Endoscopic Yield, Appropriateness, and Complications of Pediatric Upper Gastrointestinal Endoscopy in an Adult Suite: A Retrospective Study of 822 Children

Background/Aims@#This study aimed to study the endoscopic yield, appropriateness, and complications of pediatric endoscopy performed by adult gastroenterologists in an adult endoscopic suite. @*Methods@#This a retrospective study in which records of all the patients less than 18 years of age who underwent endoscopy in the last 5 years were studied. The indications of endoscopy in children were categorized as appropriate or inappropriate per the latest guidelines by American Society for Gastrointestinal Endoscopy and North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Positive endoscopic yield was defined as the presence of any abnormality on endoscopy. @*Results@#Among the total of 822 children (age <18 years), the most common indications were variceal surveillance/eradication in 157 (19.1%), followed by dyspepsia in 143 (17.4%), upper gastrointestinal (UGI) bleeding in 136 (16.5%), recurrent abdominal pain in 94 (11.4%), unexplained anemia in 74 (9%), recurrent vomiting in 50 (6.08%), chronic refractory gastroesophageal reflux disease in 34 (4.1%) and others; 780 out of 822 endoscopic procedures (94.9%) done in children were appropriate as per the guidelines. The endoscopic yield was 45.8%, highest in patients with UGI bleeding (71.3%), followed by variceal surveillance (54.8%), recurrent vomiting (38%), dyspepsia (37.8%), and recurrent abdominal pain (36%). Minor adverse events occurred in 7.3% of children. @*Conclusions@#Pediatric endoscopy performed by an experienced adult gastroenterologist may be acceptable if done in cooperation with a pediatrician.

Lateral epicondylitis; comparison of autologous blood and corticosteroid in the treatment. A prospective, randomized, controlled trial

With aging, chemical hormonal and vascular factors have their part to play in lateral epicondylitis. The objective is to compare results of autologous blood injection and corticosteroid injection in treatment of lateral epicondylitis. Out Patient Department of Peshawar Institute of Medical Sciences, Peshawar from March 2013 to February 2014. Material and A prospective randomized control trail conducted on 58 patients fulfilling inclusion criteria. DASH score and VAS score used as outcome measures and both were recorded before injections and at each follow up made at 2 weeks, 6 weeks, 12 weeks and 24 weeks interval. P-value was calculated where applicable. Out of 79 patients 65 met the inclusion criteria. Mean age was 41.43 years +/- 13.43. 36 were females and 29 males. Dominant elbow involved in 39 patients. Mean duration of symptoms was 7.1 +/- 2.9 months. 7 patients lost in follow up. DASH score improved in both groups. but when compared there was no significance difference between the two groups [P value 0.33 at 12 weeks and 0.09 at 24 week follow up]. Similarly Mean VAS improved at 12 and 24 week follow up] in both groups but when compared the difference was non-significant [P value. 071 at 12 weeks and 0.12 at 24 weeks follow up. Both steroid and autologous blood injection has shown improvement in pain and physical activity and provide acceptable results although none superior to other significantly

one year review of various complications in fracture shaft of femur managed with closed intramedullary interlocking nail

To determine the frequency of complications in fractures shaft of femur managed by close antegrade intramedullary interlocking nail. It was a descriptive cross sectional study of one year duration from March 2010 to March2011 held at department of Orthopedics and Traumatology, Lady Reading Hospital Peshawar. Forty four consecutive patients with femoral shaft fracture fulfilling the inclusion criteria were managed with closed antegrade interlocking nail. Complications in terms of infection, angulation, rotation, non-union, shortening and knee stiffness were measured. The mean age of the patients was 33.70 +/- 14.53 years. Twelve patients [27.3%] were females and 32 [72.2%] were males. Thirty five [79.5%] had road traffic accident, 3 [6.8%] sustained fractures due to fall from a height and 6 [13.6%] were due to fire arm/bomb blast injury. Thirty five [79.5%] had close and 9 [20.5%] had open fracture. There were four cases [9.1%] of infection; [two superficial and two deep wound infection]. 40 patients [90.9%] regained full range of motion [0[0] - >130[0]] in knee and 4 patients [9.1%] had 0[0]-120[0] range of motion. There was only one case [2.3%] of up to 2.5cm limb shortening. 42 [95.4%] patients achieved union. Two [4.5%] patients had non-union. These patients were treated by standard protocol of exchange nailing after reaming and ultimately achieved union. Three cases [6.8%] had angulation of > 10[0] [dorsal or ventral]. None of our patients in this study had rotation deformity. Most common early complication with closed antegrade intramedullary nailing was infection and late complication was non-union