Megaloblastic anemia and non-vegetarian diet – Is there a changing trend?

Background: According to various studies, non-vegetarians are not at an inherent risk of developing megaloblastic anemia, a common deficiency of Vitamin B12. However, recent trends of the consumption of non-vegetarian food in the processed form as well as changes in cooking methods may gradually change the trend of the occurrence of megaloblastic anemia in nonvegetarians. Very few studies have been conducted on the same in a non-vegetarian population. Objectives: The objective of this study was to study the prevalence of megaloblastic anemia in a non-vegetarian population. Materials and Methods: The study was conducted on 100 non-vegetarian adults after due approval of the institutional ethics committee. The patients were evaluated on the basis of their hematological profile including peripheral smear examination and indices. Results: About 29% of total patients presented with features suggestive of megaloblastic anemia, of which 72% of patients agreed to predominantly be consuming non-vegetarian food from processed sources such as fast-food outlets at an average frequency of 3 weeks. Conclusion: There is a changing trend of megaloblastic anemia in the non-vegetarian population. Processing of food and change in conventional cooking practices along with the recent decline in home cooking of meat seem to be the major factors putting the non-vegetarians at a risk of developing megaloblastic anemia.

Frequency & predictors of pancreatitis in symptomatic primary hyperparathyroidism

Background & objectives: The frequency and predictors of pancreatitis in primary hyperparathyroidism (PHPT) are not well understood. The objective of the present study was to evaluate the frequency of pancreatitis in patients with PHPT and its association with clinical and biochemical parameters of the disease. Methods: In this retrospective study all consecutive patients with PHPT registered in the PHPT registry (www.indianphptregistry.com) from the year 2004 to 2013 were included. The clinical, biochemical and radiological parameters related to pancreatitis were evaluated in histologically proven PHPT patients. Results: A total of 218 patients (63 men; mean age: 40.6±14.4 yr) underwent surgery for PHPT during the study. Pancreatitis occurred in 35 [16%, 18 acute and 17 chronic pancreatitis (CP)] patients and male:female ratio was 1:0.94. Skeletal manifestations were seen less frequently in PHPT with pancreatitis as compared to that of PHPT without pancreatitis. PHPT with pancreatitis had significantly higher serum calcium (12.4±2.0 vs. 11.7±1.5 mg/dl, P <0.05) in comparison to PHPT without pancreatitis. PHPT with acute pancreatitis (AP) had higher serum calcium (P <0.05) and parathyroid hormone (PTH) (P <0.05) levels than PHPT with CP. Curative parathyroidectomy improved the symptoms associated with pancreatitis as there was no recurrence in AP group, whereas recurrence was observed only in about 10 per cent patients of the CP group. Interpretation & conclusions: Pancreatitis was observed in 16 per cent of PHPT patients with male predominance in the study population. No recurrence of AP was observed after curative surgery. It may be proposed that serum amylase with calcium and PTH should be measured in all patients of PHPT with pain abdomen to rule out pancreatitis.

Cross sectional study of health profile of Interns of 2014 batch of Terna medical college, Nerul.

Background: Health check-up of M.B.B.S. interns is not done routinely. They expose themselves to the hospital environment for a longer time than their student days. It results in a higher rate of contracting and transmitting infectious diseases in a hospital setting than their student days. Objectives: To study the health profile of interns of 2014 batch of Terna Medical College. Materials & Methods: A predesigned pre tested questionnaire was developed to collect the information on identification data, socio economic & demographic data, and current morbidity. Anthropometric measures including height, weight, waist circumference & hip circumference were taken. Accordingly, BMI, Waist/ Hip ratio were calculated. General examination, systemic examination inclusive of refractory error was conducted. Interns were investigated for haemoglobin estimation, random blood sugar examination. Observations & results were tabulated & subjected to statistical analysis. Results: It was found that, 41.38% female interns & 28.57% male interns were anaemic. We observed that 60% of male interns & 27.59% female interns were pre obese & obese. 80% of the male interns & 37.93% of the female interns had increased waist/hip ratio. Out of 22 anaemic interns, 45.45% were pre obese & obese. None of the interns have hypertension, diabetes mellitus. Conclusion: Awareness regarding life style modification habits namely proper & timely diet, exercise should inculcate in the interns.

Effect of gender, biochemical parameters & parathyroid surgery on gastrointestinal manifestations of symptomatic primary hyperparathyroidism.

Background & objectives: Information on gastrointestinal manifestations and then response after curative parathyroid surgery is scarce in symptomatic primary hyperparathyroidism (PHPT). This study was carried out to analyse gastrointestinal manifestations in patients with PHPT and their associations with biochemical parameters. Methods: This retrospective study included 153 patients with symptomatic primary hyperparathyroidism (PHPT). The signs and symptoms pertaining to gastrointestinal system were analyzed. The difference of symptoms between men and women and difference in biochemical parameters in presence of different symptoms were evaluated. The relationship between serum calcium, phosphate and parathyroid hormone (PTH) levels with presence of gallstone and pancreatitis was also studied. Result: Of the 153 patients, 46 (30%) were men. The mean age was 39.2 ± 13.9 yr. Nearly 80 per cent of PHPT patients had at least one symptom/ sign related to gastrointestinal system. The most common gastrointestinal manifestations were abdominal pain 66 (43%), constipation 55 (36%), and nausea/or vomiting 46 (30%). Nearly one-fourth 34 (22%) of patients had a history of either gallstone disease or cholecystectomy or both. The prevalence of gallstone disease was higher in women (P<0.05). Imaging and biochemical evidence of pancreatitis was found in 27 (18%) patients. Pancreatitis was more common in men compared to women (P<0.05) despite the higher prevalence of gallstones in women. Serum calcium, phosphate or PTH levels were not associated with high risk for gallstone disease, however, serum calcium (P<0.05) was associated with 1.3 times higher risk of developing pancreatitis. In majority of patients, gastrointestinal manifestations resolved within three months of curative parathyroidectomy. Except two patients, none had recurrence of pancreatitis. Interpretation & conclusions: The study revealed that the gastrointestinal symptoms were common in patients with symptomatic PHPT. There was not much gender difference in gastrointestinal symptoms except higher occurrence of gallstones in women and pancreatitis in men. There was no difference in biochemical profile between those who had and did not have gastrointestinal symptoms.

Extracranial head and neck circulation aneurysms in a case of polyarteritis nodosa.

Polyarteritis nodosa (PAN) is a rare systemic necrotising medium vessel vasculitis. The hallmark of this condition is aneurysms which are seen in visceral arteries. Aneurysms of extracranial neck and head vessels are rare. We describe a case of PAN who had such aneurysms together with characteristic aneurysms in the mesenteric circulation.

Spontaneous rupture of normal spleen.

Spontaneous rupture of a normal spleen is very rare. We report a case where multiple episodes of spontaneous bleeding from the spleen gave an 'onion skin' appearance on CT scan.

Conversion of loop colostomy to end colostomy: is dismantling necessary?

Twelve patients who had previously undergone preliminary pelvic loop colostomy were treated by conversion of loop colostomy to end colostomy by alternative technique ie without dismantling of loop and conversion to end stoma. The results of this technique were compared with those of conventional procedure which was performed in ten patients. The new technique results in a 'mature' end colostomy in situ with little pain at the stoma site, no risk of retraction and lower risk of peristomal infection. We therefore recommend this procedure for all patients needing such conversion.