Biomedical subjects
Publications and source records attributed to R Aggarwal.
A case of symptomatic colonic lipoma, mimicking malignant tumour on colonoscopy, barium contrast studies and at laparotomy, is reported. The diagnosis was established on histopathology after left hemicolectomy.
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In 1991 the largest epidemic of viral hepatitis E yet reported occurred in Kanpur (population, 2.1 million), India. The incidence of icteric hepatitis from December 1990 to April 1991 among the inhabitants of 420 randomly sampled houses in seven of the city's 50 wards was 3.76% (138 out of 3666 individuals), i.e., an estimated 79,091 persons in the city as a whole were affected. The attack rate was higher for males than females (5.3% versus 3.3%; P = 0.013) and for adults than children aged < 10 years (4.26% versus 1.29%; P = 0.0006). The incidence of hepatitis was higher in those city wards that were supplied with drinking-water consisting of a mixture of river Ganges and tubewell water than in those wards supplied only with tubewell water (5.6% versus 1.2%; P = 10(-6)). In the mixed-water areas, the incidence decreased as the drinking-water source changed from only tap to both tap and handpump, to only handpump (7.8%, 6.8%, and 4.3% respectively; P = 0.023). None of the sera collected from 41 hepatitis patients during the epidemic showed evidence of hepatitis virus A or B. There were two peaks in the epidemic (in February and April 1991). The first peak was probably caused by faecal contamination of river water, indicated by water analysis data, and the second, by inadequate chlorination of water in a reservoir. There was no evidence of secondary intrafamilial spread.
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Campylobacter jejuni is an infrequent cause of self limiting acute diarrheal disease in adults in the Indian subcontinent. We report the occurrence of a life threatening diarrhea due to C jejuni infection in a patient with immunoproliferative small intestinal disease. We postulate that immunosuppression due to malignancy, malnutrition and cancer chemotherapy was responsible for the unusually severe diarrhea.
A total of 138 eye specimens were processed for aerobic and anaerobic cultures. Clinical data were obtained from 50 patients with unilateral ophthalmic infection. Cultures from the uninfected eye of 38 of these 50 patients were also processed for comparison. In addition, 50 cultures were obtained from one or both eyes of 30 healthy controls who had no eye infection. Anaerobes and aerobes were isolated from infected eyes of 6 (12%) and 37 (74%) patients respectively. No growth was observed in infected eye of 8 (16%) patients. A mixture of aerobes and anaerobes were recovered only in 2 cases. Of the total 47 aerobic isolates from infected eye specimens, Staphylococcus aureus (11), coagulase negative staphylococci (12) and Streptococcus pneumoniae (9) were predominant isolates. Six anaerobes isolates included Gram positive nonsporing anaerobic bacilli (4 including Propionibacterium acne) as predominant isolates. Clostridium perfringens was isolated from a case of post operative endoophthalmitis. From the uninfected eye of same patients though the number and types of aerobic bacteria were similar, none grew any anaerobes. Aerobic and anaerobic bacteria were isolated in 70 and 6 per cent of eye swabs respectively from the healthy controls.
Information was obtained using questionnaires regarding evaluation techniques in use in various institutions imparting gastroenterology training in India. Although methods used for entrance, in-course and certification evaluation vary in ten institutions conducting DM courses in gastroenterology, it is possible to achieve uniformity in many areas.
Stool samples from patients affected during a large epidemic of hepatitis in north India were examined for the presence of hepatitis E virus (HEV) genome by means of reverse transcription-polymerase chain reaction. 6 of 10 samples studied were positive for the HEV genome, which suggest that HEV caused this large epidemic.
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In a prospective study, 37 consecutive patients with radiation-induced proctosigmoiditis were randomized to receive a four-week course of either 3.0 g oral sulfasalazine plus 20 mg twice daily rectal prednisolone enemas (group I, N = 18) or 2.0 g twice daily rectal sucralfate enemas plus oral placebo (group II, N = 19). The two groups were comparable with respect to demographic features, duration of symptoms, and clinical and endoscopic staging of the disease. Fifteen patients in group I and 17 in group II completed the trial. At four weeks, both groups showed significant clinical improvement (P less than 0.01 for group I and P less than 0.001 for group II) and endoscopic healing (P less than 0.01 for group I and P less than 0.001 for group II). When the two groups were compared, sucralfate enemas showed a significantly better response as assessed clinically (P less than 0.05), although endoscopically the response was not statistically different (P greater than 0.05). We conclude that both treatment regimens are effective in the management of radiation proctitis. Sucralfate enemas give a better clinical response, are tolerated better, and because of the lower cost should be the preferred mode of short-term treatment.
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We describe the second reported case of peritonitis caused by the alga Prototheca wickerhamii in a patient on continuous ambulatory peritoneal dialysis (CAPD). This organism, which grows slowly on agar media, is recognised as a race cause of other infections. The condition is clinically similar to cases of fungal peritonitis, but there are important differences, particularly when choosing the best treatment.
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