Lymphocytic Esophagitis Presenting With Food Impaction.

Lymphocytic esophagitis (LyE) is a rare diagnosis made on esophageal biopsy whose pathogenesis is poorly understood. Since its appearance in the literature 15 years ago, it still remains an enigma due to its low prevalence. In this case report, a 71-year-old male presented with an episode of acute dysphagia due to food impaction. Urgent endoscopy was performed to fragment the food bolus. Repeat endoscopy showed a stricture, and lymphocytic esophagitis was found on esophageal biopsy. A proton pump inhibitor (PPI) was initiated with symptomatic improvement. With its increasing prevalence, lymphocytic esophagitis should be on the differential for causes of dysphagia.

Timing and Outcomes of Percutaneous Endoscopic Gastrostomy After Ischemic Stroke.

Background: Guidelines recommend using percutaneous endoscopic gastrostomy (PEG) for dysphagia after 2 weeks of stroke onset. We aimed to study the impact of PEG timing on outcomes in patients with ischemic stroke. Methods: In this retrospective study of patients with ischemic stroke and PEG between 2014 and 2019, early PEG was defined as PEG tube placed within 14 days of stroke and late PEG after 14 days. Outcomes of 30-day mortality, PEG-related complications, and functional swallow recovery were compared between early and late PEG. Logistic regression model assessed factors associated with PEG timing. Results: The median time of PEG tube placement after stroke was 10.9 days. Of the 161 included patients, 60.9% had early PEG, and its associated patient factors were nursing facility discharge (adjusted odds ratio (OR): 3.4, confidence interval (CI): 1.48 - 7.82) and infection (OR: 0.32, CI: 0.139 - 0.178). Late PEG had 3.27 times greater odds of swallowing recovery, but mortality and complications were not significantly different between early and late PEG. Conclusions: Skilled nursing facility disposition and lack of infection were predictors of early PEG, constituting the majority of PEG placed for ischemic stroke-related dysphagia. Although better odds of swallowing recovery were seen with late PEG, likely implicating better patient selection, overall, the timing of PEG tube placement did not impact short-term mortality and complications.

Eosinophilic Colitis in Recurrent Sigmoid Volvulus.

Eosinophilic colitis (EC) falls along the spectrum of a series of inflammatory gastrointestinal disorders in which eosinophils infiltrate the gut without known tissue eosinophilia. Eosinophilic gastrointestinal disorders include eosinophilic esophagitis, eosinophilic gastritis, and the least common EC. The presentation of EC is extremely variable in mucosal, submucosal, and transmural inflammation. We present a case of recurrent volvulus with histologic findings of eosinophilia.

Pesticides Hazardous Hotspots: Empirical Evidences from North India.

The pesticide use in Indian agriculture showed a declining trend in the late 1990s and early 2000s. Since 2007, pesticide use gained an upward trend. To study the pesticide use pattern and identify pesticide hotspots, we collected data from a sample of 1201 apple, rice, vegetable, and cotton growers from the temperate Kashmir Valley, subtropical Jammu, and Punjab. Our study provided some interesting empirical results: prophylactic pesticide applications in apple crop making it a pesticide guzzler [25.2 kg of active ingredient (ai)/ha] with use of riskiest carcinogen pesticides (9 kg of a.i/ha) and field use environmental impact quotient (FEIQ) (620.4/ha) being the highest, the Kashmir Valley is the "pesticide hottest spot", followed by cotton and rice areas of Punjab and vegetable cultivation in Jammu subtropics. Pesticides banned for use in vegetables, such as monocrotophos were also applied by farmers in vegetable crops. However, rice areas in Kashmir and Jammu were only treated with herbicides. The protective measures taken by farmers while mixing and applying pesticides were primitive, resulting in localized mild/moderate pesticide poisoning besides loss of consciousness. We also found that the official data on the pesticide use are underreported and hence unreliable. Our study shows that neither the pesticide use by mass nor the pesticide use frequency, in combination or alone, is the robust indicator to measure the pesticide hazardous hotspots; besides these, FEIQ and less hazardous pesticides that are not probable or possible carcinogen should be rather used in conjunction.

Parental care-seeking pathway and challenges for autistic spectrum disorders children: A mixed method study from Bhubaneswar, Odisha.

BACKGROUND: Autism spectrum disorder (ASD) is globally a major cause of childhood disability. It is estimated that in India approximately 1.7-2 million children are affected with this disorder. Early diagnosis is an important criterion to start early interventions for ASD treatment. However, for every childhood problem that receives a medical diagnosis, there is a period between a parents' first recognition of unusual symptoms and the eventual diagnosis. Several factors influence this initial symptoms recognition and final diagnosis. AIMS: The present study attempts to decipher parents' perception regarding ASD and to understand the early signs of ASD recognition among parents, treatment-seeking pathways adopted their experiences and challenges in the overall process. SETTING AND DESIGN: A facility-based cross-sectional study was undertaken at Bhubaneswar, Odisha. METHODOLOGY: Parents of children with ASD were recruited for this study. Seventy-six interviews were conducted, and the data were analyzed. RESULTS: The major symptom identified by the majority of the parents was social difficulty among their children. Maximum parents had not heard about ASD before their child was diagnosed with the disorder. Parents consulted multiple professionals or traveled long distances to confirm the diagnosis. Child psychiatrists often confirmed the diagnosis and referred patients to rehabilitation centers. CONCLUSION: Lack of awareness, unavailability of services, and stress contributed to the delay in ASD diagnosis. There is a need for designing proper awareness and genuine center for the treatment. Similarly, referral and counter-referral mechanism is also required to be established to save delay in diagnosis and initiate prompt treatment in the field of ASD.

Dysferlin-Deficient Muscular Dystrophy Identified Through Laboratory Testing for Elevated Aminotransferases.

We present a 24-year-old combat veteran who underwent extensive work-up for elevated aminotransferases, including liver biopsy, with no underlying pathology identified. Subsequent investigations showed elevated creatinine kinase and aldolase. The patient was later diagnosed with biopsy-proven dysferlin-deficient muscular dystrophy. Persistent transaminase elevation despite negative liver work-up should prompt clinicians to consider extrahepatic sources of enzyme elevation. Promptly correlating aminotransferase elevation with musculoskeletal pathology may present an opportunity for clinicians to detect myopathies such as muscular dystrophy in their preclinical stages.