Diagnostic upper gastrointestinal endoscopy

To evaluate Oesophagogastroduedenscopy [OGD] in term of its indications and endoscopic findings. Retrospective audit. Medical "C" unit Department of Medicine Government Lady Reading Hospital Post Graduate Medical Institute Khyber Medical University Peshawar from July 2002 to June 2007. Adult patients who underwent upper gastrointestinal [GI] endoscopies during the last 5 years period were included in the study. The procedure was performed as per the standard protocol with diagnosis based on established criteria. A total of 2282 were scoped 53.3% [n=1216] were female and 467% [n=1066] male. The mean age of the study population was 43.75 Standard Deviation [SD] +/- 1800 Dyspepsia [54.5%], upper GI bleed [12.3%], recurrent vomiting [11.1%] and dysphagia [7.8%] accounted for the common indications of the procedure. Endoscopy was normal in 164% [n=374] of patients Amongst the others [n=1908] single endoscopic diagnosis was made in 91% of the patients and in the remaining 9% of patients combination of lesions were seen. The endoscopic findings included gastritis and duodenitis alone or in combination [29.4%] oesophagitis [13.9%] duodenal ulcer [6.6%] gastric ulcer [7.4%] oesophageal varices [3.7%] and growth oesophagus [2.9%]. Gastric ulcer was more common than duodenal ulcer. Upper GI endoscopy is safe and an excellent diagnostic modality with high diagnostic yield. Dyspepsia upper GI bleed recurrent vomiting and dysphagia are the commonest indication for OGD. Gastro-duodenitis oesophagitis peptic ulcer disease oesophageal varices and growth oesophagus are the common endoscopic diagnosis

Percutaneous needle peritoneal biopsy in the diagnosis of exudative ascites

Percutaneous needle peritoneal biopsy in diagnosis of exudative ascites has gained wide acceptance and many workers have utilized it with a high diagnostic yield and no significant complications. Present study has been carried out to determine the efficacy of percutaneous needle peritoneal biopsy in the diagnosis of exudative ascites of unknown aetiology. It is a descriptive case study conducted in Medical 'C' Unit, Lady Reading Hospital, Postgraduate Medical Institute, Khyber Medical University Peshawar over a period of 2 years, i.e., from Nov, 2003 to December 2005. A total of 45 patients having unexplained exudative ascites underwent blind needle peritoneal biopsy. The biopsy specimen was subjected to histopathology. Ascitic fluid was also obtained for analysis. Post biopsy patients were observed for 24 hours for any untoward complications. A total of 45 patients [17 male and 28 female] with age range from 20 to 65 years and having exudative ascites were studied. The commonest presentation of our patients was abdominal distension [93.3%], pain abdomen [46.67%], fever [44.4%] and weight loss [33.3%]. Histopathology of the peritoneal biopsies was reported as follows. Eighteen cases [40%] showed non specific chronic inflammation, 10 [22.2%] cases showed caseating granulomatous inflammation suggestive of tuberculosis and 6 [13.3%] cases showed metastatic adenocarcinoma. In one patient peritoneal mesothelioma was reported. In the remaining10 patients [22.2%] biopsies were either non representative or inconclusive. The ascitic fluid showed predominantly lymphocytes in 86.6% of cases. Only three patients were reported to be having atypical cells on fluid cytology. The procedure was found safe. No patient was lost due to complications related to the procedure. Only one patient had evidence of intra peritoneal bleed. The commonest problem post biopsy was pain [91.1%] and mild swelling [53.3%] at biopsy site. Peritoneal biopsy is fairly safe and inexpensive procedure with good diagnostic efficacy in patients with undiagnosed exudative ascites

Upper gastrointestinal endoscopic findings in patients with dyspepsia

The aim of the study was to evaluate oesophagogastroduedensocopy [OGD] findings in patients presenting with dyspepsia. This retrospective, observational study was conducted in Medical "C" unit. Department of Medicine Post Graduate Medical Institute Government Lady Reading Hospital Peshawar from August 2002 to September 2005. Adult patients who underwent upper gastrointestinal [GI] endoscopies for dyspepsia during the period were included in the study. The endoscopies were performed as per the standard protocol with diagnosis based on accepted criteria. A total of 765 patients with dyspepsia had endoscopy. Amongst them 49.8% [n=381] were female and 50.2% [n=384] male. The mean age of the study population was 39.43 years [SD+ 17.46]. A single endoscopic diagnosis was made in 57.2% [n=438] of the studied patients. In 12.8% [n=98] combinations of lesions were seen. Gastritis [13.85%, n=106], oesophagitis [11.1%, n=85], duodenal ulcer [8.1%, n=62], hiatus hernia [7.32%, n=56], duodenitis [7%, n=54%] and gastric ulcer [3.4%, n=26] were the common finding on endoscopy. Duodenal ulcer was more common as compared to gastric ulcer [8.1% vs. 3.4%]. Endoscopy was normal in 30% [n=229] of patients. These patients apparently had functional dyspepsia. Gastro-duodenitis, oesophagitis, peptic ulcer disease and hiatus hernia are the commonest endoscopic diagnosis in patients with dyspepsia. Upper GI endoscopy is a useful diagnostic modality in elucidation of the causes of dyspepsia

Frequency and clinical course of hepatitis E in tertiary care hospitals

To find out the frequency of hepatitis E virus as a cause of acute hepatitis and its clinical course in hospitalized patients. Design: Cross-sectional hospital-based study. Place and Duration of Study: The study was conducted in two tertiary care teaching hospitals i.e., Khyber Teaching Hospital and PGMI Lady Reading Hospital, Peshawar [Pakistan] from January to December 2002. Patients and Amongst the total number of 1922 admitted patients, 148 had history of nausea, vomiting and jaundice and raised serum bilirubin with raised hepatic transaminases [ALT], were screened for HBV [hepatitis B virus], HCV [hepatitis C virus] and subsequently for HEV [hepatitis E virus]. Acute hepatitis A, autoimmune hepatitis and Wilson's disease were excluded by doing appropriate test as and when required. The patients with hepatitis E were then monitored by checking their serial transaminases on day 1,4,8 and day 18 or until their transaminases dropped to normal. They were also clinically assessed and followed-up. Amongst the total admission of 1922 patients during one year period, 148 had acute hepatitis and out of these, 21 patients [14.189%] suffered from hepatitis E. Seventeen patients were below the age of 40. There were increased number of cases during the late summer and early winter seasons. Majority of the hepatitis E patients recovered during the short follow-up period of two weeks. Two patients had fulminant hepatitis. A four months pregnant young female died of her illness despite intensive treatment. Hepatitis E virus is fairly common cause of acute hepatitis in hospitalized patients. Most of the patients are having a benign self-limiting illness