Prevalence and risk factors for Barrett's esophagus in patients with GERD in northern India; do methylene blue-directed biopsies improve detection of Barrett's esophagus compared the conventional method?

The reported rates of Barrett's esophagus [BE] ranged from 2.6% to 23% in Indian patients with gastro-esophageal reflux disease [GERD] symptoms. The role of methylene blue chromoendoscopy during endoscopy, either for the diagnosis of Barrett's esophagus or for the detection of dysplasia and early cancer, remains controversial. Our study was designed to find out the endoscopic as well as histological prevalence of BE in India in a specified patient population affected by GERD, and whether methylene blue chromoendoscopy improves detection of specialized intestinal metaplasia in endoscopically suspected Barrett's esophagus in GERD patients. Three hundred and seventy eight patients with characteristic symptoms of GERD from Northern India were subjected to upper endoscopy. On endoscopic suspicion of columnar lined epithelium [CLE] either 4-quadrant conventional biopsies at 2 cm interval or Methylene Blue [MB] directed biopsies were obtained randomly. The two groups were compared for the detection of Specialized Intestinal Metaplasia [SIM], which was diagnosed if the intestinal goblet cells were present. Out of 378 patients with GERD, 56 [14.81%] were suspected of CLE on endoscopy. After taking biopsy samples from the 56 patients, only 9 [2.38%] had specialized intestinal metaplasia on histopathological examination. Five [15.15%] patients in the conventional group and four [17.39%] patients in the chromoendoscopy group [P=0.55] were diagnosed as having BE. On univariate analysis the predictors of SIM were symptoms of reflux and length of CLE. The prevalence of biopsy proven BE and CLE in Northern India was 2.38% and 14.81%, respectively in patients with symptoms of GERD. The results of MB directed biopsies were similar to conventional biopsies in detecting SIM

Prevalence of exfoliative glaucoma among Kashmiri population: a hospital based study

The Prevalence of exfiolative glaucoma has shown extensive variation all over world ranging from 0 to 50%. To know the prevalence of exfoliative glaucoma in Kashmir. A hospital based cross-sectional study was conducted from January 2006 to January 2007 on 300 patients with documented raised intra ocular pressure [IOP], glaucomatous changes in the fundus and open angle of anterior chamber. The study included 236 males and 64 females. Out of 300 patients, 115 had exfiolative glaucoma and among those left eye was involved in 47 patients, right eye in 31 and 37 had bilateral involvement. The patients above 60 years of age were found to have this condition more frequently as compared to those below 60 years of age. Occupation of patients had a strong association with this condition, as the disorder was seen more commonly in patients engaged in outdoor activites. The patients with exfiolative glaucoma were found to be having less Visual acuity; a higher IOP at presentation and a more severe and early optic nerve head involvement as compared to those with open angle glaucoma. The study reveals that prevalence of exfoliative glaucoma as seen in our OPD based cross sectional study was found to be 38.3%. This prevalence was high as compared to prevalence studies conducted in southern parts of the country and low as compared to the studies conducted in the Scandinavian countries. The difference in the prevalence of the condition was probably inpart related to the differences in the climatic conditions, ethnic origin and in part related to genetic factors of the studied population