Physician accuracy in diagnosing colorectal polyps

Since the medical management of persons with adenomatous colorectal polyps differs from that of those with hyperplastic polyps, accuracy of diagnosis is essential. Although many physicians have grown confident that their skills of visual diagnosis are adequate, few data exist to support this confidence. In order to examine the accuracy of physicians' judgments regarding colorectal polyp histology, the visual diagnosis of physicians experienced in endoscopy was compared with the histologic report. Eighty-one polyps were discovered by flexible sigmoidoscopy among 718 participants in a colon cancer screening program. Eighty percent of all polyps were detected accurately. The diagnostic sensitivity of detecting adenomas was 69 percent, while specificity (accurate diagnosis of hyperplastic polyps) was 86 percent, and there were an additional eight false negative and eight false positive diagnoses. Further analyses revealed that there are individual patterns of diagnostic mistakes made by physicians and that mistakes frequently are related to polyp size. These findings are particularly important in light of the expanding numbers of relatively inexperienced primary care providers performing flexible sigmoidoscopy whose diagnoses may be strongly dependent on polyp size. This research was done through, and supported by, the Center for Occupational Health, Department of Family Medicine, Wayne State University, Detroit, Michigan.     

Prevalence of advanced liver fibrosis and steatosis in type-2 diabetics with normal transaminases: A prospective cohort study

BACKGROUND Nonalcoholic fatty liver disease(NAFLD)and type-2 diabetes mellitus(T2DM)have an intricate bidirectional relationship.Individuals with T2DM,not only have a higher prevalence of non-alcoholic steatosis,but also carry a higher risk of progression to nonalcoholic steatohepatitis.Experts still differ in their recommendations of screening for NAFLD among patients with T2DM.AIM To study the prevalence of NAFLD and advanced fibrosis among our patient population with T2DM.METHODS During the study period(November 2018 to January 2020),59 adult patients with T2DM and 26 non-diabetic control group individuals were recruited prospectively.Patients with known significant liver disease and alcohol use were excluded.Demographic data and lab parameters were recorded.Liver elastography was performed in all patients.RESULTS In the study group comprised of patients with T2DM and normal alanine aminotransferase levels(mean 17.8±7 U/L),81%had hepatic steatosis as diagnosed by elastography.Advanced hepatic fibrosis(stage F3 or F4)was present in 12%of patients with T2DM as compared to none in the control group.Patients with T2DM also had higher number of individuals with grade 3 steatosis[45.8%vs 11.5%,(P<0.00001)and metabolic syndrome(84.7%vs 11.5%,P<0.00001)].CONCLUSION A significant number of patients with T2DM,despite having normal transaminase levels,have NAFLD,grade 3 steatosis and advanced hepatic fibrosis as measured by liver elastography.     

Comparison of outcomes of diabetic and nondiabetic patients undergoing primary angioplasty for acute myocardial infarction

We sought to determine whether diabetes mellitus independently conferred poor prognosis in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI). In 3,742 patients enrolled in the Primary Angioplasty in Myocardial Infarction (PAMI) studies with the intention of undergoing primary PCI, we compared in-hospital mortality, 6-month mortality, and 6-month major adverse cardiovascular events (MACEs), i.e., composite of death, reinfarction, or ischemic target vessel revascularization (TVR), between diabetics (n = 626, 17%) and nondiabetics (n = 3,116, 83%). We evaluated the independent impact of diabetes on outcomes after adjustment for baseline clinical and angiographic differences. Diabetics had worse baseline clinical characteristics, longer pain onset-to-hospital arrival time, and longer door-to-balloon time. They had more multivessel coronary disease and lower left ventricular ejection fractions, but better baseline Thrombolysis In Myocardial Infarction (TIMI) flow. Diabetics underwent primary PCI less often (88% vs 91%, p = 0.01). During the index hospitalization, diabetics were more likely to die (4.6% vs 2.6%, p = 0.005). During 6-month follow-up, diabetics had higher incidences of death (8.1% vs 4.2%, p <0.0001) and MACEs (18% vs 14%, p = 0.036). In multivariate analysis, diabetes was independently associated with 6-month mortality (hazard ratio 1.53, 95% confidence interval 1.03 to 2.26, p = 0.03), but not with in-hospital mortality or 6-month MACEs. We conclude that diabetics with AMI have less favorable baseline characteristics and are less likely to undergo primary PCI than nondiabetics. Despite excellent angiographic results, diabetics had significantly worse 6-month mortality.     

Magnetic Resonance Imaging and Localized In Vivo Proton Spectroscopy in Patients with Fulminant Hepatic Failure

Magnetic resonance imaging (MRI) and in vivo proton spectroscopic changes in the brain in three patients with fulminant hepatic failure are described. MRI showed cerebral atrophy in two and changes somewhat similar to what have been described in chronic hepatic encephalopathy. MR spectroscopy showed low myoinositol with high glutamine in grade IV coma, which returned to normal as patient showed clinical recovery. We conclude that these techniques will be useful in understanding the complex pathophysiology of fulminant hepatic failure.     

Analysis of CCR5 and SDF‐1 genetic variants and HIV infection in Indian population

HIV‐1 infection and progression exhibits interindividual variation. The polymorphism in the chemokine receptors CCR5 and CXCR4, the principal coreceptors for HIV‐1 and their ligands like SDF‐1 have a profound effect in altering the HIV‐1 disease progression rate. A single nucleotide polymorphism designated SDF1‐3′UTR‐801G‐A has been associated with resistance to HIV‐1 infection or delayed progression to AIDS. In this study, the SDF1‐3′A polymorphism, CCR5?32 polymorphism and CCR5 promoter polymorphism at positions 58934 G/T, 59029 G/A, 59353 T/C, 59356 C/T, 59402 A/G and 59653 C/T were analysed in Indian population. The polymorphisms in HIV‐1 patients and healthy individuals were evaluated by conventional PCR, RFLP‐PCR and direct sequencing techniques. The CCR5?32 mutant allele was found to be almost absent in Indian population. The analysis of the CCR5‐59356C/T polymorphism revealed a trend towards an association of the C allele with an increased risk of HIV‐1 infection. The frequency of allele CCR5‐59356C was higher in HIV‐1 patients (100%) as compared to healthy control subjects (89%, P = 0.003). The correlation of SDF1‐3′A and CCR5 promoter CCR5‐58934G/T, CCR5‐59029G/A, CCR5‐59353T/C, CCR5‐59402 A/G and CCR5‐59653C/T polymorphisms and protection to HIV‐1 infection and progression to AIDS was found to be nonsignificant. Nine haplotypes with more than 1% frequency were detected but were not significant in their protective role against HIV. Comparative analysis with global populations showed a noteworthy difference in CCR5 and SDF‐1 polymorphisms’ frequency distribution, indicating the ethnic variability of Indians. Although susceptibility to infections cannot be completely dependent on one or few genetic variants, it is important to remember that SDF‐1 and CCR5 variants have been correlated globally with HIV‐1 infection and disease progression. In the light of that, higher frequency of SDF‐1 variants in the Indian population is noteworthy.     

Prediction Model for Low Birth Weight and its Validation

Objective

To evaluate the factors associated with low birth weight (LBW) and to formulate a scale to predict the probability of having a LBW infant.

Methods

This hospital based case–control study was conducted in a tertiary care university hospital in North India. The study included 250 LBW neonates and 250 neonates with birth weight ≥2,500 g. Data were collected by interviewing mothers using pre-designed structured questionnaire and from hospital records.

Results

Factors significantly associated with LBW were inadequate weight gain by the mother during pregnancy (<8.9 kg), inadequate proteins in diet (<47 g/d), previous preterm baby, previous LBW baby, anemic mother and passive smoking. The prediction model made on these six variables has a sensitivity of 71.6 %, specificity 67.0 %, positive LR 2.17 and negative LR of 0.42 for a cut-off score of ≥29.25. On validation, it has a sensitivity of 72 % and specificity of 64 %.

Conclusions

It is possible to predict LBW using a prediction model based on significant risk factors associated with LBW.