Higher Trough Concentrations of Infliximab are Associated with Clinical Remission and Mucosal Healing in Patients with Inflammatory Bowel Disease

There is increasing evidence that clinical remission (CR) and mucosal healing (MH) are associated with better response to treatment, less hospitalization, lower surgery rates, and improved quality of life in patients with inflammatory boweldisease (IBD). 

Infliximab (IFX), an anti-tumor necrosis factor alpha (TNF-α) antibody, has promoted MH and improved long-term outcomes in patients with moderately to severely active Crohn’s disease (CD) and ulcerative colitis (UC). Despite its effectiveness in both induction and maintenance of remission, a substantial number of patients will eventually loose response. Sustained response, long-term CR and complete MH have become major goals in IBD therapy. Read more>>>>>>>>>>>>>>>

Bowel Habit Pattern and Perception about Bowel Habit Pattern of Medical Students

Defining normal bowel habit is important when evaluating diarrhea or constipation. Normal stool frequency and consistency vary from person to person and in different populations due to several factors including dietary habit, quantity of fiber intake and difference in gut transit time. Studies showed that 98%normal persons had bowel movement ranging between three stools per day and three per week and Some degree of urgency, straining, and incomplete evacuation should be considered normal. 

Studies reported that mean stool frequency is higher in several Asian populations (7.09 -14/week), but data on stool form is lacking. A recent community-based study reported a mean stool frequency of 9 ± 3.7 per week and T4 (55.9%) as the predominant stool type in the general population of Bangladesh. Daily fecal output varies depending on dietary pattern. In most of the Asian communities due to high fiber intake stool volume is higher than Western population. In North India, among the vegetarians’ a stool output of 312 gm/24 hour was reported. Read more>>>>>>>>>>>>>

Role of Gastric Acid in Dyspepsia

“Dyspepsia” is a Greek word, which means bad digestion. Functional dyspepsia is a clinical syndrome characterized by chronic or recurrent upper abdominal pain or discomfort, in the absence of underlying organic disease to explain the symptoms. The symptom complex includes epigastric pain, bloating, early satiety, fullness, epigastric burning, belching, nausea and vomiting. The Rome II definitionexcludes patients with predominant reflux symptoms. 

The annual prevalence of recurrent abdominal pain or discomfort is approximately 25%. Functional dyspepsia tends to be a rather common, chronic condition, which, with the ever-increasing cost of drugs, poses a constant challenge to the treating physician. The management of dyspepsia represents a major component of clinical practice; 2-5% of family practice consultations are for dyspepsia. Empirical acid suppression is one of the main approaches for the treatment of functional dyspepsia. Read more>>>>>>>>>>>>

A Rare Case of Herniated Renal Cyst Through Grynfeltt’s Triangle

Lumbar hernias represent a rare entity among the abdominal wall defects. They are rare defects involving two weak areas of the postero-lateral abdominal wall: the superior lumbar triangle of Grynfeltt-Lesshaft, which is the most common site, and the inferior lumbar triangle of Petit. Antomically Grynfeltt’s triangle is bounded: above by the twelfth rib, medially by the sacrospinalis muscle, laterally by the posterior border of the internal oblique muscle.

This rare hernia can be classified as congenital (approximately 20%), generally associated with other malformations, or acquired (around 80%), presenting in adults spontaneously or secondary to trauma or surgical incisions. The hernial sac content is generally characterized by retroperitoneal fat. We present a case of a 80 years old man who presented right lower back pain associated with a palpable mass for 5 years. The past medical history revealed a not well defined surgical procedure for a right renal trauma. Read more>>>>>>>

Clinical Experience with Lift Technique For Complex Anal Fistulas

An anal fistula is an abnormal pathological tract between the anal canal and the perianal skin which primarily originates from the abscess formation with crypto-glanduler infection. The estimated prevalence of anal fistula is 12 to 28/100.000 of theper year and male to female ratio is 1.8:1.The classification of the anal fistula has shown variabilities, but the simplest and the most widely used one is the Park’s classification. In this classification five main types are described according to the relationship of the fistula to the anal sphincter muscles; intersphincteric, transsphincteric, suprasphincteric, extrasphincteric and superficial fistulas. 

This system doesn’t describe the presence of abscesses, fistulas connections to bladder or vagina, so that modified Park’s classification system had been formed. The anal fistulas are also described as simple or complex fistulas by American Gastroenterological Association. The simple fistulas originate below the dentate line (low type) and involves small part ofthe sphincter complex. Superficial, low intersphincteric or low transsphincteric fistulas are in this group.

Conversely complex fistulas originate above the dentate line (high type), and involves the significant part of the sphincter mechanism. Anterior fistula in women, recurrent fistula,fistulas with multiple tracts, patients with preexisting incontinence are included in this group. And complex fistulas may be associated with local irradiation or Crohn disease. Read more>>>>>>>>>>>>>>

Pediatric Siblings in Inflammatory Bowel Disease

The Inflammatory Bowel Diseases (IBD) represent several diseases in which there is inflammation of various segments of the intestinal tract. In addition, there are many manifestations involving other systems of the body, i.e., extra intestinal manifestations. IBD is felt to be a disease of immune dysregulation. There has been great progress in elucidating the epidemiology, genetics, and pathophysiology of IBD during the past severaldecades. Yet the overall incidence of IBD has continued to increase.

IBD has also become a more global as well. There has also been a concomitant increase in cases of IBD presenting in the pediatric age group. Numerous epidemiologic studies have searched for factors that may shed light on the etiology of IBD. However, the specific etiology(ies) of IBD remain elusive. Familial occurrence of IBD is a well-established risk factor. A patient with IBD has a significantly greater chance of having a first-degree relative who also has IBD. Read more...........

Surgical Treatment of a Perianal Paget's Disease

Paget´s disease is an intraepithelial adenocarcinoma of the mammary glands. It’s extra-mammary location was described afterwards. Extra-mammary Paget’s disease (EMPD) is a rare and slow progressive skin lesion arising from the apocrine glands located in the perineum, perianal region, groin, scrotum and vulva. Its incidence and prevalence are not well known. The main histologic feature are the Paget cells; large, basophil, vacuolated, PAS+ cells. As noted in previous publications Perianal Paget’s disease can be associated with synchronous ormetachronous visceral malignancies. 

This makes necessary to complete the study of the patient with a colonoscopy and imagery, such as CT scan. And also imposes a long-term follow-up. Symptoms are nonspecific sometimes leading to a delay diagnosis. Clinical presentation includes exfoliated, exudative, and warty or hypopigmented patches associated with perianal pruritus or pain. Dermatologists generally diagnose it after the lack of response to both local and systemic treatments. Read more......................