A Study of Chemical Composition of Gall Stones in a Tertiary Care Hospital.

Gallstones are a major health problem & have been recognized since antiquity. Gallstones are generally classified into pure cholesterol, pigment and mixed type. Knowing the chemical composition of gallstones is essential for determining etiopathogenesis of gallstone disease. Fourier Transform Infrared Spectroscopy (FTIR) method is the most widely used technique in chemical analysis of gall stones. Reports on chemical analysis of gallstones are available from different endemic regions of India. However, no reports are available about the composition and etiopathogenesis of gallstones in Himachal Pradesh. METHODSGallstones from 400 patients of cholelithiasis were collected after cholecystectomy at Indira Gandhi Medical College Hospital (I.G.M.C.), Shimla, between June 2016 to June 2018, and were subjected to chemical analysis by FTIR method. The data was further correlated with regard to age, gender, socio-economic status, various life style factors like diet, obesity, physical activity, with stone number and colour. RESULTSChemical analysis of gall stones revealed that pure cholesterol, mixed and pigment variety were 94 %, 2 % and 4 % respectively. Majority of the patients were below the age of 50 years (66 %). Male to female ratio was 2.7:1. Both sexes had predominantly pure cholesterol stones. Most of the patients belonged to the lower middle class (56.5 %) & all socio-economic classes showed predominantly pure cholesterol stones. Similarly, there was no predilection of any type of stone to a particular physical work category. 53.5 % patients were non-vegetarians and 46.5 % were vegetarians. There was no correlation between diet and BMI with type of stones. In our study, 66 % of patients had multiple stones. Multiple stones were seen in all varieties of stones. Pure cholesterol stones showed a variety of colours contrary to traditional classification. CONCLUSIONSIn Himalayan population, the predominant type of gall stones were pure cholesterol stones. Mixed stones and pigment containing stones were found in much smaller frequencies. This result is in contrast to that of rest of the Indian subcontinent from where larger percentage of pigment and mixed stones has been reported. And pure cholesterol stones showed maximum variation in colours contrary to our expectation.

Rare Case of Large Antesternal Goitre,

A 55 years male presented with a large, painless, gradually increasing swelling in the neck and antesternal area for the last 35 years. The swelling started growing in front of the neck and later on occupied the areas in front of the chest. Patient was having constant dragging sensation due to this swelling and this swelling had to be supported during eating and drinking & it was interfering in his normal daily activities. When the growth developed small ulcer on its lower part, he reported to I.G. Medical College Hospital. The patient had no concomitant morbidity, no past history of any surgical or medical disease or treatment. There was no relevant family medical history.

Prevalence of Non-Alcoholic Fatty Liver with Gall Stones Disease in Himalayan Population

Non-Alcoholic Fatty Liver Disease (NAFLD) is the hepatic pandemic of the 21st century. It is the amassing of fats in the hepatic tissue without significant alcohol intake that results in hepatic steatosis. Patients with gall bladder stones may have associated NAFLD as these ailments share similar factors like obesity, hypertriglyceridemia and diabetes mellitus. However, few, if any, reports are available about the association of NAFLD with gallstones in the hilly population. Hence, this study was conducted to find out the prevalence of NAFLD in patients with gall bladder stone disease.METHODSThis study was done in the Department of Surgery, Indira Gandhi Medical College, Shimla, from June 2017 to May 2019. A total of 300 patients of ultrasound proven gall bladder stones was studied for NAFLD by Fibroscan (transient elastography). Transient elastography (TE) is a noninvasive method that has been shown to be useful for the detection of liver steatosis and fibrosis. NAFLD was diagnosed based on the value of CAP (Controlled Attenuation Parameter) & degree of fibrosis was assessed based on liver stiffness measurement (LSM) value on TE. Steatosis was graded as S0, S1, S2, and S3 while fibrosis was graded as F0-F1, F1, F2, F3, and cirrhosis. Minimum cut-off CAP value for diagnosing NAFLD was 214 dB/m & significant fibrosis was taken with LSM value >7.5 kPa.RESULTSPatients of gall stone disease showed significant liver steatosis, suggestive of NAFLD in 189 patients (63%), based on CAP value; however, 111 patients (37%) did not have significant steatosis. In patients with NAFLD, 57 (30%) had mild steatosis (s1) while 39 (20.53%) & 24 (12.63%) had moderate (s2) and severe (s3) steatosis respectively. Similarity, 72 (24%) patients had significant fibrosis while 228 (76%) patients had no to insignificant fibrosis on TE, 51 (17%) patients had moderate fibrosis, while 14 (4.5%) and 8 (2.5%) patients had severe fibrosis & cirrhosis respectively.CONCLUSIONSHigh prevalence of NAFLD in patients of gall stone disease was observed. Most of the patients had mild NAFLD i.e. grade S1 steatosis & in addition, fibrosis was present in 24% patients of NAFLD with gall stone disease.

Suicide Ideation in Depressed People Living with HIV/AIDS in District Jhansi, Uttar Pradesh (India)

Introduction: Suicide ideation is common amongst peoplewith HIV/AIDS but may not often indicate any significantrisk of suicide. However, persistent suicide ideation withassociated depression, could be serious and must beinvestigated promptly and carefully. This communicationaims at examining prevalence of suicide ideation in depressedPeople Living with HIV/AIDs (PLHAs) and in relation tosome of its socio-demographic and clinical variates.Material and Methods: This is a part of a cross sectionalstudy on depression in 104 HIV/AIDS patients, registered atART Clinic of a teaching hospital, undertaken in 2013-14 atJhansi in Uttar Pradesh (India). On applying GHQ tool, 70patients of depression were identified. These 70 patients werefurther studied for suicide ideation.Results: The prevalence of suicide ideation among depressedHIV/AIDS was found 60% as well as significant associationof suicide ideation was found with occupation, habitat and permonth income of depressed HIV/AIDS patients.Conclusions: The significant association between sociodemographic profile of depressed HIV/AIDS patients andsuicide ideation is an important marker that should alertclinicians to underlying suicidal risk. Clinicians shouldroutinely enquire on suicidality in depressed PLHAs andassist them in their early diagnosis and intervention.