Endoscopic findings in non ulcer dyspepsia; a new perspective

Objective: To see the pattern of endoscopic findings in patients with non-ulcer dyspepsia. Study Design: Observational cross sectional study. Place and Duration of Study: Department of Gastroenterology, Combined Military Hospital Kharian Pakistan, from Jan 2015 to Dec 2015

Material and Methods: Two hundred and seventy seven patients were included in the study. Patients presenting with dyspeptic symptoms at outpatient Gastroenterology Department were included in this study. Upper GI endoscopy was carried out and those having ulcers or any structural lesion were excluded from the study. Endoscopic findings were interpreted with IBM SPSS version 22

Results: Out of 277 patients, 146 were male and 131 female. Their minimum age was 12 and maximum age was 86 years with 44 +/- 15.5 [mean +/- SD]. Maximum numbers of patients were between ages of 31 to 50 years. Endoscopy was normal in 112 [40.4%] patients, showed mild gastritis in 118 [43.7%], moderate gastritis in 17 [6.1%], duodenitis in 19 [6.9%], and mixed findings in 8 [2.9%] patients. Bile was present in 144 [52%] and absent in 133 [48%] of the endoscopies

Conclusion: Mostly patients have either normal findings or mild gastritis on upper GI endoscopy. Gastric bile reflux was a common observation

Frequency of helicobacter pylori in histologically proven gastritis cases - a study of 100 cases

Objective: To determine the frequency of Helicobacter pylori [H. pylori] based on endoscopic of special stains in gastritis cases

Study Design: Prospective descriptive study

Place and Duration of Study: Histopathology department, Army Medical College Rawalpindi, from Oct 2016 to Mar 2017

Material and Methods: One hundred [100] cases were included in the study. Gastric biopsies of the patients histologically diagnosed as gastritis were included in the study, which were evaluated for the presence of H. pylori with the help of special stain [Modified Giemsa stain]

Results: Gastric biopsies of 100 patients, who were diagnosed as gastritis on histopathological examination were analyzed with the help of Giemsa stain for the presence or absence of H. pylori. Out of these 100 cases, 60 were males and 35 were females. Most patients were between the age group of 30-40 years. Histological examination and special stain analysis revealed presence of H. pylori in 30 cases [30%], while rest of the 70 cases [70%] showed no H. pylori. Out of 30 cases positive for H. pylori, 28 cases [93%] had chronic active gastritis, while 2 cases [7%] had no element of activity

Conclusion: Among the cases of chronic gastritis, H. pylori negative gastritis was more common than H. pylori associated gastritis. A significantly decreased frequency of H. pylori in histologically gastritis cases in our population may be due to more frequent use of complete or incomplete therapies against H. pylori by general practitioners at some stage of disease

Histopathological outcome of pancytopenia cases on bone marrow trephine biopsy

Objective: To determine the histological outcome of pancytopenia cases on bone marrow trephine biopsy and to see the frequency of various causes of pancytopenia in our population

Study Design: Descriptive study

Place and Duration of Study: Pathology department, Combined Military Hospital [CMH], Kharian [Pakistan]. One year [Jan 2015-Dec 2015]

Material and Methods: Two hundred bone marrow trephine biopsies were done in one year [2015], out of which 40 were done for evaluation of pancytopenia. The criteria for diagnosis of pancytopenia were; haemoglobin less than 10 g/dl, total leukocyte count [TLC] less than 4.0 x 109/1 and platelet count less than 100,000 x 109/1. Patients with pancytopenia secondary to drugs, chemotherapy and radiotherapy were excluded from the study

Trephine biopsies showing marked crushing and having inadequate material were also excluded from the study. Biopsies were processed, slides made and examined under light microscope by haematologist and histopathologist. Frequencies of various causes of pancytopenia diagnosed on histopathology were calculated. The findings were analyzed by using SPSS version 10.0

Result: Out of 40 cases of pancytopenia, male to female ratio was 3:2. The age range was between 1 year to 75 years. Histopathological analysis of bone marrow trephine biopsies revealed megaloblastic anaemia as the most common cause of pancytopenia [30%], followed by aplastic anaemia [25%] and hypersplenism [15%]

Conclusion: Megaloblastic anaemia is the most common cause of pancytopenia in our population as compared to aplastic anaemia mentioned in most of the international studies. This indicates prevalence of nutritional deficiency in our population and megaloblastic anaemia must be kept at top of list while evaluating pancytopenia cases. Early diagnosis and treatment of megaloblastic anaemia will prevent any further complication of this disease

Histopathological analysis of gastric mucosal biopsies in non ulcer dyspepsia

Objective: To find out the pattern of gastric mucosal histopathological findings in gastric biopsies of patients with non ulcer dyspepsia

Study Design: Prospective descriptive study

Place and Duration of Study: Histopathology department Combined Military Hospital [CMH] Kharian Pakistan from Jan to Dec 2015

Material and Methods: One hundred patients presenting at outpatient gastroenterology department with dyspepsia having no endoscopic lesion were included in the study. Two gastric mucosal biopsies from antrum and two from corpus were taken. The specimens were processed and examined histologically to see the changes

Results: Gastric biopsies of 100 patients including 65 males and 35 females presenting with non ulcer dyspepsia were studied. Most of the patients were between the age group of 31-50 years. Histological examination of gastric biopsies revealed 70% of patients having histological features of gastritis, while 30% having no significant histological finding. Chronic inflammation was seen in 70 cases [70%], activity in 15 cases [15%], glandular atrophy in 2 cases [2%] and intestinal metaplasia in 2 cases [2%]. H.Pylori were identified in 25 cases [25%] based on haematoxylin and eosin [H and E] staining and modified giemsa staining

Conclusion: Most the cases of non ulcer dyspepsia show histological evidence of gastritis, however a significant number of patients showed no gastric mucosal histological abnormality. A significantly low frequency of H. Pylori in gastric biopsies noted in non ulcer dyspepsia cases may be due to more frequent use of antibiotics and acid suppressant drugs used by general practitioners at some stage of disease

Comparison of dinoprostone with transcervical balloon catheter for labour induction

Objective: To compare transcervical balloon catheter with dinoprostone in terms of frequency of cesarean Section

Study Design: Randomized controlled trial

Place and Duration of Study: Department of Obstetrics and Gynaecology, Combined Military Hospital Peshawar, from 1[st]Nov 2011to 30[th] Jun 2012

Methodology: A total of 800 patients were selected who underwent labour induction. They were randomly divided into group 'A' and 'B' with 400 patients in each group. Patients in group 'A' were induced using Dinoprostone 3mg placed in posterior vaginal fornix and repeated after 6 hours if labour did not establish. In group 'B'Foley catheter [26fr] was placed within the cervical canal and inflated with 60 ml of sterile water for labour induction. Patients who underwent caesarean section in both the study groups were then recorded. Induction to delivery interval was also noted in both the study groups

Results: Mean age of sample was 27.78 +/- 4.507. In Group A out of 400 Patients 102 [25.5%] while in Group B 91 [22.7%] underwent cesarean section [p=0.826]

Conclusion: There is no difference in the rate of caesarean section when using Prostaglandin E2 [Dinoprostone] or the Balloon Catheter [Foley Catheter] for induction of labour

Higher frequency of cholelithiasis in eosinophilic cholecystitis - an unusual finding

To determine the frequency of cholelithiasis in eosinophilic cholecystitis in our population. Prospective descriptive study. Histopathology department, Combined Military Hospital [CMH], Peshawar [Pakistan] from Dec 2011 to Nov 2014. Eighteen hundred [1800] cholecystectomy specimens were included in the study. The specimens which were properly fixed in 10% formalin were included in the specimen, while poorly fixed and autolysed specimens were excluded. The specimens were examined grossly, measured and block selection was done. The slides made were examined under light microscope by one histopathologist and findings were analyzed. Out of 1800 cholecystectomy specimens, 25 cases [1.38%] were diagnosed as eosinophilic cholecystitis. Out of these 25 cases, 20 [80%] were females having an age range of 30-50 years, while 5 [20%] were males with an age range of 35-55 years. Out of these 25 cases of eosinophilic cholecystitis, 22 [88%] were having cholelithiasis, while 3 [12%] were acalculous eosiniophilic cholecystitis. Eosinophilic cholecystitis in our population is mostly calculous which is very significant finding contrary to data given in western literature, where most of eosinophilic cholecystitis is aclculous. This needs further evaluation to determine any genetic, geographic, environmental, dietary, microbiological or any other factor responsible in etiopathogenesis of calculous eosinophilic cholecystitis in our population, which could be helpful in prevention and management of this disease

Laparoscopic findings of female infertility - a study of 186 cases at a tertiary care hospital

To study the various causes of female infertility, diagnosed at laparoscopy. Descriptive study. The study was conducted at Military Hospital Rawalpindi, Pakistan from April 2008 to December 2010. A series of 186 patients, having either primary or secondary infertility admitted through gynae outpatient department undergoing diagnostic laparoscopy and meeting inclusion criteria were studied. The data was collected prospectively and analysed in the form of frequency and percentages by using SPSS version 10. Amongst the cohort of 186 patients, 148 [79.6%] had primary and 38 [20.4%] had secondary infertility. Their ages ranged from 20 to 43 years. Mean age of study participants was 30.14 +/- 4.04 years. Mean duration of infertility was 9.5 years. No laparoscopic abnormality was found in 51 [27.9%], while there were abnormal findings in 135 [72.6%] patients. Commonest etiological factor was tubal blockade in both types of infertility. Other factors were endometriosis, pelvic adhesions and fibroids. Laparoscopy is minimally invasive yet a reliable procedure for visualization of internal architecture of the female pelvis

Endometrial biopsy findings in infertile patients

To evaluate the etiopathological factors in infertile patients, detectable on endometrial biopsy. A total number of 100 endometrial biopsies were studied which were obtained from the patients undergoing investigations for infertility over a period of two years from Jan 2003 - Dec 2004, at Histopathology department Combined Military Hospital Sialkot, to find out the cause of infertility in these cases. All these patients were in fertile age group and were between 25 - 35 years of age. All of these biopsies were taken in premenstrual phase. The most common finding was late secretory endometrium [40%] which was consistent with the phase at which the biopsy was taken. Proliferative endometrium indicating anovulatory cycles was noted in 25% cases. Among the pathological findings, the most common was chronic non specific endometritis [15%] followed by endometrial hyperplasia [8%], chronic granulomatous endometritis of tuberculous etiology [5%] and endometrial polyp [3%]. 4% of the biopsies showed mid secretory endometrium which was also out of phase for the time at which biopsy was taken. Although endometrial biopsy is not the only diagnostic tool in women having infertility, however the confirmation of hormonal changes consistent with ovulation can be very helpful in management of these patients. The presence of out of phase endometrium and other endometrial patterns may direct the physician toward appropriate therapy. In addition, the therapy can be directed according to a specific etiology, if detected

Histopathological findings in menorrhagia a study of 100 hysterectomy specimens

Menorrhagia is common cause of anemia and may be due to multiple reasons. The exact percentage of different diseases presenting with menorrhagia is not known in our set up. Tojmd out the causes of menorrhagia by histological examination of hysterectomy method. A two year study from Jan 2003 to Dec 2004 of 100 cases of menorrhagia undergoing hysterectomy was conducted at Combined Military Hospital, Sialkot Histopathological examination of all hysterectomy specimens was done to find out the definitive causes of menorrhagia. Majority of the patients presenting with menorrhagia belonged to 41-50 yrs age group [63%]. The most common histopathological diagonosis was found to be leimyoma in 48% of the cases followed by adenomyosis Chronic Endometritis [3%], Endometnal Polyps [3%] and Endometnal Hyperplasia [3%] were less commonly found causes Six percentage of the patients had unremarkable findings on histopathological examination of their specimens. The result of study is consistent witn previous reports showing absence of malignancy in this age group with predominance of leiomyoma and adenomyosis amongst benign pathologies