Cholera admissions in adults 1989-1994: a hospital based study

In order to gain insight into the distribution of cholera over the years and proportion of monthly admissions under our adult medical services, we scrutinized our records of hospital discharges between 1989 and 1994. Only culture positive cases were included. Each year most of the cases of cholera are admitted between May and November with almost disease free interval from December to April. In 1992 admission rate was 4.24/1000 medical admissions which increased to 12.65 in 1993 and 13.73 in 1994. Though the Vibrio cholerae 01 Ogawa was the major isolate upto May, 1993, Vibrio cholerae non-01 serogroup 0139 dominated between June and August, 1993. Ogawa strain re-established itself in October, 1993. In August, 1994, non-01 strain reappeared and became the major isolate in September. Cholera has caused multiple epidemics throughout the Indian subcontinent. Since 1800, there have been seven pandemics of cholera. The seventh pandemic originated in Indonesia and continues today

Fulminant hepatic failure in pregnant women: acute fatty liver or acute viral hepatitis?

Background: Hepatitis E virus, which is endemic in our region, can cause severe liver dysfunction in pregnant women and this can be clinically confused with acute fatty liver of pregnancy. Methods: We studied the clinical and laboratory data as well as the maternal and fetal outcomes of 12 pregnant women presenting with fulminant hepatic failure in order to determine the etiology of the disease. The clinical diagnoses were subsequently correlated with serologic assays for acute HEV infection. All patients were severely ill with deep jaundice, grade 3-4 encephalopathy and abnormal prothrombin times. Results: A clinical diagnosis of acute viral hepatitis was made in nine patients and of acute fatty liver in the other three cases. IgM and IgG antibodies confirmed acute viral hepatitis E in six of the nine patients while one had acute hepatitis A infection. HEV IgM and IgG antibodies were, however, also positive in two of the three patients thought to have acute fatty liver. Maternal and fetal mortality were 16.6% and 50%, respectively.CONCLUSIONS: We conclude that hepatitis E is the usual cause of acute liver failure in our pregnant women and that clinical and laboratory features do not permit accurate distinction between acute HEV infection and acute fatty liver of pregnancy. The prognosis in patients with acute HEV infection is much better than in other groups with severe liver failure (mortality 16% vs 68%)

The Fermi level effect in III-V intermixing: The final nail in the coffin?

Copyright 1997 American Institute of Physics. This article may be downloaded for personal use only. Any other use requires prior permission of the author and the American Institute of Physics. This article appeared in Journal of Applied Physics 81, 2179 (1997) and may be found at

Peculiar histopathological features of giardiasis in distal duodenal biopsies

Histological changes in 20 Giardia positive duodenal biopsies (Group A) were compared with 50, Giardia negative duodenal biopsies (Group B), taken during the same period. Stool examinations in Group B were negative for Giardia. Surface epithelium, villous and crypt architecture and cellular infiltrates were examined and compared between the groups. Atrophic changes in the villi were more common in Group A as compared to B(P \u3c 0.0001). Intraepithelial neutrophil infiltration (P \u3c 0.001), infiltration of the lamina propria with plasma cells (P \u3c 0.5), and presence of eosinophils in the lamina propria (P \u3c 0.001) were significant findings in group A. Some of the changes were related to the density of Giardia colonization e.g., the goblet cell depletion (P \u3c 0.05) and the density of plasma cell infiltration in lamina propria (P \u3c 0.01). Erosions and ulcerations were less commonly seen in group A. Thus we conclude that giardiasis manifests its peculiar features in the distal duodenal mucosa and a biopsy of this region is an important diagnostic tool for detection of this disease

Microscopic colitis: a diagnosis to consider

Microscopic colitis is a syndrome of chronic watery diarrhoea for which no cause can be identified other than the presence of diffuse, chronic inflammation in the lamina propria on colonic biopsy. Endoscopically and radiologically the colon appears normal. We studied case records of 215 patients presenting to our institution over a three year period with chronic diarrhoea. Nineteen patients were included in the study where two pathologists agreed on the presence of chronic inflammation on colonic biopsies. All patients had watery diarrhoea with urgency. Stool examination, laboratory indices, radiology of the large and small bowel and colonoscopy were normal in all patients. Patients did not respond to a variety of drugs. A significant improvement was noted in one patient given salazopyrin. In developing countries chronic diarrhoea is most often attributed to infection and treated with antibiotics. Microscopic colitis should be considered in the diagnosis of such patients

OUTCOME OF ENDOSCOPIC THERAPEUTIC INTERVENTIONS: ARE THEY DIFFERENT AMONG VARIOUS NON- MALIGNANT ESOPHAGEAL DISEASES

Background: This study was carried out to evaluate and compare the outcome of various causes of non-malignant lesions of the esophagus after endoscopic therapeutic intervention. Methods: A cohort of patients with non-malignant dysphagia presenting at Aga Khan University hospital, a tertiary care setting who underwent endoscopic intervention was studied. Response to treatment was evaluated by improvement in dysphagia score on a scale of 0-4 and weight gain. Results:99 subjects (53 males) were included. Mean age was 48.6 +/- 17.2 years. Dysphagia for solids was present in 48%, for liquids in 3% and for both in 49% patients. Significant weight loss (\u3e10% body weight) occurred in 35 (35.3%) patients. Achalasia was diagnosed in 49.5%, peptic stricture in 30.4%, post sclerotherapy stricture in 12.1%, corrosive injury in 4%, post-operative stricture in 4%. In comparative analysis of achalasia and inflammatory groups, good response to dysphagia was seen in 40/49 (82%) and 22/50 (44%) respectively p \u3c 0.001. Weight gain was 35/49 (72%) and 22/50 (44%) p Conclusion: Dysphagia and weight loss were common presentations in non-malignant esophageal diseases. Therapeutic intervention in inflammatory group was associated with high complication than the achalasia group