Jejunal GIST — An Obscure Cause of Melaena

Gastrointestinal Stromal Tumours (GISTs) are one of the rare causes of Alimentary Tract Neoplasm. They arise from the Interstitial Cells of Cajal (ICC) with overexpression of proto-oncogenes like KIT, PDGFRA and BRAF-Kinase, etc1. The typical location of these tumors is the stomach with Jejunal GIST being the rarest variant. The maximal incidence of the disease is reported in the sixth decade of life. GISTs are often asymptomatic and clinicians are misdirected towards a different diagnosis because of its variable nature of presentation. The clinical feature typically ranges from non-specific abdominal symptoms like nausea, vomiting, bloating, etc, to abdominal emergencies like hemorrhage, anemia, or obstruction. Although mostly benign, there is a high probability of progression to malignancy2. Thus, in patients with no appreciable cause of gastrointestinal bleed or chronic abdominal discomfort, GIST should have high suspicion index. This can help to limit the progression and thereby prevent further complications. Due to its location, it is difficult to identify by Endoscopy or Colonoscopy. Single Balloon Enteroscopy (SBE) and CT Scan of Abdomen are the primary investigational modalities. The treatment aims at resection of the mass with continued Postsurgical surveillance and targeted molecular therapy in some cases. Herein, we report a 14-year-old boy with chronic paleness and gradual onset repeat episodes of Melaena. Despite repeated blood transfusions, the patient had a Hemoglobin

The beneficial role of N-acetylcysteine as an adjunctive drug in treatment of COVID-19 patients in a tertiary care hospital in India: an observational study

Background: N-acetyl cysteine, a mucolytic agent, demonstrates free radical scavenging and anti-inflammatory properties, and prevents endothelial dysfunction by inhibition of NF-KB and formation of no adducts. This has a potential role to tackle cytokine storms, endothelial dysfunction and prothrombotic state observed in COVID-19 manifestations like ARDS and Multi organ dysfunction.Methods: Institution based descriptive cross sectional study, 164 patients from laboratory confirmed RT PCR positive COVID-19 patients, in the study period from 27th May 2020 to 10th August 2020, were assessed, in medical college Kolkata, a dedicated COVID-19 care facility.Results: It was observed that moderate-severe patients who received N-acetyl cysteine along with standard therapy had average hospital stay duration of 12 days, higher rate of discharge, average duration of oxygen therapy of 8 days, less number of deaths and reduced transfer to critical care facilities.Conclusions: N-acetyl cysteine can be considered as an adjunctive therapy with standard protocol driven care, due to its beneficial anti-inflammatory and free radical scavenging properties.