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Dr. Philip  Abraham  Md image

Dr. Philip Abraham Md

301 N 8Th St
Springfield IL 62701
217 287-7541
Medical School: Southern Illinois University School Of Medicine - 1999
Accepts Medicare: Yes
Participates In eRX: Yes
Participates In PQRS: No
Participates In EHR: Yes
License #: 036116505
NPI: 1548375629
Taxonomy Codes:
207RP1001X 207RS0012X

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Awards & Recognitions

About Us

Practice Philosophy

Conditions

Dr. Philip Abraham is associated with these group practices

Procedure Pricing

HCPCS Code Description Average Price Average Price
Allowed By Medicare
HCPCS Code:95810 Description:Polysomnography 4 or more Average Price:$376.18 Average Price Allowed
By Medicare:
$223.32
HCPCS Code:95811 Description:Polysomnography w/cpap Average Price:$227.62 Average Price Allowed
By Medicare:
$124.75
HCPCS Code:31624 Description:Dx bronchoscope/lavage Average Price:$248.75 Average Price Allowed
By Medicare:
$146.65
HCPCS Code:94726 Description:Pulm funct tst plethysmograp Average Price:$81.19 Average Price Allowed
By Medicare:
$12.09
HCPCS Code:99291 Description:Critical care first hour Average Price:$276.90 Average Price Allowed
By Medicare:
$215.61
HCPCS Code:95810 Description:Polysomnography 4 or more Average Price:$176.84 Average Price Allowed
By Medicare:
$119.65
HCPCS Code:94729 Description:C02/membane diffuse capacity Average Price:$56.71 Average Price Allowed
By Medicare:
$8.10
HCPCS Code:94060 Description:Evaluation of wheezing Average Price:$60.06 Average Price Allowed
By Medicare:
$12.40
HCPCS Code:94010 Description:Breathing capacity test Average Price:$44.58 Average Price Allowed
By Medicare:
$8.10
HCPCS Code:95811 Description:Polysomnography w/cpap Average Price:$275.57 Average Price Allowed
By Medicare:
$239.70
HCPCS Code:99204 Description:Office/outpatient visit new Average Price:$170.28 Average Price Allowed
By Medicare:
$156.43
HCPCS Code:94620 Description:Pulmonary stress test/simple Average Price:$70.25 Average Price Allowed
By Medicare:
$56.83
HCPCS Code:99205 Description:Office/outpatient visit new Average Price:$206.22 Average Price Allowed
By Medicare:
$194.08
HCPCS Code:94070 Description:Evaluation of wheezing Average Price:$69.40 Average Price Allowed
By Medicare:
$57.58
HCPCS Code:80047 Description:Metabolic panel ionized ca Average Price:$23.46 Average Price Allowed
By Medicare:
$11.98
HCPCS Code:99215 Description:Office/outpatient visit est Average Price:$145.94 Average Price Allowed
By Medicare:
$135.00
HCPCS Code:99222 Description:Initial hospital care Average Price:$141.76 Average Price Allowed
By Medicare:
$131.88
HCPCS Code:99223 Description:Initial hospital care Average Price:$202.23 Average Price Allowed
By Medicare:
$192.67
HCPCS Code:99203 Description:Office/outpatient visit new Average Price:$110.98 Average Price Allowed
By Medicare:
$101.96
HCPCS Code:94729 Description:C02/membane diffuse capacity Average Price:$55.46 Average Price Allowed
By Medicare:
$49.03
HCPCS Code:94726 Description:Pulm funct tst plethysmograp Average Price:$56.15 Average Price Allowed
By Medicare:
$49.74
HCPCS Code:99213 Description:Office/outpatient visit est Average Price:$73.95 Average Price Allowed
By Medicare:
$67.78
HCPCS Code:99214 Description:Office/outpatient visit est Average Price:$106.33 Average Price Allowed
By Medicare:
$100.17
HCPCS Code:96365 Description:Ther/proph/diag iv inf init Average Price:$72.15 Average Price Allowed
By Medicare:
$66.32
HCPCS Code:94375 Description:Respiratory flow volume loop Average Price:$42.46 Average Price Allowed
By Medicare:
$36.82
HCPCS Code:94060 Description:Evaluation of wheezing Average Price:$61.07 Average Price Allowed
By Medicare:
$56.00
HCPCS Code:99233 Description:Subsequent hospital care Average Price:$103.17 Average Price Allowed
By Medicare:
$98.30
HCPCS Code:71020 Description:Chest x-ray Average Price:$33.70 Average Price Allowed
By Medicare:
$28.84
HCPCS Code:99231 Description:Subsequent hospital care Average Price:$42.23 Average Price Allowed
By Medicare:
$37.57
HCPCS Code:99232 Description:Subsequent hospital care Average Price:$72.80 Average Price Allowed
By Medicare:
$68.52
HCPCS Code:94010 Description:Breathing capacity test Average Price:$37.07 Average Price Allowed
By Medicare:
$33.29
HCPCS Code:96367 Description:Tx/proph/dg addl seq iv inf Average Price:$31.27 Average Price Allowed
By Medicare:
$27.88
HCPCS Code:70220 Description:X-ray exam of sinuses Average Price:$40.49 Average Price Allowed
By Medicare:
$37.19
HCPCS Code:83880 Description:Natriuretic peptide Average Price:$43.40 Average Price Allowed
By Medicare:
$40.17
HCPCS Code:80053 Description:Comprehen metabolic panel Average Price:$18.16 Average Price Allowed
By Medicare:
$14.97
HCPCS Code:J2920 Description:Methylprednisolone injection Average Price:$5.00 Average Price Allowed
By Medicare:
$1.90
HCPCS Code:84484 Description:Assay of troponin quant Average Price:$16.74 Average Price Allowed
By Medicare:
$13.94
HCPCS Code:J2930 Description:Methylprednisolone injection Average Price:$5.26 Average Price Allowed
By Medicare:
$2.58
HCPCS Code:83874 Description:Assay of myoglobin Average Price:$20.89 Average Price Allowed
By Medicare:
$18.29
HCPCS Code:82553 Description:Creatine mb fraction Average Price:$18.95 Average Price Allowed
By Medicare:
$16.35
HCPCS Code:85610 Description:Prothrombin time Average Price:$8.00 Average Price Allowed
By Medicare:
$5.56
HCPCS Code:85379 Description:Fibrin degradation quant Average Price:$16.84 Average Price Allowed
By Medicare:
$14.42
HCPCS Code:J0280 Description:Aminophyllin 250 MG inj Average Price:$2.00 Average Price Allowed
By Medicare:
$0.40
HCPCS Code:94640 Description:Airway inhalation treatment Average Price:$17.60 Average Price Allowed
By Medicare:
$16.06
HCPCS Code:Q2038 Description:Fluzone vacc, 3 yrs & >, im Average Price:$14.12 Average Price Allowed
By Medicare:
$12.61
HCPCS Code:85025 Description:Complete cbc w/auto diff wbc Average Price:$12.47 Average Price Allowed
By Medicare:
$11.02
HCPCS Code:90732 Description:Pneumococcal vaccine Average Price:$62.96 Average Price Allowed
By Medicare:
$61.56
HCPCS Code:J7611 Description:Albuterol non-comp con Average Price:$1.36 Average Price Allowed
By Medicare:
$0.11
HCPCS Code:J3302 Description:Triamcinolone diacetate inj Average Price:$1.25 Average Price Allowed
By Medicare:
$0.28
HCPCS Code:96372 Description:Ther/proph/diag inj sc/im Average Price:$23.35 Average Price Allowed
By Medicare:
$22.44
HCPCS Code:J7040 Description:Normal saline solution infus Average Price:$1.39 Average Price Allowed
By Medicare:
$0.57
HCPCS Code:94664 Description:Evaluate pt use of inhaler Average Price:$16.00 Average Price Allowed
By Medicare:
$15.46
HCPCS Code:85018 Description:Hemoglobin Average Price:$3.75 Average Price Allowed
By Medicare:
$3.35
HCPCS Code:J3301 Description:Triamcinolone acet inj NOS Average Price:$1.94 Average Price Allowed
By Medicare:
$1.68
HCPCS Code:G0009 Description:Admin pneumococcal vaccine Average Price:$20.27 Average Price Allowed
By Medicare:
$20.07
HCPCS Code:36415 Description:Routine venipuncture Average Price:$3.14 Average Price Allowed
By Medicare:
$3.00
HCPCS Code:G0008 Description:Admin influenza virus vac Average Price:$17.68 Average Price Allowed
By Medicare:
$17.55
HCPCS Code:J7674 Description:Methacholine chloride, neb Average Price:$0.50 Average Price Allowed
By Medicare:
$0.49

HCPCS Code Definitions

99213
Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 15 minutes are spent face-to-face with the patient and/or family.
J3301
Injection, triamcinolone acetonide, not otherwise specified, 10 mg
J7674
Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg
70220
Radiologic examination, sinuses, paranasal, complete, minimum of 3 views
J2930
Injection, methylprednisolone sodium succinate, up to 125 mg
99231
Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is stable, recovering or improving. Typically, 15 minutes are spent at the bedside and on the patient's hospital floor or unit.
99223
Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of high severity. Typically, 70 minutes are spent at the bedside and on the patient's hospital floor or unit.
99222
Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of moderate severity. Typically, 50 minutes are spent at the bedside and on the patient's hospital floor or unit.
J2920
Injection, methylprednisolone sodium succinate, up to 40 mg
J0280
Injection, aminophyllin, up to 250 mg
G0009
Administration of pneumococcal vaccine
G0008
Administration of influenza virus vaccine
99291
Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes
99233
Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant complication or a significant new problem. Typically, 35 minutes are spent at the bedside and on the patient's hospital floor or unit.
99232
Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Typically, 25 minutes are spent at the bedside and on the patient's hospital floor or unit.
96372
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular
99205
Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family.
71020
Radiologic examination, chest, 2 views, frontal and lateral
J7611
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg
96367
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); additional sequential infusion of a new drug/substance, up to 1 hour (List separately in addition to code for primary procedure)
96365
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour
95811
Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist
95811
Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist
95810
Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist
99203
Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family.
J7040
Infusion, normal saline solution, sterile (500 ml=1 unit)
99204
Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family.
J3302
Injection, triamcinolone diacetate, per 5mg
94060
Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration
94620
Pulmonary stress testing; simple (eg, 6-minute walk test, prolonged exercise test for bronchospasm with pre- and post-spirometry and oximetry)
99214
Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 25 minutes are spent face-to-face with the patient and/or family.
94375
Respiratory flow volume loop
31624
Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage
94010
Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation
94070
Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents (eg, antigen[s], cold air, methacholine)
94010
Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation
94060
Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration
94726
Plethysmography for determination of lung volumes and, when performed, airway resistance
94726
Plethysmography for determination of lung volumes and, when performed, airway resistance
94664
Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device
99215
Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent face-to-face with the patient and/or family.
95810
Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist
94640
Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device)
Q2038
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone)
94729
Diffusing capacity (eg, carbon monoxide, membrane) (List separately in addition to code for primary procedure)
94729
Diffusing capacity (eg, carbon monoxide, membrane) (List separately in addition to code for primary procedure)

Medical Malpractice Cases

None Found

Medical Board Sanctions

None Found

Referrals

NPI
Doctor Name
Specialty
Count
1861488801
Internal Medicine
3,245
1639395114
Hematology/Oncology
1,991
1467552133
Infectious Disease
1,730
1235239906
Hematology/Oncology
1,703
1699751354
Internal Medicine
1,698
1508962366
Infectious Disease
1,587
1639253701
Cardiovascular Disease (Cardiology)
1,542
1487737177
Cardiovascular Disease (Cardiology)
1,526
1245217603
Cardiovascular Disease (Cardiology)
1,522
1710905906
Hematology/Oncology
1,499
*These referrals represent the top 10 that Dr. Abraham has made to other doctors

Publications

The Mycobacterium tuberculosis PPE protein Rv1168c induces stronger B cell response than Rv0256c in active TB patients. - Infection, genetics and evolution : journal of molecular epidemiology and evolutionary genetics in infectious diseases
Tuberculosis (TB) caused by Mycobacterium tuberculosis is a serious global health problem and is responsible for millions of deaths every year. For effective control of this dreadful disease, it is necessary to diagnose TB cases at the initial stages of infection. The serodiagnosis of disease represents simple, rapid and inexpensive method that can be used at the primary health care levels. In this study we have compared sensitivity of two PPE proteins of M. tuberculosis, i.e., Rv0256c and Rv1168c for their use as serodiagnostic markers in active tuberculosis patients. Employing a standardized enzyme immunoassay with these PPE proteins as candidate antigens we were able to successfully discriminate the TB patients' sera from the BCG-vaccinated healthy controls. Further, we observed that Rv1168c displayed higher sensitivity in detecting extrapulmonary and smear negative pulmonary TB cases which are difficult to diagnose by available diagnostic methods. Overall the study highlights that Rv1168c can be used as a potential serodiagnostic marker for the diagnosis of active tuberculosis disease.Copyright © 2015. Published by Elsevier B.V.
Simple biochemical parameters and a novel score correlate with absence of fibrosis in patients with nonalcoholic fatty liver disease. - Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology
Liver biopsy is the gold standard for detecting fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). Due to limitations of biopsy, various combinations of serum markers have been studied to predict liver fibrosis; many of these are patented and expensive, thereby restricting their evaluation. We prospectively evaluated the correlation of commonly used serum markers with fibrosis in Indian patients with NAFLD.Fifty-one patients (age 50.4 [SD 11.5] years) with biopsy-proven NAFLD underwent estimation of platelet count, total bilirubin, AST, ALT, serum albumin, γ-glutamyl transpeptidase (GGT), prothrombin time, serum cholesterol, triglycerides, α2-macroglobulin (A2M), apolipoprotein A1 (Apo A1), and haptoglobin. FIB-4, AST/platelet ratio index (APRI), and AST/ALT ratio were calculated and correlated with fibrosis (NAS-II score) on liver biopsy.Thirty-eight (74.5 %) patients had inflammation and 48 (94.1 %) had ballooning degeneration on histology; 29 had fibrosis, of whom 11 had ≥F2 fibrosis. High GGT (odds ratio [OR] 8.4 [1.85-38.10]; p = 0.007, area under the curve [AUROC] 0.65), low platelet count (OR 7.57 [1.83-31.45]; p = 0.001, AUROC 0.833), and low Apo A1 (OR 12.04 [2.98-47.3]; p = 0.0002, AUROC 0.76) were associated with advanced fibrosis on multiple logistic regression; a novel score formulated by assigning 1 point for an abnormal value for each of these parameters correlated with absence of fibrosis (p = 0.0001; OR 0.102 [95 % confidence interval (CI) CI 0.025-0.418]), with negative predictive value of 94.29 % [95 % CI 80.81 to 99.13].A score using simple markers including GGT, Apo A1, and platelet count correlated with absence of liver fibrosis in patients with NAFLD.
Gut microbiome, gut function, and probiotics: Implications for health. - Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology
New insights from a rapidly developing field of research have ushered in a new era of understanding of the complexity of host-microbe interactions within the human body. The paradigm shift from culturing to metagenomics has provided an insight into the complex diversity of the microbial species that we harbor, revealing the fact that we are in fact more microbes than human cells. The largest consortium of these microbes resides in the gut and is called the gut microbiota. This new science has expanded the ability to document shifts in microbial populations to an unparalleled degree. It is now understood that signals from the microbiota provide trophic, nutritional, metabolic, and protective effects for the development and maintenance of the host digestive, immune, and neuroendocrine system. Evidence linking changes in the gut microbiota to gastrointestinal and extraintestinal disorders like irritable bowel syndrome, inflammatory bowel disease, obesity, diabetes, and celiac disease have begun to emerge recently. Probiotics act through diverse mechanisms positively affecting the composition and/or function of the commensal microbiota and alter host immunological responses. Well-controlled intervention trials, systematic reviews, and meta-analysis provide convincing evidence for the benefit of probiotics in prevention and treatment of gastrointestinal as well as extraintestinal disorders.
Colorectal cancers in ulcerative colitis from a low-prevalence area for colon cancer. - World journal of gastroenterology : WJG
To determine the incidence and risk factors for colorectal cancer (CRC) in patients with ulcerative colitis from a low prevalence region for CRC.Our prospective database yielded a cohort of 430 patients [age: 44 ± 14.6 years; 248 men (57.7%)] with ulcerative colitis (median disease duration 6, range: 1-39 years) for analysis. Of these, 131 (30.5%) had left-sided colitis and 159 (37%) extensive colitis. Patients with histologically confirmed CRC within the segment with colitis were compared with those without CRC, to determine the risk factors for the development of CRC.Twelve patients (2.8%) developed CRC. The overall incidence density was 3.56/1000 patient-years of disease - 3/1000 in the first 10 years, 3.3/1000 at 10 to 20 years, and 7/1000 at > 20 years. Three of our 12 patients developed CRC within 8 years of disease onset. On univariate analysis, extensive colitis, longer duration of disease, and poor control of disease were associated with development of CRC. On multivariate analysis, duration of disease and extent of colitis remained significant.CRC occurred in 2.8% of patients with ulcerative colitis in our population - an incidence density similar to that in Western countries in spite of a low overall prevalence of colon cancer in our population. The risk increased with extent and duration of disease.
Indian Society of Gastroenterology consensus statements on Crohn's disease in India. - Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology
In 2012, the Indian Society of Gastroenterology's Task Force on Inflammatory Bowel Diseases undertook an exercise to produce consensus statements on Crohn's disease (CD). This consensus, produced through a modified Delphi process, reflects our current recommendations for the diagnosis and management of CD in India. The consensus statements are intended to serve as a reference point for teaching, clinical practice, and research in India.
Hepatic vein obstruction is the most common type of hepatic venous outflow obstruction regardless of socioeconomic status. - Annals of gastroenterology : quarterly publication of the Hellenic Society of Gastroenterology
Data regarding role of socioeconomic status (SES) as etiology and site of involvement of veins in hepatic venous outflow tract obstruction (HVOTO) is scarce and only described from Nepal. We prospectively evaluated the role of SES in patients with HVOTO.70 consecutive patients (41 females; mean age 29, range 3-65 years) with HVOTO were studied. Their clinical history, socioeconomic factors (income, education, and occupation), birth history, dietary factors, living standards, baseline characteristics, liver function, and clinical parameters were evaluated.Of the 70 patients analyzed, 48 (68.5%) had hepatic vein (HV) obstruction, 7 (10%) had isolated inferior vena cava (IVC) obstruction, and 15 (21.5%) had combined HV and IVC obstruction. Of the 10 patients belonging to the upper SES, 7 had isolated HV obstruction, and 3 had combined IVC and HV obstruction; no patient had isolated IVC obstruction. Of the 60 patients belonging to the lower SES, 41(68.4%) had HV obstruction, and 19 (31.6%) had IVC involvement with (n=12) or without (n=7) HV involvement. HV/IVC involvement did not correlate with setting of delivery (hospital vs. home), birth weight, birth complications, immunization in childhood, ventilation in house, water storage facilities, history of diarrhea, or diet. Patients with HVOTO living in a mud house had IVC obstruction more commonly than HV (6/22 vs. 4/48; P=0.04).Isolated hepatic vein obstruction is the most common site of obstruction in patients with HVOTO in India, even among those belonging to low SES. Patients with HVOTO living in a mud house have IVC obstruction more commonly. Other socioeconomic factors studied do not appear to correlate with the site of obstruction.
Comparison of split-dosing vs non-split (morning) dosing regimen for assessment of quality of bowel preparation for colonoscopy. - World journal of gastrointestinal endoscopy
To compare (using the Ottawa Bowel Preparation Scale) the efficacy of split-dose vs morning administration of polyethylene glycol solution for colon cleansing in patients undergoing colonoscopy, and to assess the optimal preparation-to-colonoscopy interval.Single-centre, prospective, randomized, investigator-blind stud in an academic tertiary-care centre. Two hundred patients requiring elective colonoscopy were assigned to receive one of the two preparation regimens (split vs morning) prior to colonoscopy. Main outcome measurements were bowel preparation quality and patient tolerability.Split-dose regimen resulted in better bowel preparation compared to morning regimen [Ottawa score mean 5.52 (SD 1.23) vs 6.02 (1.34); P = 0.017]. On subgroup analysis, for afternoon procedures, both the preparations were equally effective (P = 0.756). There was no difference in tolerability and compliance between the two regimens.Overall, previous evening - same morning split-dosing regimen results in better bowel cleansing for colonoscopy compared to morning preparation. For afternoon procedures, both schedules are equally effective; morning preparation may be more convenient to the patient.
Acid-fast bacilli culture positivity and drug resistance in abdominal tuberculosis in Mumbai, India. - Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology
Culture positivity for Mycobacterium tuberculosis complex (MTB) in abdominal tuberculosis (TB) using Lowenstein Jensen medium and Bactec system varies from 25 % to 36 %. Data on the prevalence of drug resistance in primary abdominal TB is scant. Our aim was to study the acid-fast bacilli (AFB) culture positivity rate in primary abdominal TB using Bactec Mycobacterial Growth Indicator Tubes (MGIT) system and the prevalence of drug resistance in these patients.Records of patients with abdominal TB (diagnosed on clinical features, endoscopy, histology, microbiology) seen during the period 2008 to 2013 were retrieved from the Gastroenterology and Microbiology departments. Patients with extra-abdominal TB (five pulmonary, two nodal), adnexal (one), and HIV (one) were excluded from analysis.Of 61 patients, 31 (50.8 %) had a positive AFB culture. In the 30 culture-negative patients, histology showed non-caseating granulomas in 25 patients. Drug sensitivity pattern was analyzed in 18 patients; resistance was detected in eight (14.3 % of all patients and 44.4 % of patients in whom drug sensitivity was done) including three (5.4 % of all subjects and 16.6 % in whom drug sensitivity was available) who were multidrug-resistant.The rate of AFB culture positivity in primary abdominal TB was 50.8 % using Bactec MGIT. Likelihood of drug resistance was seen in 14.3 %, of whom 5.4 % were multidrug-resistant.
Efficacy and safety of intravenous ulinastatin versus placebo along with standard supportive care in subjects with mild or severe acute pancreatitis. - The Journal of the Association of Physicians of India
Ulinastatin is reported to inhibit pro-inflammatory markers and also inhibits coagulation and fibrinolysis. The drug is available in East Asia for the treatment of acute pancreatitis.To study the effect of addition of ulinastatin to standard care on mortality and morbidity in Indian subjects with acute pancreatitis.Randomized, double-blind, placebo-controlled, multi-centre trial across 15 centres in India.Subjects, aged 18 to 70 years, with acute pancreatitis and elevated serum C-reactive protein (CRP) levels, were eligible for enrolment. Acute pancreatitis was diagnosed if the patient had at least two of the following criteria: suggestive abdominal pain, serum amylase and/or lipase > 3 times upper limit of normal, and imaging findings of acute pancreatitis. Subjects were classified as having mild or severe acute pancreatitis on the basis of the APACHE II score (< 8 mild, > or = 8 severe). Standard care was given to all subjects as per the treating physician's protocol. Eligible subjects were randomized to receive intravenous infusion of 200,000 IU ulinastatin or placebo in 100 mL of 0.9% saline given over one hour every 12 hours for 5 days.Of 135 randomized subjects, 129 completed the study (mild 62, severe 67). Pancreatitis was due to alcohol intake in a majority (81%) of subjects. Baseline characteristics were similar between the ulinastatin and placebo groups. Efficacy was evaluated in subjects who had received at least 3 days (6 doses) of ulinastatin/placebo. One subject with severe pancreatitis in the ulinastatin group versus six in the placebo group died (p = 0.048). New organ dysfunction developed in 5 ulinastatin vs 4 placebo group subjects (p = 0.744) with mild pancreatitis and 12 ulinastatin vs 29 placebo group subjects (p = 0.0026) with severe pancreatitis. Adverse events were significantly lower in subjects with severe pancreatitis in the ulinastatin group as compared to the placebo group (p = 0.00001). Reduction in serum CRP was not different between the groups. Median hospitalization was shorter by one day in the ulinastatin group; the difference was not significant. There was no infusion-related adverse event.Ulinastatin prevents new organ dysfunction and reduces mortality in subjects with severe pancreatitis.
Comparison of Manning, Rome I, II, and III, and Asian diagnostic criteria: report of the Multicentric Indian Irritable Bowel Syndrome (MIIBS) study. - Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology
Attempts to diagnose and subtype irritable bowel syndrome (IBS) by symptom-based criteria have limitations, as these are developed in the West and might not be applicable in other populations.This study aimed to compare different criteria for diagnosing and subtyping of IBS in India.Manning's and the Rome I, II, and III criteria as well as the Asian criteria were applied to 1,618 patients (from 17 centers in India) with chronic lower gastrointestinal (GI) symptoms with no alarm features and negative investigations.Of 1,618 patients (aged 37.5 [SD 12.6] years; 71.2% male), 1,476 (91.2%), 1,098 (67.9%), 649 (40.1%), 849 (52.5%), and 1,206 (74.5%) fulfilled Manning's, Rome I, II, and III, and the Asian criteria, respectively. The most common reason for not fulfilling the criteria was absence of the following symptoms: "more frequent stools with onset of pain," "loose stool with onset of pain," "relief of pain with passage of stool," "other abdominal discomfort/bloating," and, in a minority, not meeting the duration criterion of 3 months/12 weeks. By stool frequency, constipation-predominant IBS (<3 stools/week) was diagnosed in 319 (19.7%), diarrhea-predominant IBS (>3 stools/day) in 43 (2.7%), and unclassified in 1,256 (77.6%). By Bristol stool form, constipation, diarrhea, and unclassified were diagnosed in 655 (40.5%), 709 (43.8%), and 254 (15.7%) patients, respectively. By their own perception, 462 (28.6%), 541 (33.4%), and 452 (27.9%) patients reported constipation-predominant, diarrhea-predominant, and alternating types, respectively.By Manning's and the Asian criteria, a diagnosis of IBS was made frequently among Indian patients with chronic functional lower GI symptoms with no alarm features; the Rome II criteria gave the lowest yield. By the stool frequency criteria, a majority of patients had unclassified pattern, unlike by the stool form and patients' perception of their symptoms.

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