Introduction: The prevalence and histopathological type of gastric polyp vary between populations. In the recent past aggressive treatment of Helicobacter pylori (H. pylori) and the excessive use of proton pump inhibitors (PPIs) have altered the prevalence of specific types of gastric polyp. This study was designed to evaluate the prevalence and histopathology background of gastric mucosa in cases with fundic gland polyps (FGP). Material and Methods: The medical record of patients who underwent esophagogastroduodenoscopy in 2 centers in Northern India from 2011-2018 were reviewed. Results: The prevalence of gastric polyps was 5%, of which 900 (50%) were fundic gland polyps (FGP). Mean age of presentation was 51.42 years, 70% were located in fundus/ corpus, 62% had dyspepsia, chronic inactive gastritis (CIG) was present in 60%, 95% were multiple and 27% were more than 1cm in size. Conclusions: As a result of anti-H. pylori treatment and the excessive use of PPIs, FGP are most common in Northern India. CIG, H. pylori gastritis and Intestinal metaplasia were seen in gastric histology of the cases. These results are interesting and provide new perspective to look for pathogenesis of gastric polyps.
Background: Proton pump inhibitors (PPI) are considered one of reasons for changing prevalence of gastric fundic gland polyps (FGP), not only in western world but trend is being seen in Asian countries as well. Aims and Objective: This study was designed to evaluate prevalence of FGP and to look into endoscopic and histological profile of these polyps in PPI users and non-PPI users. We also assessed background gastric mucosal histology in FGP patients. Materials and Methods: This is a retrospective observational study of 1800 cases. Medical records of patients who underwent esophagogastroduodenoscopy (EGD) in three gastroenterology centres between 2011 and 2019 were analysed at Noora super speciality Hospital, Kashmir; Northern India. Biopsy specimens of patients with FGP were reviewed by expert pathologists. PPI use was quantified as significant when Pantoprazole 40 mg per day or equivalent doses of other PPI was used four times or more per week for more than one year. Statistical Analysis was conducted using SPSS version 22. Results: FGP were most common, observed in 900 (50%) of all gastric polyp cases. PPI use one year and more was noted only in 360 (40%). FGP were mostly located in fundus 630 (70%), multiple in 840 (93.33%), with average size between 6 to 10 mm. On histology parietal cell hyperplasia, parietal cell protrusion and foveolar hyperplasia were seen in 666 (74%), 716(79.55%) and 254 (28.22%) cases respectively. Background gastric histology was normal in 543 (60.33%). Conclusions: FGP were most common gastric polyps in Northern India. We observed similar endoscopic and histological characters in FGP irrespective of whether cases were using PPI or not. Majority of cases had normal background gastric mucosal histology.
Purpose: The aim of this prospective study was to ascertain the nature and prevalence of incidentally discovered adrenal masses on routine chest and abdominal CT scans in patients with no known malignancy. Study was conducted in a tertiary care hospital in northern state of India. Methods and Materials: We analyzed the scans of 4469 patients in our hospital performed between December 2014 to April 2015. We found 240 incidental adrenal masses in 213 (5.12%) patients while reviewing the scans. Patients with no known malignancy and no suspicion for a hyperfunctioning adrenal mass were further isolated. A total of 337 patients were excluded. The remaining 4132 patients who fulfilled the criteria constituted the study group. The number, size and imaging features of the adrenal mass in each patient was recorded. Biochemical and demographic details were recorded. Results: A total of 240 adrenal incidentalomas were identified, including 27 bilateral lesions in 213 patients with a prevalence of 5.15%. The male patients had a slightly higher prevalence of AI than females (5.86% vs. 4.24%. These lesions were characterized with following methods: Histopathology (n=8), Imaging characterization (n = 220), Clinco-Laboratory diagnosis (n=12). In our study the most common type of adrenal mass was adenoma (n=169, 70.45%). Next common lesion was myelolipoma seen in 16(6.66%) patients. Haematoma was seen in 13 (5.41%) cases and cyst was seen in 12 (4.58%) cases. Metastaic disease was diagnosed in 10 (4.16%) cases , 4 cases were diagnosed on histology and 6 were were confirmed on imaging. There was 1 (0.41%) case of pheochromocytoma in our study. Macronodular hyperplasia was seen in 3 (1.28%) patients. A total of 16 lesions in 8 patients showed features suggestive of tuberculosis. Conclusion: Adrenal incidentalomas being common lesions need complete evaluation as there can be risk of malignancy or hormonal hyperfunction. The imaging features can predict the underlying pathology and biochemical evaluation should be done for hormonal hyperfunction. Thus there should be comprehensive reporting and selective testing strategy, so that these lesions are not missed.
Background and Objective: Cardiovascular disease (CVD) is a significant cause of morbidity and mortality worldwide, with high-risk patients requiring effective management to reduce their risk of cardiovascular events. Bempedoic acid is a novel therapeutic agent recently approved as an add-on therapy to statins in patients with uncontrolled LDL-c. Bempedoic acid inhibits cholesterol synthesis in the liver, which ultimately reduces the risk of cardiovascular events. Therefore, the present study aims to assess the efficacy and safety of bempedoic acid in patients with uncontrolled LDL-c (Previously on moderate or high-intensity statins) with a high risk of CVD in real-world settings. Methods: This is a multicenter, retrospective, observational study on the data of high-risk-CVD patients collected from Bempedoic Acid on Efficacy and Safety in patients (BEST) Registry. The clinical data of 140 patients who were already on statin therapy and were receiving Bempedoic acid at a dose of 180 mg, along with measurements of the level of LDL-c, HbA1c, HDL, TG, TC, PPPG, FPG, AST, ALT, serum creatinine was taken into consideration. The primary outcome includes a change in LDL-c level, and secondary outcomes involve a change in the level of HbA1c, HDL, TG, TC, PPPG, FPG, AST, ALT, and serum creatinine at week 12 and 24. Adverse events were reported at both time points. Results: A total of 140 patients were included in the present study with a mean age of 51.8 ± 9.2 years and had primary confirmed diagnosis of dyslipidemia with uncontrolled LDL-c. The mean levels of LDL-c decreased from the mean baseline value of 142.67 ± 46.49 mg/dL, to 106.78 ±33.92 mg/d; a statistically significant reduction by 23.23% (p < 0.01) at week 12. Similarly, at week 24, the mean LDL-c value reduced to 90.39 ± 38.89 mg/dL. A 33.38 % decrease was observed (p < 0.01). Other parameters such as non-HDL, FPG, PPPG, AST and serum creatinine also showed statistically significant reduction at week 12 and week 24. Conclusion: The present study demonstrates that bempedoic acid is an effective add-on medication in lowering LDL-c levels in high-risk CVD patients with uncontrolled LDL-c.
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