My association with Dr Nijhawan dates back to when I was a schoolboy. He was my elder brother's closest friend. He was always bubbling with energy and wild laughter. He was an effervescent, jovial, tall and handsome young boy, who went to do medicine from Sawai Man Singh (SMS) Medical College, Jaipur, where he excelled not only in academics, but also in sports, cultural and literary events. He was a true all-rounder and had the passion and perseverance to take up any assignment. He was a very hard-working student whose college notes were most sought after by his juniors due to his impeccable handwriting.With little exposure in the field of gastroenterology at Jaipur, it was really commendable for him to get selected for the DM course at the All India Institute of Medical Sciences, New Delhi, in his first attempt itself, in 1987. He did his DM under the guidance of Prof B N Tandon, who was himself a pioneer in the field of clinical gastroenterology in the country.In 1991, he joined as an Assistant Professor at SMS Medical College and since then, he has never looked back. At present, he is a Senior Professor at the Department of Gastroenterology. He is a great teacher and mentor to his students and peers. Apart from gastroenterology, he has been teaching all his colleagues how to live life to the fullest. He makes one realize how one can enjoy life by being positive, practicing regular sports and taking part in cultural activities. Recently, he has taken to photography as well, which has brought forth his hidden talent, artistic and innovative skills.With his keen interest in research and amazing engineering skills, he developed numerous indigenous endoscopic accessories that have been widely accepted throughout the country. These were innovative, easy to use and cost-effective, which made these extremely popular among all gastroenterologists and GI surgeons. A few of these, including achalasia balloon dilator, foreign body removal accessories (loop basket and magnets), are widely used at several endoscopy centers. He also has over 200 national and international publications on various aspects of gastroenterology.
Background: Background: Celiac diseases are found to be associated with other autoimmune diseases such as autoimmune thyroiditis, type I diabetes, Addison’s disease, primary biliary cirrhosis, and inflammatory bowel disease (IBD). In literature, only a few cases were described simultaneously presenting both conditions in the same patient. Case Presentation:: A 23-year-old Indian male presented with a one-month history of loose motion 10-12 times per day, having watery stool, and nocturnal diarrhea. The patient had pallor, weakness, fatigability, and anorexia/weight loss. The patient also had a history of periumbilical pain abdomen and black-colored stools. In our study, both conditions are clinically symptomatic in the same patient, as proved by endoscopic changes and histopathologically. Esophagogastroduodenoscopy (EGD) examination shows severe scalloping of duodenal folds and nodularity, indicating celiac disease changes. A colonoscopy examination was performed, which revealed multiple linear longitudinal ulcerations, friability, erosions and absent vascularity, which indicates Crohn’s disease. Duodenal biopsy shows celiac disease (Marsh IIIa), and Colonic biopsy shows Crohn’s disease. The patient was treated with improvement in abdominal pain, weight, and anemia. Conclusion: Celiac and Crohn’s both conditions are clinically symptomatic in the same patient, as proved by endoscopic and histopathological changes.
Background: Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a common complication of therapeutic endoscopy. The aim of this trial was to determine whether a combination of rectal diclofenac and vigorous hydration with Ringer's lactate is superior to the corresponding individual treatments for preventing PEP in high-risk patients. Methods: This randomized, open-label, controlled trial was conducted from August 2020 to January 2022. We included patients who were at high risk of developing PEP. Three intervention groups were made: group A, diclofenac sodium suppository (100 mg); group B, aggressive hydration with Ringer's lactate; group C, a combination of diclofenac and aggressive hydration. PEP was defined as a serum amylase level > 3 times the upper limit of normal with epigastric pain within 24 hours after endoscopic retrograde cholangiopancreatography. Results: A total of 144 patients were included and 48 cases were randomized to each intervention group. The incidence of PEP was 8.3%, 10.4%, and 8.3% in groups A, B, and C, respectively. A personal history of alcohol consumption and more than one pancreatic duct guidewire cannulation were significantly associated with the development of PEP. Conclusion: No difference in the incidence of PEP was observed with or without the use of aggressive hydration. Combining aggressive hydration with a rectal nonsteroidal anti-inflammatory drug for preventing PEP cannot be recommended.
Background: Sarcopenia and low serum testosterone levels are both associated with increased mortality in patients with advanced liver disease. Sarcopenia is a major stumbling block of liver cirrhosis and adversely affects other outcome variables. Objective: The aim of this study is to compare testosterone levels between sarcopenia and non-sarcopenia cirrhosis patients, to compare serum testosterone levels with cirrhosis severity (Child-Pugh Score), evaluate the correlation between serum testosterone levels and L3 SMI Index (Sarcopenia), the correlation between serum testosterone levels with other prognostic markers of cirrhosis (MELD score) Method: An observational study of 131 prospectively collected liver cirrhosis patients, who met the inclusion and exclusion criteria, was conducted in the Department of Gastroenterology, National Institute of Medical Sciences and Research, NIMS University, Jaipur, Rajasthan, India, between August 2019 and July 2021. Spearman’s correlation coefficient was used to evaluate the correlation between testosterone levels and L3 SMI. Results: The mean testosterone level in sarcopenia patients was significantly lowered compared to non-sarcopenia patients (152.05± 90.48 vs. 364.28 ±73.55; p=0.05). The mean testosterone level was highest in Child A than in Child B and lowest in Child C, which was statistically significant (383.50 ± 54.41 vs. 225.06 ± 58.43 vs. 83.38 ± 25.49, p=0.05). There was a significantly positive correlation between serum testosterone levels and L3 SMI index by MRI (r = 0.619 and p-value <0.000). There was a significant negative correlation between the MELD score and serum testosterone levels. Conclusion: Serum testosterone levels were significantly lower in sarcopenic as compared to non-sarcopenic patients. Serum testosterone levels progressively decreased as liver disease severity increased. There was a significant positive correlation between serum testosterone levels and L3-SMI Index (Sarcopenia)
A foreign body or food bolus impaction in the gastrointestinal tract is a common occurrence in emergency endoscopy. In 80-90% of patients, the foreign body will pass spontaneously through the gastrointestinal tract without complications, and in 10-20% of the patients, an endoscopic or surgical intervention is deemed necessary. We report an unusual case of a foreign body, a large mango seed, that was stuck at the level of the mid-esophagus and was refractory to removal by standard endoscopic techniques.
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