Pattern and Final Visual Outcome in Paediatric Ocular Trauma in Central India.

Paediatric ocular trauma is one of the most common causes of preventable visual morbidity in children. One third vision loss occurs in the first decade of life, which is crucial stage for visual development. We wanted to evaluate the final visual outcome of paediatric ocular trauma and determine the various aetiological factors contributing to ocular trauma.METHODSProspective data regarding age, sex, visual acuity, etiological factors of 100 children who visited the emergency in the department of ophthalmology was collected. Children below 18 years of age were included. Children who could not cooperate or lost to follow-up were excluded from the study. Chi square test was done. P values were considered statistically significant at 0.01% level.RESULTSOf the 100 cases, closed globe injury accounted for 69% and the sex ratio was 3.2:1.48 children had visual acuity > 6/12, 18 had visual acuity 6/18 – 6/36, and 3 children had no perception of light (NOPL).CONCLUSIONSPaediatric ocular trauma is a major cause of the non-congenital unilateral blindness. Such injuries cannot always be prevented, but by identifying the underlying aetiological factor of serious injuries, it may be possible to determine the most effective method of reducing the incidence of visually challenging trauma. Although prognosis is mainly dependent on the extent of injury, choice of appropriate management can favourably affect the visual outcome.

Comparison of Intubation Characteristics of McCoy Laryngoscope and LMA CTrach with Cervical Collar in Situ- A Simulation Study.

Cervical spine motion restriction is an integral component of protocol for management of trauma victims. The use of rigid cervical collar for the same, presents a hurdle in airway management in patients where intubation is mandated for successful resuscitation. Hence, techniques alternative to conventional laryngoscopy need to be explored through simulation studies, to ease the process of intubation and benefit the actual trauma victims. We wanted to assess the performance of McCoy laryngoscope and LMA CTrach assembly and compare the intubation characteristics in patients with cervical collar.METHODS80 patients of ASA status I or II, scheduled for elective surgery requiring general anaesthesia and endotracheal intubation were randomly allocated to two groups- A and B. Patients in Group A were intubated using McCoy laryngoscope and Group B using LMA CTrach, with cervical collar in situ. Airway assessment included measuring thyromental distance, observing MPC grade and measuring inter-incisor distance, before and after application of semirigid cervical collar. Glottic view was noted using modified Cormack-Lehane grading. Device insertion time, total intubation time, number of attempts, haemodynamic factors and airway complications during the procedure were noted.RESULTSThere was decrease in inter-incisor distance and worsening of MPC grade in both groups post application of cervical collar. The time taken for device insertion in Group A was 16.95 + 3 sec, and in Group B was 33 + 4 sec (P= 0.0001). The total intubation time in Group A was 40.4 + 6 sec and in Group B was 57.4 + 4.37 sec (P= 0.0001). CL grade I was more common in Group B (31) than Group A (17) (P= 0.003). The number of attempts required, mean haemodynamic parameters and airway complication were comparable between the two groups.CONCLUSIONSThe McCoy laryngoscope requires less time to obtain glottic view and subsequent intubation, but LMA CTrach provides better glottic exposure. Thus, LMA CTrach has better performance characteristics in patients with cervical collar in situ.

Epidemiology and symptom profile of gastroesophageal reflux in the Indian population: Report of the Indian Society of Gastroenterology Task Force.

Background Gastroesophageal reflux disease (GERD) and its complications are thought to be infrequent in India; there are no data from India on the prevalence of and risk factors for GERD. The Indian Society of Gastroenterology formed a task force aiming to study: (a) the frequency and profile of GERD in India, (b) factors including diet associated with GERD. Methods In this prospective, multi-center (12 centers) study, data were obtained using a questionnaire from 3224 subjects regarding the frequency, severity and duration of heartburn, regurgitation and other symptoms of GERD. Data were also obtained regarding their dietary habits, addictions, and lifestyle, and whether any of these were related or had been altered because of symptoms. Data were analyzed using univariate and multivariate methods. Results Two hundred and forty-five (7.6%) of 3224 subjects had heartburn and/or regurgitation at least once a week. On univariate analysis, older age (OR 1.012; 95% CI 1.003–1.021), consumption of non-vegetarian and fried foods, aerated drinks, tea/coffee were associated with GERD. Frequency of smoking was similar among subjects with or without GERD. Body mass index (BMI) was similar in subjects with and without GERD. On multivariate analysis, consumption of non-vegetarian food was independently associated with GERD symptoms. Overlap with symptoms of irritable bowel syndrome was not uncommon; 21% reported difficulty in passage of stool and 9% had mucus in stools. About 25% of patients had consulted a doctor previously for their gastrointestinal symptoms. Conclusion 7.6% of Indian subjects have significant GERD symptoms. Consumption of non-vegetarian foods was an independent predictor of GERD. BMI was comparable among subjects with or without GERD.

Seroprevalence of hepatitis B infection during pregnancy and risk of perinatal transmission.

Objectives To investigate the seroprevalence of hepatitis B surface antigen (HBsAg) in pregnant women and possible risk factors for perinatal hepatitis B virus (HBV) transmission. Methods Four thousand pregnant women were evaluated using history, examination, and test for serum HBsAg using commercial enzyme immunoassay kits. For HBsAg positive women, liver function tests and a test for hepatitis B e antigen (HBeAg) was done. HBV DNA analysis was done by polymerase chain reaction (PCR). Results Of 4,000 women studied, 37 (0.9%) tested positive for HBsAg. Of these 37 women, 6 (16%) presented with acute hepatitis and 31 (84%) were asymptomatic. The highest HBsAg positivity rate was seen in the age group of 21– 25 years (1.15%) followed by 26–30 years (0.86%). Assessment of risk factors revealed history of tattooing in 29/37 (78.4%) women. HBeAg was positive in 21 of 37 (56.8%) women. Of the 16 HBeAg negative women, 5 were positive for HBV DNA and anti-HBe antibody, 6 had only anti-HBe antibody and 5 had neither HBV DNA nor anti-HBe. Vertical transmission was seen in 65% (13/20) of babies born to mothers who were positive for HBeAg and HBV DNA. In contrast, it was only 9.1% (1/11) for babies born to mothers who were negative for both HBeAg and HBV DNA. Of the 25 babies delivered vaginally, 15 (60%) developed vertical transmission. None of the four babies delivered by elective cesarean section had evidence of vertical transmission. Conclusions Seroprevalence of HBsAg in antenatal women was found to be 0.9%. HBe-antigen and HBV DNA positivity was associated with a higher chance of vertical transmission

Microscopic colitis in patients presenting with chronic diarrhea.

Aim: To investigate the prevalence of microscopic colitis among patients presenting with chronic watery diarrhea. Material and Methods: Colonic biopsies from 400 patients presenting with chronic watery diarrhea and other symptoms pertaining to lower gastrointestinal tract were studied. After a detailed clinical history and thorough physical examination full length colonoscopy was done using flexible colonoscope. Colonic biopsies were taken from abnormal and normal areas. Three to five micron thick sections were cut and stained with hematoxylin and eosin and Masson's trichrome stain to highlight sub epithelial collagen. Results: Fifteen out of 400 (3.7%) colonic biopsies from patients presenting with chronic diarrhea had evidence of microscopic colitis. Five out of fifteen biopsies (33%) were diagnosed as collagenous colitis, 10 biopsies (67%) had evidence of lymphocytic colitis; 14/400(3.5%) histologically normal biopsies were taken as controls to compare various demographic and risk factors. Ten out of 15 patients (67%) were clinically diagnosed as irritable bowel syndrome. In the remaining five an infective etiology was suspected. On colonoscopy12/15 (80%) had no abnormality and 3/15 (20%) had mild hyperemia. Conclusion: A possibility of microscopic colitis should be considered while examining colonoscopic biopsy of a patient with chronic watery diarrhea and normal colonoscopy to avoid the misdiagnosis that may affect the treatment of patients

Significance of cytomorphological and microbiological examination of bile collected by endoscopic cannulation of the papilla of vater.

Background: Bile analysis yields important information such as "biliary microlithiasis" and biliary tract colonization by microorganisms like Salmonella typhi or paratyphi, Escherichia coli , etc., which may progresses to cholelithiasis and have been found to have a role in the development of gallbladder cancer in India. Aim: To perform microscopic, cytomorphological and microbiological examination of bile collected during endoscopic retrograde cholangiopancreatography in patients with benign and malignant lesions of the gallbladder. Materials and Methods: Bile was collected from 48 patients by a catheter inserted through the cystic duct during endoscopic retrograde cholangiopancreatography. Direct microscopy and grading of crystals was performed. Smears prepared from centrifuged deposits were stained with Giemsa, Papanicolaou stain and Gram's stain for cytological and microbiological examination. Special staining for Helicobacter pylori was performed using Loeffler's Methylene blue and Warthin Starry stain. The rest of the sample was used for culture and complete microbiological examination. Results: Thirty-six patients had inflammatory lesions while 12 had malignant lesions. Crystals were observed in 93% of the cases, 13 (28.8%) had only cholesterol crystals, three (6.6%) had bilirubinate and 29 (64.4%) had both cholesterol and bilirubinate crystals. Smears from the centrifuged deposit mainly showed coccoid or cocobacillary bacteria on Gram's staining (81.3%). Five of 12 (41.6%) malignant cases showed epithelial atypia while none of the benign or inflammatory lesions showed such a change in hematoxylin and eosin and Pap-stained smears. Microbiologic analysis showed Staphylococcus aureus (14%), S. saprophyticus (5.5%), Peptococcus (5.5%), Peptostreptococcus (5.5%), Proteus mirabilis (5.5%), E. coli (17%), Enteorbacter cloacae (5.5%) and H. pylori (2.8%). Conclusion: Complete microscopic and microbiological examination of bile directly obtained from the common bile duct during endoscopic retrograde cholangiopancreatography yielded good results as fresh samples could be analyzed. It may help in diagnosis of many gallbladder lesions in early stages, thereby reducing the morbidity and mortality.

Management of chronic hepatitis B virus infection: a promising approach using small interfering RNA (siRNA).

Hepatitis B virus infection continues to be a major global health problem with an estimated 350 million carriers. The response to available treatment modalities is not impressive. The advent of RNA Interference--a phenomenon of sequence-specific degradation of RNAs mediated by double-stranded RNA--holds promise as a potential therapy for chronic hepatitis B virus infection. Synthetic preparations of short RNA (21-23 bp long) can be used to mediate this process of gene silencing with a lower immune response. The duration of suppression can be further increased by using a vector delivery system. Small interfering RNA (siRNA) has several advantages over conventional therapy, which include fewer side-effects, a lower chance of developing escape mutants and non-requirement of viral replication for its action. A potent knockdown of the gene of interest with high sequence specificity makes RNA interference a powerful tool that has shown antiviral effect against hepatitis B virus. However, the 'off-target effect', i.e. suppression of genes other than the intended target, poor siRNA stability, inefficient cellular uptake, widespread biodistribution and non-specific effects need to be overcome. The problem of long-term toxicity of siRNA should be addressed and an ideal vector delivery system needs to be designed before it can be put to clinical use.

Prevalence of H. pylori in patients with gastric cancer.

The present study was taken with an aim to assess the prevalence of H. pylori in patients with gastric carcinoma and correlate it with gross appearance and histological type. Endoscopic biopsies from 54 patients with gastric carcinoma and 50 age and sex matched controls were taken after thorough upper gastrointestinal examination. Gross appearance of the tumour was noted and two biopsies each from the site of malignancy and from normal appearing areas were taken. Sections were stained with Haematoxylin & Eosin and Loeffler's methylene blue for histopathological details and presence of H. pylori. Prevalence of H. pylori in controls was slightly higher than the patients group (80% Vs 78%). Ulcerated type of gross appearance had maximum prevalence of H. pylori (88%). Prevalence of H. pylori was more in diffuse type of gastric cancer than intestinal type (86% Vs 68%). A significant association between H. pylori and grades of gastritis was noted (P < 0.01) in controls as well as in patient group but it failed to show a significant association with tumour grades, intestinal metaplasia, site of the tumour and age of the patients. So, it can be inferred that prevalence of H. pylori infection is not directly associated with pathogenesis of gastric cancer but it may act as a co-carcinogen by damaging the mucosa and thereby making it more susceptible to effects of carcinogen.

Giardia lamblia trophozoites in gastric biopsies.

To assess the prevalence of gastric giardiasis in gastric biopsies of patients with carcinoma stomach and in patients taking treatment for duodenal ulcer. Gastric biopsy specimens from 54 patients of carcinoma stomach and 100 antral biopsies from patients taking treatment for duodenal ulcer were included in the study. Sections were stained with haematoxylin and eosin, methylene blue and May Grunwald-Giemsa stains and examined for presence of Giardia lamblia trophozoites. Eight out of 54 (14.9%) biopsies of gastric carcinoma patients harboured trophozoites of Giardia lamblia. Associated H. pylori infection was present in all biopsies (8/8; 100%). Atrophy and intestinal metaplasia was present in 62.5% (5/8) and 25% (2/8) cases respectively. Sections from seven out of 35 patients (20%) taking treatment for duodenal ulcer showed presence of G. lamblia. H. pylori infection, gastritis and atrophy were found in 85.7% (6/7), 71.4% (5/7) and 28.6% (2/7) cases respectively. First gastric biopsy in these patients was negative for G. lamblia but 2nd and 3rd biopsies were positive. A careful search for G. lamblia trophozoites should be made while examining the gastric biopsies, especially in patients with carcinoma stomach, intestinal metaplasia, atrophic gastritis and those taking treatment for duodenal ulcer. This may help in indirect diagnosis of clinically unsuspected cases of intestinal giardiasis and may explain persistence of vague upper gastrointestinal tract (UGIT) symptoms despite clearance of H. pylori in patients on anti-ulcer therapy.

Duodenal metastases from squamous cell carcinoma of the lung: endoscopic management of bleeding and biliary and duodenal obstruction.

Intestinal metastases from cancer of the lung are rare. We report a 65-year-old man with duodenal metastases from squamous cell cancer causing GI bleeding and biliary and duodenal obstruction; these were managed endoscopically.

Asymptomatic essential thrombocythemia: a case report.

Essential thrombocythemia (ET) is a clonal disorder of unknown etiology involving multipotent hematopoietic progenitor cell and belongs to the spectrum of chronic myeloproliferative disorders (CMPD). It is rarest of the CMPD with no case reported from India. The case being presented was detected incidentally during routine investigations in an adult female who presented with mild abdominal discomfort.

AgNOR counts are not altered in alcoholic cirrhosis.

One hundred and two liver biopsy specimens were stained for Argyrophilic nucleolar organizer regions and associated proteins to assess its utility in differentiating normal, cirrhotic and neoplastic liver tissue. A statistically significant (p < 0.001) difference was observed between mean AgNOR counts of normal (1.53 +/- 0.4), post-hepatitic cirrhosis (3.65 +/- 0.53) and hepatocellular carcinoma (7.94 +/- 1.18). In contrast the mean AgNOR count of biopsies with alcoholic cirrhosis (1.57 +/- 0.06) was significantly less (p < 0.001) than post-hepatitic cirrhosis and was similar to that of normal liver tissue. It is concluded that AgNORs can act as a good adjuvant to histology in diagnosing liver diseases especially in differentiating post-hepatitic and alcoholic cirrhosis.

Complications of endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy: diagnosis, management and prevention.

Endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy are carried out for a variety of billo-pancreatic diseases. These procedures were earlier performed at only a handful of tertiary centres in India. However, of late, they are being performed at several centres and even smaller clinics. Although, endoscopic sphincterotomy is one of the most commonly performed endoscopic procedure, there are no data on the number of procedures performed each year in India. It is estimated that in the USA alone more than 200,000 procedures are performed each year. The procedure has the dubious distinction of being considered as one of the most hazardous of all endoscopic procedures and is associated with a small but significant morbidity and mortality. The immediate complications of endoscopic sphincterotomy include pancreatitis, haemorrhage, perforation and cholangitis in addition to those associated with the use of sedation and anaesthesia. There are also reports of the long term adverse effects of the destruction of the sphincter of Oddi. There is also controversy as to what should be the minimum requirements for training and who should be allowed to perform these procedures.