ENDOSCOPIC FINDINGS IN PATIENTS PRESENTING WITH DYSPHAGIA

INTRODUCTION: Dysphagia is a condition in which disruption of swallowing process interferes with patient ability to eat due various causes. Endoscopy is the mainstay of diagnostic workup of these patients and subsequent treatment. AIM: The objective of the study was to determine the frequency of various types of endoscopic ndings in patients with dysphagia. METHODS: Cross-section descriptive study carried out in DDHD, KMC, Chennai, a tertiary care hospital from November 2018 to May 2019. Duration of symptoms was noted and all patients underwent upper gastrointestinal endoscopy to nd out the cause of dysphagia. Tissue biopsies were obtained and further histopathological examination was performed to correlate the ndings with symptoms of dysphagia. RESULTS: A total of 197 patients presenting with dysphagia were studied, 93 (47%) were males and 104 (53%) were females. The mean age was 55 ± 8 years. Oesophageal malignancy was the most common nding noted in 54(27%) patients. It was followed by post cricoid web in 24 (12%), benign stricture oesophagus 21(10%), cricopharngeal malignancy in 14(7%), anastomatic stricture 14(7%), normal UGI in 12(6%), post RT stricture in 11(5%), peptic stricture in 8(4%), hypopharynx malignancy in 8(4%), OGJ growth in 8(4%), corrosive stricture in 7(4%), patients and reux esophagitis in 5 (2.9%) patients, oesophageal candidiasis in 5(2.9%), achalasia in 4(2%) ,pyriform fossa malignancy in 3(1.5%),oesophageal web in 3(1.5%), one patient each in Schatzki's ring, pill esophagitis, oesophageal varices, oesophageal diverticula(0.5 %). CONCLUSION: Malignancies and malignancy related conditions are more common cause of dysphagia in our set of population. Patient presenting with dysphagia, endoscopy is initial and better choice of investigation unless contraindicated

The burden of serious fungal infections in Azerbaijan

Background: Azerbaijan is an upper middle-income country in South Caucasus with an area of 86,600 km2 and a total population of 10 million people and gross domestic product of US $4480 per capita. The aim of this research is to estimate fungal infection burden and highlight the problem at national and international levels. Methods: Fungal infection burden was estimated using data from epidemiological papers and population at risk and LIFE (Leading International Fungal Education) modelling. Results: The number of people living with human immunodeficiency virus (PLHIV) in 2018 was 6193, 29% of them not receiving antiretroviral therapy. Based on 90% and 20% rates of oral and oesophageal candidiasis in patients with CD4 cell count <200 µl–1 we estimate 808 and 579 patients with oral and oesophageal candidiasis, respectively. The annual incidences of cryptococcal meningitis and Pneumocystis pneumonia are 5 and 55 cases, respectively. We estimated 2307 cases of chronic pulmonary aspergillosis (CPA), 4927 patients with allergic bronchopulmonary aspergillosis (ABPA), and 6504 with severe asthma with fungal sensitization (SAFS). Using data on chronic obstructive pulmonary diseases (COPD), lung cancer, acute myeloid leukaemia rates, and number of transplantations, we estimated 693 cases of invasive aspergillosis following these conditions. Using a low-European rate for invasive candidiasis, we estimated 499 and 75 patients with candidemia and intra-abdominal candidiasis respectively. The number of adult women (15–55 years) in Azerbaijan is ~2,658,000, so it was estimated that 159,490 women suffer from recurrent vulvovaginal candidiasis (rVVC). Discussion: In total, the estimated number of people suffering from fungal diseases in Azerbaijan is 225,974 (2.3% of the population). However, the fungal rate is underestimated due to lack of epidemiological data. The most imminent need is improvement in diagnostic capabilities. This aim should be achieved via establishing a reference laboratory and equipping major clinical centers with essential diagnostics assays.

Opportunistic fungal infections in persons living with advanced HIV disease in Lagos, Nigeria; a 12-year retrospective study

Introduction: Nigeria has a large estimated burden of AIDS-related mycoses. We aimed to determine the proportion of pa- tients with AIDS-related opportunistic fungal infections (OFIs) at an urban antiretroviral treatment (ART) centre in Nigeria. Methods: A retrospective analysis of a cohort of ART-naïve, HIV-infected patients, assessed for ART eligibility and ART- experience at the PEPFAR outpatient clinic at Lagos University Teaching Hospital over a 12-year period (April 2004-Feb- ruary 2016) was conducted. Results: During this period, 7,034 patients visited the clinic: 4,797 (68.2%) were female; 6161 patients had a recorded base- line CD4 count, and the median CD4 count was 184 cells/µl (IQR, 84-328). A baseline HIV-1 viral load (VL) was recorded for 5,908 patients; the median VL was 51,194 RNA copies/ml (IQR, 2,316-283,508) and 6,179/7046(88%) had initiated ART. Some 2,456 (34.9%) had a documented opportunistic infections, of whom 1,306 (18.6%) had an opportunistic fungal infection. The total number of OFI episodes was 1,632: oral candidiasis (n=1,473, 90.3%), oesophageal candidiasis (n=118; 8%), superficial mycoses (n=23; 1.6%), Pneumocystis pneumonia (PJP) (n=13; 0.8%), and cryptococcal meningitis(CM) (n=5; 0.4%). 113 (1.6%) were known to have died in the cohort. Conclusion: Approximately 1 in 5 HIV-infected patients in this retrospective cohort, most of whom had initiated ART, were clinically diagnosed with an OFI. Improved access to simple accurate diagnostic tests for CM and PJP should be pri- oritised for this setting. Keywords: Opportunistic fungal infections; ART Adherence; Advanced HIV disease.

Homoeopathic Treatment of Oesophageal Candidiasis: A Case Report

The most prevalent cause of infectious oesophagitis is oesophageal candidiasis. Of patients that have infectious oesophagitis, 88% are from Candida albicans. Candida infections of the oesophagus are considered opportunistic infections and are seen most commonly in immunosuppressed patients. A case is presented in this article with radiological evidence of Candida infection noted in the oesophagus with positive rapid urease test. Malignancy and HIV were excluded. The patient was treated with constitutional homoeopathic medicine Nux Vomica 0/1, 16 doses, up to Nux Vomica 0/4, 16 doses each. Follow-up imaging at 5 months showed complete resolution of the oesophageal candidiasis. This case report suggests homoeopathic treatment as a promising complementary or alternative therapy and emphasises the need of repertorisation in individualised homoeopathic prescription.

The Burden of Serious Fungal Infections in Tajikistan

Tajikistan is a low-income country in Middle Asia with a population of 8.9 million people. Five percent of the population lives on less than 1.9 USD a day and 54% live on less than 5.5 USD a day. We have estimated the burden of serious fungal infections in Tajikistan. It was estimated that 168,834 Tajik women develop recurrent vulvovaginal candidiasis. Among HIV-positive patients, we estimate 490 patients with oesophageal candidiasis and 1260 patients with oral candidiasis, 41 cases of cryptococcal meningitis and 210 cases of Pneumocystis pneumonia annually. According to our estimations there are 774 cases of chronic pulmonary aspergillosis (CPA) as a sequel of tuberculosis; CPA may occur as a consequence of multiple pulmonary conditions and the total prevalence of 4161 cases was estimated. We have estimated 6008 cased of allergic bronchopulmonary aspergillosis (ABPA) and 7930 cases of severe asthma with fungal sensitisation (SAFS), and 137 fungal asthma deaths annually. We have estimated 445 cases of candidemia a year applying a low European rate. There are approximately 283 cases of invasive aspergillosis annually. There are 189,662 (2.1% of the population) people suffering from serious fungal infections in Tajikistan. Hence, improving diagnostics is the first step of understanding a scale of the fungal burden.