Effects of ramadan fasting on peptic ulcer disease as diagnosed by upper gastrointestinal endoscopy

The diagnostic methods such as upper gastrointestinal endoscopy [UGE] have played an important role in the evaluation of peptic ulcer [PU]. Every year, millions of Muslims fast in Ramadan month. The aim of this study was to evaluate the effect of fasting on PU via UGE. Patients and methods: A total of 321 patients in the period from 2009 to 2011, who underwent UGE as a diagnostic work-up mainly for epigastric pain, were analysed. Patients were divided into three groups: Patients who have been evaluated by UGE, in the month just before Ramadan [group I, n = 69], in Ramadan month [group II, n = 132] and in the month just after Ramadan [group III, n = 120]. Continuous data were expressed as the mean +/- SD, and were compared with one-way analysis of variance [ANOVA] test amongst groups. Categorical data were given as percentages and were compared with the chi-squared test. Epigastric pain was the most common indication for referral in each group. Interestingly, the indication 'bleeding' was found to be the least in group II, but was far from statistical significance. The highest prevalence of duodenal ulcers and duodenitis was found in group II; the differences to the other groups were statistically significant. Duodenal ulcers and duodenitis were found more during Ramadan month. We recommend that, the patients with epigastric pain may fast by taking their medications

Surgical management strategies in patients with primary hyperparathroidism: Which technique in which patients?

This study was planned to investigate the efficacy of either 99mTc-sestamibi scan or ultrasonography in predicting the operative treatment in patients with primary hyperparathyroidism [PHPT]. Subjects and Method: Thirty patients [25 female, 5 male; mean age: 53 years] being operated for symptomatic primary PHPT were included in this study. Ultrasonography was used in 29 patients while 99mTc-sestamibi scintigraphy was done in 28 patients to localize the hyperfunctioning gland[s]. Standard bilateral neck exploration was done in 6 patients. Although unilateral intervention had been planned for 24 patients, bilateral intervention was performed in 9 of them. Sensitivity of 99mTc-sestamibi was 81%, while that of ultrasonography was 42%. 99mTc-sestamibi localization method led to misleading results in 10/28 [35.7%] patients. False-positive localization and accompanying thyroid pathologies played an important role in determining transition from unilateral to bilateral intervention. Our findings indicate that bilateral intervention remains a successful management option without prior localization in patients with PHPT especially in an endemic goiter region