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Transbronchial lung biopsy via fiberoptic bronchoscope is an extremely useful technique by which bronchial as well as lung biopsies along with brushings and washings can be easily and safely taken. Fiberoptic bronchoscopy (FOB) was performed and biopsies were done in 250 patients. In addition, bronchial brushings and washings were also taken in 140 and 115 cases, respectively. Adequate material was obtained in 242 cases. The cases were broadly classified into neoplastic and nonneoplastic categories. Malignancies and specific granulomatous diseases, tuberculosis and sarcoidosis were the main diseases diagnosed. Brushings showed a sensitivity of 88.2% and a specificity of 98.9% for the diagnosis of neoplasms. On the other hand, washings had only a 34.9% sensitivity and a 98.6% specificity in diagnosing neoplastic disorders. We concluded that FOB is a safe and effective tool in the diagnostic work-up of suspected malignancies and neoplastic lung diseases.

Background Carcinoma of the gall bladder is the most common malignancy of the biliary tract. Ultrasonography guided Fine Needle Aspiration Cytology (FNAC) plays a crucial role in early detection of gall bladder (GB) lesions. Early diagnosis of GB lesions is a necessity in view of rising trend in GB carcinoma related mortality in India. The aim of this study is to determine the diagnostic accuracy of pre-operative ultrasonography guided FNAC in the diagnosis of GB masses. Methods This was a retrospective observational study performed at a tertiary care university hospital over a period of one and a half years. A total of 47 patients with clinico-radiological suspicion of GB malignancy were subjected to USG guided FNA. 20 of these patients underwent diagnostic Trucut biopsy in addition to FNA. Results Forty-one out of 47 patients analyzed were positive for malignancy with female preponderance; MF ratio of 0.6:1. There were 29 females (61.8%) and 18 males (38.2%) in the range of 34 to 85 years. Cytomorphology was inconclusive for malignancy in two patients and unsatisfactory in one case. Two were labeled as chronic cholecystitis and one as acute cholecystitis. Adenocarcinoma was the most common malignancy found in 36 patients (76.6%). Conclusion USG guided FNAC is a rapid, safe and successful diagnostic procedure with high sensitivity for diagnosis of GB lesions. In the present scenario of increasing incidence of GB malignancy, FNAC has proved to be a useful first choice of investigation in the detection of GB lesions.

Cryptococcal meningitis commonly affects immunocompromised cases and can have varied presentation. In some instances, the presence of a plethora of inflammatory cells on cerebrospinal fluid (CSF) in an immunosuppressed patient can lead to further investigations, which unravel the presence of cryptococcal meningitis. The aim of this retrospective study was to analyze the spectrum of CSF findings of immunosuppressed patients who were diagnosed to have cryptococcal meningitis. Retrospective analysis of CSF cytospin slides exhibiting pleocytosis and belonging to immunocompromised patients was performed, and these cases were found to have cryptococcal meningitis. Out of 932 cases of CSF (January 2016-July 2017), 10 had pleocytosis and 5 of these 10 cases demonstrated spores of Cryptococcus. Male-to-female ratio was 1:1.5. All the patients were immunocompromised and had CSF leukocytosis. Lymphocytes and monocytes were present in all samples while only one case showed plasma cells. Spores of Cryptococcus were also noted in all the cases and highlighted on India Ink Preparation and Gomori Methenamine Silver stain. All the cases were positive for agglutination-based cryptococcal antigen assay, except one where the test was not done. All immunosuppressed patients having pleocytosis in CSF were found to have cryptococcal infection. Therefore, pleocytosis in CSF in any immunosuppressed patient should raise the suspicion of cryptococcal meningitis. The pathologist and the clinician need to be vigilant in such scenarios to rule out any opportunistic infection and investigate the patient thoroughly for any underlying immunosuppression.

Fine needle aspiration cytology has long been an accepted diagnostic modality in combination with physical examination and mammography to investigate breast lesions. In the present era, more proficient methods such as stereotactic mammographically guided breast biopsy is the preferred choice, however, in low resource setting, FNAC still remains the most cost effective and sampling modality to diagnose breast cancer. With the intention to evaluate the efficacy and limitations of FNAC in evaluation of breast lesions in low resource setting, we employed the Masood's cytological staging system to stratify the breast lesions and correlate them with histopathology wherever possible. All breast lesions aspirates were analyzed and classified according to the Masood's cytological scoring system and correlated with histopathological findings wherever adequate material was available. A total of 776 patients were studied of which 23 aspirates were unsatisfactory, 120 aspirates were categorized as inflammatory breast disease. Six hundred and thirty-three cases were classified according to Masood's cytological system. Nonproliferative breast diseases (Group I) encompassed maximum cases with 55% followed by carcinoma in situ and invasive cancers (Group IV) with 39% and proliferative breast disease without atypia (Group II) and with atypia (Group III) which had equal number of cases constituting 2.4% each. Cyto-histopathological correlation done in 102 cases revealed 100% concordance in group IV and 75% concordance in group III while it could not be performed in Group I and II as no histopathological specimen was available in those patients. Masood Cytological grading for breast aspirates is a reliable and an easily reproducible system which can be used to formulate appropriate treatment protocols in cases presenting with breast lesions.

Background: Celiac Disease involves the small intestine patchily affecting more frequently the proximal small bowel but the histological changes have been observed till terminal ileum. Of late in addition to D2, the duodenal bulb (D1 region) biopsies have been found helpful in identifying a small group of patients with CD. Therefore, multiple site biopsies are recommended as histological changes are not uniform throughout small intestine. Methods: During this present 1.5 years prospective study, we evaluated 84 cases of suspected celiac disease with respect to the light microscopy (D1, D2, and D3 biopsy) and serology (anti tTg and or EMA). Histological examination was done according to Modified Marsh grading system. Results: Out of 84 cases with raised anti tTg, the segmental biopsies significantly increased the diagnostic accuracy from 39/44 cases (88.6%) to 43/44 cases (97.7%) and 44/44 cases (100%) when D2 alone, D1 + D2 and D1 + D2 + D3 biopsies were evaluated, respectively. Of the suspected cases of celiac disease patients (tTg > 10 ULN and associated weight loss, diarrhea), additional D3 biopsy increased the diagnostic yield by 2.1%, compared to D1, D2 region biopsy and 6.38% compared to standard D2 biopsy alone. Of the 28 cases (tTg > 10 times ULN + EMA positive and associated weight loss, diarrhea), the potential celiac disease (histologically Type 1/Normal) cases reduced from 28.5% (standard D2 region alone) to 21.4% and 17.8% when additional biopsies were taken from D1 region and D3 region, respectively, and additional D3 biopsy increased the diagnostic yield by 10.8% (compared to standard D2 biopsy alone) and 3.7% (compared to D1 and D2 biopsy). Conclusion: We believe multiple sites duodenal biopsies including D3 region biopsies might increase the diagnostic accuracy of adult celiac disease in addition to sensitive and specific serologic tests.

BACKGROUND/AIMS Radiologically guided fine-needle aspiration cytology (FNAC) of internal organs is not cost-effective. Rapid on-site evaluation (ROSE) of smears by a cytopathologist can improve the diagnostic yield of FNACs and save time and money by reducing the need for repeat procedure/biopsy. To determine the role of ROSE in the diagnostic outcome of hepatic lesions by comparative analysis of FNAC with and without ROSE by a cytopathologist. MATERIALS AND METHODS Hepatic FNACs were retrospectively analyzed over two separate time periods from January 2011 to June 2013 and from January 2015 to July 2016. Smears from 2015-2016 were subjected to ROSE by a cytopathologist after staining with toluidine blue for 1 min to assess adequacy of the material. Final report was given after hematoxylin and eosin, May Grunwald Giemsa, and Papanicolaou staining were performed. Chi-square test (non-parametric) was used to determine if there was a statistically significant increase in the diagnostic yield with ROSE. RESULTS During 2011-2013, of the 160 radiologically guided FNACs for hepatic lesions, 22 were non-diagnostic, whereas during 2015-2016, of 142 radiologically guided hepatic FNACs, only six were non-diagnostic. With the application of ROSE, there was a statistically significant increase in the diagnostic yield of hepatic FNACs from 86.25% to 95.8% (p=0.015). CONCLUSION ROSE performed by a cytopathologist using toluidine blue can increase the diagnostic yield of hepatic FNACs and reduce the cost of healthcare by eliminating the need for a repeat procedure.

Background: Congenital malformations (CMF) are major causes of fetal demise which can be detected antenatally by Ultrasonography (USG). Methods: We studied 100 perinatal autopsies for CMF. Sensitivity of USG was determined and accuracy of USG with that of autopsy was compared. Results: At Autopsy 134 individual CMF were seen in 40 cases. The sensitivity of USG in detecting major CMF was 54.47%. A complete agreement between autopsy and USG findings was seen in 13/40 (32.5%) and partial agreement in 17/40 (42.5%) fetuses while autopsy completely changed antenatal diagnosis in 10/40 (25%) fetuses. Major findings were added in all 17 fetuses with partial agreement. In 2 cases, CMF suspected on USG were not detected on autopsy due to fetal maceration. Conclusion: Autopsy significantly adds to the prenatal USG diagnosis and may help in predicting the probability of recurrence, and thus counseling the affected couple to prevent any such future event.

A 55-year-old previously healthy woman was admitted with fever and cough. Chest X-ray and CT showed features of viral pneumonitis. Her nasopharyngeal swab was positive for severe acute respiratory distress syndrome coronavirus-2 (SARS-CoV-2) by reverse transcription (RT)-PCR. Her complete blood

Sarcina ventriculi is a rare gram-positive, anaerobic bacteria, associated with delayed gastric emptying. We report a case of a 45-year-old lady, who presented with features of gastric outlet obstruction, and coinfection of S. ventriculi and Candida was detected on examining gastric brushings and biopsy. S. ventriculi is identified by its peculiar configuration in the form of tetrads and octets. Coexistence of S. ventriculi with other organisms is highly unusual.

We are reporting a case of bilateral eosinophilic mastitis which is rare and hardly heard. It is a mimicker of carcinoma breast both clinically & radiologically. A 30 years old non diabetic female presented with bilateral breast lumps with history of rhinitis off & on and peripheral eosinophilia. Mammography was suspicious while ultrasonography was diagnostic of bilateral mastitis. Aspiration cytology exhibited inflammatory lesion rich in eosinophils. Histopathology revealed the diagnosis of eosinophilic mastitis. Eosinophilic infiltration of the breast is a rare manifestation of tissue involvement in peripheral eosinophilia and bilateralism is even rarer.

Hepatocellular carcinoma (HCC) is a major cause of morbidity and mortality in all parts of the world. We analyzed the clinical presentation, etiology, and tumor characteristics of HCC presenting to our hospital. All patients diagnosed to have HCC from September 2007 to August 2010 were prospectively enrolled. HCC was diagnosed according to EASL criteria—USG/CT/MRI of the abdomen and/or serum alpha-fetoprotein and/or histology (where indicated). Detailed clinical and laboratory parameters were noted. Barcelona Clinic Liver Cancer (BCLC) staging was done. One hundred and twenty-eight patients (22 females, mean±SD; age, 49.8 ± 10.2 years) were diagnosed to have HCC. Underlying cirrhosis was present in 99.2 %. Hepatitis C virus infection, alone (21.9 %) or with alcohol (22.9 %) was the most common etiological factor, followed by alcohol alone; 33.6 % of the patients had more than one etiological factor. Most patients (83.5 %) presented with features of decompensated cirrhosis. HCC leading to decompensation of cirrhosis was the first presentation of the liver disease in nearly one third of the cases. Serum alpha-fetoprotein was >200 ng/mL in 67.2 % of the patients, while it was normal in 18.7 % of the patients. The mean±SD size of HCC was 5.3 ± 2.9 cm. HCC was multicentric in 57 %, and portal vein thrombosis was present in 34.4 %. About 66 % of the patients belonged to BCLC stage C or D. Hepatitis C virus infection was the most common cause of HCC in Punjab. One-third of the patients had multiple etiological factors and almost all had underlying cirrhosis and presented at advanced stage.

The role of infliximab in the treatment of acute severe ulcerative colitis is established. However, all the data available in the literature are from western countries. This is the first report on the use of infliximab in patients with severe steroid-refractory ulcerative colitis from India. Retrospective analysis of 28 patients who had received infliximab therapy for induction of remission, with three doses of 5 mg/kg at 0, 2, and 6 weeks, was performed. Twenty-four (85.6 %) patients had shown a clinical response by week 8 and, hence, avoided urgent colectomy. In 2 years of follow up, 9/16 (56 %) patients had not required colectomy. Infliximab averted colectomy in a proportion of patients with severe steroid-refractory ulcerative colitis.

Hydatid disease, caused by the larval stage of Echinococcus granulosus, is found most commonly in the liver and lungs, but no organ is immune. The ovarian involvement is often secondary to a cyst's dissemination localized in a different site. Occasionally, the cyst enlarges, thus mimicking an ovarian tumor. Patients with hydatid cysts at unusual locations present with atypical presentations and pose a diagnostic dilemma. A high index of suspicion is required in order to make a correct diagnosis pre-operatively to prevent spillage of the cyst contents during surgery. We report a case of hydatid cyst in the ovary in a young female. Diagn. Cytopathol. 2017;45:267-269. © 2016 Wiley Periodicals, Inc.

Chronic gastritis is a very common disorder which is commonly caused by Helicobacter pylori. Histopathological examination is the mainstay of the diagnosis. We evaluated 300 gastric antral biopsies using revised Sydney system and concluded that it helps to analyse gastric biopsies in a very comprehensive manner. It was seen that H. pylori, chronic inflammatory infiltrate, neutrophilic infiltration, presence of lymphoid follicles and aggregates and surface epithelial damage are strongly associated with each other. The presence of one of these histological feature is a strong indicator for presence of other features. On the other hand intestinal metaplasia and atrophy of gastric glands was not associated with the above mentioned histological features. In the presence of dense chronic inflammation and infiltration by neutrophils one should carefully search for H. pylori organism. We also correlated histological features with endoscopy and found that cases of duodenal ulcer had more severe antral gastritis on histology as compared to those with hyperemia or antral erosions.

Sustained virological response (SVR) is achieved in a high proportion of patients with chronic hepatitis C infection, particularly those with genotype 2 or 3 HCV infection. However, data on long-term durability of virological response in patients who achieve SVR are limited.To evaluate the long-term durability of virological response in patients who have achieved SVR with interferon-based combination therapy.One hundred patients with chronic HCV infection who had obtained SVR after IFN and ribavirin combination therapy were followed up for up to 8 years with annual HCV RNA testing.During a followed up of 6 months to 8 years, 8 of 100 patients with initial SVR developed late relapse of HCV infection. Relapse was more common in patients who had cirrhosis (5/28 [18%] vs. (3/72 [4%] with no cirrhosis; p=0.037).SVR is durable in most patients, but some patients do have late relapse; long term follow up may be particularly important in a subset of patients with HCV infection who have liver cirrhosis.

Background: Celiac disease, as of today, is said to exist in almost all parts of the world, although it is rare among people of purely African–Caribbean, Japanese and Chinese background. The disease has also been considered uncommon in India until recently. Hospital records have revealed an increasing trend of the disease in predominantly wheat-eating areas of North India. The aim of the present study was to determine the prevalence of celiac disease among school children in Punjab, North India. Methods: The study was carried out in the Ludhiana district of Punjab, Northern India. A total of 4347 children aged 3–17 years attending different schools were enrolled. A structured questionnaire was used to collect sociodemographic data and symptoms and signs related to celiac disease and various sociodemographic factors. The screening for celiac disease for the suspected celiacs was done by testing for antitissue transglutaminase (anti-tTG) by indirect solid-phase immunometric assay (ELISA). All children with high anti-tTG whose parents consented underwent upper gastrointestinal endoscopy for small bowel biopsy from the second part of the duodenum. Histopathology was expressed according to the Marsh classification of 1992. Follow up was carried out among children who were put on a gluten-restricted diet, at monthly intervals for 3 months and every 3 months thereafter. The diagnosis of celiac disease was established on the basis of the revised European Society of Paediatric Gastroenterologists and Nutritionists (ESPGAN) criteria (confirmed cases). Results: A total of 4347 school children (1967 girls, 2380 boys, age range 3–17 years) were screened for celiac disease. Out of these, 198 suspected children were identified for further evaluation. Twenty-one children tested positive for anti-tTG assay (10.6%, 95% confidence interval: 16.91–34.79). Seventeen of these 21 children agreed to undergo biopsy; of these, 14 had histological changes consistent with celiac disease and all these 14 children had clinical response to gluten restriction. Three children with high anti-tTG had normal mucosa on duodenal biopsy and were not labelled as being in the celiac disease group. In the final analysis the disease prevalence was one in 310 children. Conclusions: This is the first study on celiac disease prevalence among school children from India. Although this disease frequency of one in 310 is thought to be an under-assessment, it clearly shows that celiac disease is not rare in wheat-eating areas of North India.

Data on transmission of HCV infection from mother to infant in India are limited. Between July 2006 to June 2007, women attending our hospital in the third trimester of pregnancy were screened for anti-HCV. Those testing positive for anti-HCV were tested for HCV RNA. Infants of mothers with HCV infection were followed for up to 24 months. Eight of 488 pregnant women (1.6%) tested positive for anti-HCV; of these, seven had detectable HCV RNA. Two of 7 (29%) children born to HCV-infected mothers had persistently positive HCV RNA, indicating perinatal transmission; one additional child had transient HCV positivity. Passive transfer of HCV antibodies was observed in five babies. HCV infection was detected in 1.4% of pregnant women, and perinatal transmission of HCV to newborns was detected in 29% of such cases.

A solid pseudopapillary tumour of the pancreas (SPT) is a rare neoplasm accounting for less than 2% of exocrine pancreatic neoplasms. SPT occurs in adolescent young females and is mostly benign. It is a low-grade malignant tumour that may evolve years before symptoms start and has a favourable prognosis. In this report we present five cases (four females, one male, aged 16, 45, 23, 17 and 55 years, respectively) of SPT localised in the pancreas, and discuss the clinical, imaging and histologic findings with a review of the literature. We retrospectively reviewed these five patients with SPT who underwent surgical resection in our hospital with a definitive histologic diagnosis of SPT.

Kikuchi's disease is a rare, benign, self-limited disorder, characterised clinically by fever and tender regional lymphadenopathy. It has been reported worldwide and is particularly common in people of Asian descent. The cause of Kikuchi's disease is unknown. It predominantly affects young females and can closely mimic several infectious and immunological conditions. Histopathologic features of lymph nodes in Kikuchi's disease are characteristic and permit differentiation of this benign condition from lymphomas, systemic lupus erythematosus and infectious lymphadenopathies. We report a female patient presenting with fever and tender cervical lymphadenopathy. She was being treated for tubercular lymphadenitis and was referred after she developed a transient hepatitis and a skin rash following treatment with anti-tubercular drugs. An excisional biopsy of the lymph node revealed histiocytic necrotising lymphadenitis, consistent with Kikuchi's disease. A brief review of the pathogenesis and differential diagnosis of Kikuchi's disease is presented.

Skin and soft tissue infections (SSTI) are an important cause of morbidity and mortality in patients with cirrhosis. This prospective study aimed to analyze the clinical profile and factors affecting outcome of SSTIs in cirrhotics. All cirrhotics hospitalized between September 2007 and August 2010 were included. Frequency, site, extent, and type of SSTI were noted. Of 1,395 cirrhotics, 19.4 % (n = 271) had bacterial infections, out of which 32.8 % (89/271) had SSTI. Alcohol was the predominant etiological factor for cirrhosis; 95.2 % belonged to Child class B/C, and 67 % gave history of barefoot walking. The most common site of SSTI was the lower limbs (87.1 %), cellulitis was the most common type (61.2 %), and gram-negative bacilli (GNB) is the most common organism (86.7 %). Mortality rate was 23.5 %. Serum creatinine and model for end-stage liver disease (MELD) score were independent predictors of mortality. SSTIs in cirrhotics were common and mostly involved the lower limbs. Cellulitis was the most common type, and GNB was the most common organism. Serum creatinine and MELD score were independent predictors of mortality.

Epidemiological data on hepatitis C virus (HCV) infection from India are scanty. We conducted a population-based seroepidemiologic survey to estimate the prevalence of hepatitis C in Punjab state of northern India. A house-to-house survey was conducted in a defined population of 26,273 subjects. Information was gathered according to a predesigned questionnaire with socio-demographic characteristics (age, gender and substance abuse), family history of HCV infection, general health status, associated co-infection, immunization history and potential risk factors for HCV transmission. At the time of clinical evaluation, blood was tested for anti-HCV and those found positive were tested for HCV RNA. Among 5,258 subjects screened, 272 were found to be anti-HCV positive (prevalence rate of 5.2 %); highest prevalence being noticed in 41–60 years age group. Anti-HCV positive rate were not different among males and females. Sixty-seven subjects (1.3 %) were found to be HBsAg positive; four of these being co-infected (5.9 %). Various risk factors for acquiring HCV infection identified were history of surgery, dental treatment and unprotected sex. Other associations were strong family history of HCV positivity, alcohol consumption and diabetes mellitus. Chronic HCV infection is a major health problem in Punjab; it appears to be more common than HBV infection. Exercising safe health care related procedures should be emphasized in our country as main modes of transmission of infection identified were related to these.

Treatment of HCV infection in patients with thalassemia major (TM) is limited by the lack of large clinical trials and concerns about ribavirin-induced hemolysis.We conducted a prospective, randomized, open-label study to determine efficacy and tolerability of pegylated-interferon alfa 2b (1.5 microg/kg/week) alone (group A) or with ribavirin (12-15 mg/kg/day; group B) in patients with TM and chronic HCV infection. Patients with genotype 1 or 4 HCV were treated for 48 weeks and those with genotype 3 or 2 HCV for 24 weeks. Early viral response (EVR; after 12 weeks of treatment), end-of-treatment virological response (ETR) and sustained virological response (SVR; 6 months after stopping therapy) were assessed.Of 40 patients, 20 each were allocated to the two treatment groups. EVR rates in group A and B were 15 (75%) and 18 (90%), respectively. ETR occurred in 17/20 (85%) patients in each group. SVR occurred in 8 (40%) patients in group A and 14 (70%) in group B. Blood transfusion requirements increased in one patient in group A and four patients in group B. One patient in group A had severe sepsis and one in group B had nephrotic syndrome. Two patients in each group required reduction in drug dose.In patients with TM and chronic HCV infection, pegylated interferon alfa 2b and ribavirin combination therapy achieves a higher SVR rate than pegylated interferon alone, and is well tolerated except for an increase in blood transfusion requirement.

Cyclosporine A (CsA) has been found to be the first successful therapy used in the recovery of patients with steroid-refractory ulcerative colitis (UC). However, the long-term benefits of cyclosporine remain questionable. We report our results on the use of CsA in patients with severe steroid-refractory UC.The records of all patients with steroid refractory UC treated with CsA from January 2003 to December 2007 were reviewed. Demographics, clinical characteristics of the disease, responsiveness to CsA, complications arising from the treatment and the need for surgery were recorded for all patients.Of 146 admissions of severe UC, 24 patients who were steroid refractory (mean age 41.7 years; 11 men) received intravenous cyclosporine (4 mg/kg/day) for mean of 6.63 days (range 1-7), followed by oral CsA for a period of 3 months. All patients had failed to respond to intravenous hydrocortisone given for 7 days. Four patients required a colectomy immediately, three of whom failed to respond to CsA, and one had convulsions following drug administration. Nineteen of the 24 patients (79%), in whom a colectomy was avoided during the early stages of their treatment, were followed up for a mean of approximately 38 months (range 12-62 months). Three patients required surgery on follow up; one was operated at day 94, another in the second year and one in the third year. Overall, 16 of 24 patients (67%) remained colectomy-free. The main side-effects observed included infections, tremors, paresthesias, headache, hypertension, hypertrichosis and peripheral neuropathy. Three of seven patients who had to undergo surgery died within 2 weeks.Our study shows that surgery can be avoided in two-thirds of patients with steroid refractive severe UC. However, the drug toxicity and mortality are significant.

Coexistence of celiac disease with chronic calcific pancreatitis is rare. We describe a 26-year-old woman with chronic calcific pancreatitis in whom non-response to treatment was due to celiac disease.

The treatment of hepatitis C virus (HCV)-related cirrhosis is difficult due to high frequency of adverse effects. We retrospectively reviewed the case records of patients with HCV cirrhosis to evaluate the efficacy and tolerability of pegylated (peg) interferon and ribavirin treatment in these patients.Medical records of 28 patients with HCV-related compensated cirrhosis were reviewed. The treatment protocol was a combination therapy of peg interferon alfa-2b (1 microg/Kg/week) plus oral ribavirin (10-12 mg/Kg/day). Primary endpoint was sustained virological response, with additional endpoints of drug tolerance, clinical or biochemical worsening and death.End-of-treatment virlogic response was seen in 24 of 28 patients (85%) and sustained virologic response in 15 of 28 (53%) patients. Biochemical end-of-treatment response and sustained response were seen in 20 and 16 patients (71% and 57%), respectively. Treatment had to be stopped in 3 patients due to decompensation of liver status in two and drug intolerance in one, while dose modification was required in two patients.Combination therapy with peg interferon plus ribavirin seems effective in patients with liver cirrhosis. High relapse rate, poor biochemical recovery and possibility of decompensation are issues that need to be kept in mind.

To determine the prevalence of celiac disease (CD) in siblings of patients with this disease in Punjab, where wheat is the staple diet.Families of 80 patients with CD diagnosed as per modified ESPGAN criteria were offered family screening. Their siblings aged 2-15 years were tested for serum IgA anti-tissue transglutaminase antibody (anti-tTG) antibody. Those with positive or borderline test and some of those with negative test underwent endoscopic duodenal biopsy. Siblings with characteristics histological findings and showing improvement on follow-up were labeled as having celiac disease.Of the 63 siblings of 48 index cases studied, 15 tested positive for anti-tTG; of these 13 had celiac disease. Three tested borderline for anti-tTG; none of them had CD. Of the 45 anti-tTG-negative subjects, two agreed to undergo biopsy; one of these had features of CD. Overall, 14 of 63 (22%) siblings had CD, including 8 who had no symptoms suggestive of CD.CD is common among siblings of patients with CD in Punjab and may be asymptomatic.

Wnt/beta-catenin signaling plays an important role in normal development. However, its aberrant activation is associated with several cancers. The aim of this study is to examine the Wnt/beta-catenin pathway in patients with advanced pancreatic adenocarcinoma (n = 31). Paraffin sections from tumors (n = 16) and normal pancreata (n = 3) were used to determine the localization of beta-catenin. An additional 15 frozen tumors, adjacent normal pancreata (n = 5), or normal pancreata (n = 4) were utilized for protein isolation. Tumors were also examined for mutations in exon 3 of the CTNNB1 gene. More than 65% of the tumors showed an increase in total beta-catenin, consistent with its enhanced membranous, cytoplasmic, and nuclear localization, but only two showed mutations in CTNNB1. The majority of the remaining tumors demonstrated concurrent increases in Wnt-1 and frizzled-2 (positive regulators) and a decrease in Ser45/Thr41-phospho-beta-catenin. Electrophoretic mobility shift assay demonstrated beta-catenin-T-cell factor binding in tumors only. Adenomatous polyposis coli and axin, which are both negative regulators, remained unchanged. Unexpectedly, total glycogen synthase kinase-3beta protein was elevated in these tumors. Elevated levels of E-cadherin were also observed, although E-cadherin-beta-catenin association in tumors remained unaffected. Thus, Wnt/beta-catenin activation was observed in 65% of pancreatic adenocarcinomas, independently of beta-catenin gene mutations in most tumors.

The association of ulcerative colitis with Takayasu's arteritis is rarely reported. The occurrence of the two together is possibly related to a common pathophysiology involving alteration in immune mechanisms. Takayasu's arteritis is more prevalent in Japan and South East Asia whereas Ulcerative Colitis is more in Western countries. The coexistence of these two diseases is uncommon and hence this report.

The association of Paterson Brown Kelly Syndrome and celiac disease is not widely reported. Both the entities have iron deficiency anemia. This case report emphasizes the need of screening for celiac disease in patients with Paterson Kelly Syndrome.

The aim of the study was to analyse the morphology, clinical presentation and predisposing factors for chronic hepatitis C infection.Clinical presentation of 220 patients who presented with hepatitis C virus infection over five years period (January 1996 to December 2000) were recorded. Liver biopsy specimens from 80 adult patients with chronic hepatitis C virus were evaluated using a semiquantitative scoring system. The possible predisposing risk factors for infection in these patients were recorded.Grading of chronic hepatitis C was minimal/mild in 51 (64%) cases. Seven (8.7%) had high-grade necroinflammatory activity. Fibrosis was absent in 22(27.5%), mild in 29(36.25%), moderate in 11 (13.75%) and 18(22.5%) had evidence of cirrhosis. No significant correlation was found between the level of transaminases and degree of fibrosis or grade of inflammation. More number of patients with history of alcohol consumption had moderate/severe grade of necroinflammatory activity and cirrhosis as compared to those not taking alcohol at all. Potential predisposing factors were use of unsterile syringes, previous surgery and tattooing in multivariate analysis.Nearly two-thirds of patients of chronic hepatitis C where liver biopsy was possible have minimal/mild disease at time of diagnosis; 22% have cirrhosis. Though disease severity can only be assessed by liver histology, liver biopsy may not be possible in a sizeable proportion of patients as they present with advanced liver disease. Most of the patients do not have specific symptoms. Reusable needles/syringes is the commonest potential risk factor.

We report a 47-year-old woman who developed features of rheumatoid arthritis 20 weeks after initiation of treatment with pegylated interferon and ribavirin for chronic hepatitis C. She continued to have symptoms six months after discontinuation of the drugs which she received for 24 weeks with rival clearance.

To study the presentation of adult celiac disease in a northern Indian hospital.Case records of all patients diagnosed as having adult celiac disease in the Gastroenterology unit of this hospital during January 1996 till December 2001 were reviewed. Celiac disease was diagnosed according to the revised ESPGAN criteria. Adult celiac disease was diagnosed if disease manifestations started after 15 years of age. All patients had a minimum of one-year follow up.The mean duration of illness in the 96 patients (mean [SD] age 32.9 [11.4] years; 50 men) diagnosed over the 6-year study period was 7.3 (2.4) years. Diarrhea was present is 67.7% of cases; 18.7% presented with refractory iron-deficiency anemia, and 9.4% with abdominal symptoms like flatulence and distension. Three patients presented with dysphagia and anemia and were diagnosed as having Plummer-Vinson syndrome. Ulcerative colitis, non-alcoholic steatohepatitis, and aphthous ulcers were associated conditions. All patients had significant improvement in symptoms and hematological and biochemical parameters after dietary gluten restriction.Adult celiac disease is not rare and usually presents as diarrhea, abdominal distension and flatulence, and refractory anemia.

Acute gastrointestinal symptoms are known to occur with organophosphorus compounds poisoning. Delayed complication in the form of gastric outlet obstruction has not been reported to date. We report gastric outlet obstruction developing after diazinon ingestion in a young girl. She responded to endoscopic balloon dilatation.

Azathioprine is useful as a steroid-sparing drug in patients with ulcerative colitis. Its role as monotherapy in the maintenance of disease remission has not been evaluated.In this prospective, randomized, open-label study, 25 patients with severe ulcerative colitis received either azathioprine (2.5 mg/Kg/day; Group A, n = 12) or sulfasalazine (6 g/day; Group B, n = 13). All patients received oral corticosteroids in a tapering dosage schedule initially. Treatment failure was defined as either disease relapse or drug withdrawal because of adverse effects.Five of 12 patients in Group A and 8 of 13 patients in Group B had sustained remission during the stipulated study period of 18 months (p = ns). Two patients in Group A had to stop azathioprine because of adverse effects (bone marrow suppression and acute pancreatitis). In Group A, all patients who had treatment failure developed it in the first half of the study while in Group B treatment failure occurred in both halves.The relapse rate of ulcerative colitis on maintenance therapy with azathioprine or sulfasalazine is comparable; there was a trend towards earlier treatment failure with azathioprine.

Non-parenteral transmission of hepatitis C virus (HCV) is controversial. There are no data on intrafamilial spread of HCV from India, where the family set-up differs from that in developed countries.First-degree relatives of patients with HCV-related chronic liver disease underwent testing for anti-HCV antibody and levels of transaminases. History of exposure to blood/blood products, surgery or other known risk factors, and of alcohol intake was recorded. Total duration of residence with the patient, and duration of residence after establishment of diagnosis in the patient was also recorded.Of 272 first-degree relatives, 125 agreed to participate. Of these, 20 (16%) tested positive for anti-HCV. This rate was significantly higher than the 1.6% anti-HCV positivity rate in our volunteer blood donors. Twelve anti-HCV-positive and 4 anti-HCV negative contacts had elevated transaminases. Alcohol consumption by contact, longer duration of residence with the index case after the diagnosis of liver disease, and presence of cirrhosis in the index case were associated with increased risk of HCV infection among contacts.Family contacts of patients with HCV-related chronic liver disease have an increased risk of HCV infection; this risk is particularly high if they consume alcohol, have a long duration of residence with the index case after diagnosis of liver disease, and if the index case has cirrhosis.

Oral cyclosporine has been reported to be useful in inducing remission in patients with active severe ulcerative colitis who fail to respond to intensive steroid therapy. We present our experience of its use in six patients.

Severe ulcerative colitis is conventionally treated with parenteral corticosteroids followed by oral corticosteroids. Regular use of corticosteroids is associated with side effects. Corticosteroid pulse therapy, i.e., use of supraphysiologic dose followed by complete withdrawal, which is likely to have fewer side effects, was tried in the current study.Dexamethasone pulse therapy, i.e., 100-mg/d infusion in 5% dextrose, was used for 3 consecutive days in 14 patients with severe ulcerative colitis. Ulcerative colitis disease activity was assessed on days 7, 15, 30, and 60. The primary end point was defined as the number of patients who achieved clinical remission and an activity index less than 150 at day 15. The second end point was the number of patients who remained in remission and had an activity index less than 150 at 30 and 60 days. None of the patients enrolled got subsequent oral corticosteroids after their 3 days of megadose corticosteroid infusion.Clinical remission was achieved in 93% patients (13 of 14 patients) by day 15. Two of these 13 patients suffered relapse during follow-up, and hence, the clinical remission was sustained in 79% patients at 30 and 60 days.Dexamethasone pulse therapy is highly effective in inducing remission in patients with ulcerative colitis, but randomized controlled trials are needed to compare dexamethasone pulse therapy with standard oral continuous corticosteroid regimens.

The search is on to find more effective drug regimens for patients with severe ulcerative colitis, as conventional drugs such as sulfasalazine and its congeners fail to prevent relapse in a significant number of patients. Azathioprine has also been reported to be useful as a steroid-sparing drug in patients who suffer from frequent relapses. As these drugs when used individually fail to sustain remission in a significant number of patients, we evaluated the combination of these two drugs. Methods. Thirty-five newly diagnosed patients with severe ulcerative colitis were randomized into two groups; group A (combination therapy) received sulfasalazine and azathioprine, while group B (sulfasalazine monotherapy) received sulfasalazine and placebo. In addition, all the patients received steroids initially to achieve clinical remission. The patients were followed-up for a period of 1 year. The therapeutic outcome was measured by the number of patients who suffered relapse in each group. Results. All the patients completed the 1-year study period. While 4 patients (23.5%) in group A suffered relapse of disease, 10 (55.6%) in group B suffered relapse, the difference being statistically significant. The relapse-free period was also significantly longer in group A. Conclusions. Combination therapy (sulfasalazine and azathioprine) is more effective than sulfasalazine and placebo in the maintenance of remission in patients with severe ulcerative colitis.

their content of “ gluten,”cause celiac disease, which is the best recognized form of gluten allergy. The yearly increase in the number of patients diagnosed with celiac disease appears alarming. Projections of this trend from our hospital data to the years 2010 and 2020 indicate an enormous increase in its incidence. These results are alarming, though it must be kept in mind that ours is a hospital-based study. Nevertheless, serious thought should be given to identifing the possible reasons for the increasing prevalence of disease in India. Is it just an increased awareness of the disease? Is it that the wheat of today differs appreciably in composition or characteristics from the wheats of times past? Is it that the enormous potential benefits from the genetically improved crops are causing people to ignore such unforeseen effects? Is it that the alteration of just one or two genes with known traits through biotechnology to increase yield or quality in the already popular crop variety leads to this menace? Or is it that conventional plant breeding methods leading to the introduction of unknown genes (wild variety) whose traits have not been studied are causing an increase in incidence? Most of these concerns are technical issues that need to be addressed through appropriate research. First and foremost, the specific peptide sequence of the gliadin responsible for triggering intestinal in flammation needs to be identified. Gene-altered wheat and its products have found their way into the Indian markets. The alarming increase in the incidence of celiac disease invokes fears about the type and quality of wheat being used. The hypothetical risks posed by its use need to be scientifically evaluated. Animal model trials with the various transgenic crops of wheat over the years need to be carried out.

Background Based on age of presentation, celiac disease (CD) is categorised as pediatric CD and adult CD. It however remains unclear if these are genetically and/or phenotypically distinct disorders or just different spectrum of the same disease. We therefore explored the common genetic components underlying pediatric and adult CD in a well characterized north Indian cohort. Methods A retrospective analysis of children (n = 531) and adult (n = 871) patients with CD between January 2001 and December 2010 was done. The database included basic demographic characteristics, clinical presentations, associated diseases and complications, if any. The genotype dataset was acquired for children (n = 217) and adult CD patients (n = 340) and controls (n = 736) using Immunochip. Association analysis was performed using logistic regression model to identify susceptibility genetic variants. Results The predominant form of CD was classical CD in both pediatric and adult CD groups. There was remarkable similarity between pediatric and adult CD except for quantitative differences between the two groups such as female preponderance, non-classical presentation, co-occurrence of other autoimmune diseases being more common amongst adult CD. Notably, same HLA-DQ2 and –DQ8 haplotypes were established as the major risk factors in both types of CD. In addition, a few suggestively associated (p