Clinical Characteristics of Patients With Ineffective Esophageal Motility by Chicago Classification Version 4.0 Compared to Chicago Classification Version 3.0

Background/Aims@#Chicago classification version 4.0 (CCv4.0) of esophageal motility disorders developed a more stringent diagnostic criteria for ineffective esophageal motility (IEM) than version 3.0. We studied the implications of the new diagnostic criteria on the prevalence of IEM, and clinically characterized and compared the population of patients who no longer meet diagnostic criteria for IEM to those who retain the diagnosis. @*Methods@#We included all consecutively performed high-resolution esophageal impedance manometries from 2014 to 2021. Three cohorts of patients with IEM were created: Patients with IEM by Chicago classification version 3.0 (CCv3.0; CC3 group), by CCv4.0 only (CC4 group), and by CCv3.0 who are now considered normal (Normal group). Demographics, manometric and reflux parameters, and clinical outcomes were compared. @*Results@#A total of 594 manometries were analyzed. Of those, 66 (11.1%) met criteria for IEM by CCv3.0 (CC3), 41 (62.0%) retained an IEM diagnosis using CCv4.0 criteria (CC4), while 25 (38.0%) patients no longer met criteria for IEM (Normal). The CC4 group had higher esophageal acid exposure, especially supine (% time - 18.9% vs 2.2%; P = 0.005), less adequate peristaltic reserve (22.0% vs 88.0%;P = 0.003), and higher Demeester score (49.0 vs 21.2; P = 0.017) compared to the Normal group. There was no difference in bolus clearance between the groups. @*Conclusions@#IEM under CCv4.0 has a stronger association with pathologic reflux, especially supine reflux, and inadequate peristaltic reserve, but impairment in bolus clearance is unchanged when compared with IEM diagnosed based on CCv3.0. Further studies are required to determine the implications of these findings on management strategies.

[Vertebral hydatidosis [Report of 22 cases]]

Hydatidosis affects the bone in 0.5 to 2% of cases, with 44% of these cases involving the spine. To describe the radiological characteristics of spinal hydrated. This retrospective study about 22 patients [14 men and 8 women] aged between 10 and 63 years old. The mean age was 29 years, they were explored by conventional explorations in 22 cases, myelography in 12 cases, computed tomography in 15 cases and magnetic resonance imaging in 3 cases. Imagning showed multicystic bony lesions. Thoracic involvement was present in 13 cases, lumbar involvement in 5 cases, cervical in 2 cases and sacral involvement in 2 cases. The process involved 2 adjacent vertebrae in 4 cases, 3 adjacent vertebrae in 5 cases, 4 adjacent vertebrae in 2 cases and the entite sacrum in 2 cases. Vertebral collapse was noted in 3 cases. The extension into the spinal canal was noted in 5 cases. Other sites of involvement were also noted, especially in liver and spleen. The presence of multicystic vertebral lesions with involvement adjacent soft tissues should raise the possibility of spinal hydatidosis in endemic countries

Neurological complications after acute organophosphorus poisoning

Study was done in medical unit 1 BV hospital Bahawalpur to evaluate the neurological complications in Surviving patients of acute organophosphorus poisoning. There were 38 patients of acute poisoning admitted in unit 1 from 1 Jan 1994 to 31st Dec 1995.5 patients died due to poisoning. Out of thitrythree surviving patients five developed pure motor polyneuropathy which was axonal type. The mean duration for appearance of axonopathy clinically following poisoning was 31.8 days. There was no sensory neuropathy and other neurobehavioural changes. On follow up visits for one year there was no improvement