Objectives. To evaluate the occurrence, clinical course and outcomes of olfactory and gustatory dysfunction in patients with laboratory confirmed coronavirus disease 2019 infection. Methods. This is a prospective cross-sectional study of patients diagnosed with coronavirus disease 2019 infection by reverse transcription polymerase chain reaction over two months. The epidemiological and clinical outcomes studied were: age, sex, general symptoms, and olfactory and taste dysfunction. Results. A total of 410 coronavirus disease 2019 infected patients were included in the study, with 262 males (63.9 per cent) and 148 females (36.1 per cent). Ninety-nine patients (24.1 per cent) reported chemosensory dysfunction, of which 85 patients (20.7 per cent) reported both olfactory and taste dysfunction. Olfactory and taste dysfunction were proportionally more common in females. The mean duration of olfactory and taste dysfunction was 4.9 days, with a range of 2-15 days.

An 82-year-old man presented to the Emergency department of our hospital with chief complaints of severe lower abdomen pain, and fever since morning. He gave history of frequent bloating sensation of abdomen associated with constipation. The pain was sudden in onset following straining while defecating in the morning of the same day. On examination there was no icterus or pallor. Patient was very dehydrated, tachypnoeic with tachycardia. The abdomen was distended with diffuse abdominal guarding. Bowel sounds were absent. Patient was admitted and investigated with a provisional diagnosis of Hollow viscus perforation. Blood examination revealed counts to be elevated and chest X-ray showed gas under the diaphragm. After resuscitating the patient and correcting the metabolic derangements he was taken for exploratory laparotomy.On opening the peritoneum, faecal peritonitis was evident. A thorough peritoneal wash was given and site of perforation was looked for. The small bowel was sequentially traced for a breach in the wall starting from the terminal ileum, but there was no breach in the wall. The large bowel was traced from ceacum distally. The sigmoid colon just proximal to recto sigmoid junction revealed the site of perforation of about 4cm transversely [Table/ Fig-1]. Through the perforation a pedunculated smooth surfaced growth of about 5x6cm was protruding out through the tear in the sigmoid colon. The proximal colon was not dilated or thinned out as one would expect in chronic cases of obstruction. The rest of colon and liver was palpated for synchronous lesions/Secondaries and found to be absent. A limited resection of the sigmoid colon with primary resection anastomosis with transverse colon diversion colostomy was performed. The specimen was sent for HPR which was suggestive of an Intestinal submucosal lipomatous polyp [Table/ Fig-2]. 10x view section shows normal mucosa with underlying adipocytes(arrow) within submucosa and muscular layer & [Table / Fig-3] 40x view of the lipocytes.The patient postoperatively developed septicaemia and needed prolonged ICU care. He was discharged on the 18 th Post operative day. ABSTRACTColonic lipomas are rare benign tumours that are usually asymptomatic. Large colonic lipomas can present with symptoms such as constipation, abdominal pain, bleeding per rectum, and intussusception. We report the case of an 82-year-old man presenting with sudden onset lower abdomen pain and features of peritonitis. An exploratory laparotomy revealed a perforation of sigmoid colon with a fleshy mass protruding through the perforation. No case of spontaneous perforated sigmoid colon by submucous giant lipoma is reported yet in the literature. We discuss the details of first such case, our management, the outcome and also briefly review the literature.

Background and Study Aim: The European guidelines for colorectal cancer screening state that snare resection should remove any polyps ≥5 mm. This study aimed to investigate if these new guidelines are adhered to in clinical practice. Patients and Methods: This study consists of patients who underwent colonoscopies in Tallaght Hospital, Dublin (AMNCH), between 2012 and 2015. The size of the polyp, the method of removal, and the subspecialty and grade of the endoscopists were all recorded. Results: 6,000 colonoscopies were reviewed and 687 (12.5%) of these patients were found to have polyps. In 655 (95%) colonoscopies, the caecum was positively identified. In all, 371 (54%) of the polyps detected were < 5 mm; resection via forceps was carried out in n405 cases (59%). Overall, 16% (n = 45) of the polyps > 5 mm underwent resection with forceps, showing that the new European guidelines are not being tightly adhered to. Conclusions: This study found an 84% compliance with polypectomy resection guidelines which is an improvement on previous studies. However, endoscopist grade significantly affected compliance and may reflect overall competency, highlighting the need for specific training in snare polypectomy techniques.

Background:Urine is a supersaturated solution with solutes in very high concentration. Matrix gla protein (MGP) is one of the proteins involved in inhibition of extracellular calcification. Among the various polymorphisms studied, polymorphism of SNP rs4236 in the MGP gene is found to have association with nephrolithiasis. We evaluated the significance of SNP rs4236 polymorphism in nephrolithiasis among the Indian population.Materials and Methods:The study was conducted in 2013 and 2014 among fifty participants. Twenty-five of them were patients with documented symptomatic stone disease and the 25 controls had no history of stone disease and ultrasonogram was normal. Serum creatinine was estimated in all patients. DNA was isolated from the blood sample and amplified by polymerase chain reaction using defined primers. Single strand conformational polymorphism was done to identify abnormal bands and the same was sequenced.Results:The patients and controls were matched in age and sex. The serum creatinine levels were similar in both groups. The predominant change in SNP rs4236 in patients was a G to A nucleotide change, resulting in AA homozygous genotype. This was found in 60% of patients. The rest (40%) of patients and all (100%) controls had heterozygous AG genotype. This corresponds to a stone disease with an odds ratio (OR) of 75 (P < 0.003).Conclusion:This first study in Indian population shows that genotype AA polymorphism of SNP rs4236 of MGP gene was found to be significant risk factor for renal stone disease. Studies with larger sample size may be needed to confirm this finding and elucidate the exact OR.

Introduction: There are clear European Society of Gastrointestinal Endoscopy (ESGE) guidelines for the use of Small Bowel Capsule Endoscopy (SBCE), the use of bowel prep is routinely recommended but there are queries about its overall efficacy. The diagnostic yield of SBCE depends on the quality of visualization of the small bowel mucosa and its complete passage through the small bowel. Previous studies have suggested that longer small bowel capsule transit times (SBCTT) can increases diagnostic yield. The use of pro-motility agents including bowel prep can shorten SBCTT. Other factors that influence SBCTT are not fully understood. Aims/ Background: The aim of the study is to evaluate whether indication for SBCE affects SBCTT and diagnostic yield Method: We collected data from all capsule endoscopies performed in Tallaght Hospital, Ireland from 2015 to 2016 inclusively. We excluded capsules with incomplete reports. SBCTT and diagnostic yield was compared according to each referral group. Parametric data was compared using student t-test and a p value of <0.05 was considered significant. Results: 649 SBCE's with complete data sets were identified, 313 (48%) males, and mean age 52.9 (16-93). Indication for SBCE were; IBD diagnosis and assessment 233 (36%), Coeliac Disease diagnosis and assessment 16 (2%), obscure occult GI bleeding including anaemia 330 (51%), obscure overt GI bleeding 22 (3%), lesion assessment 9 (1%), abnormal radiology 9 (1%), and others 30 (5%). In our department, bowel prep is not routinely used for SBCE. Overall mean SBCTT was 241 (21-717) minutes and overall 288 (44%) patients had a positive SBCE. When comparing indications with SBCTT, there were no significant difference in SBCTT according to referral groups except for coeliac disease which was significantly longer (296v240, p< 0.01). Mean overall SBCTT was significantly longer for positive studies, (256v229, pZ0.006 95% CI 12.01-43.4) and within the IBD group (222.3v256.6 p<0.02) but not for other indications. Conclusions: Our study supportsthat longer SBCTT is positively associated with diagnostic yield. Indication for SBCE can affect SBCTT. This study brings into question the regular use of prep pre-SBCE which can reduce transit times and suggests that only selective use according to indication should be considered.