Quality of colonoscopy and spectrum of lower gastrointestinal disease as determined by colonoscopy

To document the quality of colonoscopy practice and the pattern of colonic disease including polyp detection rate at Shifa International Hospital, Islamabad, Pakistan. An observational study. Shifa International Hospital, Islamabad, Pakistan, from May 2013 to June 2014. This retrospective study recorded demographics of patients, indications and quality indices of 505 colonoscopies performed during the study period. Preparation was done with low residue diet and polyethylene glycol. Conscious sedation was generally used. Quality indices studied were compared with guideline standard. Out of 505 colonoscopy patients, 305 were males and 200 were females. The indications for colonoscopic examination were lower gastrointestinal bleeding [26.5%, n=134], screening for colorectal cancer [14.1%, n=71], chronic diarrhea [12.9%, n=65], abdominal pain [10.9%, n=55], anemia [9.1%, n=46], constipation [7.3%, n=37], hematochezia and diarrhea [6.3%, n=32], altered bowel habits [5.1%, n=26], weight loss [3.6%, n=18], colonic thickening on CT scan [3.0%, n=15] and others [1.2%, n=6]. Bowel preparation was adequate [in 92%, n=465] cases. Cecal intubation rate was 88.71% [n=448]. Endoscopic diagnoses were hemorrhoids [36.2%, n=183], normal [22%, n=111], polyps [11.3%, n=57], ulcerative colitis [8.7%, n=44], cancer [4%, n=20], diverticulosis [3.4%, n=17], infective colitis [2.6%, n=13], intestinal TB [2.6%, n=13], non-specific colitis [2.2%, n=11], proctitis [1.8%, n=9] and others [5.3%, n=27]. There is room for improvement in quality of colonoscopy, cecal intubation rate is slightly below the recommended standard and polyp detection rate is quite low however, it is not clear if the low rate of polyp detection is due to missed lesions or low population incidence. Time to reach caecum and withdrawal time should clearly be documented in the notes which can help to evaluate quality of the procedure in a better way

Renal failure in patients with end stage liver disease and its impact on clinical outcome

To evaluate the prevalence of renal failure [RF] in the patients of end stage liver disease [ESLD], to determine the causes of RF in these patients and its impact on patient's outcome. Descriptive, analytical study. Shifa International Hospital, Islamabad, Pakistan, from May 2011 to March 2013. A total of 523 patients with end stage liver disease [ESLD] were evaluated, renal failure [RF] and its causes were recognized in these patients according to established criteria. Outcome of these patients was assigned as reversal of RF or mortality. Data was analyzed using SPSS version 16. Chi-square test was used for comparing proportions and t-test was used for comparing mean values. P < 0.05 was considered significant. Out of 523 patients, 261 [49.9%] had RF. Acute kidney injury [AKI] was the most common presentation seen in 160 [61%] patients. Hypovolemia and infections were the most frequent causes of RF. Mortality was significantly higher in the patients with RF, when compared to the patients without RF [31% vs. 4.5%, p < 0.001]. Reversal of RF was seen in 98 [37%] of the affected patients. Reversal was more common in the patients with hypovolemia. The mortality was higher in the patients with hepatorenal syndrome [HRS] and infections. Renal failure in the end stage liver disease is an important prognostic factor. Etiology of RF is the key factor in patients' outcome. Patients of ESLD with RF had higher mortality. Majority of the cases of RF were reversible in patients of ESLD coming in the setup

incidentally discovered asymptomatic para-aortic paraganglioma with peutz-jeghers syndrome

Peutz-Jeghers syndrome [PJS] is an autosomal dominant inherited disorder characterized by mucocutaneous melanin pigmentation and gastrointestinal [GI] tract hamartomatous polyps and an increased risk of malignancy. In addition to polyposis, previous studies have reported increased risk of GI and extra GI malignancies in PJS patients, compared with that of the general population. The most common extraintestinal malignancies reported in previous studies are pancreatic, breast, ovarian and testicular cancers. We report the case of a 17-year-old boy who presented with generalized weakness, recurrent sharp abdominal pain and melena, had exploratory laparotomy and ileal resection for ileo-ileal intussusception. Pigmentation of the buccal mucosa was noted. An abdominal computed tomography scan [CT] revealed multiple polyps in small bowel loops. Gastroscopy revealed multiple dimunitive polyps in stomach and pedunculated polyp in duodenum. Colonoscopy revealed multiple colonic polyps. Pathological examination of the polyps confirmed hamartomas with smooth muscle arborization, compatible with Peutz-Jeghers polyps. CT scan guided left para-aortic lymph node biopsy revealed the characteristic features of extra-adrenal para-aortic paraganglioma. Although cases of various GI and extra GI malignancies in PJS patients has been reported, the present case appears to be the first in literature in which the PJS syndrome was associated with asymptomatic extraadrenal para-aortic paraganglioma. Patients with PJS should be treated by endoscopic or surgical resection and need whole-body screening

Does countersinking improve implant primary stability in low density bone?

In order to evaluate the effect of countersinking on dental implants primary stability installed in low density bones, thirty dental implants were installed in the most proximal region of oxen ribs and grouped as follow: Group1: Fifteen implants installed by standard drilling with countersinking, Group2: Fifteen implants installed by standard drilling without countersinking. The graduated manual torque wrench and wireless resonance frequency analyzer were used to record the peak insertion torque [IT] and implant stability quotient [ISQ] values respectively. The results revealed a significant difference in IT and ISQ values between the two groups of study with higher values recorded in group two. From these findings and with the limitation of this study, it was concluded that in low density bones, the avoidance of countersinking during implant bed preparation will significantly increases implant primary stability

Evaluation of quality and patient satisfaction during endoscopic procedure: a cross sectional study from South Asian country

To assess the quality of gastrointestinal [Gl] endoscopic procedures and patient satisfaction in endoscopy suite of South Asian country. Patients coming to the endoscopic suite of Aga Khan University Hospital [AKUH] were interviewed and assessed in this cross-sectional study. Quality of Gl endoscopic procedures was evaluated using assessment tools as suggested by The American Society of Gastroenterology. Patient satisfaction after the procedure was assessed using a modified GHAA-9 questionnaire. The questionnaire was statistically evaluated using Pareto analysis and Spearman rank correlation. In this study, 323 patients were evaluated with a mean age of 43 +/- 14.36 years. Out of all the procedures 251 [77.7%] were gastroscopies while 72[22.3%] were colonbscopies. Patients undergoing different therapeautic procedures were 121 in number [37.46%]. Pre-procedure education was rated as excellent or very good by 91.3% of the patients. Midazolam was used for sedation with an average dose of 3 mg. Technically successful procedures included 99.2% gastroscopies and 98.6% colonoscopies. Mean score of patients regarding satisfaction on mGHAA-9 questionnaire was 30 +/- 3.965. Patient dissatisfaction calculated In our study was 3.6% with the length of time spent waiting before procedure and length of time waiting to get an appointment for the procedure contributing to 90% of dissatisfaction. Quality of endoscopic procedures at our centre is at par with international standards with acceptable complication rate and good patient satisfaction

Burden of common mental disorders in patients with Functional Dyspepsia

To assess the frequency of common mental disorders among diagnosed functional dyspepsia patients. A case-control study with 150 cases of functional dyspepsia [FD] and 150 healthy controls were recruited from Gastroenterology Clinic at the Aga Khan University Hospital Karachi from 1st March 2009 through 31st August 2009. Urdu version of WHO-developed Self-Reporting Questionnaire [SRQ] was administered to diagnose patients of FD and healthy controls. A cut off score of 8 on SRQ was used to confirm cases of Common mental disorders [CMD]. Data was entered and analyzed by SPSS version 16.0. There was significant difference in CMD i.e. 107 [71.33%] versus 23 [15.33%] in cases and controls respectively [p- <0.001]. Among cases CMD was more common in females i.e. in 57 [80.3%] as compared 50 [63.3%] in males [p- 0.022]. There is high prevalence of Common mental disorders among patients with functional dyspepsia and this needs to be addressed while treating patients