Gastric cancer profile in kashmiri population with special dietary habits.

The present study is a comprehensive retrospective analysis of 1341 gastric neoplasms out of 10 733 individuals subjected to upper gastrointestinal endoscopy at the main teaching cum referral hospital in the Kashmir Valley. Of these 78% were males and 22% females, majority being in the age group of 41-60 years with 60% of the patients being smokers. On endoscopy, the commonest site of cancer was the body of stomach 40.7%, followed by the antrum 35.5% and the cardiac region 23.8%. Endoscopic features revealed nodular masses 39%, polypoid masses 21%, malignant ulcers 11%, infiltrative masses 12%, rounded tumor masses 9%, linitus plastica 5% and early gastric carcinoma 3%. Histology revealed adenocarcinoma 91%, (including mucoid carcinoma 9%, and schirrous carcinoma 7%), leiomyosarcoma 7%, and reticulum cell sarcoma 2%. No significant association between Helicobacter pylori infection and gastric cancer was observed in a short study out of these patients. The peculiar geography and some special dietary habits with a possible familial predisposition may have a bearing on the high risk of gastric cancer in the valley.

Helicobacter pylori Infection in Endoscopic Biopsy Specimens of Gastric Antrum: Laboratory Diagnosis and Comparative Efficacy of Three Diagnostic Tests.

Aims and objectives The present study was undertaken to compare the diagnostic yield of three available test procedures for detecting Helicobacter pylori (H. pylori) infection in endoscopic biopsies.Methods H. pylori infection was sought in 150 patients referred for upper gastrointestinal (GI) endoscopy. Multiple (about six) biopsy specimens were taken from pyloric antrum in each patient. Two biopsy specimens were subjected to one minute endoscopy room test - OMERT (a modified form of urease test), two were sent for histopathological analysis, where multiple sections were subjected to Giemsa staining and two were sent for microbiological evaluation after Gram's staining of heat fixed biopsy material.Results H. pylori positivity using histology, microbiology and OMERT was observed to be 33%, 30% and 27% respectively. However, overall 40% patients were infected when the results from three test procedures were combined, as H. pylori positivity was repeated more than once by these procedures separately. Histology was found to be superior to other two tests in our study, especially when multiple sections were examined, for the distribution of the organism was patchy. Amongst the infected, H. pylori was seen in only 30% of all 3-8 sections cut from a biopsy, whereas in 70% it was noted in a single section only.Conclusion The study revealed that histology has the highest detection rate and can be chosen as the "gold standard" amongst the three low cost test procedures available at present in our setup.

Effect of diazepam sedation on arterial oxygen saturation and patient tolerance during esophagogastroduodenoscopy.

The impact of intravenous (I/V) diazepam sedation on arterial oxygen saturation (SaO(2)) and patient tolerance was studied in 100 patients in the age group of (27-60) years, who were subjected to esophagogastroduodenoscopy (EGD) for different indications. Equal number of patients in the same age group, who did not receive the sedation acted as controls. It was observed that SaO(2) showed a transient fall during the first few minutes of the endoscopic procedure even without sedation and diazepam administration did not significantly (p > 0.05) aggravate this oxygen desaturation. It was also observed that diazepam sedation increased the procedure tolerance of the patients when compared with controls (p < 0.01). In conclusion, it was inferred that I/V diazepam may act as a safe and favourable sedative for EGD.

Helicobacter pylori infection in endoscopic biopsy specimens of gastric cancer: a preliminary evaluation in a high risk population of kashmir valley.

OBJECTIVE: The aim of the present study was to assess the prevalence of Helicobacter pylori (H. pylori) infection in Kashmiri patients with gastric cancer and to compare this with a matched control population. METHODS: Fifty patients with gastric cancer and thirty age/sex matched controls were included in the study. All the subjects were hailing from Kashmir Valley. For detection of H. pylori, biopsy specimens were used both from cases and controls. RESULTS: An insignificant association was shown between H. pylori and both intestinal and diffuse type of gastric cancer. CONCLUSIONS: The data provides support against the significant association between H. pylori and gastric cancer in this part of world, a place where the age standardized incidence of gastric cancer is alarmingly high. We conclude that other factors like personal and special dietary habits of Kashmiri population may be more important for the development of gastric cancer.

Risks of HIV infection in the health care setting.

PIP: This article focuses on the risks of acquiring HIV infection from occupational exposures, especially in the health care setting. Health care workers mostly prone to HIV infection are nurses, laboratory technicians, surgeons, housekeepers, morgue technicians, and non-nursing attendants. Based on multicenter trials of more than 3000 health care workers, the risk of HIV infection is very high after needle stick injury or parenteral injury, which result in direct inoculation of infected material. Meanwhile, the risk is very low following mucous membrane exposure. Other factors, which have profound effect on the risk of HIV infection in health care workers, include the volume of inoculum, the quantity of virus, depth of penetration, type and size of needle, and actual infection of blood. Prevention of HIV infection among health care workers is achieved by minimizing or eliminating occupational exposure to infective materials especially blood products. This is done by encouraging use of engineering and work practice controls and through training and medical surveillance, labeling of hazardous material, and universal precautions for infection control. In the US, occupational safety and health agency (OSHA) regulates all these measures. Furthermore, the new OSHA regulation require hospitals and health care facilities to have a policy for the management of HIV exposure that includes pre-exposure training, immediate post exposure care, post-exposure counseling, and long term management.^ieng

Trichophytobezoar without gastrointestinal complaints.

Gastrointestinal complaints may be the presenting symptoms of trichophytobezoar. We report a patient, who had an epigastric lump and enlarged lymph nodes on the left side of the neck, but without any gastrointestinal complaint. The clinical diagnosis suggested lymphoma or gastric cancer with secondary masses in the cervical lymph nodes. The diagnosis ultimately proved to be tubercular lymphadenitis on biopsy and gastric trichophytobezoar on endoscopy and laparotomy.

Endoscopic evaluation of peptic ulcer disease during ramadan fasting.

The effects of fasting on peptic ulcer disease were evaluated in a prospective study, involving 23 fasting patients who underwent endoscopy before and after Ramadan. Eighteen patients took an H(2)-blocker (ranitidine, 150 mg twice daily) regularly at "Suhur" and "Iftar" as prescribed, while 5 were drug defaulters. On the first endoscopy the diagnosis in 4 patients was active acute duodenal ulcer (AADU), in 8 patients was active chronic duodenal ulcer (ACDU) in 8 patients was healed duodenal ulcer (HDU), in 2 patients was erosive duodenitis (ED), and in 1 patient was chronic gastric ulcer (CGU). All of the patients with AADU showed signs of healing on repeat endoscopy. None of the ACDU patients showed signs of healing on repeat endoscopy. Instead, 7 patients in this group bled during fasting. All of the 5 drug defaulters belonged to the ACDU group. One patient in the HDU group had developed an active ulcer near the previous scar, as which was seen on repeat endoscopy. The 2 patients with ED showed signs of healing, while the only patient with CGU had bled from the same ulcer as seen on repeat endoscopy. The results were compared with those of 15 nonfasting control subjects (6 patients with ACDU, 3 with HDU, and 6 with ED as diagnosed on the first endoscopy), who took an H(2)-blocker regularly. The repeat endoscopy did not show any change in these patients. In conclusion, we inferred that Ramadan fasting may prove hazardous in patients with peptic ulcer disease in general and with active chronic ulcers in particular, although the fact that only 23 patients volunteered for this study, of whom 5 were drug defaulters, is a limitation.