Consensus guidelines on management of oral potentially malignant disorders

Oral cancer is usually preceded by oral potentially malignant disorders (OPMDs) and early detection can downstage the disease. The majority of OPMDs are asymptomatic in early stages and can be detected on routine oral examination. Though only a proportion of OPMDs may transform to oral squamous cell carcinoma (OSCC), they may serve as a surrogate clinical lesion to identify individuals at risk of developing OSCC. Currently, there is a scarcity of scientific evidence on specific interventions and management of OPMDs and there is no consensus regarding their management. A consensus meeting with a panel of experts was convened to frame guidelines for clinical practices and recommendations for management strategies for OPMDs. A review of literature from medical databases was conducted to provide the best possible evidence and provide recommendations in management of OPMDs

Incidence of Helicobacter pylori in Perforated Duodenal Ulcers: A Prospective Study

Introduction: It was found that duodenal ulcer patients tend to have an elevated maximal acid output (MAO), in response to histamine or pentagastrin, reflecting a greater parietal cell mass (Blair et al., 1987). In addition, the physiology control of acid secretion is abnormal. Basal acid is increased to greater extent than would be predicted from the increase in MAO. A work on hormonal control focused on the antral acid-stimulating hormone gastrin. Research showed that the inhibition of gastrin release by intragastric acid is decreased in duodenal ulcer patients (Moss and Calam, 1992). Somatostatin is an important mediator of gastric inhibition, and both the number of immunoreactive somatostatin cells and the amount of somatostatin peptide in gastric antral mucosa are diminished in duodenal ulcer patients (Mc Henry Jr et al., 1993). Helicobacter pylori decreases the reflex inhibition of peptone-stimulated gastrin release by luminal acid. This reflex is known to be mediated through the release of somatostatin. Eradication of H. pylori from duodenal ulcer patients elevates somatostatin RNA by about 2 times in antral and duodenal mucosa but not in corpus biopsies, reflecting the typical distribution of mucosal involvement in duodenal ulcer patients (Sipponen, 1992). Materials and Methods: A total of 25 patients who underwent surgery for perforated duodenal ulcer on emergency basis in the Department of General Surgery in S.V.S. Medical College between October 2012 and September 2014 were included in this study. Inclusion Criteria: (1) Patients between 18 and 70 years of age and (2) patients having perforated duodenal ulcers were included in the study. Exclusion Criteria: (1) Patients below 18 years and above 70 years of age, (2) patients on nonsteroidal anti-inflammatory drugs (NSAIDs) for more than 1 month duration, (3) patients who have received anti-H. pylori treatment, and (4) patients with gastric ulcers or ulceroproliferative growth were excluded from the study. The study population consisted of 150 patients between the age group of 18 and 55 years. Exploratory laparotomy was performed in all cases. Two mucosal biopsies were taken through the perforation. One specimen is immediately put into a preformed H. pylori detection kit for rapid urease test (RUT), which shows the presence of urease-producing bacteria by a change in the color of the medium within a time frame which is read as follows. Results: The mean age of the patient is 43.6 years. All the patients are males. 80% are smokers (21 of 25 patients). Three were addicted to pan chewing and 4 were in the habit of gutka chewing. 14 of 25 patients had a history of pain abdomen more in the epigastrium relived by taking antacids/H2 blockers. 15 of 25 patients had a history of NSAID abuse. None of the patients ever used steroids. 49% of patients whose mucosal biopsy was subjected to RUT tested positive for urease (10 strongly positive and 4 moderately positive). 11 of 25 tested negative for RUT. 16 of the 20 patients (80%) whose mucosal biopsy was, especially, investigated for H. pylori by Genta tested positive for the bacteria. Conclusions: This study has demonstrated that H. pylori is present both at the ulcer edge and antrum in a large percentage of perforated ulcers, and ulcer relapse in the form of perforation is probably correlated with pre-existing H. pylori infection. What remains to be evaluated is the relationship between the presence/absence of infection and future relapse and perhaps also H. pylori eradication and relapse, in perforated peptic ulcer patients treated with simple repair only. However, our study showed 50% association of H. pylori with duodenal ulcer perforation, and the extensive usage of antibiotics and liberal utility of proton pump with or without combination of H2 receptor blockers shows 50% positivity and 50% negativity with the incidence of H. pylori

Evaluation of Serum C-reactive Protein in Acute Appendicitis and its Correlation with Histopathology

Introduction: Acute appendicitis is the most common abdominal surgical emergency. Despite extraordinary advances in radiographic imaging and diagnostic laboratory investigations, the diagnosis of acute appendicitis remains an enigmatic challenge in this modern era. The wide range of causes and varied patient presentations pose a formidable diagnostic and therapeutic dispute. Appendicectomy is the most common cause of acute surgical abdomen with a lifetime risk of 7%.[1] Classic clinical and laboratory findings usually allow for prompt diagnosis and treatment. Materials and Methods: In a prospective study, 100 patients clinically diagnosed as acute appendicitis were selected by purposive sampling method and evaluated as per criteria for serum c-reactive protein (CRP) levels and leukocyte count preoperatively and were followed up postoperatively with histopathology reports. The data were analyzed for finding the significance of serum CRP in the diagnosis of acute appendicitis. Results: CRP was positive in 75 of 77 patients who had histologically proven acute appendicitis and in 3 with normal appendix. The sensitivity, specificity, and diagnostic accuracy were 97.4%, 86.96%, and 95%, respectively. Leukocytosis and neutrophilia when used alone were not specific for acute appendicitis, but when combined with CRP value, diagnostic accuracy was high. Ultrasonography was useful in establishing alternative diagnoses but had low sensitivity for acute appendicitis. Conclusions: CRP contains important diagnostic information and hence should always be included in the diagnostic workup of acute appendicitis. Since acute appendicitis is very unlikely in those patients with normal white blood cell count and CRP value, conservative treatment is advised.