The prevalence of celiac disease (CD) in Indian children is not well documented, with most of the studies focusing on high-risk groups and not the general population. This study was conducted to determine the prevalence of CD in asymptomatic school children of Jaipur, Rajasthan. A cross- sectional study was conducted among healthy school children of Jaipur. Demographic data, symptoms, and signs including dermatological examination were recorded. The screening for CD was done by ELISA-based anti–tissue transglutaminase (tTG) immunoglobulin A (IgA) antibody testing. Children with high IgA anti-tTG underwent upper gastrointestinal endoscopy for small bowel biopsy from the second part of the duodenum. This study involved 575 subjects, out of which, 6 (1.04%) were found to be IgA tissue transglutaminase antibody (IgA-tTG) positive. All 6 subjects were found to be having changes consistent with celiac disease on duodenal biopsy. To conclude, the calculated prevalence of celiac disease was 1 in 96 subjects.

Background and Aim of the study: Percutaneous Transhepatic Biliary Drainage (PTBD) is performed as a preoperative procedure for resectable malignancies, prior to neo adjuvant chemotherapy or as a palliative technique. This prospective study was done to evaluate technical success, clinical success, stent/catheter patency rate, survival rate and complications of PTBD in patients with malignant obstructive jaundice. Materials and method: All patients from June 2018 to November 2019, with malignant obstructive jaundice who have undergone PTBD were included in this study. Results: One Hundred and One patients were planned for PTBD, technical success was achieved in 93 (92.07%) patients. 97 (96%) patients underwent PTBD for palliation and 4 (4%) for preoperative drainage. Unilateral approach was used in majority of our patients (97.8%). 3 patients (2.9%) underwent internalization with 7 Fr plastic stent. 55 patients were female (54.45%). Mean age was 55.35± 22 years. Cause for malignant biliary obstruction was carcinoma gall bladder (77.7%), cholangio carcinoma (9.9%), carcinoma head of pancreas (6.9%), periampullary (3.9%), and metastatic lymhadenopathy at porta (3.2%). Type of block was hilar in 90 patients (89.1%) and lower end block in 11 patients ( 1 0 . 8 9 % ) . E n d o s c o p i c R e t r o g r a d e Cholagiopancreatography (ERCP) failure was in 25 patients (24.75%). Clinical success was achieved in 88 patients (94.6%). The difference in the pre and post intervention bilirubin levels at 1 month as estimated with wilcoxon signed rank test is found to be statistically significant. Successful biliary drainage had a positive impact on Quality of Life (QOL). Stent/catheter patency period in our study was 51± 46 days (range 14 -120 days). Survival in our patients was 74± 90 days (Range 15270 days).Kaplan-Meier log rank survival analysis showed that there was no statistical significance between the survival rates of the patients when they were grouped according to the post PTBD bilirubin levels.16.1% of our patients had minor complications. Major complications in our centre were 45.15%. Conclusion: Percutaneous management of malignant biliary obstruction is a good method for palliation with good technical success (92%) and clinical success (94.6%). Unilateral approach was used in majority of our patients (97.8%) as drainage of 25%-30% of normal liver is adequate to improve jaundice and liver functions. PTBD is an effective alternative in ERCP failure patients (25% in our study). Successful biliary drainage alleviates jaundice, improves liver function, and has a positive impact on QOL.

We did cross-sectional study for normal values of amino-transferases in school children aged 2–18 years. Median (IQR) AST and ALT values in study subjects were 30 (27–34) U/L and 23 (19–29) U/L. We also provided age-and sex-related percentiles of aminotransferases of children. We observed a peak of median AST serum values in the age group 6–8 years followed by continuous decline with increasing age. While in ALT, we observed maximum values in age group 2–5 years followed by continuous decline. There was a statistically significant difference in values of amino-transferases between sexes.

BACKGROUND There are limited studies on the seronegative celiac disease from the Indian subcontinent. The aim of this study was to assess the prevalence, pathological, genetic, and clinical profile of patients with seronegative celiac disease. METHODS This prospective observational study was conducted in the Department of Gastroenterology, SMS Hospital, Jaipur, between October 2017 to March 2019. Consecutive patients with seronegative celiac disease with age ≥ 3 years were enrolled for the assessment of demography, clinical features, histological findings, celiac serology, genetic analysis, and response to gluten-free diet. RESULTS Out of total of 312 patients with celiac disease, 13 (4.16 %) patients (median age 25 years [range 5-46 years], 10 female) were diagnosed as having seronegative celiac disease. Presenting symptoms were chronic diarrhea in nine (69.23%), abdominal pain in six (46.15%), weight loss in five (38.46%), and short stature in two (15.38 %) patients. On histological analysis, Marsh stage 2 was seen in five (38.46%), Marsh 3c in two (15.38%), Marsh 3a in three (23.07%), and Marsh 3b in three (23.07%) patients. On HLA analysis, HLA-DQ2.5 was seen in six (46.15%) patients, HLA-DQ2.2 in five (38.46%), and HLA-DQ8 in two (15.38%) patients. CONCLUSION The prevalence of seronegative celiac disease in our study was 4.16%. The most common symptoms were chronic diarrhea and abdominal pain, and the histological grade was Marsh stage 2.

the esophagus, the most common cause was acid injury in 38 (79.17%) patients, followed by alkali injury in four (8.34%) patients. In six (12.5%) cases, the nature of corrosive was not known. Most of the corrosive injuries, they mentioned, were due to suicidal intake (64.58%) rather than accidental exposure (33.34%). The authors in the present study attributed 63 (29.17) cases, in which no cause was found for functional dysphagia. However, they did not further investigate these patients by means of investigations, like esophageal biopsies or manometry, to rule out other causes, like eosinophilic esopagitis or motility disorders, which may also have normal esophagogastroscopy findings. The authors had a follow-up period of 6 months which is too short to characterize the natural course of diseases, like corrosive stricture of esophagus. No mention has been made of any therapeutic intervention during this follow-up period which may add greater incentive to the natural course of these disorders. Furthermore, the etiology of dysphagia with respect to age distribution of population needs to be defined. The results of the present study were similar to a study conducted at a tertiary center in Jammu and Kashmir by Iqbal et al5 in 2018. They include 58 patients and found a benign cause in 31 (53.4%) patients, carcinoma esophagus in 23 patients, and four had moderate-to-severe dysplasia. Most common benign etiology was gastro-esophageal reflux disease (GERD) and most common malignant etiology was squamous cell carcinoma. The present study encourages other studies from India, especially from different geographic regions, as etiologies may differ from one region to the others. Also, the etiologies differ widely among different age groups. Larger and multicentric studies are needed to address these issues.

We read with much interest the study conducted by Bhaskar et al1Bhasker B. Sachdev S. Marwaha N. Grover S. Singh T. Dhiman R.K. Knowledge and attitude regarding hepatitis B and C among blood donors and non-donors in north India.Journal of Clinical and Experimental Hepatology. 2018; 9: 318-323Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar titled “Knowledge and Attitude Regarding Hepatitis B and C Among Blood Donors and Nondonors in North India.” The study showed knowledge of the prospective blood donor with regard to the risk factors for acquiring hepatitis B and C and the mode of spread through blood transfusion. This forms the basis of selection of a low-risk blood donor. Among the 1000 participants, including 2000 blood donors and 2000 nondonors, it was shown that neither the existing level of knowledge nor the attitude of both donors, as well as nondonors toward hepatitis B and C is adequate for being able to select a low-risk blood donor. We appreciate the authors of the present study for their commendable job in assessing the knowledge of voluntary blood donors and selection of low-risk blood donors to decrease the transmission of hepatitis B and C. Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are important public health problems with broad clinical manifestations, from asymptomatic infection, hepatitis to cirrhosis and hepatocellular carcinoma.2Tan Y.J. Hepatitis B virus infection and the risk of hepatocellular carcinoma.World J Gastroenterol. 2011; 17: 4853-4857Crossref PubMed Scopus (67) Google Scholar,3World Health Organization Hepatitis C.2014http://www.who.int/mediacentre/factsheets/fs164/en/Google Scholar To expand our knowledge regarding population prevalence of hepatitis B and C, we recently conducted a study to determine the prevalence of HBV and HCV among school children of urban and rural Jaipur. A total of 576 children were included. The mean age was 12.23 ± 7.24 years, of which 218 (37.84%) were men and 358 (62.15%) were women. Of these, 5 children were HbsAg positive, making the prevalence of hepatitis B 0.868%. Of these 5 children, two were men and three were women. All these 5 children were from rural Jaipur and none from urban Jaipur. All the children who were positive were >10 years old. Table 1 shows the distribution of hepatitis B and C positive cases by urban or rural background. The proportion of cases was higher in students from rural background compared with urban with a P value of 0.0253. The mean aspartate aminotransferase (AST) of HBsAg-positive subjects was 37 ± 7.16 U/L and mean alanine aminotransferase (ALT) of the subjects was 31.6 ± 8.16 U/L. None of the children were found to be anti HCV positive.Table 1Distribution of Hbsag Seropositivity According to Demographics.TotalHBsAg positiveHBsAg negative% PositiveP valueUrban20102010%O.247Rural37553700.868% Open table in a new tab In a population-based study conducted by Chowdhury et al4Chowdhury A. Santra A. Chakravorty R. et al.Community based epidemiology of Hepatitis B virus infection in West Bengal, India: prevalence of Hepatitis B e antigen-negative infection and associated viral variants.J Gastroenterol Hepatol. 2005; 20: 1712-1720Crossref PubMed Scopus (49) Google Scholar, 7653 subjects were screened and 2.97% tested positive for HBsAg. A study by Lodha et al5Lodha R. Jain Y. Anand K. Kabra S.K. Pandav C.S. Hepatitis B in India: a review of disease epidemiology.Indian Pediatr. 2001; 38: 349-371PubMed Google Scholar from New Delhi depicted the prevalence of HBV infection to be 1–2%. Our study showed a decline in prevalence of Hepatitis B compared with previous studies performed in North India in 2001 and 2005.4Chowdhury A. Santra A. Chakravorty R. et al.Community based epidemiology of Hepatitis B virus infection in West Bengal, India: prevalence of Hepatitis B e antigen-negative infection and associated viral variants.J Gastroenterol Hepatol. 2005; 20: 1712-1720Crossref PubMed Scopus (49) Google Scholar,5Lodha R. Jain Y. Anand K. Kabra S.K. Pandav C.S. Hepatitis B in India: a review of disease epidemiology.Indian Pediatr. 2001; 38: 349-371PubMed Google Scholar Effective vaccination may have contributed to this low prevalence. The low prevalence of HBV infection indicates the positive impact of routine infant hepatitis B vaccination, which was included in the National Immunization Program in 2007–08, in the prevention of transmission in the studied population. In our study, we also found Hepatitis B to be prevalent in rural Jaipur and no case was positive in urban Jaipur. This may be because of more education and awareness about the disease and better immunization in urban areas. The prevalence of hepatitis C in our study was 0%. In a population-based study performed by Chowdhury et al6Chowdhury A. Santra A. Chaudhuri S. et al.Hepatitis C virus infection in the general population: a community-based study in West Bengal, India.Hepatology. 2003; 37: 802-809Crossref PubMed Scopus (159) Google Scholar from West Bengal, seroprevalence of HCV antibody positivity was 0.87%. These results highlight the importance of prevention programs for children and adolescents, both to avoid risk behavior and to maintain the low prevalence of C among these groups of individuals. We hope in future more population based studies be conducted taking more number of study subjects. The authors have none to declare. The authors thank Mrs Meera Saxena and Mrs Mansi Saxena, principals of the rural and urban schools of Jaipur, respectively, for their assistance.