Incidence of colorectal cancer in Kashmir valley, India

Abstract Background There is wide variation in the incidence of colorectal cancer globally and also within the same country among different racial or ethnic groups. The present population-based study was undertaken to determine the incidence of colorectal cancer in Kashmiri population which is non-migratory and ethnically homogeneous having stable food habits. Methods Over a period of one year, all newly diagnosed and histological proved cases of colorectal cancer in all possible areas, where such patients are diagnosed and treated were prospectively registered. Results A total of 212 cases of colorectal cancers were registered; of them 113 (53.3%) originated in the colon and other 99 (46.7%) in rectum. Male to female ratio was 1.2:1

Awareness, knowledge, and risks of zoonotic diseases among livestock farmers in Punjab

Aim: The present study was conducted to assess the awareness, knowledge, and risks of zoonotic diseases among livestock farmers in Punjab. Materials and Methods: 250 livestock farmers were selected randomly and interviewed with a pretested questionnaire, which contained both open and close ended questions on different aspects of zoonotic diseases, i.e., awareness, knowledge, risks, etc. Knowledge scorecard was developed, and each correct answer was awarded one mark, and each incorrect answer was given zero mark. Respondents were categorized into low (mean − ½ standard deviation [SD]), moderate (mean ± ½ SD), and high knowledge (Mean + ½ SD) category based on the mean and SD. The information about independent variables viz., age, education, and herd size were collected with the help of structured schedule and scales. The data were analyzed by ANOVA, and results were prepared to assess awareness, knowledge, and risks of zoonotic diseases and its relation with independent variables. Results: Majority of the respondents had age up to 40 years (70%), had their qualification from primary to higher secondary level (77.6%), and had their herd size up to 10 animals (79.6%). About 51.2% and 54.0% respondents had the history of abortion and retained placenta, respectively, at their farms. The respondents not only disposed off the infected placenta (35.6%), aborted fetus (39.6%), or feces (56.4%) from a diarrheic animal but also gave intrauterine medication (23.2%) bare-handedly. About 3.6-69.6% respondents consumed uncooked or unpasteurized animal products. About 84.8%, 46.0%, 32.8%, 4.61%, and 92.4% of livestock farmers were aware of zoonotic nature of rabies, brucellosis, tuberculosis, anthrax, and bird flu, respectively. The 55.6%, 67.2%, 52.0%, 64.0%, and 51.2% respondents were aware of the transmission of zoonotic diseases to human being through contaminated milk, meat, air, feed, or through contact with infected animals, respectively. The transmission of rabies through dog bite (98.4%), need of post-exposure vaccination (96.8%), and annual vaccination of dogs (78%) were well-known facts but only 47.2% livestock owners were aware of the occurrence of abortion due to brucellosis and availability of prophylactic vaccine (67.6%) against it as a preventive measure. About 69.2% respondents belonged to low to medium knowledge level categories, whereas 30.8% respondents had high knowledge (p<0.05) regarding different aspects of zoonotic diseases. Age, education, and herd size had no significant effect on the knowledge level and awareness of farmers toward zoonotic diseases. Conclusion: Therefore, from the present study, it may be concluded that there is a need to create awareness and improve knowledge of livestock farmers toward zoonotic diseases for its effective containment in Punjab

Bannayan-Rilay-Ruvalcaba syndrome presenting with recurrent lower gastrointestinal bleed: A Case Report and a review of the literature

Bannayan-Rilay-Ruvalcaba syndrome (BRRS) is a rare congenital disorder, characterized by macrocephaly, hamartomas, lipomas, and genital lentiginosis with or without PTEN gene mutations. We report a case of BRRS in a 12-year-old male child with recurrent bleeding per rectum with hamartomatous intestinal polyposis involving whole colon and few polyps in stomach and first part of duodenum; small subcutaneous lipomas over left lumber area. In addition patient had macrocephaly, cutaneous hyperpigmentation with lentiginosis, and pigmented freckles on the external genitalia. Bleeding polyps were removed with snare polypectomy. Patient was put on iron supplements and is on regular follow-up

Diagnostic role of capsule endoscopy in patients of obscure gastrointestinal bleeding after negative CT enterography

Background and Objectives: Computed tomographic enterography (CT-EG) has emerged a useful tool for the evaluation of small bowel in patients of obscure gastrointestinal bleeding (OGIB). However, CT-EG may be negative in about 50-60% of patients. We aimed to see the efficacy of capsule endoscopy (CE) in patients of OGIB, who had initial negative CT-EG. Materials and Methods: All consecutive patients of OGIB after initial hemodynamic stabilization were subjected to CT-EG. Those having negative CT-EG were further evaluated with CE. Results: Fifty-five patients of OGIB with mean standard deviation age, 52.7 (19.0), range 18-75 years, women 31/55 (56.4%) were subjected to CT-EG. Nine (17.6%) patients had positive findings on CT-EG, which included mass lesions in six, thickened wall of distal ileal loops, narrowing, and wall enhancement in two and jejunal wall thickening with wall hyperenhancement in one patient. Forty-two patients had negative CT-EG of which 25 underwent CE for further evaluation. CE detected positive findings in 11 of 25 (48%) patients which included vascular malformations in three, ulcers in seven, and fresh blood without identifiable source in one. The diagnostic yield of CE in overt OGIB was more compared to occult OGIB ((7/14, 50%) vs (4/11, 36.4%) P = 0.2) and was higher if performed within 2 weeks of active gastrointestinal (GI) bleed (P = 0.08). Conclusions: In conclusion, CE is an additional tool in the evaluation of obscure GI bleed, especially mucosal lesions which can be missed by CT-EG

Etiology, clinical presentation, diagnosis and management of lower gastrointestinal bleed in a Tertiary Care Hospital in India: A retro-prospective study

Introduction: Lower gastrointestinal bleeding (LGIB) is one of the leading causes for hospital admissions in gastroenterology wards all over the world. Patients usually present with hematochezia or bloody diarrhea. Colonoscopy is usually the initial diagnostic intervention followed by other more sophisticated tests. Bleeding may stop spontaneously, but evaluation is important because patients may harbor a sinister lesion like cancer. Aim of the Study: To determine the various etiologies, clinical presentations, a diagnostic test used and treatments received by LGIB patients admitted in our department. Materials and Methods: A total of 300 cases were studied which included 180 retrospective cases and 120 prospective cases. For retrospective cases, all the information was obtained by analyzing their case records while as prospective patients were managed as per a predefined protocol and details of various investigations and treatments documented. Results: Most commonly affected was elderly population (>60 years), constituting 40% (120/300) of studied population. Males constituted 59% (177/300) and females 41% (123/300). The most common clinical presentation of LGIB in our patients was hematochezia (63.6%, 191/300). Growth/polyp was the most common finding on colonoscopic examination seen in 29.3% (n = 88) patients. Inflammatory lesions were seen in 77 out of 239 (25.7%) patients. Wireless capsule endoscopy was positive in 13 out of 24 patients (54%). Computed tomography (CT) enterography showed positive results in 6 out of 25 (24%) cases. Red blood cell scan was done in seven patients while as CT angiography in in four patients. Therapeutic endoscopy was successful in 115 out of 239 patients with positive colonoscopy, polypectomy was the commonest procedure performed. Medical management was carried out in 34.6% patients. Surgical treatment was offered to 21% patients. Conclusion: Colonoscopy is the initial and most common investigation used in the evaluation of GI bleed. A polyp is the most common diagnosis while as polypectomy the most common therapeutic procedure

Pantoprazole infusion as adjuvant therapy to endoscopic treatment in patients with peptic ulcer bleeding: Prospective randomized controlled trial

Abstract Background and Aim: Following successful endoscopic therapy in patients with peptic ulcer bleeding, rebleeding occurs in 20% of patients. Rebleeding remains the most important determinant of poor prognosis. We investigated whether or not administration of pantoprazole infusion would improve the outcome in ulcer bleeding following successful endoscopic therapy. Methods: In this double-blind, placebo-controlled, prospective trial, patients who had gastric or duodenal ulcers with active bleeding or non-bleeding visible vessel received combined endoscopy therapy with injection of epinephrine and heater probe application. Patients who achieved hemostasis were randomly assigned to receive pantoprazole (80 mg intravenous bolus followed by an infusion at a rate of 8 mg per hour) or placebo for 72 h. The primary end-point was the rate of rebleeding. Results: Rebleeding was lower in the pantoprazole group (8 of 102 patients, 7.8%) than in the placebo group (20 of 101 patients, 19.8%; P = 0.01). Patients in the pantoprazole group required significantly fewer transfusions (1 ± 2.5 vs 2 ± 3.3; P = 0.003) and days of hospitalization (5.6 ± 5.3 vs 7.7 ± 7.3; P = 0.0003). Rescue therapies were needed more frequently in the placebo group (7.8% vs 19.8%; P = 0.01). Three (2.9%) patients in the pantoprazole group and eight (7.9%) in the placebo group required surgery to control their bleeding ( P = 0.12). Two patients in the pantoprazole group and four in the placebo group died ( P = 0.45). Conclusion: In patients with bleeding peptic ulcers, the use of high dose pantoprazole infusion following successful endoscopic therapy is effective in reducing rebleeding, transfusion requirements and hospital stay