Helicobacter pylori infection and micronutrient deficiencies.

It is known that deficiencies of micronutrients due to infections increase morbidity and mortality. This phenomenon depicts itself conspicuously in developing countries. Deficiencies of iron, vitamins A, E, C, B12, etc are widely prevalent among populations living in the third world countries. Helicobacter pylori (H pylori) infection has a high prevalence throughout the world. Deficiencies of several micronutrients due to H pylori infection may be concomitantly present and vary from subtle sub-clinical states to severe clinical disorders. These essential trace elements/micronutrients are involved in host defense mechanisms, maintaining epithelial cell integrity, glycoprotein synthesis, transport mechanisms, myocardial contractility, brain development, cholesterol and glucose metabolism. In this paper H pylori infection in associated with various micronutrients deficiencies is briefly reviewed

Is there an association of giardiasis with beta-thalassemia minor?

Beta–thalassemia minor is a symptomless carrier state of a hemoglobinopathy which predisposes to bacterial infections. We report three cases presenting with giardiasis, a parasitic infection of gastrointestinal tract caused by Giardia lamblia. Patients presented with recurrent diarrhea and abdominal pain for over a year. An esophagogastroduodenoscopy finding varied from normal to acute duodenitis. Duodenal biopsy demonstrated changes consistent with mild chronic non-specific inflammation with G. lamblia trophozoites. All three patients were diagnosed as β -thalassemia minor hemoglobin electrophoresis. They were treated with Diloxanide furoate 500 mg and Metronidazole 400mg three times daily for five days. Their symptoms resolved and a stool test repeated one week after the end of treatment was normal. The host immune system both humoral and cellular components have a role in protection and clearance of Giardiasis. However, β -thalassemia minor patients have an observed probability of gardiasis but not a confirmed incidence

Gastric corpus polyps associated with Proton Pump Inhibitors therapy

The prevalence of Gastroesophageal Reflux Disease (GERD) is rapidly rising in Asia. We describe here a case of 51 years old man who had surgery for esophageal leiomyoma and received long-term therapy with Proton Pump Inhibitors (PPIs) for persisting reflux symptoms. On Esophago-Gastroduodenoscopy (EGD) several sessile polyps were seen in the gastric corpus. Earlier EGD done 15 years back had not demonstrated those polyps. Sections revealed polypoid fragments of glandular epithelium with dilated glands and negative histology for H. pylori. Polymerase chain reaction for 16S ribosomal RNA gene (16S rRNA PCR) of H. pylori was also negative. This is the first report originating from an Asian country describing Fundal Gland Polyps (FGPs) in the corpus of stomach rather than fundus in a patient on long-term PPI therapy

Dengue fever with hepatitis E and hepatitis A infection

Infection with dengue viruses produces a spectrum of clinical illness ranging from a nonspecific viral syndrome to severe and fatal haemorrhagic disease. Important risk factors include the strain and serotype of the infecting virus, as well as the age, immune status, and genetic predisposition of the patient. The teaching point in this case study was Dengue fever which occurred concomitantly with Hepatitis A and Hepatitis E virus infection

Esophageal polypoidal mass: presentation of an uncommon pleomorphic carcinoma

Pleomorphic carcinomas are primary malignant tumours that are known to arise in the lungs, pancreas, gall bladder and intestine. A patient with polypoid tumour of the esophagus is described in this report. The patient presented with dysphagia. Diagnostic and therapeutic intervention required endoscopic evaluation and treatment. Benign esophageal tumours are rarely seen and originate from the upper third of esophagus. We observed an esophageal tumour which was interpreted as spindle cell carcinoma of the esophagus that caused obstruction. We present the clinical picture and histopathological findings of the tumour. To our knowledge this is the first local report of spindle cell carcinoma occurring in the esophagus and describes its endoscopic and histopathological features with distinctive biphasic morphology

Phloroglucinol in Irritable Bowel Syndrome

Objective: To determine the efficacy and tolerability of phloroglucinol, an antispasmodic agent in the treatment of Irritable Bowel Syndrome (IBS). Methods: It was an open label (quasi interventional) study. One hundred patients coming to the gastroenterology clinics of Aga Khan University Hospital with IBS as defined by the Rome II criteria were enrolled between February 2004 and September 2004 to participate in the trial and were treated as outpatients. Phloroglucinol (Himont) 50mg orally three times daily was given for two months. Symptoms were assessed before and during treatment using a questionnaire. Results: One hundred patients were enrolled in the study. Of them 61% (61/100) were males and 39% (39/100) were females. Their mean age was 41±14 years. Sixty-eight patients completed the study and 28 dropped out. On Phloroglucinol treatment there was an overall statistically significant improvement in abdominal pain (p\u3c0.001), frequency of stools per day (p\u3c0.001), urgency (p\u3c0.001), passage of mucus per rectum (p\u3c0.001),sense of incomplete defecation (p=0.001) and bloating (p=0.001). However, no response was seen in the feature of straining in both genders (p=0.676). The difference in response to treatment according to gender separately showed statistically significant improvement in the sense of incomplete defecation in females alone(p=0.003). Conclusion: Phloroglucinol in a dose of 50mg three times daily is effective and well tolerated by the IBS patients. It relieves most of the symptoms of IBS (JPMA 56:5;2006

Effect of screening and management of diabetes during pregnancy on stillbirths

Background:Diabetes during pregnancy is associated with significant risk of complications to the mother, fetus and newborn. We reviewed the potential impact of early detection and control of diabetes mellitus during pregnancy on stillbirths for possible inclusion in the Lives Saved Tool (LiST). Methods: A systematic literature search up to July 2010 was done to identify all published randomized controlled trials and observational studies. A standardized data abstraction sheet was employed and data were abstracted by two independent authors. Meta-analyses were performed with different sub-group analyses. The analyses were graded according to the CHERG rules using the adapted GRADE criteria and recommendations made after assessing the overall quality of the studies included in the meta-analyses. Results: A total of 70 studies were selected for data extraction including fourteen intervention studies and fifty six observational studies. No randomized controlled trials were identified evaluating early detection of diabetes mellitus in pregnancy versus standard screening (glucose challenge test between 24(th) to 28(th) week of gestation) in pregnancy. Intensive management of gestational diabetes (including specialized dietary advice, increased monitoring and tailored dietary therapy) during pregnancy (3 studies: 3791 participants) versus conventional management (dietary advice and insulin as required) was associated with a non-significant reduction in the risk of stillbirths (RR 0.20, 95% CI: 0.03-1.10) (\u27moderate\u27 quality evidence). Optimal control of serum blood glucose versus sub-optimal control was associated with a significant reduction in the risk of perinatal mortality (2 studies, 5286 participants: RR=0.40, 95% CI 0.25-0.63), but not stillbirths (3 studies, 2469 participants: RR=0.51, 95% CI 0.14-1.88). Preconception care of diabetes (information about need for optimization of glycemic control before pregnancy, assessment of diabetes complications, review of dietary habits, intensification of capillary blood glucose self-monitoring and optimization of insulin therapy) versus none (3 studies: 910 participants) was associated with a reduction in perinatal mortality (RR=0.29, 95% CI 0.14 -0.60). Using the Delphi process for estimating effect size of optimal diabetes recognition and management yielded a median effect size of 10% reduction in stillbirths. Conclusion: Diabetes, especially pre-gestational diabetes with its attendant vascular complications, is a significant risk factor for stillbirth and perinatal death. Our review highlights the fact that very few studies of adequate quality are available that can provide estimates of the effect of screening for aid management of diabetes in pregnancy on stillbirth risk. Using the Delphi process we recommend a conservative 10% reduction in the risk of stillbirths, as a point estimate for inclusion in the LiST

Prevalence of Hepatitis D in HBsAg positive patients visiting liver clinics

Objective: To estimate the prevalence of hepatitis D in HBsAg (hepatitis B surface antigen) positive patients visiting liver clinics. Methodology: All HbsAg positive patients who had visited two liver clinics; in Karachi and in Jacobabad, from October 2007 to March 2008, were included in this study. These patients were tested for HBV DNA and HDV RNA by PCR technique, HBeAg and anti-HDV. Clinical status of the patients was evaluated by examination, routine biochemical tests and ultrasound. Results: Total numbers of patients included in the study were 362 comprising of 151 patients from the clinic in Jacobabad and 211 from Karachi. The patients ranged from 4 to 70 years age (mean age 29.75 ±11.27). Out of the total patients 297 (82%) were males. All the patients were screened for HDV antibody out of which 212 (58.6%) tested positive. Total 65 anti-HDV positive patients were tested for the HDV RNA by PCR, out of which 30 (46.2%) tested positive for the virus. Three hundred and forty (340) patients were screened for HBeAg, out of which 71 (20.9%) tested positive. Three hundred and seven patients were screened for HBV DNA by PCR, out of which 88 (28.7%) were positive for the virus. HBV DNA was positive in 16.2% of HbeAg negative patients (pre-core mutants). The frequency of positive HDV antibody was 69.23% in patients from Kashmore, 67% in Jacobabad, 65.4% in Jaffarabad, 65.21% in Quetta, 60% in Naseerabad, 36.58% in Karachi, 58.33% in other areas of Balochistan and 60.71% in other areas of Sindh. Positive HDV antibody status was associated with more severe and advanced disease (p\u3c0.0001) Conclusion: This data shows extremely high prevalence of hepatitis D in the referred patients from some areas of Southern Pakistan. Effective preventive measures are the need of the hour and Pakistan may be considered as one of the areas of highest HDV prevalence around the globe (JPMA 59:434; 2009)