Histopathological study of pancreatobiliary tumors in a tertiary care center: a 7 year study

Background: The aim of this study was to comprehensively analyse the histopathological spectrum of pancreatobiliary tumors with special reference to ampulla of Vater.Methods: The retrospective study was done for 5 years and a prospective study was carried out for 2 years in the Department of Pathology.Results: A total of 110 cases were included; 103 underwent a standard Whipple procedure and 7 underwent localised resection (partial pancreatectomy). The average age was 52.64 years (16-80 years) and males outnumbered females (3:2). Malignant (93.63%) lesions outweighed benign lesions (6.36%). Among malignant lesions, 71 (68.93%) were peri-ampullary, 15 (14.56%) were pancreatic, 11 (10.67%) were duodenal and only 6 (5.825%) were cholangiocarcinoma. The most common presenting feature was jaundice followed by pain in the abdomen. The mean tumor size was 2.38 cm (0.5-15cm). The pathological stage of most of the tumors was T2 (58.2%), followed by T3 (22.7%), T1 (11.8%) and T4 was only 1.8%. Proximal duodenal resection margin was free in 90.9%, distal duodenal resection margin was free in all cases, CBD resection margin was involved in only 2 cases (1.8%), while the pancreatic duct resection margin was involved in 2.7%. The nodal status was N0 in 61.8%, N1 in 23.6% and Nx in 9.1%.Conclusions: Adenocarcinoma (well differentiated-47.3%) is the most common histological variant of pancreatobiliary region

Gastro-intestinal helminths of pigeons (Columba livia) in Gujarat, India

A study was conducted to assess the prevalence of helmith parasites of domestic wild and zoo pigeons in Gujarat, India by faecal sampling and postmortem examination. Qualitative examination of 78 faecal samples revealed 71 (91%) with parasitic infections of nematodes (85%), cestodes (31%) and Eimeria sp (77%). There were 200-1600 nematode eggs per gram during the monsoon season, which was high compared to the 200-1000 eggs per gram in winter and summer. In post-mortems 85% had parasitic infections, of nematodes (75%), cestodes (69%) and Eimeria sp (58%). Two species of nematodes (Ascaridia columbae and Capillaria obsignata) and five species of three genera of cestodes (Raillietina echinobothridia, R. tetragona, R. cesticillus, Cotugnia digonophora and Hymenolepis sp) were identified. Despite their parasitic infections, not a single pigeon revealed any alarming clinical signs

Role of dutasteride (5-alpha-reductase inhibitor) in patients undergoing transurethral resection of prostrate

Background: Bladder outflow obstruction due to benign prostate hyperplasia is the commonest urological condition affecting men over 50 years of age. Medical therapy is usually the first line management of BPH. The most frequent complication is encountered is perioperative bleeding and postoperative bleeding. Preoperative use of 5-alpha-reductase inhibitors like dutasteride to reduce surgical bleeding is still a topic of debate. The aim of this study was to evaluate whether pretreatment with dutasteride for 4 weeks prior to surgery can reduce surgical blood loss as well as post op blood loss and complications.Methods: A total of 60 patients with BHP who were to undergo TURP were enrolled and randomized into 2 groups. The dutasteride group consisted of 30 patients who were treated with dutasteride (0.5mg) for 4 weeks before surgery and the control group consisted of 30 patients.Results: The preoperative hemoglobin levels of cases and controls was done followed by postoperative hemoglobin. The average fall in hemoglobin was 0.9mg/dl in cases and 2.1mg/dl in controls. Concluding that group of patients taking dutasteride (cases) peri and post-operative surgical bleeding was significantly reduced on pretreatment of dutasteride for 4 weeks before TURP.Conclusions: Many other surgical treatments are being developed for BHP, but TURP is the gold standard treatment. However, morbidity and blood loss are major potential complications and taking dutasteride 4 weeks prior to transurethral resection of prostrate can be effective in reducing its complications

Correlation of red cell distribution width with inflammatory markers and its prognostic value in patients with diabetes and coronary artery disease

Background. Recent studies have shown red blood cell distribution width (RDW) as a marker for severity and prognosis in coronary artery disease patients. Other studies have also correlated RDW with diabetes mellitus and inflammation. However, such correlation and prognosis in patients with concomitant coronary artery disease and diabetes after percutaneous intervention remains unclear. Material and methods. Our study group comprised of 730 subjects including 700 patients (cases) and 30 normal subjects (control group). Patients who presented with coronary artery disease were divided into diabetic and non-diabetic groups. All patients had RDW measured at admission and percutaneous intervention was done. Follow-up for adverse events was carried out between 6 to 12 months. Results. RDW was elevated in patients as compared to control group (p < 0.05). RDW correlated well with inflammatory markers including erythrocyte sedimen­tation rate, C-reactive protein, HbA1c, white blood cells and troponin. RDW was higher with more severe atherosclerosis based on SYNTAX and Gensini scores (p < 0.05). Prognosis was found to be worse in patients with high RDW as well as in diabetics. Conclusions. RDW has positive correlation with other inflammatory marker. It may be used as a marker in determining the severity and prognosis in diabetic patients with coronary artery disease

Evaluation of an Immunochromatographic Lateral Flow Assay (OXA-48 K-SeT) for Rapid Detection of OXA-48-Like Carbapenemases in Enterobacteriaceae

We evaluated an immunochromatographic lateral flow assay for the detection of OXA-48-like carbapenemases (OXA-48 K-SeT) in Enterobacteriaceae (n=82). 100% sensitivity and specificity was observed using bacteria recovered from both solid media and spiked blood culture bottles, with the result obtained in less than 10 minutes

Prognostic significance of serum potassium level for major adverse cardiac events and death in patients with coronary atherosclerotic disease

Introduction: Serum potassium levels have been shown in some animal studies to be associated with theprocess of atherosclerosis. We decided to assess the correlation of serum potassium level in ischemic heart diseasepatients with disease severity and its relationship with prognosis in terms of major acute cardiac events (MACE). Material and methods: This was a cross-sectional cohort study carried out at cardiology department of RehmanMedical Institute, from July 2016 to 31st Aug. 2018 a period of 26 months. 622 patients were included in thestudy. Clinical and angiographic characteristics were assessed based on the serum potassium level. Correlation ofserum potassium level with Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery(SYNTAX) and Gensini scores was also evaluated. Follow up for MACE was carried out after one year. Results: Mean serum potassium level was 3.93 ± 0.95 (mEq/l) in coronary artery disease patients. Serumpotassium level showed negative correlation with SYNTAX score (r = –0.60, p < 0.05) and Gensini score(r = –0.64, p < 0.05). There was also a significant difference between low and high potassium level in relationto the multi-vessel disease on coronary angiography (p < 0.05). Low potassium level was a good predictor ofadverse outcomes as shown by Kaplan-Meier analysis. Multivariate Cox regression analysis showed that serumpotassium level and diabetes were independent predictors of MACE (p < 0.05). Conclusion: Low serum potassium level is correlated with more severe coronary atherosclerosis. Low potassiumlevels are associated with significantly poor outcomes

Psychological impact of cancer on patients in a tertiary care centre: a prospective study

Background: Diagnosis of cancer, although physical in nature, has far reaching emotional impact on the person. The study aimed to analyse the psychological impact of cancer on patients with a focus on levels of distress and psychiatric comorbidity.Methods: It was a prospective study conducted on 169 consenting individuals in the department of radiation oncology, SKIMS, Jammu and Kashmir, India, in collaboration with the department of psychiatry, SKIMS medical college, Jammu and Kashmir, India, from November 2013 to January 2015. The NCCN distress thermometer was used to observe the temporal variations in the levels of distress over a period of time.Results: Anxiety disorders (panic disorder, generalized anxiety disorder and post-traumatic stress disorder) were the most common psychiatric disorders diagnosed constituting 59%, followed by depression in 29%. About 12% patients were not diagnosed with any psychiatric ailment. One female patient with anxiety disorder developed acute psychosis. Counselling and psychotherapy provided improvement in 45% patients with cancer. In all, 86.4% required medication during the course of treatment and majority had improvement with it. A mean distress score of 7.73 was seen before, 8.29 during and 7.66 after treatment.Conclusions: Cancer bore a significant impact on the psychological bearing of patients, ranging from anxiety disorder, post-traumatic stress disorder, depression to psychosis. Hence there is a need for monitoring psychological symptoms in cancer patients and development of appropriate psycho-oncology services