Journal Issue: No 3, Issue 19, JULY-SEPT, 2007
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Volume
Number
Issue Date
2007
Journal Title
Journal ISSN
1812-2027
Journal Volume
Articles
Helicobacter pylori infection, glandular atrophy, intestinal metaplasia and topography of chronic active gastritis in the Nepalese and Japanese population: The age, gender and endoscopic diagnosis matched study
(Kathmandu University, 2007) T, Matsuhisa; M, Miki; N, Yamada; SK, Sharma; BM, Shrestha
Background: The incidence and mortality from gastric cancer is high in Japanese but extremely low in
Thailand. It is different among Asian countries. The aim of this study is to investigate the difference of peptic
ulcer disease, glandular atrophy, intestinal metaplasia and topography of chronic active gastritis between the
Nepalese and Japanese population.
Materials and methods: Nepalese patients were paired with Japanese patients by age, gender and
endoscopic diagnosis in order to compare the prevalence of H. pylori infection (N=309) and the difference of
H. pylori related peptic ulcer disease (N=48). Glandular atrophy and intestinal metaplasia scores were also
compared between the Nepalese and Japanese population in H. pylori positive cases (N=152) and negative
cases (N=145) using paired cases by age, gender and endoscopic diagnosis. Paired H. pylori-positive
Nepalese and Japanese population were also used to compare the ratio of corpus gastritis to antrum gastritis
(C/A ratio) (N=152).
Results: Among peptic ulcer diseases, gastric ulcer was frequent in Japanese and duodenal ulcer was
frequent in Nepalese. The prevalence of H. pylori infection in the Nepalese and Japanese population were
similar. Glandular atrophy and intestinal metaplasia scores in the H. pylori positive Japanese were
significantly higher than those of Nepalese in all positions according to triple site biopsy. Furthermore, there
were significant differences in glandular atrophy and intestinal metaplasia scores between in the H.
pylori-negative Nepalese and Japanese population except intestinal metaplasia score in the greater curvature
of the upper corpus. Japanese C/A ratio was significantly higher than that of Nepalese. Corpus predominant
gastritis (C/A ratio>1.00) was characteristic in the elderly Japanese. Nepalese was antrum predominant (C/A
ratio<1.00) in every age group.
Conclusions. Gastric ulcer was a common disease in Japanese, in contrast duodenal ulcer was common in
Nepalese. H. pylori infected Japanese patients showed severe atrophic and metaplastic gastritis in comparison
with Nepalese. These results may be associated with the high incidence of gastric cancer in Japanese. Corpus
predominant gastritis was found in the elderly Japanese and antrum predominant gastritis was found in every
age Nepalese.
Key words: H. pylori, atrophy, metaplasia, corpus-predominant gastritis, Nepal
Breathing comfort associated with different modes of ventilation: A comparative study in non-intubated healthy Nepalese volunteers
(Kathmandu University, 2007) PR, Baral; B, Bhattarai; R, Pande; U, Bhadani; A, Bhattacharya; M, Tripathi
Objective: To compare subjective experience of comfort associated with various commonly used supportive modes
of mechanical ventilation for weaning in the intensive care unit (ICU).
Subjects and Methods: The study was carried out in general ICU of a community-based teaching hospital in 30
healthy adult Nepalese volunteers of either sex and 19-37 years of age. The subjects were randomly made to
experience breathing via anatomical facemask through ventilator circuit with synchronized intermittent mandatory
ventilation (SIMV), assisted spontaneous breathing (ASB), biphasic positive airway pressure (BiPAP), and
continuous positive airway pressure (CPAP) modes of ventilation with parameters set at intermediate level of
respiratory support. Subjective comfort of breathing was noted using a 10cm visual analogue scale (VAS) with no
discomfort at one end and maximum imaginable discomfort at the other. Inspiratory and expiratory experience of
discomfort was also noted using a four point ranking scale (0-no discomfort, 1-mild discomfort, 2-moderate
discomfort and 3-severe discomfort). In addition, presence or absence of feeling of breathlessness and inflation was
also noted.
Results: BiPAP was the most comfortable mode of ventilation (p<0.01) on visual analogue scale. SIMV and CPAP
modes were associated with higher discomfort than other modes during inspiratory and expiratory phases
respectively. Breathlessness and inflation were least felt in BiPAP and SIMV modes respectively.
Conclusion: Perception of breathing comfort can vary widely with various supportive modes of ventilation in the
ICU. Hence, no single supportive mode should be used in all patients during weaning from mechanical ventilation.
Key words: assisted spontaneous breathing; biphasic positive airway pressure; breathing comfort; continuous
positive airway pressure; mechanical ventilation; supportive modes synchronized intermittent mandatory ventilation;
weaning