Management of Chronic Pancreatitis- Step Up?

( Peeyush Varshney ),( Rk Singh ),( Anu Behari ),( Ashok Kumar ),( Vk Kapoor ),( Rajan Saxena ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: Endoscopic treatment is used in several units prior to surgical treatment for pain in chronic pancreatitis. There is limited information on patients who undergo surgical ‘salvage’ after endoscopic failure. We conducted a comparative study between patients who had undergone surgery after prior non-surgical intervention and upfront surgery. Methods: Patients who underwent surgical drainage in our institution over the last 6 years were reviewed, in two groups- Group A (n=29) - surgery with prior non-surgical interventions (ESWL and/or endoscopy); Group B (n=79) - upfront surgery. Pain scores and QOL scores were measured prospectively. Results: The two groups were comparable for baseline characteristics except that group A patients had more strictures/ stones in body and tail region (P<0.05). Short term morbidity was more in Group A vs Group B (65% vs 26%, P<0.01) - wound infection (45% vs 10%, P<0.01; Gastroparesis (10% vs nil, P<0.01). On long term followup complete pain relief was worse in Group A patients (37% vs 68%, P=0.05). Quality of life scores (WHOQOL- BREF) in social domain was significantly better in Group B. Improvement in exocrine and endocrine insufficiency was similar in both groups. Conclusions: Patients with chronic pancreatitis who undergo ‘salvage’ surgery after non-surgical interventions are at increased risk of postoperative morbidity, lower quality of life and poor pain control as compared to those who undergo upfront surgery. Patients with pancreatic body/tail strictures/ stones have poor outcomes with non-surgical interventions and may be considered for upfront surgery.

Total robotic right hepatectomy for multifocal hepatocellular carcinoma using vessel sealer

Peeyush Varshney,Vaibhav Kumar Varshney 한국간담췌외과학회 2023 Annals of hepato-biliary-pancreatic surgery Vol.27 No.1

Rapid adoption of a robotic approach as a minimally invasive surgery tool has enabled surgeons to perform more complex hepatobiliary surgeries than conventional laparoscopic surgery. Although various types of liver resections have been performed robotically, parenchymal transection is challenging as commonly used instruments (Cavitron Ultrasonic Surgical Aspirator [CUSA] and Harmonic) lack articulation. Further, CUSA also requires a patient-side assistant surgeon with hepatobiliary laparoscopic skills. We present a case report of total robotic right hepatectomy for multifocal hepatocellular carcinoma in a 70-year-old male using ‘Vessel Sealer’ for parenchymal transection. Total operative time was 520 minutes with a blood loss of ~400 mL. There was no technical difficulty or instrument failure encountered during surgery. The patient was discharged on postoperative day five without any significant complications such as bile leak. Thus, Vessel Sealer, a fully articulating instrument intended to seal vessels and tissues up to 7 mm, can be a promising tool for parenchymal transection in a robotic surgery.

Serum albumin is the strongest predictor of anti-tumor necrosis factor nonresponse in inflammatory bowel disease in resource-constrained regions lacking therapeutic drug monitoring

Peeyush Kumar,Sudheer K. Vuyyuru,Prasenjit Das,Bhaskar Kante,Mukesh Kumar Ranjan,David Mathew Thomas,Sandeep Mundhra,Pabitra Sahu,Pratap Mouli Venigalla,Saransh Jain,Sandeep Goyal,Rithvik Golla,Shubi 대한장연구학회 2023 Intestinal Research Vol.21 No.4

Background/Aims: Evidence on predictors of primary nonresponse (PNR), and secondary loss of response (SLR) to anti-tumor necrosis factor (anti-TNF) agents in inflammatory bowel disease is scarce from Asia. We evaluated clinical/biochemical/molecular markers of PNR/SLR in ulcerative colitis (UC) and Crohn’s disease (CD).Methods: Inflammatory bowel disease patients treated with anti-TNF agents (January 2005–October 2020) were ambispectively included. Data concerning clinical and biochemical predictors was retrieved from a prospectively maintained database. Immunohistochemistry for expression of oncostatin M (OSM), OSM receptor (OSM-R), and interleukin-7 receptor (IL-7R) were done on pre anti-TNF initiation mucosal biopsies.Results: One-hundred eighty-six patients (118 CD, 68 UC: mean age, 34.1±13.7 years; median disease duration at anti-TNF initiation, 60 months; interquartile range, 28–100.5 months) were included. PNR was seen in 17% and 26.5% and SLR in 47% and 28% CD and UC patients, respectively. In CD, predictors of PNR were low albumin (<i>P</i><0.001), postoperative recurrence (<i>P</i>=0.001) and high IL-7R expression (<i>P</i><0.027) on univariate; and low albumin alone (hazard ratio [HR], 0.09; 95% confidence interval [CI], 0.03–0.28; <i>P</i><0.001) on multivariate analysis respectively. Low albumin (HR, 0.31; 95% CI, 0.15–0.62; <i>P</i>=0.001) also predicted SLR. In UC, predictors of PNR were low albumin (<i>P</i><0.001), and high C-reactive protein (<i>P</i><0.001), OSM (<i>P</i><0.04) and OSM-R (P=0.07) stromal expression on univariate; and low albumin alone (HR, 0.11; 95% CI, 0.03–0.39; <i>P</i>=0.001) on multivariate analysis respectively. Conclusions: Low serum albumin at baseline significantly predicted PNR in UC and PNR/SLR in CD patients. Mucosal markers of PNR were high stromal OSM/OSM-R in UC and high IL-7R in CD patients.

Coenzyme Q10: a progress towards the treatment of neurodegenerative disease

Peeyush kumar,Pramod kumar,Alpana ram,Mithilesh kumar,Rajeev kumar 경희대학교 융합한의과학연구소 2010 Oriental Pharmacy and Experimental Medicine Vol.10 No.4

Coenzyme Q10 (CoQ10, or ubiquinone) is an electron carrier of the mitochondrial respiratory chain (electron transport chain) with antioxidant properties. In view of the involvement of CoQ10 in oxidative phosphorylation and cellular antioxidant protection a deficiency in this quinone would be expected to contribute to disease pathophysiology by causing a failure in energy metabolism and antioxidant status. Indeed, a deficit in CoQ10 status has been determined in a number of neuromuscular and neurodegenerative disorders. Primary disorders of CoQ10 biosynthesis are potentially treatable conditions and therefore a high degree of clinical awareness about this condition is essential. A secondary loss of CoQ10 status following HMG-CoA reductase inhibitor (statins) treatment has been implicated in the pathophysiology of the myotoxicity associated with this pharmacotherapy. CoQ10 and its analogue, idebenone, have been widely used in the treatment of neurodegenerative and neuromuscular disorders. These compounds could potentially play a role in the treatment of mitochondrial disorders, Parkinson’s disease, Huntington’s disease, amyotrophic lateral sclerosis, Friedreich’s ataxia, and other conditions which have been linked to mitochondrial dysfunction. This article reviews the physiological roles of CoQ10, as well as the rationale and the role in clinical practice of CoQ10 supplementation in different neurological diseases, from primary CoQ10 deficiency to neurodegenerative disorders. These will help in future for treatment of patients suffering from neurodegenerative disease.

Coenzyme Q₁₀: a progress towards the treatment of neurodegenerative disease

Kumar, Peeyush,Kumar, Pramod,Ram, Alpana,Kuma, Mithilesh,Kumar, Rajeev Kyung Hee Oriental Medicine Research Center 2010 Oriental pharmacy and experimental medicine Vol.10 No.4

Coenzyme $Q_{10}$ ($CoQ_{10}$, or ubiquinone) is an electron carrier of the mitochondrial respiratory chain (electron transport chain) with antioxidant properties. In view of the involvement of $CoQ_{10}$ in oxidative phosphorylation and cellular antioxidant protection a deficiency in this quinone would be expected to contribute to disease pathophysiology by causing a failure in energy metabolism and antioxidant status. Indeed, a deficit in $CoQ_{10}$ status has been determined in a number of neuromuscular and neurodegenerative disorders. Primary disorders of $CoQ_{10}$ biosynthesis are potentially treatable conditions and therefore a high degree of clinical awareness about this condition is essential. A secondary loss of $CoQ_{10}$ status following HMG-CoA reductase inhibitor (statins) treatment has been implicated in the pathophysiology of the myotoxicity associated with this pharmacotherapy. $CoQ_{10}$ and its analogue, idebenone, have been widely used in the treatment of neurodegenerative and neuromuscular disorders. These compounds could potentially play a role in the treatment of mitochondrial disorders, Parkinson's disease, Huntington's disease, amyotrophic lateral sclerosis, Friedreich's ataxia, and other conditions which have been linked to mitochondrial dysfunction. This article reviews the physiological roles of $CoQ_{10}$, as well as the rationale and the role in clinical practice of $CoQ_{10}$ supplementation in different neurological diseases, from primary $CoQ_{10}$ deficiency to neurodegenerative disorders. These will help in future for treatment of patients suffering from neurodegenerative disease.

Fault Immune Pico-Hydro Powered Base Station of Remote Telecommunication Tower

Vishal Verma,Peeyush Pant,Bhim Singh 전력전자학회 2016 JOURNAL OF POWER ELECTRONICS Vol.16 No.4

This paper presents the dynamic excitation control of a siphon-turbine coupled pico-hydro powered cage rotor induction generator and load matching for off-grid electricity generation. Through the proposed dual-role of the current-controlled voltage source converter (VSC), acting as static synchronous compensator and load controller, real and reactive power are dynamically controlled in a decoupled manner with a self supported DC-bus. The proposed scheme entails minimal computation for ensuring the rated (set) capacity of real power. The scheme also exhibits fault immunity for protection, thus enabling the effective handling of constant power electrical loads presented by base telecom station towers in remote locations. The performance of the system is evaluated under MATLAB/Simulink and is experimented through a developed hardware prototype. Simulation and experimental results show close conformity and validate the effectiveness of the proposed scheme.

Robotic-assisted resection of proximal jejunal ischemic stricture and intracorporeal robot-sewn anastomosis

Vishu Jain,Peeyush Varshney,Subhash Chandra Soni,Vaibhav Kumar Varshney,B Selvakumar 대한내시경로봇외과학회 2022 Journal of Minimally Invasive Surgery Vol.25 No.4

With the advent of robotic surgery as an effective means of minimally invasive surgery in the last decade, more and more surgeries are being performed robotically in today’s world. Robotic surgery has several advantages over conventional laparoscopic surgery, such as three-dimensional vision with depth perception, magnified view, tremor filtration, and, more importantly, degrees of freedom of the articulating instruments. While the literature is abundant on robotic cholecystectomy and highly complex hepatobiliary surgeries, there is hardly any literature on robotic small bowel resection with intracorporeal anastomosis. We present a case of a 50-year-old male patient with a symptomatic proximal jejunal ischemic stricture who underwent robotic-assisted resection and robot-sewn intracorporeal anastomosis in two layers. He did well in the postoperative period and was discharged on postoperative day 4 with uneventful recovery. We hereby discuss the advantages and disadvantages of robotic surgery in such a scenario with a review of the literature.

Interferon-gamma release assay has poor diagnostic accuracy in differentiating intestinal tuberculosis from Crohn’s disease in tuberculosis endemic areas

Karan Sachdeva,Peeyush Kumar,Bhaskar Kante,Sudheer K. Vuyyuru,Srikant Mohta,Mukesh K. Ranjan,Mukesh K. Singh,Mahak Verma,Govind Makharia,Saurabh Kedia,Vineet Ahuja 대한장연구학회 2023 Intestinal Research Vol.21 No.2

Background/Aims: Intestinal tuberculosis (ITB) and Crohn’s disease (CD) frequently present with a diagnostic dilemma because of similar presentation. Interferon-gamma release assay (IGRA) has been used in differentiating ITB from CD, but with sparse reports on its diagnostic accuracy in tuberculosis endemic regions and this study evaluated the same. Methods: Patients with definitive diagnosis of ITB (n=59) or CD (n=49) who underwent IGRA testing (n=307) were retrospectively included at All India Institute of Medical Sciences, New Delhi (July 2014 to September 2021). CD or ITB was diagnosed as per standard criteria. IGRA was considered positive at >0.35 IU/mL. Relevant data was collected and IGRA results were compared between ITB and CD to determine its accuracy. Results: Among 59 ITB patients (mean age, 32.6±13.1 years; median disease duration, 1 year; male, 59.3%), 24 were positive and 35 tested negative for IGRA. Among 49 CD patients (mean age, 37.8±14.0; median disease duration, 4 years; male, 61.2%), 12 were positive and 37 tested negative for IGRA. Hence, for diagnosing ITB, IGRA showed a sensitivity, specificity, positive and negative predictive values of 40.68%, 75.51%, 66.67%, and 51.39%, respectively. The area under the curve of IGRA for ITB diagnosis was 0.66 (95% confidence interval, 0.55–0.75). In a subset (n=64), tuberculin skin test (TST) showed sensitivity, specificity, positive and negative predictive values of 64.7%, 73.3%, 73.3%, and 64.71%, respectively. IGRA and TST were concordant in 38 (59.4%) patients with κ=0.17. Conclusions: In a tuberculosis endemic region, IGRA had poor diagnostic accuracy for differentiating ITB from CD, suggesting a limited value of IGRA in this setting.

Open injury, robotic repair—moving ahead! Total robotic Roux-en-Y hepaticojejunostomy for post-open cholecystectomy Bismuth type 2 biliary stricture using indocyanine green dye

Kaushal Singh Rathore,Peeyush Varshney,Subhash Chandra Soni,Vaibhav Kumar Varshney,Selvakumar B,Lokesh Agarwal,Chhagan Lal Birda 대한내시경로봇외과학회 2023 Journal of Minimally Invasive Surgery Vol.26 No.3

Hepaticojejunostomy is currently the best treatment for post-cholecystectomy biliary strictures. Laparoscopic repair has not gained popularity due to difficult reconstruction. We present case of 43-year-old-female with Bismuth type 2 stricture following laparoscopic converted open cholecystectomy with bile duct injury done elsewhere. Position was modified Llyod-Davis position and four 8-mm robotic ports (including camera) and 12-mm assistant port were placed. The procedure included noticeable steps such as adhesiolysis, identification of gallbladder fossa, identification of common hepatic duct, lowering of hilar plate etc. Operating and console time were 420 and 350 minutes and blood loss was 100 mL. Patient was discharged on postoperative day 4. Robotic repair (hepaticojejunostomy) of biliary tract stricture after cholecystectomy is safe and feasible with good outcomes.

Fault Immune Pico-Hydro Powered Base Station of Remote Telecommunication Tower

Verma, Vishal,Pant, Peeyush,Singh, Bhim The Korean Institute of Power Electronics 2016 JOURNAL OF POWER ELECTRONICS Vol.16 No.4

This paper presents the dynamic excitation control of a siphon-turbine coupled pico-hydro powered cage rotor induction generator and load matching for off-grid electricity generation. Through the proposed dual-role of the current-controlled voltage source converter (VSC), acting as static synchronous compensator and load controller, real and reactive power are dynamically controlled in a decoupled manner with a self supported DC-bus. The proposed scheme entails minimal computation for ensuring the rated (set) capacity of real power. The scheme also exhibits fault immunity for protection, thus enabling the effective handling of constant power electrical loads presented by base telecom station towers in remote locations. The performance of the system is evaluated under MATLAB/Simulink and is experimented through a developed hardware prototype. Simulation and experimental results show close conformity and validate the effectiveness of the proposed scheme.