Is There an Association between Variceal Bleed and Helicobacter pylori Infection in Cirrhotic Patients with Portal Hypertension?: A prospective cohort study.

Objectives: This study aimed to determine the association between Helicobacter pylori infection and variceal bleeding as well as rebleeding in cases of cirrhosis with portal hypertension. Methods: This prospective cohort study included patients with bleeding oesophageal varices and was conducted at the Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India, from August 2016 to July 2018. Results: A total of 190 patients were assessed for eligibility, of which 159 patients were included in this study. Among the 159 patients, 124 (78.0%) had alcohol-related liver disease and eight had hepatitis B virus-related liver disease. Seven patients with varices had bled neither at presentation nor during the follow-up period. A total of 78 (49.1%) patients were H. pylori infected. The primary outcome, which was correlation between prevalence of H. pylori and the incidence of bleeding/rebleeding from varices as well as encephalopathy found that patients with oesophageal varices (adjusted risk [AR] = 0.714) and H. pylori infection (AR = 0.682) had a lower risk of variceal rebleeding. Among H. pylori-negative patients, pepsinogen I was higher in patients with rebleeding (30.7 versus 14.4 ng/mL; P <0.001). The secondary outcome, which was correlation of the site of bleeding with H. pylori infection and the association of the ratio of pepsinogen I/II with bleeding showed that among H. pylori-positive patients, the ratio of pepsinogen I/II was higher in patients with rebleeding (2.9 versus 1.3 ng/mL; P = 0.023). Conclusion: H. pylori infection was associated with a lower risk of rebleeding in cases of cirrhosis with portal hypertension. Irrespective of the status of the H. pylori infection, rebleeding was associated with increased levels of gastric acid output, as demonstrated by the level of pepsinogen.

Hydrogen Peroxide Poisoning-A Rare Cause of Portal Venous Gas.

Hydrogen peroxide is a clear and odorless liquid at room temperature that can easily be mistaken for water. Its ingestion results in varied clinical and radiological squeals depending on the volume and concentration of the liquid. We present a case of a 22-year-old lady who accidentally ingested 30 to 40 mL of 3% hydrogen peroxide and presented with hematemesis and abdominal pain. On further radiological evaluation, she was found to have portal venous gas and pneumatosis of the bowel wall. She was conservatively managed with 100% oxygen and nil per os for 2 days following which the portal venous gas resolved. Hydrogen peroxide ingestion causes a massive release of oxygen and when its volume exceeds its solubility in blood, gas embolism occurs that is responsible for portal venous gas and pneumatosis. Close monitoring with conservative management will suffice in mild cases without the need for any therapeutic intervention.

A Comparative Study of Fine-Needle Aspiration and Nonaspiration Cytology Diagnosis in Thyroid Lesions.

BACKGROUND: Aspiration cytology is one of the first-line diagnostic tests in thyroid malignancies. Fine-needle aspiration cytology (FNAC) in thyroid lesions causes hemorrhagic smear and cell trauma, often leading to the repetition of smear and delay in diagnosis. This study was conducted to identify the diagnostically superior technique with regard to thyroid swelling and to assess the quality of smears obtained from FNAC and fine-needle nonaspiration cytology (FNNAC). METHODOLOGY: This was a prospective diagnostic study carried out for 2 years in a tertiary care center from South India. All patients with complaints of thyroid swellings, after examination, underwent FNNAC, followed by FNAC of the lesion. They underwent thyroidectomy when indicated. The final postoperative biopsy reports were compared with the preoperative reports of these two techniques (FNNAC and FNAC). The quality of smears was compared using Mair's score. RESULTS: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in diagnosing malignancy were 93.4%, 100%, 100%, 98.78%, and 98.96% for FNNAC and 94.12%, 100%, 100%, 98.82%, and 99% for FNAC, respectively, which were comparable. Regarding the quality of smears, FNNAC had more smears with less blood in the background. FNAC had more smears with adequate cellularity. The difference in overall Mair's score between the two techniques was not significant (P = 0.28). CONCLUSION: No difference was found in the accuracy of FNAC and FNNAC in diagnosing thyroid lesions. Furthermore, the smear quality of both techniques was comparable. Hence, either can be used based on the operator's preference and experience.