Celiac Neuropathy: A Case Report from Kashmir (India).

Celiac disease is considered to be rare in parts of the world where rice is a staple cereal. Kashmir is one of such places. We present an adult Kashmiri man, who had peripheral neuropathy, which turned out to be associated with celiac disease and improved remarkably with total elimination of gluten containing foods. This is probably the first case of celiac neuropathy reported from India.

Cancer trends in Kashmir; common types, site incidence and demographic profiles: National Cancer Registry 2000-2012.

BACKGROUND: An assessment of cancer incidence in population is required for prevention, early diagnosis, treatment and resource allocation. This will also guide in the formation of facilities for diagnosis, treatment, rehabilitation and follow-up for these patients. The demographic trend of cancer will help to identify common types and etiological factors. Efforts at clinical, research and administrative levels are needed to overcome this problem. SETTINGS AND DESIGN: Present retro prospective study was conducted in regional cancer center of a tertiary care hospital. MATERIALS AND METHODS: After permission from ethics committee, a retro prospective study of 1 year duration was undertaken to study the profile of cancer patients and to compare it with other cancer registries in India. STATISTICAL ANALYSIS: Pearson's Chi-square test and simple linear regression were used. Statistical Package for the Social Sciences version-16 (University of Bristol information services (www.bristol.ac.uk/is/learning/resources) was used. RESULTS: The overall incidence of cancer in Kashmir is on the increase and common sites of cancer are esophagus and gastroesophageal (GE) junction, lung, stomach, colorectal, lymphomas, skin, laryngopharynx, acute leukemias, prostate and brain in males.In females common sites are breast, esophagus and GE junction, ovary, colorectal, stomach, lung, gallbladder, lymphomas, acute leukemias and brain. CONCLUSION: Cancers of esophagus, stomach and lungs have a high incidence both in men and women in Kashmir. Future studies on sources and types of environmental pollution and exposures in relation to these cancers may improve our understanding of risk factors held responsible for causation of these malignancies in this region. This will help in the allocation of available resources for prevention and treatment strategies.

Cost analysis of in-patient cancer chemotherapy at a tertiary care hospital.

AIM: Cancer remains a major health problem in all communities worldwide. Rising healthcare costs associated with treating advanced cancers present a significant economic challenge. It is a need of the hour that the health sector should devise cost-effective measures to be put in place for better affordability of treatments. To achieve this objective, information generation through indigenous hospital data on unit cost of in-patient cancer chemotherapy in medical oncology became imperative and thus hallmark of this study. DESIGN AND SETTING: The present prospective hospital based study was conducted in Medical Oncology Department of tertiary care teaching hospital. MATERIALS AND METHODS: After permission from the Ethical Committee, a prospective study of 6 months duration was carried out to study the cost of treatment provided to in-patients in Medical Oncology. Direct costs that include the cost of material, labor and laboratory investigations, along with indirect costs were calculated, and data analyzed to compute unit cost of treatment. RESULTS: The major cost components of in-patient cancer chemotherapy are cost of drugs and materials as 46.88% and labor as 48.45%. The average unit cost per patient per bed day for in-patient chemotherapy is Rs. 5725.12 ($125.96). This includes expenditure incurred both by the hospital and the patient (out of pocket). CONCLUSION: The economic burden of cancer treatment is quite high both for the patient and the healthcare provider. Modalities in the form of health insurance coverage need to be established and strengthened for pooling of resources for the treatment and transfer of risks of these patients.

Active epilepsy as indicator of neurocysticercosis in rural northwest India.

Objective. To determine the contribution of neurocysticercosis as a cause for active epilepsy and to establish Neurocysticercosis as major definable risk of epilepsy in our setup. Methods. We conducted a door-to-door survey of 2,209 individuals of Bhore Pind and Bhore Kullian villages in Chattah zone of district Jammu (Jumma and Kashmir, Northwest India) to identify patients with symptomatic epilepsy. Patients with active epilepsy were investigated with neuroimaging techniques to establish diagnosis of NCC (neurocysticercosis). Results. Among 25 patients with epilepsy 10(40%) had CT/MR evidence of past or recent NCC infection. This gave us the point prevalence of 4.5/1000 for Neurocysticercosis in our study population. Interpretation. The study shows a high prevalence of NCC accounting for symptomatic epilepsy in our part of India.

Finger clubbing in a patient of myelofibrosis with renal cell carcinoma.

Finger clubbing has many well known causes. We present a rare association of finger clubbing in patient with myelofibrosis and non metastatic renal cell carcinoma, with no evidence of these well known.

Isolated pancreatic tuberculosis.

Isolated pancreatic tuberculosis (TB) is extremely rare, even in countries where TB is endemic. The recent increased reporting of TB of the pancreas is related to a worldwide increase in TB and an increase in emigration from countries where TB is endemic into countries where more sophisticated healthcare and diagnostic facilities are available. Herein, we report an unusual case of isolated pancreatic region TB, which presented with dyspeptic symptoms and was diagnosed by ultrasonography-guided needle aspiration and computed tomography scan of the abdomen. This case is unique with regard to abundant bacterial load, as evident by Ziehl Neelsen staining and absence of evidence of TB elsewhere. Pancreatic TB should be considered as a differential diagnosis of a pancreatic mass and most patients have an excellent clinical response to standard antituberculosis regimens.