Prevalence of Helicobacter pylori Infection in Peptic Ulcer Patients of Highly Endemic Kashmir Valley

Objective This study aimed to find out prevalence of Helicobacter pylori (H. pylori) in peptic ulcer disease (PUD) which is highly endemic disease in Kashmir

A novel COL4A1 frameshift mutation in familial kidney disease: the importance of the C-terminal NC1 domain of type IV collagen

BACKGROUND: Hereditary microscopic haematuria often segregates with mutations of COL4A3, COL4A4 or COL4A5 but in half of families a gene is not identified. We investigated a Cypriot family with autosomal dominant microscopic haematuria with renal failure and kidney cysts. METHODS: We used genome-wide linkage analysis, whole exome sequencing and cosegregation analyses. RESULTS: We identified a novel frameshift mutation, c.4611_4612insG:p.T1537fs, in exon 49 of COL4A1. This mutation predicts truncation of the protein with disruption of the C-terminal part of the NC1 domain. We confirmed its presence in 20 family members, 17 with confirmed haematuria, 5 of whom also had stage 4 or 5 chronic kidney disease. Eleven family members exhibited kidney cysts (55% of those with the mutation), but muscle cramps or cerebral aneurysms were not observed and serum creatine kinase was normal in all individuals tested. CONCLUSIONS: Missense mutations of COL4A1 that encode the CB3 [IV] segment of the triple helical domain (exons 24 and 25) are associated with HANAC syndrome (hereditary angiopathy, nephropathy, aneurysms and cramps). Missense mutations of COL4A1 that disrupt the NC1 domain are associated with antenatal cerebral haemorrhage and porencephaly, but not kidney disease. Our findings extend the spectrum of COL4A1 mutations linked with renal disease and demonstrate that the highly conserved C-terminal part of the NC1 domain of the α1 chain of type IV collagen is important in the integrity of glomerular basement membrane in humans

Structural organization and pattern of innervations of human Meissner’s corpuscle: a light microscopic study

Background: Human glabrous skin has very rich nerve supply in the form of specialized nerve endings like Meissner’s corpuscles, Pacinian corpuscles, Krause end bulbs etc for carrying sensory information to brain. Aim of study: To study the structure, pattern of innervations and nerve terminations of human Meissner’s corpuscle. Methods: Skin samples from sixty human beings (age range 2 to 72 years) were taken, sections prepared and stained with a cytological (Haematoxylin – Eosin and Vongieson’s stains) and a neural stain (Silver Impregnation). Results: With cytological stain, Meissner’s corpuscles were seen in dermal papillae of glabrous skin, each consisting of a cellular structure having a peripheral capsule and central core of transversely arranged cells. With neural stain, each corpuscle was seen to be oval, globular or cylindrical structure, having a capsule surrounding the core of spirally arranged nerve fibers, sandwiched by Schwann cells. In between nerve fibers of the core were seen small bundles of collagen fibers. 2-6 nerve fibers innervated each Mc from the sub corial plexus of nerves and formed various patterns of nerve endings like networks, end bulbs and varicosities inside the Meissner’s corpuscle. Conclusion: Meissner’s corpuscle is a complex structure composed of capsule - consisting of spindle shaped capsular cells interspersed in collagen fibers, surrounding a core of helically arranged nerve fibers, Schwann cells and collagen fibers

Effects of lithium carbonate on the microanatomy of thyroid gland of albino rats

Background: Lithium is routinely used to treat mania and other psychiatric disorders. It prevents the mood swing changes in bipolar disorders and the treatment is usually prolonged. Aim of current study was to observe histological changes in the thyroid gland of lithium carbonate treated albino rats.Methods: Sixty albino rats were taken and divided into two groups, group A (control group) of 15 animals, were fed with normal diet and group B of 45 animals, were fed normal diet along with lithium carbonate at the dose of 30mg/kg body weight daily. The animals were sacrificed at four, eight and twelve week’s interval, 5µm sections prepared and stained with haematoxylin and eosin stain.Results: Microscopic changes in thyroid gland of albino rats were evident after 8 weeks of drug administration which include marked pleomorphism, shrinkage in size of thyroid follicles, excess of colloid and marked vacuolations in acini. At 12th week of study, follicles were found both macro and micro follicular, with variable lining epithelium and hyperchromatic nuclei. Lining epithelium of some follicles was disrupted. The stroma was infiltrated with lymphocytes and eosinophils and there were some interfollicular hemorrhages. Conclusions: Lithium given over prolonged period will cause macro and micro follicular goiter with hyperplastic epithelium and hyper chromatic nuclei, hyperplasia of stroma with increased vascularity, sometimes hemorrhages and finally may lead to thyroiditis like picture. So, it is advised that patients on lithium therapy should be periodically evaluated for thyroid dysfunction.

Effect of cyclophosphamide on the microanatomy of liver of albino rats

Background: Cyclophosphamide is widely used in the treatment of various neoplastic diseases and diseases associated with altered immunity. Higher doses used for longer duration effects many organs like urinary bladder, lungs, liver, heart and male reproductive organs.Methods: To study the effect of cyclophosphamide on the micro anatomy of liver, sixty eight Albino rats were taken and divided into three groups, group A (control group) of 20 animals, were fed with routine diet, group B (low dose group) of 24 animals, were given cyclophosphamide at the dose of 0.5 mg/100 gms in addition to the routine diet and group C (high dose group) of 24 animals, were given high dose of cyclophosphamide at the dose of 0.7 mg/100 gms of weight of animal in addition to the routine diet. The animals were sacrificed at intervals of 3, 6, 9 and 12 weeks, 5 microns sections of the tissue were prepared and stained with Haematoxylin and Eosin stain.Results: Microscopic changes in liver were apparent in the drug treated animals. In group B the changes appeared after 6 weeks while in group C they started appearing after 3 weeks of drug treatment. The changes were in the form of fatty changes, hemorrhages and central vein congestion.Conclusion: Cyclophosphamide induces histological changes like fatty infiltration and central vein congestion in the liver. These changes are with low doses given for longer durations and manifest earlier when larger doses are used. Thus it is advised that patients receiving cyclophosphamide should be periodically evaluated for liver dysfunction.

Estimation of proteinuria as a predictor of complications of pre-eclampsia: a systematic review

Background Proteinuria is one of the essential criteria for the clinical diagnosis of pre-eclampsia. Increasing levels of proteinuria is considered to be associated with adverse maternal and fetal outcomes. We aim to determine the accuracy with which the amount of proteinuria predicts maternal and fetal complications in women with pre-eclampsia by systematic quantitative review of test accuracy studies. Methods We conducted electronic searches in MEDLINE (1951 to 2007), EMBASE (1980 to 2007), the Cochrane Library (2007) and the MEDION database to identify relevant articles and hand-search of selected specialist journals and reference lists of articles. There were no language restrictions for any of these searches. Two reviewers independently selected those articles in which the accuracy of proteinuria estimate was evaluated to predict maternal and fetal complications of pre-eclampsia. Data were extracted on study characteristics, quality and accuracy to construct 2 × 2 tables with maternal and fetal complications as reference standards. Results Sixteen primary articles with a total of 6749 women met the selection criteria with levels of proteinuria estimated by urine dipstick, 24-hour urine proteinuria or urine protein:creatinine ratio as a predictor of complications of pre-eclampsia. All 10 studies predicting maternal outcomes showed that proteinuria is a poor predictor of maternal complications in women with pre-eclampsia. Seventeen studies used laboratory analysis and eight studies bedside analysis to assess the accuracy of proteinuria in predicting fetal and neonatal complications. Summary likelihood ratios of positive and negative tests for the threshold level of 5 g/24 h were 2.0 (95% CI 1.5, 2.7) and 0.53 (95% CI 0.27, 1) for stillbirths, 1.5 (95% CI 0.94, 2.4) and 0.73 (95% CI 0.39, 1.4) for neonatal deaths and 1.5 (95% 1, 2) and 0.78 (95% 0.64, 0.95) for Neonatal Intensive Care Unit admission. Conclusion Measure of proteinuria is a poor predictor of either maternal or fetal complications in women with pre-eclampsia

Learning needs analysis to guide teaching evidence-based medicine: knowledge and beliefs amongst trainees from various specialities

<p>Abstract</p> <p>Background</p> <p>We undertook a needs assessment exercise using questionnaire survey of junior doctors' knowledge and beliefs concerning evidence-based medicine (EBM) and critical literature appraisal, as this is a core competence in postgraduate medical education.</p> <p>Methods</p> <p>We surveyed 317 junior doctors in various specialities in the UK West Midlands Deanery. Using validated questionnaires we compared the needs of different trainee groups. Results overall were internally consistent (Cronbach's alpha 0.929).</p> <p>Results</p> <p>Respondents' generally felt that they had poor training in EBM (Mean score 2.2, possible range 1 – 6) and that they needed more education (Mean score 5.3, possible range 1–6). Male trainees felt more confident at evaluating statistical tests than females (p = 0.002). Female trainees considered patient choice above the evidence more often than males (p = 0.038). Trainees from surgical speciality felt more confident at assessing research evidence (p = 0.009) whereas those from medical speciality felt more confident at evaluating statistical tests (p = 0.038) than other specialities. However, non-surgical specialities tended to believe that EBM had little impact on practice (p = 0.029). Respondents who had been qualified for 11 years or over felt overall more confident in their knowledge relating to EBM than those who had been qualified less than 10 years. In particular, they felt more confident at being able to assess study designs (p = < 0.001) and the general worth of research papers (p = < 0.001). Trainees with prior research experience were less likely to find original work confusing (p = 0.003) and felt more confident that they can assess research evidence (p = < 0.001) compared to those without previous research experience. Trainees without previous research experience felt that clinical judgement was more important than evidence (p = < 0.001).</p> <p>Conclusion</p> <p>There is a perceived deficit in postgraduate doctors' EBM knowledge and critical appraisal skills. Learning needs vary according to gender, place of basic medical qualification, time since graduation, prior research experience and speciality. EBM training curricular development should take into account the findings of our needs assessment study.</p

Psychological interventions in asthma

Asthma is a multifactorial chronic respiratory disease characterised by recurrent episodes of airway obstruction. The current management of asthma focuses principally on pharmacological treatments, which have a strong evidence base underlying their use. However, in clinical practice, poor symptom control remains a common problem for patients with asthma. Living with asthma has been linked with psychological co-morbidity including anxiety, depression, panic attacks and behavioural factors such as poor adherence and suboptimal self-management. Psychological disorders have a higher-than-expected prevalence in patients with difficult-to-control asthma. As psychological considerations play an important role in the management of people with asthma, it is not surprising that many psychological therapies have been applied in the management of asthma. There are case reports which support their use as an adjunct to pharmacological therapy in selected individuals, and in some clinical trials, benefit is demonstrated, but the evidence is not consistent. When findings are quantitatively synthesised in meta-analyses, no firm conclusions are able to be drawn and no guidelines recommend psychological interventions. These inconsistencies in findings may in part be due to poor study design, the combining of results of studies using different interventions and the diversity of ways patient benefit is assessed. Despite this weak evidence base, the rationale for psychological therapies is plausible, and this therapeutic modality is appealing to both patients and their clinicians as an adjunct to conventional pharmacological treatments. What are urgently required are rigorous evaluations of psychological therapies in asthma, on a par to the quality of pharmaceutical trials. From this evidence base, we can then determine which interventions are beneficial for our patients with asthma management and more specifically which psychological therapy is best suited for each patient

Association between proton pump inhibitor therapy and clostridium difficile infection: a contemporary systematic review and meta-analysis.

Abstract Introduction Emerging epidemiological evidence suggests that proton pump inhibitor (PPI) acid-suppression therapy is associated with an increased risk of Clostridium difficile infection (CDI). Methods Ovid MEDLINE, EMBASE, ISI Web of Science, and Scopus were searched from 1990 to January 2012 for analytical studies that reported an adjusted effect estimate of the association between PPI use and CDI. We performed random-effect meta-analyses. We used the GRADE framework to interpret the findings. Results We identified 47 eligible citations (37 case-control and 14 cohort studies) with corresponding 51 effect estimates. The pooled OR was 1.65, 95% CI (1.47, 1.85), I2 = 89.9%, with evidence of publication bias suggested by a contour funnel plot. A novel regression based method was used to adjust for publication bias and resulted in an adjusted pooled OR of 1.51 (95% CI, 1.26–1.83). In a speculative analysis that assumes that this association is based on causality, and based on published baseline CDI incidence, the risk of CDI would be very low in the general population taking PPIs with an estimated NNH of 3925 at 1 year. Conclusions In this rigorously conducted systemic review and meta-analysis, we found very low quality evidence (GRADE class) for an association between PPI use and CDI that does not support a cause-effect relationship