RFP Gastroenterology International

 Multiple primary malignant neoplasms (MPMN) is the term used to describe malignancies arising from two or more different organs with different histology and have no relation which each other. Incidences of such cases have been occasionally in the literature. Organs affected in such cases do differ in accordance to prevalence of disease in the particular region, with metachronous occurrences being more common than synchronous malignancies. Carcinoma gall bladder and Carcinoma cervix are the two most common neoplasms affecting the females in Northern India. The synchronous appearance of both malignancies together is a rare phenomenon which has never been described earlier in available literature search. We describe synchronous occurrence of locally advanced adenocarcinoma gall bladder with locally advanced squamous cell carcinoma cervix and the diagnostic as well management challenges we encountered in this case report. 50 year old post menopausal female presented with complains of pain in right upper abdomen with a palpable abdominal lump and foul smelling vaginal discharge. On examination there was a lump in right hypochondrium with an ulcerative proliferative growth in cervix. Radiological imaging showed gall bladder mass with adjacent hepatic infiltration and cervical growth invading base of bladder and right parametrium causing right hydrouteronephrosis. Image guided core needle biopsy of gall bladder revealed adenocarcinoma and punch biopsy of cervix revealed squamous cell carcinoma. With increasing life expectancy and improvement in imaging modalities there is a gradual increase in reporting of such cases. Proper Clinical assessment is needed to rule out recurrence in case of metachronous malignancies or metastasis in case of synchronous malignancies from index cancers to classify it as multiple primary malignant neoplasms. These cases not only pose a diagnostic dilemma but also difficulty in management. With more awareness and better reporting regarding the phenomena we may be able to formulate personalized treatment plans to treat these patients of MPMN

Keywords: Synchronous; Multiple Primary Neoplasms; Carcinoma; Gall Bladder; Cervix.

 A 9 year old female patient presented with history of chronic diarrhea for 4 years. She had no pain abdomen or blood in stools. She had significant weight loss. She was previously evaluated with stool examination, upper gastrointestinal endoscopy, colonoscopy, computed tomography of abdomen, even then the etiology could not be identified. She continued to have diarrhea and weight loss and then presented to our hospital. Endoscopy demonstrated diffuse nodularity in the second part of duodenum. Tissue transglutaminase antibody for celiac disease was negative. Histopathological examination of duodenal biopsy showed multiple clumps of Giardia lamblia trophozoites which was confirmatory for chronic giardiasis. Then she was treated with oral tinidazole (2 grams, single dose) which with she had improvement in symptoms with weight gain.

Keywords: Giardiasis; Diarrhoea; Giardia Lamblia; Endoscopy; Chronic Diarrhoea.

Acute pancreatitis is sudden inflammation of the pancreas that may be mild or life threatening but usually subsides. Acute Pancreatitis is an acute inflammatory process of the pancreas with varying involvement of regional tissues or remote organ systems. Gallstones and alcohol abuse are the main causes of acute pancreatitis. Severe abdominal pain is the predominant symptom. Blood tests and imaging tests, such as computed tomography, help the doctor make the diagnosis. Whether mild, moderate, or severe, acute pancreatitis usually requires hospitalization. Here case reported with a history of tooth removal and given analgesic – NSAIDS – Diclofenac post intake patient develop severe pain abdomen, vomiting and restlessness. Patient being hospitalized for the same and regular investigation done suggestive of Acute Pancreatitis. Patient recovered as per standard treatment given.

Keywords: Acute Pancreatitis; Diclofenac; Serum Amylase; Serum Lipase; NPO.

 The open abdominal surgeries are more prone to many surgical site infections due to the therapy failure or aseptic conditions during surgery. The patients undergoing these surgeries are prescribed with more than one antimicrobials as empirical or prophylaxis. This irrationality in prescription can lead to surgical site infections and antimicrobial resistance. Hence, our study aims at evaluating the drug use of antimicrobials in the open abdominal surgery. This hospital based prospective observational study was carried out in the General Surgery department at a tertiary care hospital in India. The study included 114 subjects for a period of six months. The data was collected from various sources in a predesigned data collection forms. The prescriptions containing antibiotics were evaluated and the rationality was compared using John Hopkins Antibiotic Guidelines. Amongst the study population, 57.8% were inpatients and 42.1% were out-patients. The male patients were more (50.8%) and 78.9% of the study population underwent elective surgery. The most common surgery conducted was hernioplasty 48.2%. Majority of the prescription comprised of antibiotic therapy, amongst which the third generation Cephalosporins (70.96%) were prescribed the most, as prophylaxis. The drug utilisation evaluation helps to assess the appropriate selection of safe and effective antimicrobials which is significant in pre and post-operative cases. Hence our study supports the need for clinical pharmacist in the antimicrobial management, to study drug utilization pattern and develop antimicrobial stewardship for the rational prescription.

Keywords: Drug utilization evaluation; Antimicrobials; Surgical site infection.