Prevalence of carcinoma stomach in a tertiary referral centre in Eastern India and its correlation with endoscopic findings

Carcinoma stomach still remains a major killer cancer all over the world. Delay in early diagnosis or lack of awareness, infrastructure etc. is the major factor for late presentation in developing countries. This work was carried out to study the prevalence of carcinoma stomach in a tertiary referral centre in Eastern India and its corroboration with endoscopic findings. The aim is to create an awareness regarding early diagnosis of this monstrous killer. The study was conducted on 8706 symptomatic patients attending for upper GI endoscopy, of which 165 patients were found to have adenocarcinoma of stomach and 8 patients with other stomach neoplasms. The age, sex, religious status and economic background were analysed. The endoscopic findings, histological nature and grading, site of the lesions vis-à-vis clinical signs and symptoms were analysed and statistically reviewed. Of the total 165 cases of carcinoma stomach, highest number of cases (24.8%) were among 40-49 years of age, followed by 50-59 years (23.7%). The male sex (67.6%) and patients with low socio-economic background (75.7%) were the worst sufferer. On gross microscopic findings of endoscopy, ulcero-proliferative lesions were highest (80.8%) and antrum was the commonest (46.8%) site of neoplastic lesions. Histologically, adenocarcinoma (95.4%) was commonest. The significant symptoms of presentation were pain abdomen (84%), weight loss (89%), anorexia (86%), gastric outlet obstruction (40%) while signs were anaemia (100%), epigastric tenderness (60%), lump abdomen and gastric outlet obstruction (40%). We found a large number of neoplastic lesions in endoscopy series with the highest number in males at forty. This implies a gross economic fall out on the family. The interesting finding of antral growth differs from western series. Liberal use and availability of endoscopy may help in detecting the lesions early with better outcome.     

Prevalence and pattern of use of indigenous medicines in diabetic patients attending a tertiary care centre

The aim of the study was to see the pattern of use of indigenous medicines in diabetic patients and to find out its correlation with various demographic variables in patients of type 2 diabetes. A sample of 113 patients with diabetes (type 1 and type 2) was interviewed using a structured questionnaire by trained medical personnel about the intake of indigenous medicines. Correlation of intake of indigenous medicines with various demographic variables was assessed using appropriate statistical tests. Male to female ratio in the present study was 1:3. Mean duration of diabetes was 5.2 +/- 2 years. It was found that majority of patients 101/113 (89.4%) attending diabetic clinic were using indigenous medicines in one form or the other. Most common drugs used were karela (78.8%), jamun (65.5%), methi (38.9%) and neem (28.3%). Majority were taking on advice from fellow diabetics (41.6%) and were not sure (39.8%) about the effect. No significant correlation was found with their intake and demographic variables as age, sex, per capita income, duration of diabtes, occupation, cultural background and antidiabetic medicine used. There is a high percentage of indigenous drug use in patients with diabetes which is often not reported. Treating physicians need to be alert to this possibility while managing diabetic patients in order to correctly interpret glycaemic control, hypoglycaemic episodes and other unexplained comorbidities that might arise in them.     

Ophthalmic manifestations in people living with HIV attending a tertiary care centre of Eastern India

A cross-sectional study was undertaken to evaluate ophthalmic lesions in human immunodeficiency virus-infected individuals in eastern part of India. One hundred and seventy-five Indian patients attending one tertiary care centre in Kolkata, were included in the study. Ophthalmic manifestations were found in 29.14%. Of them 64.70% had posterior segment lesion, 23.52% had neuro-ophthalmic lesion, 19.60% had anterior segment lesion, 15.69% had adnexal lesion. Human immunodeficiency virus retinopathy was the commonest ophthalmic lesion involving 23 eyes. Cytomegalovirus retinitis was found in only 10 eyes. Ophthalmic lesions were less common in this study than reported in earlier literature in India and abroad.     

Clinical profile of epilepsy, in a tertiary care centre of North-west India

The present study has been undertaken in a tertiary care centre of North-west India to know the clinical profile of epilepsy and response to drug therapy with special reference to study the effect of reduction of dosage of anti-epileptic drug after a seizure-free interval of two years. A total of 904 patients were selected during the period January, 2001 to October, 2006 who attended OPD clinic of the department of neurology, SMS Medical College and Hospital, Jaipur. Datailed clinical history was taken, general physical examination, routine blood examination, ECG and CT scan along with MRI (brain) in some cases were carried out. Of all the cases, sex ratio (male : female) was 2:1. A high proportion of cases (62.83%) were from low socio-economic group, 41.15% had normal EEG, 532 patients had normal CT scan (out of 800 cases). Single drug therapy was instituted in 71.67% cases. Patients went follow-up for 3 years. Most of the cases proved to be seizure-free after 2 years. Average maintenance dosage in patients on monotherapy can be reduced after a seizure-free interval of 2 years.     

Cadaveric renal transplantation: Our experience at a tertiary care centre in India

BackgroundRenal transplantation in developing countries like India is largely live donor transplantation. Cadaveric transplantation comprises <2% of all transplants in India.MethodsNinety-two cadaveric renal transplantations were included. Various donor and recipient characteristics were analysed along with graft and patient survival, using Kaplan–Meier method.ResultsThe mean age of the recipients was 35.5 ± 10.9 years while that of cadaver was 43.9 ± 17.0 years. Proportion of females among recipients was 47.8% while that of donors was 34.8%. The most common underlying pathology was chronic glomerulonephritis (44.6%). Antithymocyte globulin was used as induction in 84.8% of cases. Tacrolimus-based triple-drug regimen was most commonly used as maintenance (80.4%). The mean follow-up time was 39.02 ± 28.24 months. The most common cause of death was sepsis (47%). More than 50% deaths (9/17) occurred within first 3 years, while 61.5% of graft loss occurred 5 years after transplantation. The mean graft survival time was 81.6 months (95% confidence interval [CI]: 72.8–90.4). Cumulative proportion of graft survival was 91.6% at 3 years and 77.1% at 5 years. Although females have better mean graft survival time (91.6 vs 73.5 months), it was not a significant difference as shown by log-rank test (p value = 0.062). Pretransplant haemodialysis has no significant effect on graft loss, but patients on peritoneal dialysis have significantly higher odds of graft loss (odds: 4.86, p value < 0.05 [0.018]). The mean patient survival time was 99.5 months (95% CI: 84.0–114.9). Cumulative proportion of patient survival was 83.3% at 3 years and 70.8% at 5 years.ConclusionGraft and patient survival rate of cadaveric transplant at our centre was satisfactory. There is need to sensitise and augment the rate of cadaveric transplantation to increase the donor pool.     

The prevalence of depression among elderly warded in a tertiary care centre in Wilayah Persekutuan

Depression is characterized by symptoms like disturbance in behavior, cognition and mood. This is commonly known to affect people aged 60 years and above especially those who are also afflicted with illnesses. The objectives of this study were to determine the prevalence of depression and its associated factors among the elderly in a tertiary care centre in Wilayah Persekutuan. A cross sectional study design was done. Stratified cluster sampling method was used to select the respondents. All elderly patients were selected from the orthopaedic, surgical, gynaecology and medical wards in a government hospital in Wilayah Persekutuan. A 30-item Geriatric Depression Scale questionnaire was used as a screening instrument. Out of the 246 elderly subjects, 198 were interviewed giving a response rate of 80.5%. The results showed that 54% of the elderly respondents were found to have depressive symptoms. Age (p=0.022), sex (p=0.008), ethnicity (p=0.022) and functional disabilities in bathing (p=0.001), grooming (p=0.007), dressing (p= 0.007), using the toilet (p=0.002), transferring from bed to chair and back (p=0.000), mobility (p=0.000) and climbing stairs (p=0.000) were all found to be significantly associated with depression among the elderly respondents. The outcome of this study will have an important impact on the implementation of the health policy for the elderly patients admitted to hospitals.     

Prevalence of rheumatic conditions in patients with diabetes mellitus in a tertiary care hospital

Musculoskeletal disorders are common in diabetic subjects. The pathophysiology of these disorders in diabetic patients is not obvious. It could be due to connective tissue disorders, glycosylated end products, vasculopathy, neuropathy or combinations. A wide range of musculoskeletal syndromes have been described in association with diabetes, namely diabetic cheiro-arthropathy, adhesive capsulitis of shoulder, carpal tunnel syndrome, Dupuytren's contracture, hyperostosis, osteo-arthritis, hyperuricaemia, etc. This study was undertaken to find out the prevalence of these conditions in diabetes mellitus and to look for any associations with diabetic complications or therapy. A tertiary care centre-based cross-sectional study was carried out among 100 consecutive diabetic patients (WHO criteria) attending medicine department who were enrolled. The study was done at Calcutta National Medical College and Hospital, Kolkata, from March 2008 to February 2009. The diagnoses of the rheumatic conditions were made by unbiased clinical observations on the basis of standardised case definitions or criteria. Limited joint mobility (29%), adhesive capsulitis (18%), and osteo-arthritis of knee (27%) or hand (17%) were the most common rheumatic conditions in diabetics. Trigger finger (flexor tenosynovitis) and carpal tunnel syndrome were also present in 7% and 5% cases of diabetics respectively. Although hyperuricaemia was present in 9%, clinical gout was present in only 4%. There was no clear association of these syndromes with diabetic renal disease or micro-albuminuria. Most of these conditions were noted in chronic long duration diabetic subjects.     

Observations of hepatic encephalopathy profile in a tertiary care centre

A study was conducted among 67 patients presenting with hepatic encephalopathy to establish the aetiological diagnosis and record the incidence of acute and chronic liver diseases. They all had undergone thorough clinical and laboratory evaluation. The factor precipitating encephalopathy was also identified. Among 67 patients 19 (28.4%) had acute liver disease and 48 (71.6%) had chronic liver disease. Majority of patients had grade 2 encephalopathy at presentation. Among the acute cases most common aetiology was acute viral hepatitis due to hepatitis B and E viruses whereas alcoholic liver disease was the most frequent cause of chronic liver disease. The most common precipitating factor was gastro-intestinal haemorrhage.     

Seroprevalence of syphilis in patients attending a tertiary care hospital in Southern India

ObjectiveTo report our experience with two tests, anti-cardiolipin antibody test [venereal disease reasearch laboratory (VDRL) test] and specific treponemal test (Treponema pallidum hemagglutination assay), used for screening antenatal, high risk cases and cases from sexually transmitted infection in a tertiary care hospital from January 2006 till December 2008.MethodsA total of 14 639 samples received from various patient groups including antenatal cases, patients attending sexually transmitted disease (STD) clinic, blood donors and HIV positive patients were screened.ResultsAmong the 14 639 samples collected, 103 were positive by VDRL test. Of these 89 cases were confirmed by quantitative VDRL test and Treponema pallidum hemagglutination assay. The cumulative seroprevalence over two years was found to be 0.61% in this study. The syphilis seroprevalence reduced from 0.88% in 2006 to 0.40% in 2008. Among the various sub-populations studied, patients attending the sexually transmitted infection clinic showed a seroprevalence of 2.62%. The seroprevalence decreased significantly from 4.00% in 2006 to 1.39% in 2008.ConclusionsOur study showed a statistically significant declining rate of syphilis in STD clinics as well as the overall seroprevalence. These findings could be interpreted as indicators of improved programmes for prevention and management of STDs.     

Prevalence of methicillin-resistant Staphylococcus aureus and its antibiotic susceptibility pattern in a tertiary care hospital

Methicillin-resistant Staphylococcus aureus (MRSA) emerged as a nosocomial pathogen in early 1960s, causing Increasing number of outbreaks in 19708, first reported in a teaching hospital in Malaysia in 1972, causing increased mortality, morbidity, and healthcare costs. Aim of this study is to screen out MRSA from various clinical samples and to see their antibiotic susceptibility pattern. From May 2008 to May 2009, 204 S aureus strains were isolated, out of which 114 (55.8%) were MRSA, and rest methicillin-sensitive Staphylococcus aureus (MSSA). Most of the MRSA strains were obtained from pus (45%) followed by urine (20.5%). Frequency of isolating MRSA were maximum in catheter tip (80%) followed by blood (66.7%) and pus (58.7%). MRSA strains were showing 100% sensitivity to vancomycin and Iinezolid, whereas 92.9% to teicoplanin. Therefore it is concluded that antibiotics other than vancomycin can be used as anti-MRSA agents after sensitivity test, as well as irrational and indiscriminate use of antibiotics can be avoided.     

Multi-drug resistant Acinetobacter species from various clinical samples in a tertiary care hospital from South India

Background

Acinetobacter species are gram-negative coccobacilli belonging to the group of Non-Fermenting Gram-Negative Bacilli, which are ubiquitous in nature. They cause outbreaks in intensive care units and healthcare settings, and are becoming increasingly drug resistant.

Aims

To determine the prevalence of multi-drug resistant Acinetobacter species from various clinical samples.

Method

Clinical samples were processed as per standard microbiological techniques. Antibiotic susceptibility testing was carried out on all the Acinetobacter isolates by Kirby- Bauer disc diffusion method as per CLSI guidelines.

Results

A total of 122 Acinetobacter spp. were isolated. 110 (90.16 per cent) were from inpatients, and 12 (9.83 per cent) were from outpatients. Out of 122 isolates, 44 (36.06 per cent) were from the ICU. The majority of the isolates, 47 (38.52 per cent), were from pus samples followed by 25 (20.49 per cent) from endotracheal tube aspirate. Out of 122 isolates, 87 (71.31 per cent) were multi-drug resistant of which 15 (12.29 per cent) were resistant to all drugs tested.

Conclusion

Acinetobacter infections associated with multi-drug resistant and pan-resistant strains have emerged as important nosocomial pathogens in our setting.     

Inpatient management of diabetes: survey in a tertiary care centre

Aims: Good glycaemic control in hospitalised patients with diabetes mellitus improves wellbeing and aids recovery. This survey aimed to: (1) assess glycaemic control in patients with diabetes admitted to hospital for reasons other than diabetes, (2) compare the glycaemic control in patients treated in medical and surgical units, and (3) see the impact of specialists'' input on glycaemic control. Methods: The first 150 patients admitted to hospital were identified; those with acute metabolic complications of diabetes mellitus, acute myocardial infarction, pregestational or gestational diabetes, and patients in different intensive care units were excluded. Case notes were reviewed with particular attention to glycaemic control, frequency of blood monitoring, complications, and the actions taken to improve glycaemic control. Results: Four of the 150 patients died in hospital. When subcutaneous insulin was used glycaemic control was good in 48%, suboptimal in 15%, and poor in 37% of patients. The results were not significantly different with subcutaneous or intravenous insulin. There was also no difference in glycaemic control among medical and surgical patients. Patients managed by designated specialists had better control than those managed by physicians (p<0.001). Hypoglycaemia was documented in 20% and two patients developed non-ketotic hyperosmolar coma while in hospital. In a few cases treatment at discharge was not changed despite poor control while in hospital. Conclusion: More attention should be given to improving glycaemic control in patients hospitalised for reasons other than diabetes. Particular care should be taken to modify the dose of insulin needed to get good glycaemic control; control was better with specialists'' input. A follow up survey will be conducted.     

Prevalence of taurodontism in premolars among patients at a tertiary care institution in Trinidad

OBJECTIVES: A study was undertaken to assess the prevalence of taurodontism in premolars in a group of adult dental patients in Trinidad and Tobago since there is no such data available for the region. METHODS: Periapical and orthopantomograms of 1090 randomly selected patients were examined for the presence of an apically displaced pulp chamber without the usual constriction at the cementoenamel junction. RESULTS: Prevalence of taurodontism in a sample of 1090 patients was 11.28%. Of the 5324 premolars examined, 4.79% were taurodonts. Prevalence of taurodontism was higher in males (6.46%) compared to females (3.66%). A Statistically significant difference (p < 0.0001) was observed in the prevalence of taurodontism in mandibular premolars compared to maxillary premolars (9.07% vs 0.56%). CONCLUSION: Prevalence of taurodontism in premolars among Trinidadian patients, as assessed by radiographic study, was 4.79% and it was higher in the males compared to females. Significant differences were also observed between mandibular and maxillary premolars.     

Emergence of multidrug resistant enterococci at a tertiary care centre

Background

Enterococci have assumed great clinical importance because of their increasing resistance to various antimicrobial agents. Thus, knowledge about the antibiogram of these multidrug resistant isolates is of utmost importance in formulating an effective antibiotic policy to treat these infections and reducing the morbidity and mortality. Aim of this study was to assess the antimicrobial resistance pattern of enterococci and determine the prevalence of multidrug resistance among them.

Methods

This cross sectional study was carried out from August 2011 to February 2014, in which 200 non-repetitive clinical isolates of enterococci were included. Antimicrobial susceptibility testing was done by disc diffusion method. Minimum inhibitory concentration (MIC) of gentamicin, streptomycin, vancomycin, teicoplanin and linezolid was determined by E-test method.

Results

The prevalence of multidrug resistance among enterococcal isolates was found to be 63%. Varying levels of resistance was seen to various antibiotics. Most of the isolates were resistant to penicillin (95%), ampicillin (95%) and cotrimoxazole (90%). High level aminoglycoside resistance (HLAR) and glycopeptide resistance was seen in 39% and 14% isolates respectively. Only 4 isolates (2%) were found to be resistant to linezolid.

Conclusion

The prevalence of multidrug resistance among enterococci was found to be 63%, the resistance being more common in Enterococcus faecium as compared to Enterococcus faecalis. The study highlights the emergence and increased prevalence of multidrug resistant enterococci which pose a serious therapeutic challenge.     

Bronchoscopy in adults at a tertiary care centre: indications and complications

Fibreoptic bronchoscopy (FOB) helps in visualisation of the endobronchial tree. Fibreoptic bronchoscopies were done in 429 cases between January 1999 and January 2000 [322 men (75.1%) and 107 women (24.9%)]. Patients were between 12 and 89 years of age (mean+/- SD = 49 +/- 15.1 years). Of which, 196 (45.7%) had lung cancer and 233 (54.4%) had non-malignant disease [Tuberculosis (TB) 26, miliary TB 16, non-resolving pneumonia 29, atypical pneumonia 10, bronchiectasis 11, aspergillosis 12, sarcoidosis 17, interstitial lung disease (ILD) 20, haemoptysis with normal chest x-ray 13 and miscellaneous 79]. In this series of 429 patients a significant number of patients (n = 127) presented with fever (38 malignant and 89 non-malignant disease, p < 0.0001), 137 had haemoptysis (74 malignant and 63 non-malignant disease, p < 0.01), 89 had chest pain (61 malignant and 28 non-malignant disease, p < 0.0001) and 29 patients presented with complaint of anorexia (21 malignant and 8 non-malignant disease, p < 0.003). High prevalence of lung lesions in the right upper lobe [10.4% (43 of 411)] and left main bronchus [12% (49 of 411)] was observed. Left upper lobe showed 8.7% (36 patients) lesions and right middle lobe showed 5.5% (23 patients) lesions. In 143 (34.8%) patients, FOB findings were normal. Out of 407 patients, FOB was suggestive of necrotic/nodular growth in 159 patients (39.1%), infiltrative growth in 8 patients (1.9%), and extrinsic compression was found in 39 patients (9.6%). In 143 patients (35.2%) no endobronchial growth was seen. Bronchial biopsy (BB) was performed in 162 (37.8%) patients, transbronchial lung biopsy in 56 patients (13.1%), bronchial washing for cytology in 350 patients (81.5%), bronchial washing for AFB in 302 patients (70.3%), bronchial washing for culture in 67 patients (15.6%), bronchial washing for fungus in 64 patients (14.9%) and Pneumocystis carinii infection was looked for in 6 patients (1.4%). Postbronchoscopy complications were recorded as follows: Early termination of FOB due to decreased O2 saturation in 10 cases (2.4%), postbiopsy bleeding in 5 cases (1.2%), post FOB fever in 5 cases (1.2%), chest pain in 7 patients (1.7%) and pneumothorax occurred in 2 patients (0.5%). FOB performed in outpatient setting is a useful and safe modality. Most patients in whom FOB was done in the present setup had suspected lung cancer. No major complications were encountered.     

Male preponderance in HIV seropositive patients with mucocutaneous complaints in a tertiary care hospital in North India

ObjectiveA panorama of mucocutaneous manifestations is seen at every stage of HIV. This study was done to study the sex prevalence in HIV/AIDS patients with mucocutaneous disorders.MethodsA total of 1 000 HIV seropositive patients attending Skin-STD clinic, Govt. Medical College, Amritsar, for any dermatologic complaints were studied in respect to the sex group preponderance.ResultsMales constituted the majority as 75.6% while females were 24.4%.ConclusionsWomen, in most of the cases, get infected from their spouses, who have acquired infection through extramarital sexual contact. HIV infection in female patients increases the risk of HIV transmission to neonates and infants, thus further spreading the HIV in a community. So it is very crucial to initiate early preventive measures to reduce HIV burden.