Pattern of medical diseases and determinants of prognosis of hospitalization during 2005 muslim pilgrimage [hajj] in a tertiary care hospital. A prospective cohort study

To document the pattern of medical diseases necessitating admission in a tertiary care hospital during Muslim pilgrimage [Hajj]. To assess the risk factors associated with mortality during hospitalization. The study was conducted at Al Noor Specialist Hospital, a 550-bed tertiary care teaching hospital, in Makkah, KSA. The participants included all Hajj patients admitted in the Department of Medicine in a 5-week period [January 3 to February 6, 2005] during the 2005 [1425 AH] Hajj. Information about demographics; past medical history; pre-Hajj functional status; presence of language barrier and translator availability; diagnosis for admission and complications during hospitalization including mortality was obtained prospectively using a standardized form. Six hundred and eighty-nine patients, belonging to 49 countries, with mean age of 62 years and male:female ratio of 1.8:1 were admitted. Two hundred-twenty [31.9%] had diabetes mellitus, 256 [37.2%] had hypertension, 219 [31.8%] had cardiac disease, and 103 [14.9%] patients had chronic lung disease. Of the 449 [65.2%] patients assessed, 284 [63.2%] patients had language barrier, and translator was not available for 152 [53.5%] of them. Pre-Hajj functional status assessment of 240 patients showed that 20 [8.3%] required assistance in performing activities of daily living [ADL], and 40 [16.7%] could not walk for half kilometer without difficulty. Common causes of morbidity were: 235 [34.1%] cardiovascular, 137 [19.9%] infectious and 85 [12.3%] neurological diseases. One hundered and fourteen [16.5%] patients died, with the common causes being pneumonia [28 patients], acute coronary syndrome [21], and stroke [20]. The risk factors associated with higher mortality were older age [65 +/- 1 versus 61 +/- 0.6 years, p=0.008], prior history of chronic lung disease [crude odds ratio, 1.81, p=0.034], dependence in any ADLs [4.90, p=0.025], inability to ambulate for half kilometer without difficulty [4.17, p=0.017] and non-availability of translator for patients with language barrier [5.51, p<0.0001]. Most patients were elderly with high prevalence of chronic medical disorders. Non-infectious diseases accounted for most morbidity and mortality. Pre-Hajj functional assessment should be carried out to identify patients at high risk of mortality. Provision of translator services for patients with language barrier is essential to improve future outcomes

role of computerized axial tomography [CT], ultrasonography [US], transhepatic cholangiography [PTC] and endoscopic retrograde cholangiopancreatography [ERCP] in differentiating inflammatory from malignant pancreatic focal mass lesion

Fifteen patients with focal inflammatory masses of the pancreas were thoroughly studied over 3-year period from 25 patients who have had suspected pancreatic disease. Ultrasound [US] and computerized axial tomography [CT] were performed as a screening. Subjective pancreatic enlargement and/or distortion [nodular or irregular contour] were detected in 15 cases. Transhepatic cholangiography [THC] was performed allowed a diagnosis of inflammatory disease in three patients demonstrating long smooth stricture of the common bile duct [CBD] and the 4th patient had a short, smooth stricture producing incomplete obstruction suggesting malignancy and in three the distal CBD was completely obstructed with rat- tail tapering highly suggestive of malignancy. Endoscopic retrograde cholangiopancreatography [ERCP] was successful in eight patients since they permitted pancreatitis in three, two patients malignancy could not be determined and three patients had findings usually associated with malignancy, two of them had complete obstruction of the pancreatic duct, while one had "double duct sign". The mass identified by CT usually of the same pancreatic attenuation, although five contained small areas of low attenuation suggesting inflammation. Ten patients with pancreatic head mass demonstrated obstructive jaundice. On US the inflammatory masses appeared hypoechoic. The pancreatic duct was identified sonographically in four of five patients seen by CT

Transvaginal sonographic histerohydrotubation versus hysterosalpingography in infertile women

Lipoidal hysterosalpingography [HSG] and vaginal sonographic histerohydrotubation [VSHT] were done in forty infertile women VSHT was done by transcervical injection of saline [20 - 50 ml] through a Foley's catheter [8 - 10] with sonographic detection of saline passage through the uterine cavity [expansion and decompression with turbulence] to be collected in Douglas pouch [tubal patency] VSHT versus HSG findings were bilateral patency [29 [72.5%] vs 26 [65%]], bilateral block [8 [20%] vs 10 [25%]], right block [2] [5%] for each] and left block [1 [2.5%] vs 2 [5%]], Sensitivity and negative predictive values of VSHT were 100% vs specificity was also above 90%, while the positive predictive value was ranged from 75% up to 80%, so VSHT is a useful diagnostic procedure in evaluation of tubal factor in problem of infertility