Colorectal polyps and heterotrophic esophageal polyp of colon in a paediatric cohort in South India

Background: Clinical profile of polyps in paediatric cases are less in South India. Juvenile Polyps were the most common polyps in paediatric cases described in literature, presenting as LGI bleed. The aim of the study is to describe the clinical profile of colorectal polyps in paediatric population in a single tertiary care centre in South India.Methods: Paediatric cases between 0 and 16 years of age who underwent colonoscopy in our department from January 2002 to July 2018 were included from database. These cases were retrospectively analysed for presence of polyps, clinical presentation, indication for colonoscopy, histopathology of the resected polyps and other demographic details.  Incomplete procedures were excluded.Results: About 166 paediatric cases underwent colonoscopy in the study period. 21 cases (12.65%) had colorectal Polyps. 85.7% of the polyps were in recto sigmoid region. Most common histological type was Juvenile Polyp (51.6%). One infant had sessile polyp in descending colon which was reported as heterotrophic esophageal mucosa in histopathology. LGI bleed was the most common presentation in children with polyps (66.6%).Conclusions: The prevalence of polyps in our cohort was 12.65%. Solitary Juvenile Polyp was the most common polyp in children, with lower GI bleed as the most common presenting feature. Rare case of heterotrophic esophageal polyp was seen in descending colon

Unveiling mediastinal pathology: role of EUS guided fine needle aspiration in diagnosing mediastinal lesions

Background: Mediastinal lesion is the focus of investigation in diagnosis of infective, granulomatous or neoplastic pathology of respiratory system. Metastatic mediastinal node assessment is an integral part of oncological management. EUS provides access to sampling of mediastinal mass, sub-carinal and aorto-pulmonary nodes. This study aims to assess the clinical impact, diagnostic yield and safety of EUS guided FNA for mediastinal lesions.Methods: Retrospective analysis of prospectively collected data of 72 cases of mediastinal lesions between January 2014 and December 2017 was done. EUS-FNA was performed with a linear echoendoscope using a 22- or 25-gauge needle. Adequacy of cellularity was assessed by on site pathologist. Patient data (demographics, intervention and follow-up) were prospectively collected and introduced in a predefined computer database for later review.Results: EUS-FNA was performed from 57 lymph nodes and 15 mediastinal masses. Adequate samples were obtained in 67 of 72 patients (93.05%). All mediastinal masses were malignant and were identified in the 3rd, 5th and 6th decade of life. Of the 57 lymph nodes, 15 were malignant, 28 had granulomatous lymphadenitis of which 16 individuals became asymptomatic after anti tubercular therapy. Sample was inadequate in 5 circumstances. No major complications were encountered with the procedure in any of the individuals.Conclusions: EUS guided tissue diagnosis is a safe technique and our data supports the use of EUS-FNA in work-up of mediastinal lesions. It is minimally invasive, accurate and has easy access to mediastinum. It has significant impact on patient diagnosis, management and should be considered over other invasive techniques

Assessment of Nutritional Status in Cirrhosis and Its Impact on Complications

BACKGROUND : Protein Calorie Malnourishment is very common in Cirrhosis and is known to be associated with increased risk of mortality and morbidity. Simple bedside parameters to identify malnutrition is essential to diagnose and manage the nutritional deficit early to improve the prognosis and quality of life of cirrhotics. AIM OF THE STUDY : To asses the nutritional status in cirrhosis patients by anthropometry, muscle strength assessment, BIA and subjective global assessment and to compare the severity of malnourishment with the severity of liver disease and risk of developing complications. MATERIAL AND METHODS : This is a Prospective, observational study, conducted in Government Peripheral Hospital, Anna Nagar, Chennai during the period of November 2013 to February 2015. All adult cirrhosis patients more than 18 years of age not in Hepatic Encephalopathy of stage 2 or more of West Haven Criteria are included in the study. Nutritional status indices like Subjective Global Assessment questionnaire (SGA), Mid arm Circumference, Triceps skin fold thickness (TSFT), Mid arm muscle circumference (MAMC), Hand grip strength(Kg/F) using were measured. Bio Impedance Analyser was used to measure Body Fat and skeletal muscle in percentages. Descriptive statistics analysed using SPSS version 22. RESULTS : 87 patients were included in the eligible study population. 90.8% of them were males. Alcohol was aetiology of cirrhosis in 72.4%. CTP A, B and C consisted of 18,27 and 42 patients respectively. BMI was not significantly different between those groups. Prevalence of malnourishment as per Subjective Global Assessment Score (SGA) score was 78.16% (n= SGA A 19, SGA B 49, SGA C 19). Malnourishment was significantly high in CTP B and C. In male patients in SGA A, B and C mean values for TSFT were 12.37, 9.13, 6.57 mm in respectively (p=0.0001, AUROC 0.843), MAC were 28, 23.8, 21.13 cm respectively ( p=0.0001, AUROC 0.878), MAMC were 24.19, 20.51 and 19.06 cm respectively (p=0.0001, AUROC 0.841), Hand Grip Strength were 31.87, 22.59 and 17.6% respectively (p=0.0001, AUROC 0.892). Prevalence of SBP was 37.93% and of HE was 25.2%, and both the complication were high with malnourished patients (p=0.0001). Bio impedance analyser values showed no significant difference with malnourishment. CONCLUSION : Subjective GlobalAssessment Score is useful in categorising nourishment status with severity of cirrhosis. TSFT, MAMC and Hand Grip Strength are useful parameters in diagnosing malnourishment. Malnourishment is a risk factor for developing SBP and Hepatic Encephalopathy