Prevalence of Helicobacter pylori infection and the effect of its eradication on symptoms of functional dyspepsia in Kashmir, India.

BACKGROUND AND AIM: Epidemiology of Helicobacter pylori infection has regional variation. Effect of eradication of H. pylori on symptoms of functional dyspepsia is uncertain, and the data in Asian scenario are scanty. The study aimed to see H. pylori positivity rate in patients of functional dyspepsia and the effect of its eradication on symptoms. METHODS: Randomized, double-blind, placebo-controlled study was the study design used. Patients of functional dyspepsia defined as per Rome 2 criteria were tested for H. pylori infection by rapid urease test and gastric biopsy. H. pylori-positive patients were randomly allocated to triple therapy (20 mg of omeprazole, 500 mg of clarithromycin, and 1000 mg of amoxicillin orally two times daily) and omeperazole plus identical placebo for 2 weeks. Symptoms were assessed with the weekly Likert scale. RESULTS: H. pylori positivity rate in functional dyspepsia was 1160/2000 (58%). At 6 weeks, the eradication rate for H. pylori in triple therapy and placebo group was (181/259 [69.8%] and 13/260 [5.0%], P = 0.001), respectively. On intention-to-treat analysis, the symptom resolution at 1 month was (157/259 [60.7%] and 136/260 [52.3%], P = 0.38), respectively. At 12 months, H. pylori eradication and healing of gastritis in triple therapy and placebo group were (116/174 [66.7%] and 12/180 [6.7%], P = 0.001) and (132/174 [75.9%] and 11/180 [6.1%], P = 0.001), respectively. On intension to treat, the resolution of symptoms in triple therapy and placebo group was (95/217 [43.7%] and 72/195 [36.9%], P = 0.13). CONCLUSION: There is high H. pylori positivity rate in patients of functional dyspepsia. The eradication of H. pylori does not resolve the symptoms despite healing of gastritis.

Hematological response of pancytopenia to glucocorticoids in patients with Sheehan's syndrome.

Sheehan's syndrome presents with panhypopituitarism after childbirth, usually preceded by post partum hemorrhage. Hematological abnormalities like pancytopenia with hypocellular marrow in these patients are reported rarely. Though multiple hormone deficiencies may contribute to Pancytopenia in Sheehan's syndrome, complete recovery is observed after achieving eucortisolemic and euthyroid state. The predominant role of thyroxine or glucocorticoids in reversing pancytopenia in these patients has not been studied. We present the clinical, hormonal, hematological course and response to glucocorticoids in a patient of Sheehan's syndrome presenting with pancytopenia. Complete recovery of pancytopenia was observed after achieving eucortisolemic state thus concluding that gulcocorticoid replacement is sufficient to reverse pancytopenia in these patients.

Sheehan's syndrome with pancytopenia--complete recovery after hormone replacement (case series with review).

Reports of pancytopenia in patients with Sheehan's syndrome are rare, because the disorder is not commonly seen in western countries. A case series of pancytopenia in three patients of Sheehan's syndrome is presented. Three women aged 22, 30, and 34 years developed Sheehan's syndrome preceded by post partum hemorrhage. During investigations, they were found to have pancytopenia with hypocellular marrow. Treatment with thyroxine and glucocorticoids resulted in complete recovery after attaining euthyroid and eucortisolemic state. Review of literature revealed the rarity of the disorder, with only four cases reported so far. Multiple anterior pituitary hormone deficiencies in Sheehan's syndrome are responsible for pancytopenia; replacement of thyroid and cortisol hormones results in complete recovery.

Assessment of biotransfer and bioaccumulation of cadmium, lead and zinc from fly ash amended soil in mustard-aphid-beetle food chain.

The present study investigates the extent of biotransfer and bioaccumulation of cadmium (Cd), lead (Pb) and zinc (Zn) from fly ash amended soil in mustard (Brassica juncea)-aphid (Lipaphis erysimi)-beetle (Coccinella septempunctata) food chain and its subsequent implications for the beetle. The soil was amended with fly ash at the rates of 0, 5, 10, 20 and 40% (w/w). Our results showed that the uptake of Cd, Pb and Zn from soil to mustard root increased with the increase in fly ash application rates, but their root to shoot translocation was relatively restricted. Increase in chlorophyll content and dry mass of mustard plant on treatments ≥20% even at elevated accumulation of Cd (1.67mgkg-1), Pb (18.25mgkg-1) and Zn (74.45mgkg-1 dry weight) in its shoot showed relatively higher tolerance of selected mustard cultivar to heavy metal stress. The transfer coefficient (TC1) of Cd from mustard shoot to aphid was always >1, indicating that Cd biomagnified in aphids at second trophic level. But, there was no biomagnification of Cd in adult beetles at third trophic level. Zinc accumulation was 2.06 to 2.40 times more in aphids than their corresponding host shoots and 1.26-1.35 times more in adult beetles than their prey (aphids) on which they fed. Lead was only metal whose TC was <1 at both second and third trophic levels. The elimination of Cd via honeydew of aphids was most efficient as the ratio of metal in honeydew to aphid (ranging from 0.21 to 0.26) was higher than the Pb (0.16 to 0.20) and Zn (0.07 to 0.09). The statistically consistent (p>0.05) biomass and predation rate of predatory beetles indicated that all levels of soil amendments with fly ash did not have any lethal or sub-lethal effects on beetles.

Primary adrenal lymphoma: Differential involvement with varying adrenal function.

Primary adrenal Non-Hodgkin's lymphoma is rare. The symptoms of the disease and response to treatment are variable depending on the type of lymphoma, tumor size, and presence of adrenal insufficiency. We report two cases of primary adrenal lymphoma who had varied presentations. One presenting with abdominal pain and weight loss was documented to have unilateral disease without any adrenal insufficiency and showed a good response to combination chemotherapy, while the second one had bilateral adrenal involvement with adrenal insufficiency and died after second chemotherapy. Functional adrenal involvement in lymphoma depends on the extent of involvement; patients with bilateral involvement almost always have adrenal insufficiency.