Frequency, distribution and determinants of Helicobacter pylori infection in adults and adolescents with gastric symptoms: cross-sectional epidemiological inquiry in district Haripur, Pakistan

Abstract Helicobacter pylori (HP) is a vital element in the etiology of peptic ulcers and gastric cancer. This research aimed to determine the frequency, distribution, and determinants of HP infection in adults and adolescents with gastric symptoms in district Haripur, Khyber Pakhtunkhwa, Pakistan. This cross-sectional study was performed from June 2018 to June 2020 at the Medical Laboratory Technology Department, The University of Haripur, Pakistan. Presence of HP was a research variable, while sex, age groups, education status, overcrowding, dining habits, milk intake, drinking water source and animal contact were grouping variables. Immuno-chromatographic technique (ICT) was used to for serological detection of HP antibodies. All variables were represented by frequency and percentage with 95%CI. Prevalence of HP and its distribution by eight socio-demographic variables was testified by the chi-square goodness-of-fit test while association was testified by chi-square test of association. Out of total 1160 cases, 557 (48%) were positive for HP. Population prevalence was higher in men, in the age group 20-40 years, illiterate, family size ≤ 10 persons, taking restaurant food, using tetra pack, using municipal water, and having animal contact. The observed prevalence of HP was similar to its expected prevalence in the population. The observed distribution of HP in the sample was different from its expected distribution in population by eight socio-demographic variables. Presence of HP was associated with all eight socio-demographic variables besides age groups.

Palliative Care among Incarcerated Populations: A National Survey of Radiation Oncologists' Perspectives and Experiences

PURPOSE/OBJECTIVE(S)

Incarcerated individuals carry a high disease burden, including cancer which is now the leading cause of illness-related deaths. Disparities in access to screening, care coordination, timely treatment, and comorbidities have been identified as contributors to late-stage diagnosis and poor cancer-related outcomes. As the first of its kind, we assessed oncologists' knowledge, attitudes, and practices (KAP) in providing cancer care to incarcerated patients.

MATERIALS/METHODS

A KAP survey on incarcerated patients with cancer was developed and piloted with volunteer radiation oncologists. Following IRB approval, the KAP survey questionnaire included physicians' demographics and Likert scale questions on practice patterns and experiences caring for incarcerated patients. The survey was distributed to 150 medical and radiation oncologists randomly selected from national societies' membership directories (ASTRO and ASCO). Data collection took place from 7/2020-12/2021, and descriptive statistics were used for analysis.

RESULTS

Of the 75 surveyed radiation oncologists (RO), 34 responded with a response rate of 45% among the specialty cohort. Most RO (59%) incorrectly identified "heart disease" as the leading cause of death among incarcerated patients, followed by "substance use disorder" (19%); only 9% correctly reported "cancer" as the leading cause of death. Most RO reported caring for a patient who underwent cancer treatment while incarcerated (70%) or recently incarcerated (within 6 months of release; 63%). 38% (n = 10/26) indicated incarcerated patients presented with delayed diagnosis at consultation. 58% (n = 14/24) reported that ≥50% of their patients who were incarcerated presented with cancer-related pain, and 82% (n = 18/22) indicated that ≥50% of their patients had a history of opioid use disorder. Yet 38% (n = 9/24) reported their clinic adequately treated cancer-related pain for incarcerated patients, while 54% (n = 13/24) reported their clinic needed improvement.

CONCLUSION

Most radiation oncologists have experience providing cancer care for incarcerated patients and acknowledge disparities in later-stage disease presentation in this patient population. Interventions are needed to ensure cancer-related pain is appropriately managed among patients experiencing incarceration. Further studies are required to understand practice patterns and ensure equitable cancer treatment for carceral populations.

ABO Blood Group in Relation to COVID-19 Susceptibility and Clinical Outcomes: A Retrospective Observational Study in the United Arab Emirates

(1) Background: The association between ABO blood groups and COVID-19 outcomes was investigated in several studies. The results were controversial. This study aimed to explore the association between ABO blood groups and COVID-19 outcomes. (2) Methods: This retrospective study included 303 COVID-19 patients treated at the NMC Royal Hospital in the United Arab Emirates between 8 April 2020 and 30 June 2020. (3) Results: The mean age of patients included in the study was 39.3 ± 10.7 years, and 72.9% of patients were males. The prevalence of blood groups O, A, B, and AB was 40.3%, 27.7%, 25.1%, and 6.9%, respectively. The correlation between ABO blood groups and COVID-19 outcomes was insignificant except in the AB group, with significantly higher odds of disease severity. Increased age, higher body mass index (BMI), and being of male gender increased the risk for pneumonia among all blood groups. Both increased age and higher BMI increased the risk of mortality, and increased age increased the risk of disease severity. Troponin and platelet counts were significantly different in the A group compared to the non-A groups. Time to viral clearance was not different among blood groups. However, adjustment for Rh groups resulted in a significantly shorter time in the B group. (4) Conclusions: There was no significant association between ABO blood groups and COVID-19 outcomes, with the exception of group AB.

Abstract T P271: Establishment of Stroke Ward Results in Immediate Reduction of Major Complications

Background and Purpose: Randomized controlled trials have consistently shown that stroke units decrease both mortality and morbidity compared with conventional care in general medical wards. There are however limited data on the specific types of in-hospital medical complications and their effect on outcomes. The objective of this study was to determine whether establishing a specialized geographically defined Stroke Ward results in reducing the major complications in patients suffering from acute stroke within the same hospital system.

Methods: This is a prospective study from January 2014 till July 2014. Data was collected from a web-based stroke registry in two phases. In phase 1 (from January 1, 2014 till March 08, 2014), we collected data of stroke patients admitted at in the medical wards. In phase 2, a protocol-based multidisciplinary care Stroke Ward became operational where most of the patients were admitted. Outcomes measures were number and type of complications, mortality, discharge disposition, and length of stay, and were adjusted for age, sex, and medical co-morbidities.

Results: There were 130 admissions in phase 1 and 345 in phase 2. Commonest complications included, aspiration pneumonia 29% vs 12% (p<0.001) and pressure ulcers in 35% vs 11% (p<0.001). Average length of stay decreased from 12 days to 4 days (p<0.001). In phase 1, 70 % of patients were discharged home, while 23% were transferred to rehabilitation while in phase 2, 75% of patients were discharged home, while 18% patients were sent to rehabilitation. Ninety percent of complications happened in medical wards, mainly in patients who over stayed in emergency department (more than 8 hours) waiting for bed in Stroke Ward or medical floor.

Conclusion: A protocol based multidisciplinary care Stroke Ward care significantly reduces common early complications of acute stroke. It also helps in significantly reducing the length of stay, saving total bed days at a tertiary care hospital, hence improving the overall care of these patients.

Epidemiology and Etiology of Intractable Epilepsy in Qatar

The medical records of 219 epileptic patients seen over a period of eight years were reviewed to determine the incidence and causes of intractable epilepsy amongst adults in Qatar: The incidence rate of hospital admission with uncontrolled epilepsy was calculated as 25per 100,000persons. Thirty-nine patients (18%) fulfilled the criteria for IE and the incidence of IE could be approximated at 4.5 per 100,000 persons. In the native Qatari population the approximated incidence of IE would be 1 in 100,000 persons per year, while in the expatriate population the rate would be 3.5 per 100,000 persons per year. The most common type of IE was idiopathic generalized epilepsy (75%) followed by symptomatic epilepsy (19%) and temporal lobe epilepsy (6%). To calculate the crude incidence of epilepsy in Qatar, the records were reviewed of 1217patients (aged 13-85 years) visiting the outpatient department or admitted to hospital because of a newly diagnosed epilepsy during the calendar year, 1st January-31st December 2001. These figures were extrapolated to an approximation of an incidence of 174 in 100,000 persons per year.

Comparison of survival periods and response in three modes of treatment for Ca esophagus at CENAR Quetta

BACKGROUND

Esophageal cancer is a fatal disease, with mortality matching the incidence. Balochistan province and Afghanistan happen to fall in the "Esophageal Cancer Belt". This study was designed to compare survival periods and response in three different modes of treatment for cancer of esophagus at CENAR Quetta i.e Radiotherapy plus Surgery, Radiotherapy plus Surgery plus single agent chemotherapy and Radiotherapy plus Surgery plus combined chemotherapy.

METHODS

During 1997, 59 patients with histopathological evidence of Ca esophagus were referred to CENAR from primary health care centers in Balochistan and Afghanistan. These 59 patients were divided into three groups. Group:I (n=22) treated by local irradiation plus surgery. Group:II (n=20) treated by local irradiation plus surgery plus Single agent chemotherapy i.e 5 florouracil. Group:III (n=17) treated by local irradiation plus surgery plus combination chemotherapy i.e Cis-Platinum and 5-florouracil. All patients were evaluated by endoscopic examination at 2 month intervals.

RESULTS

This study of 59 patients (mean age 55+/-13 years and male to female ratio of 1:3), shows that 2 year survival is 29% and median survival period is 9 month for all the patients. For group I, median survival period = 5 month, 2 year survival = 18% and complete response = 17%. For group II, Median survival period = 9 months, 2 year survival = 30% and complete response = 20%. For group III, Median survival period = 11 month, 2 year survival = 41% and complete response = 22%.

CONCLUSION

This study shows that overall survival is poor in cancer of esophagus and combined chemotherapy along with surgery and radiotherapy gives better results as compared to other two groups. Also single agent chemotherapy plus surgery plus radiotherapy give better results than radiotherapy plus surgery.

Cancer of esophagus: ten years experience at CENAR, Quetta

BACKGROUND

A retrospective study of 659 patients of Ca Esophagus was conducted from 1st January 1990 to 31st December 1999 (10 years) at CENAR Quetta. The aim of this study was to highlight the incidence, early detection, management, and various other parameters of Ca Esophagus.

RESULTS

During this period, 5819 new cases of cancer were registered. Cases of Ca Esophagus constituted 659 (11.32%) in number. It was studied that this cancer was the 3rd most common cancer registered in both sexes at our centre. 65 new cases of Ca Esophagus were registered at CENAR Quetta per annum on an average. Males slightly dominated the females. Maximum number of cases 470 (71.31%), were reported between ages 41-60 years with a median age of 55 years. Maximum number of cases 399 (60.57%), involved lower 3rd of Esophagus. Squamous cell carcinoma was the most common histopathology seen in 574 cases (87.10%). These patients were mainly treated with radiation therapy, palliatively, because by the time they reported, they were found in stage III and beyond. Some patients were also treated with chemotherapy along with radiation, but the overall prognosis was poor. A few patients have also undergone palliative surgery, such as pull through or push through tubes prior to radiotherapy.

CONCLUSIONS

Since the patients presented with late & advanced disease, it is, therefore, recommended that all cases of dysphagia particularly from this region of the country should be thoroughly investigated with the suspicion of Ca Esophagus. It is further suggested that general population be educated about the potential risk factors like smoking, use of naswar, beetle nut chewing, and intake of very hot food & beverages.

Significance of hyperintense vessels on FLAIR MRI in acute stroke

OBJECTIVE

To describe hyperintense vessels sign (HVS) in patients with acute stroke on fluid-attenuated inversion recovery (FLAIR) MRI and determine its clinical significance and utility.

BACKGROUND

Enhancement of vessels on postcontrast MRI in patients with acute stroke is considered an indicator of early brain ischemia. Recently, the FLAIR technique has shown promise in earlier and better detection of ischemic brain parenchymal lesions.

METHODS

Two observers retrospectively reviewed 304 MRI of patients with stroke and identified 30 patients with acute middle cerebral artery stroke and HVS on FLAIR obtained within 24 hours of symptom onset. These patients were evaluated with contrast-enhanced MRI (n = 9), MR angiography of carotid and intracranial circulation (n = 30), cerebral angiography (n = 8), transcranial Doppler (n = 17), and SPECT (n = 16). The extent of HVS was compared with final infarct size and NIH Stroke Scale score.

RESULTS

HVS on FLAIR was seen in 10% of the patients with acute stroke. HVS was associated with large vessel occlusion or severe stenosis (>90%). Intravascular enhancement on contrast MRI was observed in vessels that were hyperintense on FLAIR. Both cortical and subcortical infarcts demonstrated HVS. MR angiographic and cerebral angiographic findings of large vessel occlusion or severe stenosis (>90%), slow flow, low velocities by transcranial Doppler, and hypoperfusion on SPECT correlated with HVS. HVS was the earliest ischemic change in three patients scanned within 3 hours of ictus. Final infarct size was smaller than the area showing HVS in all patients.

CONCLUSION

HVS on FLAIR MRI is an indicator of slow flow and early ischemia as a result of large vessel occlusion or stenosis and inadequacy of collateral circulation. HVS does not mean that infarction has occurred but indicates brain tissue at risk of infarction. It should prompt consideration of revascularization and flow augmentation strategies.

MRI findings in 32 consecutive lipomas using conventional and advanced sequences

Intracranial lipomas are histologically benign and usually incidental magnetic resonance imaging findings that must be differentiated from ominous lesions. The authors describe 32 lipomas in 30 patients using conventional spin-echo (CSE) T1-weighted images (T1WI), CSE proton density (PDWI), CSE T2-weighted images (T2WI), fast spin-echo (FSE) T2WI, and FSE fluid-attenuated inversion recovery (FLAIR). Lipomas occurred most commonly in the trigonal choroid plexus, cerebral convexity, pericallosal, and quadrigeminal cistern regions. Lipomas were hyperintense on CSE T1WI and of variable appearance on CSE PDWI and CSE T2WI. Lipomas were isointense to hyperintense on FSE T2WI and hyperintense on FLAIR. Chemical shift artifact (CSA) usually was present on either CSE PDWI or CSE T2WI but was not seen on FSE images. One patient had intracranial hypotension associated with a large convexity lipoma. The authors conclude that lipomas appear different on CSE T2WI than on FSE T2WI. CSE PDWI and CSE T2WI are complementary in detecting CSA. The lack of CSA being detected in lipomas on FSE images most likely relates to inherent bandwidth differences compared with those of CSE. The hyperintense appearance of lipomas on FSE FLAIR and FSE T2WI may be confused with subacute hematomas. The authors recommend that if CSE technique by itself is used to exclude lipomas (in centers that are not using FSE), then T1WI, PDWI, and T2WI usually are sufficient. For centers using FSE routinely, fat saturation or CSE sequences also may be needed to exclude lipomas. Finally, the authors' series suggests that intracranial lipomas may occur in lateral locations more frequently than reported previously.

MRI in cerebral intraventricular hemorrhage: analysis of 50 consecutive cases

MRI of intraventricular haemorrhage (IVH) has not been studied formally. We aimed to describe the degradation rate and patterns shown on 1.5 T MRI in IVH, comparing them to other coexisting brain hemorrhage. We studied 50 consecutive cases using T1-, proton-density, and T2-weighted images. IVH was seen in two forms: layered (free-flowing in ventricles) (37 cases) and/or clotted (31). Both were best shown by proton-density image. Layered IVH was seen in the dependent portions of the lateral ventricles with fluid ("blood-CSF") levels, degrading more slowly than both clotted IVH and intraparenchymal hemorrhages (IPH) (acute blood products persisting for several more days; P < 0.05). Clotted IVH degraded at a rate comparable to IPH. IVH cleared rapidly and did not form hemosiderin. Subarachnoid hemorrhage (SAH) cleared faster and was less conspicuous than IVH. Hypertensive (22), aneurysmal (11), traumatic (2), idiopathic (9), or vascular malformation-related (6) IVH were seen. IVH coexisted with IPH (30) or SAH (12), or both (12). The high rate of layering with blood-CSF levels in IVH is most likely due to different densities of blood components and CSF and the fibrinolytic capability of the latter. Delayed degradation of layered IVH probably reflects high intraventricular oxygen and glucose content. Further study is necessary to determine if MRI characteristics of IVH are helpful in excluding other intraventricular diseases such as neoplasia and pyocephalus.

Cranial magnetic resonance imaging findings in bacterial endocarditis: the neuroimaging spectrum of septic brain embolization demonstrated in twelve patients

Infective endocarditis (IE) is an elusive systemic disorder that is often associated with neurologic complications. The contribution of brain magnetic resonance imaging (MRI) to the diagnosis of IE and the spectrum of such findings has been only sparsely described previously. The authors report cranial MRI findings in 12 patients with IE. Each of the patients had MRI evidence of cerebral embolization, with multiple brain lesions noted in most patients (n = 10). Cortical branch infarction was the most common lesion (n = 8), which usually involved the distal middle cerebral artery tree. The next most common finding (n = 7) was numerous small embolic lesions which typically lodged in the supratentorial gray-white junction, some of which were clinically silent and many of which enhanced (probable microabscesses). Brain hemorrhages were noted in four patients, most commonly subarachnoid hemorrhage (n = 3). Two patients developed multiple frank parenchymal macroabscesses/cerebritis lesions. A previously unreported finding in septic embolization, a stroke that became infected with abscess formation ("septic infarction"), was noted in two patients. MRI showed orbital cellulitis in two patients. Most patients studied with gadolinium showed enhancement of lesions (n = 5/8). The authors conclude that cranial MRI may be a valuable tool in the evaluation of patients with IE. The presence of characteristic cranial MRI lesions, especially of multiple types, may prompt early diagnosis and treatment.

Fluid-attenuated inversion-recovery MR imaging in acute and subacute cerebral intraventricular hemorrhage

BACKGROUND AND PURPOSE

Fluid-attenuated inversion-recovery (FLAIR) MR imaging may show subarachnoid hemorrhage (SAH) with high sensitivity. We hypothesized that the FLAIR technique is effective and reliable in the diagnosis of cerebral intraventricular hemorrhage (IVH).

METHODS

Two observers evaluated the 1.5-T MR fast spin-echo FLAIR images, T1- and T2-weighted MR images, and CT scans of 13 patients with IVH and the FLAIR images of 40 control subjects.

RESULTS

IVH appeared bright on the FLAIR images obtained during the first 48 hours and was of variable appearance at later stages. FLAIR MR imaging detected 12 of 13 cases of IVH; no control subjects were falsely thought to have IVH (92% sensitivity, 100% specificity). However, IVH could not be fully excluded in the third ventricle (20%, n = 8) or in the fourth ventricle (28%, n = 11) on some control images because of CSF pulsation artifacts. Two cases had CT-negative IVH seen on FLAIR images. One case had FLAIR-negative IVH seen by CT. Although the sensitivities of conventional MR imaging (92%) and CT (85%) were also high, FLAIR imaging showed IVH more conspicuously than did standard MR imaging and CT in 62% of the cases (n = 8). FLAIR was as good as or better than CT in showing IVH in 10 cases (77%). FLAIR images showed all coexisting SAH.

CONCLUSION

FLAIR MR imaging identifies acute and subacute IVH in the lateral ventricles with high sensitivity and specificity. In cases of subacute IVH, conventional MR imaging complements FLAIR in detecting IVH. The usefulness of the FLAIR technique for detecting third and fourth ventricular IVH may be compromised by artifacts. Blood hemoglobin degradation most likely causes the variable FLAIR appearance of IVH after the first 48 hours.

MRI findings in lumbar puncture headache syndrome: abnormal dural-meningeal and dural venous sinus enhancement

Intracranial hypotension (IH) is a treatable cause of persistent headaches. Persistent cerebrospinal fluid (CSF) leak at a lumbar puncture (LP) site may cause IH. We present postcontrast MRI of a patient with post-lumbar-puncture headache (LPHA) showing abnormal, intense, diffuse, symmetric, contiguous dural-meningeal (pachymeningeal) enhancement of the supratentorial and infratentorial intracranial dura, including convexities, interhemispheric fissure, tentorium, and falx. MRI also showed abnormal dural venous sinus enhancement, a new finding in LPHA, suggesting compensatory venous expansion. Thus, IH and venodilatation may play a role in the development of LPHA.

MRI in chronic toluene abuse: low signal in the cerebral cortex on T2-weighted images

MRI may be helpful in showing brain toxicity associated with chronic toluene inhalation. We report clinical and MRI findings over 3 years in a man with gradual neurologic decline secondary to toluene abuse. Cerebral atrophy most prominently involved the corpus callosum and cerebellar vermis. On T2-weighted images, loss of gray-white matter contrast, diffuse supratentorial white matter high-signal lesions, and low signal in the basal ganglia and midbrain were seen. In addition, MRI showed abnormal labor cortical low signal on T2-weighted images, most prominent in the primary motor and visual cortex. This cortical T2 shortening, not previously described in this condition, may reflect iron deposition.

Effect of maternal labor and mode of delivery on polymorphonuclear leukocyte function in healthy neonates

In this study, effect of maternal labor and mode of delivery on polymorphonuclear leukocyte (PMN) chemiluminescence and random and chemotactic motility was evaluated in healthy full-term neonates. PMN were obtained from cord blood of three groups of neonates: group I, 24 vaginally delivered neonates; group II, 22 neonates delivered by elective cesarean section without labor; and group III, 18 neonates delivered by cesarean section after labor. In group III, six neonates were delivered by cesarean section for fetal distress with acidemia and 12 for failure of progression of labor. Peak chemiluminescence of PMN in group III was depressed compared with groups I and II (p < 0.01). There was no difference in the peak chemiluminescence of PMN from neonates in group I versus group II. Random motility of PMN in group III was increased compared with the random motility in groups I and II (p < 0.05). Chemotactic motility of PMN was comparable in all three groups. In group III, a negative correlation was noted between peak chemiluminescence of PMN and the duration of labor (p < 0.001), whereas no such correlation was observed in group I despite a similar duration of labor. There was no correlation between duration of labor and random and chemotactic motility of PMN in groups I and III. The results of this study indicate that labor and mode of delivery per se have no effect on PMN function and that factors other than labor such as fetal acidemia, fetal distress, arrested labor, or maternal administration of drugs may play a role in alteration of PMN function.

In vitro effect of indomethacin on polymorphonuclear leukocyte function in preterm infants

Random motility and chemotaxis of polymorphonuclear leukocytes (PMN) was evaluated after in vitro exposure to 0, 300, 600, and 900 ng/mL (0.84, 1.68, and 2.52 mumol/L) of indomethacin. PMN were obtained from cord blood of 22 preterm infants of less than 37 wk gestation. For comparison, PMN were obtained from cord blood of seven healthy full-term infants and from venous blood of 10 normal adults. In preterm infants, a significant decrease of random motility and chemotaxis of PMN was noted at all three drug concentrations; impairment of PMN function was dose dependent in the three groups (p < 0.0001), with the greatest effect seen at 900 ng/mL (2.52 mumol/L). Significant impairment of random motility was noted in full-term infants when compared with adults at all indomethacin concentrations and in chemotaxis at 300 and 600 ng/mL (0.84 and 1.68 mumol/L). The study indicates that indomethacin has an adverse effect on PMN random motility and chemotaxis, which is more pronounced in preterm infants.

Polymorphonuclear leukocyte function in the preterm neonate: effect of chronologic age

In this study, effect of chronologic age on polymorphonuclear leukocyte (PMN) chemiluminescence and random and chemotactic motility was evaluated in 38 stable preterm neonates of less than 32 weeks' gestation during the first month of life. Chemiluminescence and random and chemotactic motility of PMNs from preterm neonates were first evaluated at mean postnatal age of 9.8 days and then weekly for an ensuing 21-day period. For comparison, one blood sample was obtained for PMN functions from 14 healthy term neonates younger than 72 hours of age and seven normal adults. On day 1 PMN chemiluminescence and random and chemotactic motility values in preterm neonates were significantly lower (P less than .001) compared with those in term neonates and PMN function values of term neonates were significantly lower (P less than .001) than those of adults. Although initial PMN chemiluminescence and random and chemotactic motility values in preterm neonates were depressed, subsequent values on days 7, 14, and 21 increased significantly (P less than .002). On day 21 (mean postnatal age of 30.8 days) no differences existed in chemiluminescent activity and random motility between preterm and term neonates; chemotactic motility in preterm neonates, however, remained impaired. Mean cumulative age (gestational age at birth plus postnatal age) of preterm neonates on day 21 of study was 32.5 weeks, suggesting that chronologic age has more effect on maturational changes in PMN functions than gestational age.