ABSTRACT
INTRODUCTION: Obesity is rapidly becoming a pandemic and poses a serious health risk to the individuals. Abdominal obesity is quite common in India and is a prime risk factor for diseases like diabetes, coronary artery disease, Gastroesophageal Reflux Disease (GERD), osteoarthritis etc. A complex and multifactorial aetiopathogenesis of GERD exists in presence of obesity. The current study focuses on high Body Mass Index (BMI), a marker of obesity, as a risk factor for GERD and aims for a better understanding of their complex association. AIM: To study the association between the BMI and symptoms as well as gross endoscopic appearance of GERD. MATERIALS AND METHODS: A prospective cross-sectional study was carried out at a tertiary care hospital in Maharashtra, India, between January 2016 and June 2016. A total of 176 patients referred for upper Gastrointestinal (GI) endoscopy due to dyspeptic symptoms of more than two months duration were selected. BMI (weight in kilograms/square of height in metres) was calculated for all patients and they were classified as normal weight (BMI 18.5 -24.9), overweight (BMI 25-29.9) and obese (BMI≥30). The frequency and severity of GERD symptoms was assessed by a self-administered questionnaire. Data on typical and atypical symptoms of GERD was collected. Upper GI endoscopy was done on all patients. Based on gross endoscopic appearance, the disease was divided as Endoscopy Negative Reflux Disease (ENRD) and true GERD (as per Los Angeles staging system). Association between BMI and frequency, severity and type of symptoms of GERD and also between BMI and gross endoscopic oesophagitis was studied using various statistical tests. All tests were two-tailed with a confidence level of 95%. A p-value < 0.05 was considered to be statistically significant. RESULTS: Typical symptoms of heartburn and acidic regurgitation were present in 71.6% subjects. The frequency and the severity of the dyspeptic symptoms increased significantly with increasing BMI (p<0.05). Based on the endoscopic gross appearance of the oesophageal mucosa, 48.3% participants had ENRD and 51.7% had erosive disease (GERD). High BMI had a statistically significant relationship with occurrence of both ENRD and GERD (p<0.05) but a statistically insignificant relationship with LA classification system for endoscopic oesophagitis. CONCLUSION: The prevalence, frequency and severity of symptoms of GERD increases with increase in the BMI. Erosive oesophagitis has significant correlation with increasing BMI, but the staging and classification of endoscopic erosive oesophagitis is independent of the BMI of the patients.
ABSTRACT
Emphysematous pyelonephritis (EPN) is a rare, severe infection of renal parenchyma presenting commonly with fever and flank pain and presence of gas in the renal and/or peri-renal space. EPN can be life threatening if not diagnosed and treated promptly. Air shadows in the renal or peri-renal region on imaging studies of the abdomen are diagnostic features of EPN. However, computed tomography (CT) scan of the abdomen is better than ultrasound for diagnostic classification, prognosis, and treatment options. We treated a young female with uncontrolled type II diabetes mellitus who had severe abdominal and back pain with fever. The CT scan confirmed the diagnosis of EPN. The conservative treatment itself was effective in complete resolution of the disease even though patient had severe type of EPN.
ABSTRACT
Drug hypersensitivity syndrome is characterized by fever, skin rash and internal organ involvement. It is commonly seen with aromatic group of anticonvulsants viz. phenytoin, carbamazepine and phenobarbitone. Here, we report a case of hypersensitivity reaction to pregabalin, used for treating postherpetic neuralgia.
