ABSTRACT
Objective: to determine the diagnostic yield and safety of capsule endoscopy for small bowel diseases
Introduction: the small bowel evaluation for any pathology has always been a difficult task because both upper GI endoscopy and colonoscopy could not access this area and other radiological tools like barium studies and CT enteroclysis were less sensitive with associated risk of radiation exposure. Only Push enteroscopy could evaluate the small bowel effectively but was laborious and invasive. Capsule endoscopy was introduced in year 2000 and was accepted with great enthusiasm all over the world3. Now, during the past few years it has also been used for the diagnosis of acute gastrointestinal bleeding in emergency departments and results are quite encouraging 5,6. The procedure was introduced at Department of Gastroenterology-Hepatology, Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan in year 2009. Since then, it has been regularly used for investigation of small bowel abnormalities
Methods: video Capsule Endoscopy [VCE] using GIVEN Imaging system was performed on 60 patients having various indications like obscure GI bleeding, undiagnosed iron deficiency anemia, abdominal pain and malabsorption. This was a retrospective analytic study carried out at the Department of Gastroenterology-Hepatology, Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan from February 2009 to June 2014. Statistical Analysis was done using SPSS version 22
Results: out of 60 patients, 41 [68.33%] were male, 19 [31.67%] were female. Mean age was 52 years with minimum 11 years and maximum of 85 years. No lesion was found on examination in 8.33% [n=5] patients while presence of blood in the gut resulted in poor visualization in 3.33% [n=2] patients. In remaining 88.34% [n=53] patients, the procedure detected various intestinal lesions. Our study detected presence of Angioectasias in 30.0% [n=18], visible vessels in 6.67% [n=4], strictures in 5.0% [n=3], small bowel ulcers in 10.0% [n=6], edema and erosions in 8.33% [n=5], loss of villi in 11.68% [n=7], intestinal worms in 3.33% [n=2], mass lesions in 8.33% [n=5] and Angioectasia with ulcers in 5.0% [n=3] of patients. The diagnosis in 3 patients was further verified by surgical operation, while enteroscopy was done in 2 patients for confirmation. Capsule impaction occurred in 2 patients. All images of Video Capsule Endoscopy [VCE] were of good quality
Conclusion: capsule endoscopy is a safe and effective procedure with a good diagnostic yield and can be used routinely for the diagnosis of small bowel diseases
ABSTRACT
Hypertension is commonly found in patients with Diabetic Kidney Disease [DKD]. Microalbuminuria is the first clinical sign of involvement of kidneys in patients with type 2 diabetes. Uncontrolled hypertension induces a higher risk of cardiovascular events, including death, increasing proteinuria and progression to kidney disease. To determine the correlation between microalbuminuria and hypertension and their association with other risk factors in type 2 diabetic patients. One hundred and thirteen type 2 diabetic patients attending the diabetic clinic of Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan were screened for microalbuminuria and raised blood pressure. The study was conducted from November 2012 to June 2013. Patients were divided into two groups. Group 1, those with normoalbuminuria [n=63] and Group 2, those having microalbuminuria [n=50]. Group 2 patients showed higher blood pressure values as compared to Group 1. The results were statistically significant and showed poor glycemic control as a contributing risk factor. The study concluded that there is high frequency of hypertension among type 2 diabetics but still much higher among those having microalbuminuria. So, early recognition of renal dysfunction through detection of microalbuminuria and to start treatment without any delay will confer future protection from end stage renal disease as well as hypertension and its complications in type 2 diabetic patients
ABSTRACT
Microvascular complications are the major outcome of type 2 Diabetes Mellitus progression, which reduce the quality of life, incur heavy economic burdens to the health care system and increase diabetic mortality. The aims of this study were to assess the prevalence of microvascular complications among newly diagnosed type 2 diabetic patients and to analyze the association between these complications and poor glycemic control. This cross sectional hospital based study was carried out in Diabetic Clinic of Shaikh Zayed Postgraduate Medical Institute, Lahore Pakistan. The study was conducted from November 2011 to November 2012 among newly diagnosed type 2 diabetic patients. Relevant information of all patients was recorded with the help of a proforma. They were investigated for retinopathy, nephropathy and neuropathy. We have divided the patients into two groups: Group I with good glycemic control [HbA1c < 6.5] and group II with poor glycemic control [HbA1c > 6.5]. In group II microvascular complications were 89.8%. Neuropathy, nephropathy and retinopathy were present in 68.5%, 56.2% and 31.4% respectively. These similar percentages in Group I were 50%, 0% and 31% respectively and are significantly lower. The study showed that even in newly diagnosed type 2 diabetic patients who had poor glycemic control, frequency of microvascular complications is much higher as compared to those who had average glycemic control. Thus tight glycemic control does count even in newly diagnosed type 2 diabetics to prevent and minimize the occurrence of complications