affects 0.03% of the population. Pneumatosis cystoides intestinalis (PCI) is characterized by the presence of multiple gas-filled cysts in the intestinal wall and the submucosa and/or intestinal subserosa. It is usually a secondary finding caused by a wide variety of underlying gastrointestinal or extragastrointestinal diseases. Here, we present the case of a 47-year-old man who was referred to our gastroenterology department with a history suggestive of intermittent small bowel obstruction associated with abdominal pain. Abdominal computed tomography demonstrated PCI of the small bowel. The mesentery and branches of the superior mesenteric artery and superior mesenteric vein were twisted with minimal pneumoperitoneum. Exploratory laparotomy was performed, and demonstrated segmental small bowel PCI secondary to hypermobile mesentery. The affected segment of the ileum was resected, and jejunoileal anastomosis was performed. Here, we report a rare case of segmental PCI probably due to repeated twisting of hypermobile mesentery. The clinical and imaging features of this disorder may mimic those of visceral perforation or bowel ischemia. PCI can be a cause of severe abdominal pain that may require surgical intervention. (Intest Res 2015;13:346-349)

When to Discharge a Patient After Endoscopy: A Narrative Review

Swapnil Sahebrao Walke,Shamshersingh Chauhan,Vikas Pandey,Rahul Jadhav,Vipul Chaudhari,Deepti Vishwanathan,Kailash Kolhe,Meghraj Ingle 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.1

Video endoscopy is an important modality for the diagnosis and treatment of various gastrointestinal diseases. Most endoscopicprocedures are performed as outpatient basis, sometimes requiring sedation and deeper levels of anesthesia. Moreover, advancesin endoscopic techniques have allowed invasion into the third space and the performance of technically difficult procedures thatrequire the utmost precision. Hence, formulating strategies for the discharge of patients requiring endoscopy is clinically and legallychallenging. In this review, we have discussed the various criteria and scores for the discharge of patients who have undergoneendoscopic procedures with and without anesthesia.

Antidiabetic activity of an Ayurvedic Formulation Chaturmukha Rasa: A mechanism based study

Akansha Sharma,Raj K Tiwari,Vikas Sharma,Ravindra K Pandey,Shiv Shnakar Shukla 대한약침학회 2019 Journal of pharmacopuncture Vol.22 No.2

Objectives: The objective of this study was to evaluate antidiabetic activity of Chaturmukha rasa based on streptozotocin induced diabetes model, alpha amylase inhibitory activity, alpha Glucosidase inhibitory activity and inhibition of sucrase. Methods: Chaturmukha rasa was prepared as per Ayurvedic formulary. Antidiabetic activity was measured in experimentally streptozotocin induced rats. The dose was taken as 45 mg/kg, i.p. The antidiabetic activity of Chaturmukha rasa was compared Triphala Kwatha, a marketed formulation. Further In vitro ά- Amylase Inhibitory Assay, In vitro salivary amylase Inhibitory Assay, In vitro α-Glucosidase Inhibitory Assay and In vitro Sucrase Inhibitory Assay was performed with respect to Chaturmukha rasa. The IC50 value was calculated for all the above activity. Results: Streptozotocin with Acarbose showed significant decrease in blood glucose level whereas streptozo-tocin with Triphala kwatha showed more decrease in blood glucose level than Streptozotocin with Acarbose. The combination of Streptozotocin + Triphala kwatha + Chaturmukha rasa showed a significant decrease in blood glucose level on 21st day. In vitro ά- Amylase Inhibitory Assay the Chaturmukha rasa showed IC50 value 495.94 μl when compared with Acarbose 427.33 μl, respectively. In the α-Glucosidase Inhibitory Assay Chaturmukha rasa showed IC50 value 70.93 μl when compared with Acarbose 102.28 μl, respectively. In vitro Sucrase Inhibitory Assay Chaturmukha rasa showed IC50 value 415.4 μl when compared with Acarbose 371.43 μl, respectively. Conclusion: This study supports that Chaturmukha rasa may inhibit diabetes by inhibition of salivary amylase or alpha Glucosidase or sucrase. This may be the mechanism by which Chaturmukha rasa inhibits diabetes. Further this study supports the usage of Chaturmukha rasa for the management of diabetes.