Secnidazole in the treatment of giardiasis.
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Biomedical subjects
Publications and source records attributed to H Qureshi.
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To determine the frequency and type of upper gastrointestinal lesions in patients with chronic renal failure (CRF), upper G.I. endoscopy was done in 101 cases. Of the various mucosal lesions, inflammatory changes were seen maximally (40), followed by erosions (16) and ulcers (7). Other changes included atrophic gastro-duodenal folds (17), pale mucosa (11) and moniliasis (6) which was only seen in patients with end stage CRF. Lesions were more frequent in those who were in advanced stage of CRF (81%) and those undergoing dialysis (79%), reflecting a positive correlation of upper G.I. lesions with the severity of CRF.
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The association of upper gastrointestinal (G.I.) lesions with various addictions was studied in 383 consecutive patients endoscoped over a year. Of the total, 179 (47%) had no addictions and 204 (53%) were addicted to either cigarette smoking (70%), tobacco chewing with pan (23%), pan alone (5%) or alcohol (2%). Overall, 78% cases with and 59% without addictions had an upper G.I. lesion on endoscopy (P < 0.001). Duodenal ulcer was commonest lesion in all types of addiction.
To assess the comparative efficacy of omeprazole 20 mg in the morning versus ranitidine 150 mg twice a day, in the healing of duodenal ulcer, 43 endoscopically verified cases were randomly allocated to 2 or 4 weeks (if ulcer did not heal at 2 weeks) treatment. Two cases were excluded due to deviation from the protocol. Of 21 cases treated with omeprazole 15 (71%) healed at two weeks and all (100%) at 4 weeks. Similarly of 20 cases treated with ranitidine, 14 (70%) healed at 2 and 18 (90%) at 4 weeks (P = NS). Two patients who did not heal with ranitidine, when crossed over to omeprazole healed at 4 weeks. No significant difference in the rate of pain relief, clinical or laboratory parameters or adverse effects were noted in either group. Both the drugs were well tolerated and were potent healer of duodenal ulcer; but omeprazole appears to be superior in the healing of resistent ulcers.
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To assess the healing and relapse rate of duodenal ulcer (DU) treated with H2 receptor antagonists in helicobacter pylori (HP) positive vs negative cases, we analysed 95 cases of endoscopically proven duodenal ulcer. H. pylori colonization was found in 73 (77%) patients before treatment. No difference was observed in the pre-treatment characteristics between patients with HP positive and HP negative duodenal ulcers. Healing rates with H2 receptor antagonist at 8 weeks were 90% and 91% respectively (NS). No difference in HP colonization was found between patients with and without healed ulcerie, 77% and 78% respectively. Relapse rate within 1 year was 50% in patients with HP positive vs 73% with HP negative cases. We conclude that duodenal ulcer healing and relapse rate is related to acid inhibition rather than HP colonization.
Of 138 endoscopically or surgically confirmed cases of gastric ulcer, 102 (74%) were males and 36 (26%) females. Both sexes were affected most commonly in the 6th decade of life. Pain, vomiting and gastrointestinal bleeding were the major presenting symptoms, with a median duration of 6 months. Cigarette smoking was the most common (44%) addiction and 10% were on analgesics or nonsteroidal anti-inflammatory drugs (NSAID). Family history of ulcer was uncommon (2%) and no predilection for any blood group was noted. Among males 53% were skilled workers while 94% of females were housewives. Forty five percent patients were migrants from India and the rest belonged to different provinces of Pakistan. Presentation and behaviour of different sites of gastric ulcers though varied but the results were not significant. Healing rates with H2 receptor antagonists were 33% at 4 weeks and 78% at 8 weeks.
We present the case of a woman with idiopathic portal hypertension who underwent sclerotherapy for bleeding esophageal varices. She had a rebleed 27 months after complete eradication of esophageal varices. Endoscopy showed bleeding gastric varices. Ultrasonography, and later splenoportography, revealed a large thrombus in the right branch of the portal vein causing gross dilation of the portal and splenic vein. A proximal splenorenal shunt was done to decompress the portal system and hence gastric varices. Repeat endoscopy 4 weeks after surgery revealed complete disappearance of the gastric varices, while ultrasonography at 38 weeks showed marked decompression of the portal system with complete disappearance of the thrombus from the right branch of the portal vein. No new thrombus formation was seen.
Between January, 1979 to August, 1990, 107 histologically proven cases of oesophageal carcinoma were seen. The ages of the patients ranged from 19-85 years (mean 55 +/- 14 years) with a male to female ratio of 1.2:1. Majority (70%) of the cases belonged to lower socioeconomic group and 56% were migrants from India. History of tobacco chewing or smoking was present in 78% cases. In 54%, the lesion was located in the middle third of the oesophagus, followed by lower third in 44%. Histology showed squamous cell carcinoma in 86% and adenocarcinoma in 10% cases. Of the 19 cases followed, 16 underwent surgery and 3 received chemotherapy. Two cases died within 7 months following surgery and in 6 carcinomas recurred. All cases receiving chemotherapy died within 8 months of treatment.
The cytoprotective effect of misoprostol co-administered with non-steroidal anti-inflammatory drugs (NSAIDs) was assessed in a double blind, placebo controlled study. Thirty-seven patients with rheumatoid arthritis receiving NSAIDs, having upper gastrointestinal symptoms and endoscopically confirmed gastric and/or duodenal lesions, were randomised to receive either misoprostol 200 micrograms or placebo tablets twice daily for 4 weeks. Of 31 evaluable cases, 13 of 16 (81%) patients receiving misoprostol showed endoscopic improvement as compared to 10 of 15 (67%) receiving placebo (P:NS). A significant decrease in mean (+/- SEM) mucosal lesion score was observed with misoprostol (from 3.38 +/- 0.32 to 1.32 +/- 0.44; P less than 0.001) but no change was seen with placebo (from 2.80 +/- 0.42 to 1.60 +/- 0.53; P:NS). Symptomatic relief was similar in both groups, being 44% and 40% respectively. Two patients complained of diarrhea in each group and one developed menorrhagia with misoprostol. It is concluded that though misoprostol decreased the number of NSAID-induced mucosal lesions, it was unable to relieve gastrointestinal symptoms.
Incomplete vagotomy is the single most common cause of ulcer recurrence. Completeness of vagotomy was assessed postoperatively in 17 patients using the congo red test. Various types of vagotomies included truncal vagotomy and gastrojejenostomy in 6, highly selective vagotomy in 5, truncal vagotomy and pyloroplasty in 3 and selective vagotomy with gastrojejenostomy in 3 cases. Congo red test was positive in 13 cases, with 9 of these showing evidence of incomplete vagotomy manifesting as erosions, duodenitis, stomal ulceration or ulcer recurrence.
Thirty patients with oral submucous fibrosis (OSMF) underwent fibreoptic upper G.I. endoscopy and oesophageal biopsy from 20 cms to see if any correlation is found between visual and histological changes in OSMF and oesophageal mucosa. On endoscopy, the colour of oesophageal mucosa was normal in 28 and whitish pale in 2 cases. On endoscopy mucosa felt stiff and fibrotic in 19, leathery in 4, firm/gritty in 2 and normal in 5 cases. The biopsies were difficult to take in most cases yielding small tissue samples on repeated attempts. On histology most of the samples consisted of only a few layers of hyperplastic epithelium with lamina propria and submucosa being absent in all samples. Good correlation was found between the grade of OSMF and oesophageal changes seen on endoscopy.