Spectrum of histopathological changes and its quantification using a scoring system in patients with gastroesophageal reflux disease

Aim: The aim of this study was to evaluate the role of histopathological and histomorphometric features in oesophageal biopsy of patients presenting with symptoms of Gastroesophageal Reflux Disease (GERD). Material and Methods: Present study included 42 patients and 12 controls. Complete clinical evaluation followed by endoscopic examination of the patients was done and multipleoesophageal biopsies were taken. Biopsies were processed routinely and stained with Hematoxylin and Eosin and examined for any changes related to GERD. Morphometric assessment was done by using Leitz optical micrometer. The histological scoring was done based on the parameters: basal cell hyperplasia, stromal papillae elongation, cells with irregular nuclear contour (CINC), eosinophilic infiltrate, gastric and intestinal metaplasia. A numerical score was assigned to each parameter and sum of these scores represented the total score. Statistics: The statistical analysis was done using graph pad prism, Medcalc software and Windows MS office. P value and mean standard deviation (SD) was calculated. Results: The endoscopic findings of all the controls and 83.33% of patients were normal. Only 16.67% of patients had reflux associated changes of varying grades on endoscopy. Oesophageal biopsy of all patients had changes related to GERD on histology. Immunohistochemistry confirmed that cells with irregular nuclear contour were T- lymphocytes. The mean (SD) histological scoring of control and patients were 1.75 (0.62) and 5.66 (1.31) respectively. The difference was considered to be statistically significant (P < 0.001). Thus, it was suggested that a cut-off of histological score > 3 can be used to indicate GERD. Conclusion: Patients with gastroesophageal reflux symptoms can have normal endoscopic findings but can be diagnosed on the basis of histological changes in the squamous epithelium. Scoring of the histopathological parameters along with the cut-off value can give a definitive diagnosis of GERD.

Evaluation Hypolipidemic Activity Of Arogyavardhini And Zpter Tablet In Cholesterol-Rich High Fat Diet (HFD) Induced Hyperlipidemia In Wistar Rats

Objective: The present research work aims to evaluate the hypolipidemic activity of arogyavardhini and zpter tablet in high fat diet (HFD) induced hyperlipidemia in wistar rats. Methods: Wistar rats were divided in 5 groups. The normal control group received standard pellet diet. The HFD group received HFD rich in cholesterol. The HFD+Arogyavardhini group received HFD rich in cholesterol along with Arogyavardhini treatment. The HFD+zpter group received HFD rich in cholesterol along with zpter treatment. The standard Control group received HFD rich in cholesterol and treatment with Atorvastatin. Serum Lipid profile estimation and histopathological estimations done at end treatment. Group means were compared with Analysis of Variance (ANOVA) followed by Tukey‘s post-hoc analysis (P<0.05). Result: HFD group shows significant (P<0.05) increase in total cholesterol (TC) levels (207.15 mg/dl) and triglyceride (TG) levels (223.83 mg/dl) when compared with standard pellet fed rats (TC=151.05 mg/dl and TG=164.67 mg/dl). Treatment with Arogyavardhini significantly (P<0.05) reduces the increased levels of TC (160.123 mg/dl) and TG (189.5 mg/dl) in hyperlipedimic rats. Treatment with Zpter significantly (P<0.05) reduces the increased levels of TC (163.89 mg/dl) and TG (193.167 mg/dl) in hyperlipedimic rats, which is comparable to standard treatment atorvastatin (TC= 155.81 mg/dl, TG=180.33 mg/dl). Conclusion: The observations in this study suggest that, herbal formulations arogyavardhini and zpter have the potential to overcome hyperlipidemia.

Bacteriological profile and antibiotic sensitivity pattern of neonatal septicaemia in a rural tertiary care hospital in North India.

Background: There is not much published literature on neonatal septicemia available for the Sub‑Himalayan region of North India. Hence, we undertook this study to find out the bacteriological profile and antibiotic sensitivity pattern of neonatal septicemia in the neonatal Intensive Care Unit. Material and Methods: Blood cultures were performed for all clinically suspected neonatal septicemia cases for 1‑year. Identification of all pathogenic isolates was followed by antibiotic sensitivity testing. Results: We did blood cultures for 450 neonates and 42% were culture positive. Early onset sepsis were 92 (49%) and 96 (51%) were late onset sepsis. Gram‑positive isolates were 60% and 40% were Gram‑negative. Staphylococcus aureus (40%), coagulase negative Staphylococcus species (16%), non‑fermenter group of organisms (NFGOs) (15%), and Klebsiella pneumoniae (10%) were the main isolates. Nasal cannula 101 (54%), birth asphyxia 91 (48%), and prematurity 73 (38%) were the prominent risk factors associated with septicemia. Gram‑positive organisms were highly resistant to penicillin (87%) whereas Gram‑negative isolates showed high resistance to third generation cephalosporins (53–89%) and aminoglycosides (50–67%). The S. aureus isolates were methicillin‑resistant in 41% whereas extended spectrum beta lactamase production was seen in 48% Gram‑negative isolates. Conclusion: Our study highlights the recent emergence of Gram‑positive organisms as predominant cause of neonatal septicemia in this part of Sub‑Himalayan region, along with the review of literature which shows similar results from North India and rest of the world too. Though Gram‑negative bacteria still remain the main cause of mortality in neonatal septicemia, we want to dispel the common notion among practitioners that they are the predominant isolates in neonatal septicemia.

Corporal Punishment in Nepalese School Children Facts, Legalities and Implications.

While the Convention on the Rights of the Child (CRC) demands that children be respected as human beings with the right to dignity and physical integrity, in Nepal corporal punishment is often considered necessary to children’s upbringing, to facilitate learning and to instill discipline in the children. The existence of this cruel practice towards children is attributed to the weak national policy, unhealthy academic competition among the schools, poorly trained teachers, superstitious traditional beliefs and hierarchical social structure. Consequently, the children are doomed to suffer this practice resulting in negative physical, mental and social welfare. Besides corporal punishment, sexual abuse in school going children seems to be frequent but mostly unreported. This is high time we eliminated this violence against children in schools and it calls for holistic approach. For this, it is necessary to pursue a set code of conduct and raise awareness among the teachers for the child rights in order to stop undignified, inhuman and undisciplined tradition. The awareness and capacity of the health professionals to deal with complexities of the child abuse also needs to be promoted. Furthermore, the need of improvements in the national laws and their proper implementation is a longstanding challenge for the governmental and nongovernmental organizations.

Early laparoscopic chdecystectomy

To assess the clinical outcome of laparoscopic Cholecystectomy for management of acute cholecystitis and to evaluate its safety, frequency of complications. Observational study. Surgical Units II and III of Chandka Medical College Hospital Larkana. From 01.09.2003 up to 31.12. 2007. A total of 100 consecutive cases of, acute cholecystitis confirmed subsequently by abdominal ultrasound scanning, who were admitted for early laparoscopic Cholecystectomy. There was female preponderance with male to Female ratio of 1:4.5. Mean age was 45.75, SD 11.99, and most of patients were received with in 24 hours from the onset of symptoms. In 51 patients ultrasound reveals Edematous GB in 24 [24%], Empyma 8[8%], Contracted 10[10%], Perforated 5[5%] and Gangrenous GB in 4[4%] while 49[49%] have acute cholecystitis with cholelithiasis. The conversion rate was 6%; The minimum time taken during the procedure was 50 minutes. No mortality was reported in this series. Emergency / early Cholecystectomy is reliable and safe modality cost effective, and timely surgery with modern conception in the management of acute cholecystitis, because of accelerated recovery, negligible wound infection or related complication, and less postoperative pain. So Lap Chole should be preferred technique now days for the treatment of acute cholecystitis at our Institute

Meningitis caused by Rhodotorula rubra in an human immunodeficiency virus infected patient.

Rhodotorula spp. are common saprophytes but may be responsible for systemic infections in immunocompromised patients. Meningitis caused by Rhodotorula spp. in human immunodeficiency virus (HIV) infected patients has been reported only rarely. We present a case of meningitis caused by Rhodotorula rubra in HIV infected patient. The presumptive diagnosis of cryptococcal meningitis was made on the basis of India ink preparation, Gram staining and latex agglutination test (LAT) for cryptococcal antigen. The final diagnosis was confirmed by isolation of Rhodotorula rubra from cerebrospinal fluid on culture. LAT was considered false positive. Amphotericin B and 5-fluorocytosine were administered but the patient succumbed to his illness.

Cranial vault salmonella osteomyelitis leading to extradural abscess - A case report.

A case of rarely encountered Salmonella typhi osteomyelitis of left occipital bone leading to extradural abscess, is reported. The causative organism was not suspected until the culture report was obtained. The patient responded promptly to surgical drainage and antibiotic therapy.

Bacterial indices of drinking water from natural sources.

Two hundred forty samples of water from twenty natural sources were subjected to the study for the detection of four bacterial indicators of faecal pollution. The samples were subjected to the detection of coliform, faecal coliform, E. coli, S. faecalis, Cl. welchii and plate count at 37 degrees C and 22 degrees C. All these samples were found unfit for human consumption. MPN for coliforms, E. coli and S. faecalis varied from 3 to 1800 per 100 ml of water, sero to 1800 per 100 ml water and zero to 540 per 100 ml of water respectively. Plate count at 37 degrees C and 22 degrees C varied from 2.5 x 10(3) to > 150 x 10(3) per ml of water. Cl. welchii was detected in 30.4% samples in rainy season and high plate count at 37 degrees C and 22 degrees C was observed during the same period.

Shima drinking water--a bacteriological analysis.

300 water samples, 60 from piped supply and 240 from 20 natural sources were analyzed bacteriologically for four important bacterial indicators every month over a period of one year. The MPN of total coliforms, Escherichia coli, Streptococcus faecalis were detected by multiple tube method and Clostridium perfringens was isolated using litmus milk medium. From piped water supply, only one sample was found unfit for human consumption. The plate count at 37 degrees C and 22 degrees C varied from 0.5 x 10(3) to 15 x 10(3) per ml. of water. From natural sources, MPN indices for coliforms, Esch. coli and S. faecalis varied from 3 to > 1800, 0 to > 1800 and 0 to 540 per 100 ml. of water respectively. About 1/3rd of samples showed presence of Cl. perfringens. The plate count varied from 1.0 x 10(3) to > 150 x 10(3) per ml. of water. Salmonella typhi was isolated in 1.25% samples by membrane filtration technique. The water from all the natural sources was unfit for human consumption whereas piped water supply was of good quality in general.

Fibrous histiocytoma of orbit: a case report.

A fifty year male (K.S.) presented with protrusion (Proptosis) of left eye which was gradually increasing in size for the last one year. The swelling was accompanied by pain for the last fifteen days. Preoperative X-ray & computed tomography showed erosion of frontal sinus & roof of maxillary sinus. Clinical diagnosis of a malignant tumour of eye was made & enucleation of the left eye, along with the mass was done. The specimen was received in the pathology department on 16.9.98. Grossly, encapsulated mass attached with the intact eye ball was received. The mass measured 5x3x2.5 cms. Microscopic examination revealed a benign spindle cell neoplasm and a diagnosis of fibrous histiocytoma (dermatofibroma) was made.

Health awareness and treatment compliance of high blood pressure among women in a peri-urban colony of Chandigarh, India.

Health awareness is a central issue in the control of hypertension. In a cross-sectional survey among 1727 women of > 30 years, 2 blood pressure recordings were done in 1686 cases. The prevalence of hypertension was found to be 13.1% (221 out of 1686 cases). A random sub sample of 72 hypertensive women above 30 years of age from a peri-urban colony of Chandigarh was selected to find out health awareness and treatment compliance of hypertension. Sixty-three (87.5%) of the selected women were aware of their high blood pressure. However, only 12 women (16.7%) who were on treatment had achieved control of blood pressure (< 140/90 mm Hg). Main reasons for discontinuing the treatment were ignorance about the need of regular treatment (33.3%), high cost of medicines (19.44%) and non-availability of a family member who can go with the patient to hospital (9.72%). Twenty-six (36.1%) hypertensive women did not know the importance of weight reduction for controlling high blood pressure. Twenty-three (31.9%) hypertensive women were currently smoking. A comprehensive health education approach involving health care professionals, patients and general population should be launched to improve the care of hypertensives in the community.

Esophageal bezoar: a rare but distinct clinical entity.

A 89 year old female patient presented with severe dysphagia and was suspected to have carcinoma of the esophagus. Endoscopy revealed an esophageal phytobezoar which passed down spontaneously after unsuccessful endoscopic extraction attempt. Barium swallow study revealed diffuse spasm of the esophagus. A review of English literature revealed only 17 previous cases of esophageal bezoar. Salient features of esophageal bezoars are discussed based on previous reports and the current case.

Experience with intraluminal radiotherapy in advanced oesophageal cancer.

Despite improvement in the diagnostic modalities, surgical technique, chemotherapy and radiotherapy, mortality and morbidity due to carcinoma esophagus continues to be dismal. Combination of external and intraluminal radio therapy (ILRT) has emerged as a powerful and promising palliative therapy in this disease. Thirty four patients with inoperable cancer esophagus treated with ILRT during June 1991 to December 1993 were evaluated to assess its palliative effects. Seventeen of these patients had received additional chemotherapy and external radiotherapy. Thirteen patients received only radiotherapy (both external radiotherapy + ILRT) and the remaining 4 received only ILRT. They were followed up for a mean period of 8.3 months (range 2 to 28 months) during which one patient was lost to follow up. Eight had a follow up of less than 6 months. Eight (33%) amongst the remaining 25 patients were considered disease free, 15 had recurrent and progressive disease, one developed metastasis and one patient died. In 21 (66%) dysphagia markedly improved. Nine (26%) patients survived beyond 1 year and the median survival for all patients was 8 months. Associated radiation morbidity was documented in 13 (38%) patients. We conclude that combination of external radiotherapy and ILRT is an effective and safe therapy for inoperable esophageal malignancies.