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.

D - dimers assay as an adjunct to diagnosis of cerebral venous sinus thrombosis

To determine the frequency of raised D-dimer in patients of cerebral venous sinus thrombosis [CVST] at Neurology Department, Military Hospital Rawalpindi. Descriptive study. One year duration conducted in the Department of Neurology at Military Hospital Rawalpindi from 1[st] May 2010 to 1[st] May 2011. Thirty patients were selected randomly from Neurology Department, who were recently diagnosed cases of cerebral venous sinus thrombosis [CVST] on the basis of magnetic resonance imaging [MRI] and magnetic resonance venography [MRV]. D-dimer test samples were drawn and subjected to latex agglutination test. There were 22[73.33%] males and 8[26.67%] females in our study. D dimmer assay analyses revealed 90% [27 patients] as positive and 10% [3 patients] as negative. Raised D-dimer levels are highly suggestive of CVST provided other conditions are clinically excluded and they can be used as an adjunct in the diagnosis of cerebral venous thrombosis

Treatment options for Guillain-Barre syndrome [GBS] - a comparative assessment of treatment efficacy between intravenous immune globulin [IVIG] with plasmaphoresis

To compare the therapeutic efficacy of Intravenous immune globulin [IVIG] with Plasma exchange [plasmaphoresis] in patients of Acute Inflammatory Demyelinating Polyneuropathy i.e. Guillain-Barre syndrome [GBS]. Randomized Controlled Trial [RCT]. The study was of 12 months duration conducted at Department of Medicine, Neurology Unit of Military Hospital Rawalpindi from Jun 2008 to Jun 2009. 60 Patients of GBS were randomly assigned to two treatment groups. Group A received Intravenous immune globulin [IVIG] and Group B Plasma Exchange. Patient's functional status according to London scale grade was assessed at the time of admission and at 02 and 04 weeks after giving treatment. Improvement in mean London scale Grades in each group was calculated at different weeks from baseline and then both groups were compared to each other. In each group there was significant improvement [P-value< 0.001] from baseline-2weeks and baseline-4 weeks. But when compared to each other both the groups had comparable improvement [p-value> 0.05]. Both IVIG and Plasma Exchange have equal therapeutic efficacy in the treatment of patients of GBS

comparison of pioglitazone with metformin in management of type 2 diabetes mellitus

To compare hypoglycemic effect of Pioglitazone and Metformin in type 2 Diabetes Mellitus. Quasi experimental study. Department of Medicine, Military Hospital Rawalpindi Cantt from 11-01-2007 to 12-08-2007. Sixty patients of type 2 diabetes mellitus from outdoor department were selected. On arrival at OPD each patient was examined thoroughly. Therapeutic option was allocated to the patients simply by using a table of random numbers and dividing them in two equal groups. Informed written consent was obtained. Each patient was followed on monthly subsequent visits [six in total] and his HbA1c, fasting and random blood glucose were recorded carefully. All the data thus obtained was processed and analyzed using SPSS version 10.0. Mean and SD were calculated for age, BMI, fasting blood glucose, random blood glucose and HbA1c levels. Mean drop of all three parameters were compared among two groups. At the end of six months, it was revealed that fasting and random [2 hours postprandial] blood glucose dropped more in Pioglitazone group; P=0.000 and 0.02 respectively. While almost comparable effect was observed in HbA1c [P=0.2]. Pioglitazone has significantly better hypoglycemic effect than Metformin in type 2 diabetes mellitus at the end of six months therapy

Comparison of 0.2 % glyceryl trinitrate and open lateral internal anal sphincterotomy in treatment of chronic anal fissures

To compare lateral internal sphincterotomy with 0.2 percent glyceryl trinitrate in the treatment of chronic anal fissure in terms of fissure healing and complications. Randomised Controlled Trials [RCT] Place and duration of the study: The study was of 6 months duration conducted at surgical unit Combined Military Hospital Rawalpindi from August 2006 to February 2007. Subjects and Seventy Patients were randomly assigned to two treatment groups. Group 1 was assigned to apply glyceryl trinitrate 0.2 percent paste while, in group 2 lateral internal sphincterotomy was done. Response to the treatment was assessed in terms of fissure healing and occurrence of complications. Follow up of the patients was carried out at the end of 2nd, 4th, and 6th week of treatment. In this study overall healing rate after 6 weeks with GTN was 71.4% and 100% with LIS [p< 0.001]. Conclusions: lateral internal sphincterotomy is better than GTN in fissure healing

Cardiovascular disease: a major future problem for Oman

Studies of village populations by medical students in oman have indicated moderately high prevalence rates of hypertension and obesity. With the known high prevalence of diabetes and an increasing trend towards cigarette smoking, attention is drawn to the likelihood of a future epidemic of cardiovascular disease in oman. A suggested strategy of transferring the responsibility for identification and management of risk factors for cardiovascular disease prevention from specialist to primary health care is suggested in an attempt to prevent this potential epidemic

Juvenile rheumatoid arthritis

Juvenile Rheumatoid Arthritis [J.R.A.] is a disease of children, of which joint swelling, pain and stiffness are the hallmarks and a high ESR is indicative of the continuing inflammatory process in the synovium. Permanent damage to joints may result. Correct diagnosis can only be made if the paediatrician is vigilant, as the disease may be misdiagnosed as minor trauma or rheumatic fever, or ignored altogether