A prospective observational study to study and correlate the clinical and microbiological profile of bile cultures in patients with symptomatic cholelithiasis

Background: Biliary infection has been reported in a significant proportion of patients developing gallstones. Many studies have found biliary microflora in 20% to 46% patients with a post-operative infection rate of 7% to 20% in those who undergo cholecystectomy for symptomatic gallstone disease. Various antibiotics are also used empirically as prophylaxis against post-operative infection. The study was conducted in order to determine the bacteriology and to test its sensitivity to commonly used antibiotics of aspirated bile samples taken during laparoscopic cholecystectomy, and to correlate it with the clinical profile recorded in patients with symptomatic cholelithiasis.Methods: A total of 266 patients who underwent laparoscopic cholecystectomy were included in the study over a two year period. Intra operatively, bile was aspirated from gall bladder and sent for culture and antibiotic sensitivity testing.Results: 14.66% (39 out of 266) patients had positive growth with Escherichia coli most commonly isolated in 9.77% (26/266) patients, followed by the Klebsiella species in 4.89% (13 out of 266) patients. All the cultures were sensitive to amikacin and meropenem, 97.44% to imipenem, and only 43.39% were sensitive to ampicillin. A statistically significant correlation was observed between a positive bile culture with the duration of symptoms (p=0.01874) and gall bladder thickness (p<0.0001). No correlation was seen between bile culture and history of acute cholecystitis, number or size of calculi.Conclusions: The results of this study can help develop local guidelines and recommendations based on Indian data to ensure the rational use of prophylactic antibiotics in patients with symptomatic cholelithiasis.

Neuroprotection Effects of Celastrus paniculatus Seed Oil against Monosodium Glutamate in Human IMR-32 Cells

Aims: The aim of this study is to evaluate the neuroprotective effects of Celastrus paniculatus seed oil (CPO) against monosodium glutamate in human IMR-32 cells. Study Design: Celastrus paniculatus seed oil used historically in Indian subcontinent for its neuro-enhancement property and also considered to have free radical scavenging activity. Methodology: In present study we have employed IMR-32, a neuroblastoma cells as our model system and utilized monosodium glutamate (MSG) a widely used food additive and proven inducer of free radicals to study the ameliorative effect of CPO against induced oxidative stress in neuronal cells. Results: Results showed that CPO ameliorates total protein level, decreases protein carbonyl and lipid peroxidation levels (p<0.001) as well as enhances the activity of superoxide dismutase and catalase (p<0.001) under oxidative stress conditions. Further we found that CPO increases the free radical scavenging capacity of cell by enhancing (p<0.001) glutathione level and help its regeneration by revitalizing the activity of glutathione peroxidase, glutathione S-transferase and glutathione reductase enzymes. Conclusion: It can be concluded that CPO has antioxidant property and proved to have ameliorative role against free radicals induced neuronal impairment.

Scope of prosthodontic services for patients with head and neck cancer.

Patients with head and neck cancer face high morbidity due to the disease and its treatment and are affected on a variety of personal and physical levels. Maxillofacial prosthetics offer support for other disciplines in a multidisciplinary setting; can help to prevent / minimize the sequelae from disease and treatment, and offers the patient help in the rehabilitation process. Maxillofacial prosthodontics focuses on optimizing the disrupted rudimentary function of individuals whose rehabilitation will be a lifelong proposition. Normal function may not be achieved but optimal function should always be achieved and the patients can lead a near to normal life.

Therapeutic Hypothermia for Neonatal Encephalopathy Implications for Neonatal Units in India.

Therapeutic hypothermia has recently emerged from bench to bedside. Three large multicenter trials from industrialized countries and three independent meta-analyses have shown its efficacy in reducing death and disability following neonatal encephalopathy due a perinatal hypoxic event. Many neonatal units in well-resourced settings now offer hypothermia as standard care in neonatal encephalopathy. However, these results cannot be extrapolated to low resource settings due to differences in population, risk benefits and high cost. Use of therapeutic hypothermia in low resource settings should be considered experimental and should therefore be restricted to well equipped level 2 and 3 neonatal units. The safety and efficacy of hypothermia using novel low technology methods need to be examined in rigorously controlled multicenter randomized controlled trials in these neonatal units before it can be offered as a standard care, as the risks may outweigh the benefits. The current practice of maintaining normothermia should continue, until such evidence is available.

Seroprevalence of hepatitis A virus in Mumbai, and immunogenicity and safety of hepatitis A vaccine.

OBJECTIVES: Since epidemiologic trends of hepatitis A are changing worldwide, we studied its seroprevalence in Mumbai, which is thought to be a high-endemicity area. The immunogenicity and safety of a hepatitis A vaccine were also studied. METHODS: Six hundred and seventy subjects (456 men; age range 6 mo-60 y) answered a questionnaire on social and medical history. Qualitative analysis of total anti-HAV was performed in all subjects by ELISA. One hundred and seven of 147 anti-HAV negative subjects received hepatitis A vaccine at months 0, 1 and 6. Subjects were followed up (months 1, 2, 6, 7) to look for side-effects and seroconversion. RESULTS: The seroprevalence of HAV was 523/670 (78%); 38% of children < 5 years were anti-HAV negative. Seroprevalence rates of 80% were reached by 15 years. Prevalence was lower in the higher socio-economic group (151/234; 64.5%) compared with the lower socio-economic group (372/436; 85%) (p < 0.001). One month after doses 1, 2 and 3 of the hepatitis A vaccine, seropositivity was 92%, 99% and 100%, respectively. Minor self-limited side-effects occurred in 19.5% of subjects; there were no major side-effects. CONCLUSIONS: The seroprevalence of anti-HAV is high in Mumbai. Seroprevalence is lower in the higher socio-economic groups. The hepatitis A vaccine is safe and immunogenic.

Relationship of serum gastrin and Helicobacter pylori in the gastric antral and body mucosa.

OBJECTIVE: To evaluate the relationship between serum gastrin and Helicobacter pylori status in the antrum and body of gastric mucosa. METHODS: Fasting and post-meal serum gastrin level were studied by radioimmunoassay in 41 patients with dyspepsia. These patients were divided into three groups depending on H pylori status ie H pylori present in both antrum and body; (A+B+; n = 13), present in antrum but not in the body; (A+B-; n = 7) and absent in both antrum and body A-B-; n = 21. RESULTS: There was no difference in fasting or post meal serum gastrin levels between the groups A+B+ and A+B-. Serum gastrin values 20 and 40 minutes post meal were significantly higher (p < 0.05) in the group A+B+ as compared to A+B-. CONCLUSION: Post meal serum gastrin levels are higher in patients with dyspepsia in whom Helicobacter pylori is present in the antral and body mucosa as compared to those in whom it is present in the antrum only.

Relationship of serum gastrin and Helicobacter pylori in the gastric antral and body mucosa.

OBJECTIVE: To evaluate the relationship between serum gastrin and Helicobacter pylori status in the antrum and body of gastric mucosa. METHODS: Fasting and post-meal serum gastrin levels were studied by radioimmunoassay in 41 patients with dyspepsia. These patients were divided into three groups depending on H pylori status ie H pylori present in both antrum and body; (A + B+; n = 13), present in antrum but not in the body; (A + B-; n = 7) and absent in both antrum and body; (A - B-; n = 21). RESULTS: There was no difference in fasting or post meal serum gastrin levels between the groups A + B+ and A - B-. Serum gastrin values 20 and 40 minutes post meal were significantly higher (p < 0.05) in the group A + B+ as compared to A + B-. CONCLUSION: Post meal serum gastrin levels are higher in patients with dyspepsia in whom Helicobacter pylori is present in the antral and body mucosa as compared to those in whom it is present in the antrum only.

Helicobacter pylori in dental plaque of children and their family members.

A prospective study was undertaken to determine the presence of Helicobacter pylori in the dental plaque of children and their family members. 22 children (age range: 2-12 years; males: 16) admitted to the paediatric ward for various disorders and 17 healthy family members (age range: 7-40 years; males: 9) of 13 of these children were screened for presence of Helicobacter pylori in the dental plaque by the rapid urease test. H. pylori was detected in dental plaque of 82% (18/22) children and 88% (15/17) of family members. In 85% (28/33) of the positive cases the rapid urease test was positive within 1 hour. Our observations indicate that Helicobacter pylori is present in the dental plaque of majority of children and their family members.

Age-related prevalence of Helicobacter pylori antibodies in Indian subjects.

OBJECTIVE: To determine the age-related prevalence of Helicobacter pylori antibodies in Indian subjects without upper gastrointestinal symptoms. MATERIAL AND METHODS: Sera of 340 subjects without any upper gastrointestinal complaints were screened for IgG and IgA Helicobacter pylori antibodies by the ELISA technique. RESULTS: The prevalence of IgG and IgA antibodies was 22%, 56% and 87% and 48%, 58% and 83% in 0-4, 5-9 and 10-19 year age groups respectively; thereafter it remained almost constant upto fifth decade. A significant fall in IgG and IgA prevalence was observed from fifth to seventh decades. CONCLUSION: Our data indicate that in India exposure to Helicobacter pylori occurs early in life and is widespread; about 83% of the population is exposed to Helicobacter pylori during the first two decades of life. The comparable prevalence rates of IgG antibodies to Helicobacter pylori and hepatitis A virus, in different age groups, in India and in the West, suggest a feco-oral mode of transmission for Helicobacter pylori.

Wilson's disease: varied hepatic presentations.

BACKGROUND: Wilson's disease is an inherited disorder of copper metabolism. Previous Indian studies have high-lighted the neurological manifestations of this disorder. Eleven patients with Wilson's disease with different hepatic manifestations are reported. METHODS: Patients referred to the gastroenterology department of a tertiary referral center were investigated for Wilson's disease, based on clinical suspicion, with slit-lamp examination for Kayser-Fleischer rings, serum ceruloplasmin and 24-hour urinary copper estimation. Liver biopsy was done whenever possible. RESULTS: Patients with Wilson's disease presented as acute viral hepatitis (n = 5), fulminant hepatic failure (n = 2), subacute hepatic failure (n = 2) and cryptogenic cirrhosis (n = 2). Therapy with penicillamine/trientene and zinc sulphate was started in 9 patients; 5 showed good response to therapy, one had to be switched to trientene due to penicillamine toxicity, two died, and one was lost to follow-up. CONCLUSION: Wilson's disease has varied hepatic presentations and should be suspected in all patients with unexplained liver disease. Any young adult presenting with acute hepatitis or fulminant hepatic failure who has evidence of underlying chronic liver disease or associated hemolytic anemia should be investigated for Wilson's disease. Therapy with penicillamine or trientene combined with zinc sulphate shows improvement in a majority of patients.

Electron microscopic observations in gastric mucosa of habitual tobacco chewers.

Clinical evaluation, upper gastrointestinal endoscopy and electron microscopy of mucosal biopsies from antrum, body and fundus of stomach were performed in three control subjects and 17 habitual tobacco chewers. Electron microscopic abnormalities such as discontinuous, fragmented basement membrane with reduction in hemidesmosomes, and widened intercellular spaces filled with clusters of desmosomes were found in the gastric mucosa of habitual tobacco chewers; these were similar to those reported in experimental carcinogenesis and leukoplakia. It is concluded that habitual chewing of tobacco produces electron microscopic alterations in the human gastric mucosa which may be important precursors for gastric malignancy.

Genetic hemochromatosis presenting as asymptomatic hepatomegaly.

A case of genetic hemochromatosis presented with asymptomatic hepatomegaly. The diagnosis was based on elevated serum iron, serum ferritin and transferrin saturation, a characteristic picture on magnetic resonance imaging, and liver biopsy showing cirrhosis with excessive iron deposits in the liver parenchyma. The extreme rarity of this disease in our country is perhaps determined by hereditary factors.

Helicobacter pylori and acid secretion.

BACKGROUND. Helicobacter pylori has been implicated in the aetiopathogenesis of peptic ulcer but data on the effect of infection by this organism on gastric acid secretion are equivocal. We, therefore, examined the effect of the presence of Helicobacter pylori in the antrum and body of the stomach on acid secretion. METHODS. We used the augmented histamine test and intragastric titration in three groups of patients. In one group Helicobacter pylori was present in both the antrum and body of the stomach, in the second it was present in the antrum but not the body, and in the third the organism was absent. RESULTS. There were no significant differences in acid secretion between these three groups. CONCLUSION. The presence of Helicobacter pylori in the mucosa of the gastric antrum and body has no effect on acid secretion.

Stomach in portal hypertension.

365 consecutive patient of portal hypertension [Cirrhosis 285, Non-cirrhotic portal fibrosis (NCPF) 50, Extrahepatic portal vein obstruction (EHPVO)-30] were evaluated prospectively over a period of 2 years. Of these, 33 patients underwent successful sclerotherapy with evaluation before and after the same. Portal hypertensive gastropathy (PHG) was found in 56.4% (mild 28.2%, Severe 28.2%) of total patients; while its incidence was 60.6% in cirrhosis, 54% in NCPF and 20% in EHPVO. Incidence of PHG was significantly higher in cirrhotics when compared with non-cirrhotics (60.7% vs 41.25%: p < 0.05). PHG is more common in patients with large esophageal varices as compared to those with small varices (64.1% vs 50.8%: p < 0.05). Overall incidence of gastric varices was 29.3% while its incidence in cirrhosis, NCPF and EHPVO was 22.1%, 44% and 73.3% respectively. Incidence of gastric varices was significantly higher in non-cirrhotics (NCPF + EHPVO) when compared with cirrhotic (p < 0.05) and in patients with large esophageal varices when compared with patients having small esophageal varices (p < 0.05). Peptic ulcer was found in 10.9% patients with portal hypertension. (More than 90% were cirrhotics, mainly alcoholics). 33 patients underwent successful sclerotherapy of which 11 had PHG (mild--6, severe--5) at the beginning of sclerotherapy. After successful sclerotherapy 26 patients had PHG (mild--14, severe--12) p < 0.001). There was no significant difference in incidence of gastric varices before and after sclerotherapy. Incidence of PHG was significantly higher in cirrhotics while gastric varices were seen more commonly in patients with non-cirrhotic portal hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

Ultrastructural changes in esophageal mucosa of chronic tobacco chewers.

Seventeen chronic tobacco chewers and three control subjects underwent clinical evaluation, upper gastrointestinal endoscopy and esophageal mucosal biopsies. The esophageal biopsies were processed and examined under the electron microscope. A large number of ultrastructural abnormalities such as discontinuous, fragmented basement membrane, with reduction in hemidesmosomes, widened intercellular spaces were found in the esophageal mucosa of chronic tobacco chewers which resembled the ultrastructural features of experimental carcinogenesis and leukoplakia. It is concluded that chronic chewing of tobacco produces ultrastructural abnormalities in the esophageal mucosa which could be important precursors for esophageal malignancy.

Prevalence of delta virus infection in high risk population and hepatitis B virus related liver diseases.

Two hundred and fifty four high risk persons or patients with hepatitis B virus related liver disease (209 men, 45 women; age range 1-78 years) were tested for anti-delta antibody and IgM anti-HBc to determine the prevalence of delta agent coinfection and superinfection. The prevalence of delta infection was as follows: acute viral hepatitis 23/148 (16%) and chronic liver disease 17/92 (19%), and asymptomatic HBsAg carriers 1/6 (17%). In the high risk population, the delta antibody prevalence was as follows: multiple transfusion recipients 3/8 (38%), patients with chronic renal failure 1/5 (20%) and medical professionals 2/7 (29%). Of 44 patients (34 men, 10 women; age 3-63 years) with delta infection, 26 (59%) had coinfection and 18 (41%) had superinfection. Six patients with anti-delta antibody had received blood transfusion(s) and six others gave history of parenteral exposure.