Bethesda Hospital

About: Bethesda Hospital is a healthcare organization based out in Ambur, Tamil Nadu, India. It is known for research contribution in the topics: Population & Helicobacter pylori. The organization has 386 authors who have published 472 publications receiving 15193 citations.

Letter-to-the-editor on Yang et al. Surg Endosc 2008;22:1620–1624

Abstract: Dear Sir, We read with great interest the article by Yang et al. on biochemical predictors of common bile duct (CBD) stones [1], not least because we wrote a review article on the very same subject 15 years ago [2]. Obviously, the authors are to be congratulated on the enormous amount of data they have gathered on this interesting subject. Still, they have left us with some questions. First, since it is known that a combination of clinical and biochemical parameters increases the probability of CBD stones up to [90% [3], we wonder if it was specifically asked whether there were any signs of CBD obstruction (jaundice, light faeces, dark urine)? Second, since more than 7% of the patients did not undergo ultrasonography: was this not the first diagnostic imaging technique in the authors’ clinic in all cases, or were some patients asymptomatic? Third, for reasons of costs and radiation safety: why was the number of computed tomography (CT) scans so enormously high (almost one in every four patients)? This is especially interesting as the authors themselves state that this diagnostic tool is usually not recommended as the diagnostic modality of choice to predict absence or presence of CBD stones [1]. Finally, did the authors test the combination of more than twofold elevated total bilirubin and alkaline phosphatase as a predictor for CBD stones, which works well in our experience?

Inaugural address of the President-elect and Vice Chair of the Board

Abstract: I am very excited about the wonderful opportunity that you have given me to serve as ASHP’s next president. I would like to begin by acknowledging a few key people in my life. First, my family . . . my mom and dad are my number one cheerleaders. They have been wonderful role models for me because

Glycogen Hepatopathy: A Reversible yet Relapsing Cause of Hepatitis in Type 1 Diabetics.

Abstract: Glycogen hepatopathy (GH), a rare glycogen storage disease caused by genetic or acquired overactivation of hepatic glycogen synthesis enzymes, can mimic non-alcoholic fatty liver disease (NAFLD). We describe a case of biopsy-proven GH in an adult with type 1 diabetes mellitus (DM). A 33-year-old Honduran woman with a 25-year history of type 1 DM complicated by gastroparesis, multiple episodes of diabetic ketoacidosis (DKA) and hypoglycemia, and recurrent pancreatitis was referred for abnormal liver enzymes. Family history was negative for liver disease. There was no history of alcohol or recreational drug use. Patients' medications included insulin and thyroxine. Physical exam showed hepatomegaly but no stigmata of chronic liver disease. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) had ranged from 100's to over 7000 U/L while alkaline phosphatase (ALP) was elevated to over 400 IU/L. Albumin, total bilirubin, platelets, international normalized ratio (INR), eosinophils, viral hepatitis panel, antinuclear antibody (ANA), smooth muscle antibody (Ab), anti-liver-kidney microsomal (LKM) Ab, celiac serologies, ceruloplasmin, alpha 1 antitrypsin, iron studies, and acetaminophen levels were all normal. An abdominal ultrasound showed "fatty liver" and an atrophic pancreas. CT abdomen showed hepatomegaly. The common bile duct (CBD) was found to be normal on endoscopic ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP). A liver biopsy was pursued eventually, demonstrating glycogenotic hepatocytes. GH is frequently misdiagnosed as NAFLD, a more common liver disease that occurs in association with diabetes While GH is known to be reversible, NAFLD has been known to progress to advanced liver disease, ranging from cirrhosis to hepatocellular carcinoma. Definite diagnosis often requires liver biopsy because of overlapping clinical and radiographical pictures. Elevation of both glucose and insulin levels in the setting of fragile DM control is thought to play a role via overstimulation of glycogen synthesis. Recommended treatment is stable "tight" glycemic control; pancreatic transplantation has resulted in sustained GH remission in two case reports. The required degree of stability and tightness of glucose control is not yet known. An increased awareness of GH is needed in an attempt to prevent delay in diagnosis, in a condition with an otherwise unknown incidence.

Helping Arthritis Patients in Northern KwaZuluNatal

Abstract: The South African Academy of Family Practice's Rural Health Initiative (RHI) is proud to be able to bring you the following section of the journal, that will concentrate on issues pertaining to rural health in South Africa. We hope to provoke discussion on these issues and would encourage anyone interested in rural health to offer contributions to future issues.