Epidemiology and symptom profile of gastroesophageal reflux in the Indian population: Report of the Indian Society of Gastroenterology Task Force

Background

Gastroesophageal reflux disease (GERD) and its complications are thought to be infrequent in India; there are no data from India on the prevalence of and risk factors for GERD. The Indian Society of Gastroenterology formed a task force aiming to study: (a) the frequency and profile of GERD in India, (b) factors including diet associated with GERD.

Methods

In this prospective, multi-center (12 centers) study, data were obtained using a questionnaire from 3224 subjects regarding the frequency, severity and duration of heartburn, regurgitation and other symptoms of GERD. Data were also obtained regarding their dietary habits, addictions, and lifestyle, and whether any of these were related or had been altered because of symptoms. Data were analyzed using univariate and multivariate methods.

Results

Two hundred and forty-five (7.6%) of 3224 subjects had heartburn and/or regurgitation at least once a week. On univariate analysis, older age (OR 1.012; 95% CI 1.003–1.021), consumption of non-vegetarian and fried foods, aerated drinks, tea/coffee were associated with GERD. Frequency of smoking was similar among subjects with or without GERD. Body mass index (BMI) was similar in subjects with and without GERD. On multivariate analysis, consumption of non-vegetarian food was independently associated with GERD symptoms. Overlap with symptoms of irritable bowel syndrome was not uncommon; 21% reported difficulty in passage of stool and 9% had mucus in stools. About 25% of patients had consulted a doctor previously for their gastrointestinal symptoms.

Conclusion

7.6% of Indian subjects have significant GERD symptoms. Consumption of non-vegetarian foods was an independent predictor of GERD. BMI was comparable among subjects with or without GERD.     

Glycated hemoglobin, dyslipidemia and risk of atherosclerosis in type 1 diabetic patients

The aim of this study was to determine whether the dyslipidemia was associated with glycated hemoglobin (HbA1c) and to study the relationship of dyslipidemia and glycated hemoglobin with atherosclerosis as well as the gender difference in dyslipidemia. Twenty five clinically diagnosed type 1 diabetic children and adolescents in the age group of 7-18 years and 25 age and sex matched healthy children and adolescents constituted the study population. HbA1c was positively associated with total triglycerides, LDL, VLDL and HDL in diabetic cases as compared with controls. The gender differences were studied using chi-square test which showed that females were more prone to changes in lipid profiles as related to HbA1c levels. It was concluded that type 1 diabetes mellitus patients were at increased risk of premature atherosclerosis due to associated dyslipidemia that could be due to higher levels of glycated hemoglobin. Lower HDL levels, a possible risk of atherosclerosis showed inverse association with HbA1c levels, implying that elevated glycated hemoglobin was associated with multi-fold risk of atherosclerosis. Females were at increased risk of atherosclerosis than males because of higher prevalence of dyslipidemia among them.     

Effect of Different Finishing and Polishing Agents on the Surface Roughness of Cast Pure Titanium

PURPOSE: The aim of this study was to evaluate the effect of finishing and polishing agents on surface roughness of cast commercially pure titanium using scanning electron microscope (SEM) analysis. MATERIALS AND METHODS: A standardized square steel die measuring 10 x 10 mm with a thickness of 2 mm was machine cut. An impression of this die was used to create wax patterns for casting. Sixty specimens were cast in commercially pure titanium. These were divided into three groups (A, B, and C) of 20 specimens each. Group A specimens were polished with black, brown, and green rubber discs followed by green polishing compound with buff. Group B specimens were polished with black, brown, and green rubber cones, buffed with yellow polishing cake designed for gold alloy. Group C specimens were polished with silicium carbide cones and buffed with orange polishing cake. Surface roughness of the test specimens was measured in microns with a perthometer. Data were analyzed with ANOVA and Tukey's honest significant difference (HSD) multiple comparison tests among the different groups. Qualitative analysis was done by SEM photomicrographs. RESULTS: Surface roughness values R(a) for Groups A, B, and C were 0.68 microm, 0.78 microm, and 0.27 microm, respectively. SEM photomicrographs and the statistical analysis revealed that the finishing and polishing were better with Group C test specimens with lower surface roughness values compared with groups A and B. Tests showed that Group C was statistically smoother (p< or = 0.01). CONCLUSION: Within the limitations of this study, surface roughness was less on cast CpTi specimens that were finished and polished from the cutters designed specifically for titanium.     

Kaposi's sarcoma of the bone marrow

We report a case of Kaposi's sarcoma of the bone marrow presenting as a myelophthisic anemia with bone marrow necrosis. The patient did not fit into any of the current clinical patterns described for Kaposi's sarcoma. This case illustrates the need for including Kaposi's sarcoma in the differential diagnosis of myelophthisic anemia.     

Cancer mortality and the method of chlorination of public drinking water: St. Louis City and St. Louis County, Missouri

St. Louis City and St. Louis County, Missouri share the same public drinking water source, namely the Missouri River. The 'all cancer' and most organ specific cancer mortality rates have been consistently and considerably higher for St. Louis City than for St. Louis County for the period 1960 through 1972. A change in the St. Louis County water treatment process, which included increasing the chlorine dosage and delaying the addition of ammonia to form chloramines until just prior to distribution, was instituted in 1955. St. Louis City has, by contrast, continued the lower chlorine level and early ammoniation. Trend analysis using the period 1960-67 and 1972-76 showed higher percentage as well as net cancer mortality rate per million increases for large bowel, liver and bladder cancers for St. Louis County. An apparent association between a probable increase in trihalomethane production in the St. Louis County water since 1955 and an increase in these specific cancer rates which exceed the increases in the St. Louis City rates appears to have been shown. This does not imply causality but is in general agreement with other studies which have examined water chlorination and cancer mortality.     

Biliary lithotripsy: early observations in 106 patients. Work in progress

One hundred six patients underwent extracorporeal shock wave lithotripsy for cholelithiasis. Of these, 28 patients underwent cholangiographically guided lithotripsy for bile duct stones to assist nonoperative stone removal by endoscopic or radiologic intervention. Fragmentation occurred in 20 of 28 cases (71%) with an average of two lithotripsy sessions. Hemobilia was observed in four patients (14%) for a 24-hour period. Seventy-eight of the 106 were outpatients with symptomatic cholecystolithiasis with one to five calculi who underwent cholecystographic or ultrasound-(US) guided shock wave lithotripsy as definitive therapy. US examination showed stone fragmentation in 86% of cases. With an average of 1.6 treatment sessions and 4,750 shocks, fragments were 4 mm or smaller in 46% of patients. Nine percent of patients had no fragments after an average of 10 weeks, but long-term follow-up is not yet available. Two patients developed acute pancreatitis attributable to fragment passage and one patient acute cholecystitis, likely due to cystic duct obstruction by a fragment.     

Human central nervous system primitive neuroectodermal tumor expressing nerve growth factor receptors: CHP707m

A primitive neuroectodermal tumor (PNET) presented as a cerebral hemispheric mass in a 33-year-old man. Bone marrow metastases were discovered 11 months later. A cell line (CHP707m) was derived from these metastases. In culture, the cells showed features of neuronal differentiation, forming short neurites and synthesizing low-molecular-weight neurofilament protein. Northern blotting showed the tumor cells express nerve growth factor (NGF) receptor messenger RNA, and fluorescence-activated cell-sorting demonstrated NGF receptors on the cell surface. Western blotting showed CHP707m NGF receptors are truncated. The receptors are functional; they bind iodine 125-labeled mouse NGF with an affinity of 1.6 x 10(-9) M, and short-term treatment with NGF induces expression by the tumor cells of the proto-oncogene, c-fos. Although CHP707m is the first central nervous system PNET cell line proven to express NGF receptors, immunohistological survey of tissue sections prepared from human central nervous system PNETs showed that 13 of 35 contained NGF receptor-positive tumor cells. Thus, more than one-third of such tumors might be responsive to the effects of NGF.     

Relationship of contact lenses, pregnancy, and herpes simplex virus.

Herpes simplex virus (HSV) is one of the most common causes of corneal infections in the world, affecting more than 500,000 people in the United States alone. HSV keratitis recurrences can occur with systemic immunosuppression. Pregnancy can resemble a modified state of immunosuppression resulting in an increased risk for HSV keratitis. This type of immunosuppression combined with contact lens wear may have an additive effect and increase the possibility of HSV recurrence. Despite the obvious correlation, there are no reported cases in the literature. A case of bilateral HSV keratitis in a pregnant contact lens wearer is presented with an explanation of the causes and possible treatment methods.     

Sympathetic sprouting into neonatally denervated contralateral target: superior cervical ganglion neuronal numbers and sizes

Unilateral superior cervical ganglionectomy results in establishment of an atypical functional projection from the contralateral ganglion to the denervated superior tarsal muscle in neonatal but not in juvenile or adult rats. Previous studies of peripheral nervous system development have attributed enhanced neuroplasticity to either formation of pathways by surplus cells rescued from cell death (hypothanasia-induced hyperplasia), or more vigorous terminal aborization of neurons innervating adjacent target zones (collateral sprouting with associated somatic hypertrophy). In the present study, experiments were performed to determine if neonatal sympathetic sprouting to contralaterally denervated target is associated with superior cervical ganglion neuronal hyperplasia or hypertrophy. Fluoro-Gold injections of right superior tarsal muscle in adult rats following neonatal ganglionectomies labelled cells in the contralateral superior cervical ganglion, whereas cells were labelled strictly ipsilaterally in sham operates. Profile areas of contralaterally projecting neuronal somata were twice as large as those providing ipsilateral innervation. Ganglion volumes, neuronal nuclear diameters and packing densities, and total neuronal numbers in left superior cervical ganglia of animals receiving neonatal right superior cervical ganglionectomy were comparable to those of both right and left ganglia of sham-operated controls. It is concluded that establishment of a contralateral projection does not rescue significant numbers of neurons from naturally occurring cell death. Rather, contralateral sprouting derives from neurons showing pronounced somatic hypertrophy.