Brij Sharma

Prevalence of Vitamin D deficiency and associated risk factors among children residing at high altitude in Shimla district, Himachal Pradesh, India

Introduction: Vitamin D is important for bone development in children. A high prevalence of Vitamin D deficiency (VDD) has been documented from different parts of India. However, limited data are available on VDD among children residing at high altitude region of country. Objectives: To assess the prevalence of VDD and associated risk factors among children in the age group of 6–18 years in Shimla, Himachal Pradesh. Methods: A community-based cross-sectional study was conducted in the year 2014–2015. A total of 626 children in the age group of 6–18 years were enrolled from 30 clusters which were identified using population proportionate to size sampling method. A minimum of 20 children in the age group of 6–18 years per cluster were selected using random number tables. The data on socioeconomic status, physical activity, sunlight exposure, and biochemical parameters of bone and mineral metabolism were assessed. Results: Ninety-three percent of school-age children were found Vitamin D deficient as per serum 25(OH) D levels of <20 ng/ml. The prevalence was significantly higher among females. Conclusion: A high prevalence of VDD was found in children residing in high altitude region.

A Study on the Elastic Properties of Reinforced Solids

A mathematical model for the elastic behaviour of two phase composite body has been formulated. The distribution of stresses for various cases have been dis cussed together with their corresponding elastic energies. It has been shown that a great deal of knowledge can be obtained even without analysing the interaction mechanism of composite. The mixture is assumed to be homogeneous on a macroscopic scale but not necessarily isotropic. However, two phases themselves are assumed to be homogeneous and isotropic. Further, no condition is placed on the shape of the inclusions which may for example be fibrous or plate like.

Unusual presentation of adult Marfan syndrome as a complex diaphragmatic hiatus hernia.

Marfan syndrome is multisystem connective tissue disorder that primarily involves the skeletal, cardiovascular, and ocular systems. The gastrointestinal complications in Marfan syndrome are rare, with only a few case reports described in the literature. We present a 25-year-old woman who presented with acute abdominal pain for 1 day. The imaging features revealed complex diaphragmatic hiatus hernia with organoaxial gastric volvulus. This is a unique case report about an adult patient with Marfan syndrome who presented with symptomatic paraesophageal hernia and organoaxial gastric volvulus.

Diagnostic accuracy of endoscopic brush cytology in malignancies of upper gastrointestinal tract: A prospective study of 251 patients in North India

AIM To find the spectrum and frequency of upper gastrointestinal malignancies and diagnostic accuracy of endoscopic brush cytology in their diagnosis. MATERIALS AND METHODS This study was a prospective study carried out on 251 patients over 1-year in the Department of Pathology. Brushing material was smeared directly on to at least two clean glass slides and was stained with May-Grunwald-Giemsa stain. The endoscopic biopsies were examined grossly and were fixed in 10% formalin, processed, and stained with hematoxylin and eosin stain. OBSERVATION AND RESULTS The age range of the patients varied from 8 to 90 years, with the mean being 56 years. Male to female ratio was 2.5:1. On brush cytology, out of 251 cases, 110 had benign lesions and 97 had malignant lesions. Forty-four samples were considered suspicious of malignancy. On histopathology, benign lesions were present in 105 patients while malignant lesions were seen in 139 patients. In seven cases, results were inconclusive due to inadequate/superficial biopsy. STATISTICAL ANALYSIS Statistical analysis revealed the overall sensitivity of upper gastrointestinal brush cytology as 83.45% and specificity 80.95%. The accuracy of brush cytology came out to be 82.37% in upper gastrointestinal tract. CONCLUSION Brush cytology is a reliable, safe, inexpensive, and rapid method of diagnosing upper gastrointestinal lesions. Although endoscopic biopsies are established gold standard for diagnosing gastrointestinal malignancy, use of both biopsy and brushing together increases the diagnostic accuracy.

Etiology of ascites in adults living in the Hills of Himachal Pradesh, India: A hospital-based study

Aim: Ascites is one of the major complications of liver cirrhosis. In addition, ascites can develop because of peritoneal tuberculosis, malignancy, cardiac, and renal disorders. The purpose of this study was to evaluate epidemiological data on the etiological profile of ascites in adults in a tertiary care hospital in the Northern hilly state of the Western Himalayas. Materials and Methods: A 1-year hospital-based cross section observational study was conducted in the Department of Medicine and Gastroenterology in a tertiary care center of Himachal Pradesh, located in the Northern India. In all 168 patients who were diagnosed as ascites on the basis of history, physical examination, ultrasonography, and of age >18 years were included in the study. Detail history examination and investigation were carried in each case as per protocol. Results: Cirrhosis of liver was the leading cause of ascites in our study (60.7%), tuberculosis was the second most common cause of ascites (13%), malignancy and cardiac disorders were the third (7.7%) most common causes for ascites. Alcohol was the leading cause of cirrhosis in 75 patients (73.5%). Conclusion: The study identified cirrhosis of liver as the leading cause of ascites and alcoholism as the most common cause of cirrhosis. The measures on taking care of preventable risk factors are desired.

Bleeding Ectopic Varices as the First Manifestation of Portal Hypertension

Ectopic varices are defined as dilated portosystemic collateral veins in locations other than the gastroesophageal region. We present a case of recurrent upper gastrointestinal bleeding as the first manifestation of portal hypertension. We diagnosed ectopic duodenal varices without gastroesophageal varices on upper GI endoscopy and extrahepatic portal venous obstruction (EHPVO) on CT angiography and managed this case.

A Study on the Damage of Reinforced Material

A micro-mechanical approach is used to discuss the damage of two solid phases firmly bonded together at the interfaces. A theorem of theoretical as well as of practical importance is presented. It relates the damage properties of composite material and its constituents. Conditions on the constants of constituent and composite material have been imposed to predict the superiority of composite material. The mixture is assumed to be homogeneous on a microscopic scale, but not necessarily isotropic. How ever, the two phases themselves are assumed to isotropic and homogeneous. But their elas tic moduli differ and so that the stress and the strain fields throughout the mixture are microscopically nonhomogeneous.

The diagnostic accuracy of colonoscopic brush cytology in diagnosis of colorectal malignancies: A study of 49 patients

Aims: To find the spectrum and frequency of lower gastrointestinal malignancies and diagnostic accuracy of colonoscopic brush cytology in their diagnosis. Materials and Methods: This was a prospective study carried out on 49 patients in the Department of Pathology over 1 year. Brushing material was smeared directly onto at least two clean glass slides. The air dried smears were stained with May Grunwald Giemsa stain. The endoscopic biopsies were examined grossly and were fixed in 10% formalin, processed and stained with Hematoxylin and Eosin stain, respectively. Special stains were used wherever required. Observation and Results: The study was done on 49 patients presented with colorectal and anal lesions. Age of the patients ranged from 17 to 72 years with male to female ratio being 1.57:1. On statistical analysis, the sensitivity of colonoscopic brush cytology was found to be 85.71% and specificity 61.53%. The accuracy came out to be 79.16%. Conclusion: Brush cytology is a reliable, safe, inexpensive, and rapid method of diagnosing gastrointestinal lesions. Since brushing is a relatively noninvasive procedure, routine use of brushings of colonoscopically visible lesions should be done, in addition, to biopsy to increase the diagnostic yield.

Genotyping of hepatitis B virus isolates from Lahaul and Spiti district in Himachal Pradesh, India

Hepatitis B virus (HBV) has several genotypes. In the Indian population, genotypes A and D are the most frequent. HBV infection is hyper-endemic in the Lahaul and Spiti district in Himachal Pradesh; however, the virus genotype in this area is not known. We sequenced a 398-nucleotide segment of HBV genome that included parts of pre-S1/S2 and polymerase genes from 17 specimens from this district, and assigned a viral genotype to these. Of the 17 specimens studied, 13 (76% [95% confidence interval = 50–92%]) showed the presence of genotype C HBV; the remaining four were genotype D (n = 4; 24%) HBV. Prevalence of genotype C HBV was much higher in the district than in other parts of India. This may reflect the historical mixing of this population with that in China. Since genotype C has a higher risk of chronicity and mother-to-child transmission, prevention of HBV infection may need particular emphasis in this area.

Denture-induced esophageal perforation: Role of esophagogastroduodenoscopy and fully covered self-expandable metallic stent

Acute esophageal perforations are potentially life-threatening events that carry high morbidity and mortality rates. There has been a paradigm shift in the standard treatment of acute esophageal perforations from surgery to esophageal stents over the last two decades. We report a case of a 62-year-old male, managed successfully with fully covered esophageal stent for foreign body (denture)-induced acute esophageal perforation. The report also highlights the failure of routine radiological investigation to detect and localize denture (as dentures are made of radiolucent material).