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Introduction: Despite the clinical relevance and potential implications of anaemia in CLD, the available evidence regarding the association between anaemia and the severity of liver disease remains inconsistent and limited. Method: A cross sectional study was done among 116 CLD patients to address this research gap by investigating the prevalence, Etiology, and clinical implications of anemia among patients with CLD. Result: Out of total 116 patients, 57.8% had anemia. Among patients with anaemia, there were 56 males and 11 females. 71.2% (48) had mild anaemia, compared to 20.1% (14) and 20.1% (14) who had moderate and severe anaemia, respectively. 31 out of 67 (46.3%) were classified as CPS A and CPS B, and only 5 (7.4%) were classified as CPS C. When comparing patients with and without anaemia, the mean MELD points were 12.1 and 9.5, respectively. Conclusion: there was association found between anaemia and the severity of chronic liver disease, as indicated by higher MELD, and a higher proportion of patients in the more severe Child-Pugh scores categories with anaemia. [ABSTRACT FROM AUTHOR]

Introduction: Intubation is the common medical procedure which involves the insertion of a plastic tube which is a flexible tube in the throat of the patient. Reintubation is described as the failed extubation or patient get intubation after extubation who had been initially tracheal intubated. The purpose of the study was to determine the Spiro metric parameters among post Extubated patients and the application of Non-Invasive Ventilation for - prevention of reintubation. Materials and Method: Quantitative research approach with purposive sampling technique was adopted to include 38 participants. Data were collected by providing spirometry immediately after extubation. The data were analyzed using descriptive statistics. Results: The result shows that 36.84% of participants required non-invasive ventilation after extubation who were having FEV1 between 0.38-1.48, FVC between 0.44-1.75, PEFR between50-70. Hemodynamic variable like saturation (0.01), PCO2 (0.00), PO2 (0.03), and HCO3 (0.00) were highly significant at the level of p < 0.05. Proving that patients whose saturation level& ABG profile like PCO2, PO2, and HCO3 are not maintained required NIV after extubation. Conclusion: Study concludes that in Extubated patient's prophylactic non-invasive ventilation prevents extubation failure assessing the Spiro metric parameters in patients who can maintain saturation with less oxygen support, is also important in predicting good outcome of non-invasive ventilation after extubation. [ABSTRACT FROM AUTHOR]

Background: Esophageal Cancer (EC) is one of the least responsive tumors to cancer therapy with overall poor prognosis. Published data from different regions in India have indicated their observations on the local risk factors. Presently, as there seems little prospect of early detection and effective management of this cancer, understanding the etiology of EC may suggest opportunities for its primary prevention. Material & Methods: A retrospective hospital record-based study was carried out for the period of five years (2014-2019) in Department of Gastroenterology of Indira Gandhi Medical College Shimla-a tertiary care hospital located in Sub - Himalyan ranges of North India in Himachal Pradesh. Results: A total of 363 patients were diagnosed to have EC, 58.68% were male and 41.32% were female with male to female ratio of 1.42:1. Most patients come from rural areas (82.09%) and belonged to low socioeconomic status (38.01%). Most patients were illiterate (41.87%) and were involved in farming works (52.06%). Majority (76.03%) had a history of smoking bidi followed by alcohol consumption (29.20%). The most common primary location of the malignancy was middle third of the esophagus in 44.63% followed by lower third 35.54% and upper third 19.83%. Squamous cell histology was identified in 70.24% patients, while 29.75% patients had adenocarcinoma. Conclusion: EC is one of the important cancers in northern Indian state of Himachal Pradesh. Squamous cell carcinoma is the most common type followed by adenocarcinoma. The most common primary location of the malignancy was middle third of the esophagus followed by lower and upper third. The major risk factors associated with EC included tobacco and alcohol consumption besides low socioeconomic status, illiteracy, rural background and occupation of farming. [ABSTRACT FROM AUTHOR]

CT guided FNAC is a simple and safe procedure of diagnostic value in patients with lung lesions suspected to have lung malignancy. We undertook a study on 41 patients and were able to diagnose/rule out malignancy in 85.37% of these patients, while in 14.63% of patients the smears were non diagnostic. Once malignancy was diagnosed in these patients, then the next most important step was to categorize the lesions. 44% of patients had squamous cell carcinoma, 12.12% had adenocarcinoma, 9.75% had small cell carcinoma, 7.31% had poorly differentiated carcinoma, 4.87% each had metastasis & tuberculosis and 2.43% had aspergillosis. Squamous cell carcinoma was the commonest subtype in our study, which is contrary to changing trends in incidence of lung carcinoma where adenocarcinoma has replaced squamous cell carcinoma as the commonest lung malignancy. Three of our patients had minor complication in the form of mild pneumothorax, and it resolved in all patients within 24 hours. [ABSTRACT FROM AUTHOR]

Gallbladder carcinoma is the most common biliary tract malignancy in the world. Radiological investigations are helpful in diagnosing the gallbladder diseases especially carcinoma in most of the cases, but confirmation of diagnosis requires cytopathological correlation. We have undertaken a study on 29 patients, who underwent ultrasound guided FNAC for evaluation of gallbladder lesions suspected to be carcinoma gallbladder. 82.75% of patients had malignancy or suspicion of malignancy and 10.34% patients had abscesses, while in 6.9% patients FNAC was inconclusive. Adenocarcinoma (NOS) was the most common diagnosis and was found in 62.6% of patients. Poorly differentiated carcinoma, cytology suspicious of malignancy and abscesses were present in 7% of patients each. Papillary carcinoma and squamous cell carcinoma were only seen in 3.44% patients each. None of the patients in our study developed any minor or major complications during the procedure. A precise cytological examination is required not only to diagnose or rule out gallbladder malignancy, but also for prognostication of these carcinomas. [ABSTRACT FROM AUTHOR]

Introduction: Cardiac autonomic neuropathy (CAN) is a key complication of type 2 diabetes mellitus (Ty2DM). Vascular endothelial-derived growth factor (VEGF-A) plays a key role in diabetic macrovascular and microvascular complications. It is shown to be elevated in diabetic neuropathy and has the potential to serve as a biomarker in Ty2DM. We evaluated VEGF-A levels and cardiac autonomic function in newly diagnosed Ty2DM patients. Materials and Methods: Forty-four newly diagnosed patients (with symptoms within 1 year from the date of recruitment) were included in the study. Cardiac autonomic function was assessed using heart rate variability (HRV) and Ewing's battery tests. Ewing's scores were computed and tabulated. VEGF-A levels were estimated using enzyme-linked immunosorbent assay (ELISA). Results: The patients demonstrated normal responses to the reactivity tests. Ewing's scores were 0 (0-0) and 0 (0-0) for sympathetic and parasympathetic parameters, respectively. The autonomic tone was impaired as assessed by HRV parameters. VEGF-A levels were elevated (308.3 ± 167.2 pg/mL) when compared with the previous literature. Discussion: Impaired tone with normal reactivity was suggestive of early stage of autonomic neuropathy. Elevated VEGF-A levels may be attributed to a protective action of the factor seen in early stages of neuropathy in Ty2DM. Serial VEGF-A estimation in large cohorts of newly diagnosed diabetics may validate it as a biomarker in CAN seen in Ty2DM. [ABSTRACT FROM AUTHOR]

Background  Lower gastrointestinal bleeding (LGIB) is fairly a common presentation in gastroenterology and medicine departments, and presents major diagnostic and therapeutic challenges. This study aimed to explore the varied clinical spectrum of LGIB in our region. Methods A total of 138 patients presented with chronic LGIB and were investigated using colonoscopy and relevant investigations. Results  The majority of patients were in the age group of 40 to 59 years, with a mean age of 49.5 years, slight male predominance, and male-to-female ratio of 1.19:1. The most common clinical presentation was hematochezia (97.8%). Overall, 15% patients had more than one comorbidity, and 39.13% patients were anemic, of which 7.24% received blood transfusions. Diagnostic yield of colonoscopy was 92.75%. Major causes of LGIB were anorectal causes (19.56%), inflammatory bowel disease (19.56%), colorectal carcinoma (17.39%), radiation proctitis (9.42%), infective causes (11.59%), nonspecific colitis (7.24%), and benign growths (5.07%). However, in the elderly (age > 60 years), carcinoma colon, radiation proctitis, and hemorrhoids predominated the clinical picture. Conclusion  Colonoscopy is very useful in the evaluation of patients with LGIB. The predominant causes of LGIB vary according to age as well as geographical location, and mortality of LGIB is negligible as compared with upper gastrointestinal bleeding. [ABSTRACT FROM AUTHOR]

Background: Pregnancies achieved through in-vitro fertilisation (IVF) are associated with adverse first trimester outcomes in comparison to spontaneously achieved pregnancies. In view of this, it is imperative to predict the success as well as prognosticate the pregnancy outcome of an IVF cycle not only for the clinicians but also the couples undergoing IVF. Serum beta-human chorionic gonadotropin (β-hCG) value has, thus, been used as a biomarker for pregnancy outcome after IVF and also an aid in counselling and management of the patient. Aim: The main objective of this study was to compare the predictive value of the first serum β-hCG value and the pregnancy outcome after an IVF cycle (whether fresh or frozen embryo transfer) in the two subgroups of patients. Settings and Design: The study was conducted at Assisted Reproductive Technology Centre of a tertiary care hospital, and it was a retrospective cohort study. Methods and Materials: A retrospective study was performed for post-IVF pregnancies at a single IVF centre from March 2014 to February 2015 with serum β-hCG values less than or equal to 1000 mIU/ml. The initial serum values of β-hCG on the day 16 of embryo transfer were correlated with first trimester pregnancy outcome and ongoing pregnancy rate (>12 weeks gestation). Results: Of the 208 post-IVF pregnancies included in the study, the group with β-hCG more than 500 mIU/ml had statistically significant higher ongoing pregnancy rates and a lesser poor pregnancy outcome. Conclusion: The study concluded that an early serum β-hCG value can be used as a predictor of a successful or an adverse first trimester pregnancy outcome helping in better counselling and monitoring of the high-risk precious IVF pregnancies. [ABSTRACT FROM AUTHOR]

Background and Aim: Foreign body (FB) ingestion is a common clinical problem in medical practice. Endoscopy is the therapeutic method of choice for the management of FBs with minimal complications. The aim of this study is to report our experience and outcome in a 5-year period in dealing with FBs in the upper gastrointestinal tract (GIT) using upper endoscopy. Materials and Methods: The records of all the patients who presented to the Department of Gastroenterology and who underwent endoscopic management between January, 2010, and December, 2014, were reviewed with details on age, sex, type of FBs and its anatomical location, treatments, and outcomes. Results: A total of 59 patients were analyzed. Their age ranged from 2 years to 87 years. A male predominance was noticed (59.4%). Coins and chicken bone shared the most commonly encountered FBs. Esophagus was the most common site of trapping (49/59). Upper endoscopy successfully resolved the problem by FB removal in all patients, thus the overall success rate was 100%. No complications or mortalities due to FB ingestion or removal were observed throughout the study. Conclusion: In our experience, endoscopic management of FBs in upper GIT is a safe and highly effective procedure. [ABSTRACT FROM AUTHOR]

Cutaneous leishmaniasis (CL) is a neglected disease with a global prevalence of around 12 million cases and an annual incidence of 0.6–1 million. Outbreaks of CL have been associated with natural disasters, deforestation, construction activities, wars and conflicts, and any activity through which humans invade the habitat of the vector sandflies. These factors have contributed to the increase in incidence of the disease. The occurrence of CL in the indigenous population of Jammu and Kashmir, without any history of travel to endemic areas, strongly favors the possibility of local transmission through local vectors, as well as the presence of a local reservoir. This obligates the need to undertake further studies to help in the documentation of the Leishmania species responsible for causing CL in this region, and also identifying common vectors and reservoirs. An increasing number of patients with cutaneous leishmaniasis (CL) are reporting to tertiary care centers in Jammu and Kashmir, an area that has previously been non-endemic for this disease. This merits consideration of CL as a major health problem of considerable epidemiological importance. The aims of this study were firstly to describe the clinico-epidemiological profile, therapeutic characteristics, and outcomes of patients with CL and secondly to highlight this union territory as a new focus of endemicity for CL. A two-center hospital-based prospective cohort study was conducted at two tertiary care hospitals in Jammu and Kashmir over a period of 10 years (July 2009 to June 19). All patients presenting to the outpatient departments with lesions suggestive of CL were enrolled for the purpose of this study. Demographic data were recorded on a proforma questionnaire, along with a detailed history and the results of a meticulous examination. Patients diagnosed with CL based on clinical criteria were subjected to slit skin smear (SSS) and histopathological examination for confirmation of the diagnosis. An intralesional pentavalent antimonial, sodium stibogluconate (SSG), was administered at a dose of 0.5 mL/cm2 (100 mg/mL solution) three times weekly to those patients with smaller lesions, and intravenously or intramuscularly at a dose of 20 mg/kg/day to those with larger lesions. The response to treatment was assessed by total re-epithelialization of the lesion and an absence of infiltration and erythema, with or without scarring. Treatment was given until complete resolution of the lesions or for a maximum duration of 10 weeks when given intralesionally and 3 weeks when given systemically. Clinical follow-up was performed twice weekly for the first 2 months and monthly thereafter. The final response to treatment was assessed at 6 months. The study included a total of 1300 patients with a mean age of 26.7 ± 18.5 years. The mean duration of the disease was 28.52 ± 13.5 weeks, ranging from 8 to 64 weeks. Lesions were noted mainly on exposed parts of the body, with the face being the most commonly affected site (89.00%). Nodulo-ulcerative plaques were the predominant lesion type observed (73.92%). The presence of Leishman–Donovan bodies could be demonstrated on SSS and histopathology in 60.69% and 39.54% of patients, respectively. The presence of a recognizable histological pattern conforming to CL and a response to a therapeutic trial of SSG was considered to be confirmatory in the remaining patients. Complete cure was achieved in 84.23% of cases during the study period. Single lesions were more likely to respond to treatment as compared to multiple lesions. The route of administration did not have any significant impact on the final outcome. With the disease showing an escalating trend in Jammu and Kashmir, the possibility of a new focus of endemicity and its impact on public health need to be contemplated, and appropriate measures should be initiated to contain its spread. [ABSTRACT FROM AUTHOR]