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.

Immunological study of different fraction of wheat proteins

Wheat allergy specifically refers to the adverse reaction involving IgE antibody to one or more protein fraction of wheat such as albumin, globulin, gliadin and glutenin [gluten]. The majority of IgE-mediated reactions to wheat involve albumin and globulin fraction while gluten [gliadin and glutenin] also cause allergy [Celiac disease]. Allergic reactions to wheat may be caused by ingestion of wheat containing foods or inhalation of flour [Bakers asthma]. The present study was an effort to explore the antibody response of different proteins present in wheat. ELISA results revealed that the antibody response for albumin varied from 0.92-1.78, whereas, for globulin ranged from 1.39-1.60. Antibody response against glutenin and gliadin ranged from 0.57-1.05 and 0.98-1.95 respectively, among the different varieties of wheat. All the tested wheat varieties showed the significant difference antibody response against the different fractions of protein

Does preoperative predictive lung functions correlates with post surgical lung functions in lobectomy.

Background: Patients with normal pulmonary function tolerate removal of an entire lung without respiratory problems. In patients witth impaired pulmonary function, post resectional function is of importance for the assessment of surgical risk. This necessitates the ability to measure the relative contribution of the parenchyma to be resected to the total lung function and the predicted postoperative lung functions. Objective: To determine preoperative lung functions as assessed with split lung functions and correlates with postsurgical lung functions and to determine the effect of lung resections on spirometric lung function. Material and methods: All those patients planned for lung resection surgery were included in the study. Predicted postoperative FEV1 and FVC were calculated. Preoperative spirometry was performed within a week before surgery. Predicted postoperative values were calculated. Postoperative spirometry was performed at the end of first month, third month, and sixth month for each patient. The relationship between potential predictors and postoperative complications were assessed. The predicted values were correlated with measured values (actual values) during the postoperative follow up. Results: Lobectomy was done in 64 persons. The predicted postoperative FEV1 and FVC correlated well with observed FEV1 and FVC in lobectomy (p<.05). The mean preoperative FEV1/L were 1.8 and the mean predicted postoperative (L) FEV1 were 1.4. The mean FEV1 at 1 month follow up were 1.6 and the mean FEV1 at 3 month follow up were 179.8.

Characteristics of pseudoaneurysms in Northern India; risk analysis, clinical profile, surgical management and outcome

Objective: To determine the risk factors, clinical characteristics, surgical management and outcome of pseudoaneurysm secondary to iatrogenic or traumatic vascular injury

Methods: This was a cross-sectional study being performed in department of cardiovascular and thoracic surgery skims soura during a 4-year period. We included all the patients referring to our center with primary diagnosis of pseudoaneurysm. The pseudoaneurysm was diagnosed with angiography and color Doppler sonography. The clinical and demographic characteristics were recorded and the risk factors were identified accordingly. Patients with small swelling [less than 5-cm] and without any complication were managed conservatively. They were followed for progression and development of complications in relation to swelling. Others underwent surgical repair and excision. The outcome of the patients was also recorded

Results: Overall we included 20 patients with pseudoaneurysm. The mean age of the patients was 42.1 +/- 0.6 years. Among them there were 11 [55%] men and 9 [45%] women. Nine [45%] patients with end stage renal disease developed pseudoaneurysm after inadvertent femoral artery puncture for hemodialysis; two patients after interventional cardiology procedure; one after femoral embolectomy; one developed after fire arm splinter injury and one formed femoral artery related pseudoaneurysm after drainage of right inguinal abscess. The most common site of pseudoaneurysm was femoral artery followed by brachial artery. Overall surgical intervention was performed in 17 [85%] patients and 3 [15%] were managed conservatively

Conclusion: End stage renal disease is a major risk factor for pseudoaneurysm formation. Coagulopathy, either therapeutic or pathological is also an important risk factor. Patients with these risk factors need cannulation of venous structures for hemodialysis under ultrasound guide to prevent inadvertent arterial injury. Patients with end stage renal disease who sustain inadvertent arterial puncture during cannulation for hemodialysis should receive compression dressings for 5 to 7 days

Validity of pleural fluid protein in differentiating tuberculouse from malignant pleural effusion

Validity of pleural fluid protein in differentiating tuberculouse from malignant pleural effusion keeping histopathology as gold standard. Cross sectional study. This study was conducted in the Pulmonology department post graduate medical institute, Lady Reading Hospital Peshawar, Khyber Pakhtunkhwa [KPK] Pakistan from March 2009 to March 2010. One hundred and seventy nine patients having clinical suspicion of pulmonary tuberculouse and malignancy and fulfilling the inclusion criteria were subjected to Abrams needle biopsy, plural tissue was examined by histopathology. Biopsy in order to know the significant difference of pleural fluid protein level between tuberculous and malignant pleural effusion, histopathology finding and protein concentration were determined their frequency and percentage. Among total number of 179 patients one hundred and fourteen [63.69%] were male and sixty five [36.32%] were female. The age limit from 15-80 years, the result shows that 60.9% were tuberculous and 39.9% were malignant pleuraleffusion, among these malignant 20 [11.2%] showed primary and 50 [27.9%] secondary malignancy. Tuberculous PE was more common in younger age group while malignant PE in older age group, 32 number of patients falling in category A, 59 in category B, and 88 in category C.A protein level in belonging to category C, there was statistically significant difference between tuberculous and malignant PE, tuberculous PE have high concentration of protein than malignant PE, The category [A] have malignant PE. Plural fluid total protein level determination and differentiating is a valuable tool in reaching to the diagnosis of suspectedtuberculouse from malignant pleural effusion provided it is used in addition to the adequate clinical scenario

Frequency of urinary symptoms in post menopausal women with uerovaginal prolapse

To determine the frequency of urinary symptoms in postmenopausal women with Uterovaginal Prolapse. Descriptive study. This study was conducted in Department of Obstetrics and Gynecology Unit II, Dow University of Health Sciences and Civil Hospital Karachi Pakistan from July 2006 to June 2007/ 60 [sixty] Consecutive pts were included in the study through structural Proforma from the outpatient, ward or emergency. Informed consent was obtained. A detailed history and related examinations and investigations were done. These include Urine DR, Urine C/S and Urodynamics like cystometry in selected patients. Majority of Women found have symptoms were at the age of 60 yr [36.66%] While urinary symptoms less seen at the age of 80 yr [6.66%] while Parity 6-10 was higher in Postmenopausal women to have urinary symptoms [63.33%]. The urinary symptoms found in Postmenopausal women were frequent urine passing [33.33%], Nocturia [83.33%], Retention of urine [20.0%], Dysuria [26.66%], Voiding difficulty [53.35%], Urge incontinence [20.0%] and Stress incontinence [53.33%]. Pelvic organ Prolapse and urinary symptoms like incontinence are prevalent in older women and are associated with age. Large studies are required to assess the relationship of urinary symptoms with Uterovaginal Prolapse. Because these urinary symptoms effect over quality of life of women so it is recommended to reduce genital prolapsed and associated urinary symptoms by implementing some measures such as health education of women and weight control

Recurrent dermatomyositis manifesting as a sign of recurrent transitional cell carcinoma of urinary bladder: long-term survival

The association between urological malignancies and paraneoplastic syndromes has been well documented. We report a case of recurrent dermatomyositis manifesting as a sign of metastatic recurrence of non- muscle-invasive transitional cell carcinoma of the bladder, a relationship which has only been referred to in a few reports. The case highlights a few important clinical challenges; firstly, the importance of thorough investigation for underlying malignancy in patients with dermatomyositis, as successful treatment of such malignancy can lead to resolution of paraneoplastic symptoms, and secondly, a high index of suspicion of recurrence in cases where paraneoplastic manifestations recur. Metastatic pulmonary recurrence without local evidence of disease at a follow-up of 4 years makes this case unique. Moreover, in the light of our experience and reported literature, a framework is suggested to approach such a diagnostic dilemma in the future. Description of the case will guide clinicians in the future, in case they encounter such an unusual clinical scenario. This could also serve as a hypothesis-generating source for designing future research as well

Comparative efficacy of H[1] blocker, H[2] blocker, and corticosteroid individually and in combination in resolution of sign and symptoms of acute Urticaria

To compare the efficacy of H[1] blocker, H[2] blocker, corticosteroid in combination or individually in resolution of the sign and symptoms of acute urticaria. Randomized control trial. This study was carried out at Medical Department, Naseer Teaching Hospital, Peshawar, Khyber Pakhtunkhwa [KPK] for the period of six months [July 2012 through December 2012]. In this study 140 adult patients of both gender with acute urticaria were treated with either H[1] blocker [group A], H[2] blocker [group B] or in combinations of H[1] blocker + H[2] blocker [group C], H[1] blocker + H[2] blocker + dexamethasone [group D], H[1] blocker + dexamethasone [Group E], H[2] blocker + dexamethasone [Group F] or Dexamethasone [group G] alone. The end points were resolution of sign and symptoms in each group of patients [minimum 3 hours after treatment]. Pregnant females, anemic and Patients with cardiac disease were excluded. H[1]+ H[2] blockers + dexamethasone found to be most effective therapeutic combination [95% of patients] in resolution of sign and symptoms of acute urticaria, followed by H[1] blocker + dexamethasone [90%] and H[1]+ H[2] blockers [85%]. This study concludes that the combination of H[1]+H[2] blockers + dexamethasone is more effective in relieving the patient from the sign and symptom of acute urticaria as compared to H[1] blocker or H[2] blocker or dexamethasone given alone or in combination of any two

Bladder necrosis secondary to internal iliac artery embolization following pelvic fracture

A 49-year-old man following a road traffic accident [RTA] had an unstable pelvic fracture with urethral injury. Internal pelvic fixation with Supra-pubic catheter [SPC] drainage of his bladder was done. This failed to stop the bleeding and a pelvic angiography with bilateral internal iliac embolization using steel coils was performed successfully controlling the bleeding. After 4 weeks, the patient developed wound infection [Clavien Grade III] and on exploration, bladder necrosis was found. A urinary diversion using ileal conduit with excision of bladder was performed. A biopsy of the excised bladder confirmed bladder necrosis with a foreign material [coil] in one arterial lumen

pattern, presentation and management of pardah pin inhalation: report from a single center in northern india

Objective: To describe the clinical characteristics, presentation and management of Pardah pin inhalation in female teenagers of single center in northern India

Methods: This was a prospective cross-sectional study being performed in department of cardiovascular and thoracic surgery of Sher-i-Kashmir institute of medical sciences located in northern India from January 2009 to December 2012. We included 36 female patients with Pardah pin inhalation who were admitted to our center during the study period. All patients underwent rigid bronchoscopy under local or general anesthesia. We recorded the baseline characteristics including the demographic information, the site of the pin and clinical findings as well as the management strategies and the outcome of these patients

Results: All patients were female using scarf to wrap their head and neck as religious obligation. Mean age of the patients was 14.3 +/-3.6 years. The most common symptom was chocking followed by cough being reported in all [100%] and 31 [86.1%] patients respectively. Bronchoscopy was successful in removing the pin in 31 [86.1%] patients. Pins were located in right main bronchus in 20 [55.5%] patients, and in left main bronchus in 10 [27.7%] patients. There was no mortality in our series. Pin was removed in 31 [86.1%] patients with the help of bronchoscope, but 5 [13.9%] patients needed bronchotomy for removal of the pin. Average hospital stay was 12.43 +/-1.6 hours. 1

Conclusion: Rigid bronchoscopy is an ideal approach in management of Pardah pin inhalation. However somff patients may need bronchotomy to remove the Pardah pin

Efficacy of piroxicam in osteoarthritis

To evaluate the therapeutic efficacy of this most important nonsteroidal anti-inflammatory drug by using series of 60 patients with osteoarthritis. Cross sectional study. The prospecting study was undertaken from amongst patients visiting the outpatient orthopedic department of District Head Quarter Hospital Charsadda of Khyber Pakhtunkhwa [KPK] for the period of six months from 1[st] January 2011 to 30[th] June 2011. This study was conducted on a mixed population of patients presenting with symptomatic osteoarthritis, which is relatively a common disease. Studies have shown that, the age of 40, 0% of all persons developed from mild clinical symptoms to degenerative changes in their weight bearing joints. indicates a significant therapeutic efficacy as compared to placebo, both at the 2[nd] and 4[th] week of treatment, table 3 represent the comparison of Piroxicam with placebo in the reduction of mean walking pain [hip] 2[nd] and 4[th] week of treatment on the basis of four point scale. The present study revealed sustained and significant improvement in the osteoarthritis of the knee or hip joint with Piroxicam treatment resulting in marked reduction in night-pain mean walking pain, and improved objective assessment in the functions of affected joints as compared to the findings emerging out of the use of the naproxen, aspirin and placebo

Mitomycin C instillation following ureterorenoscopic laser ablation of upper urinary tract carcinoma

Instillation of Mitomycin C [MMC] should prevent implantation of cancer cells released during endoscopic treatment and prevent recurrences as seen in carcinoma of the bladder. To develop and evaluate a protocol for a single dose MMC instillation following Holmium: YAG laser ablation of upper urinary tract transitional cell carcinoma [UUT-TCC]. A single institute prospective study. MMC instillations protocol was designed and offered to patients between August 2005 and April 2011. Following tumor ablation, MMC was instilled into upper urinary tract [UUT] over 40 minutes. All the patients were regularly followed up. Twenty UUT units [19 patients] were managed for UUT-TCCs using our MMC protocol. Two UUT units had G1pTa tumors, 14 had G2pTa, 2 had G3pTa, and 2 had G3pT1. At a mean follow-up of 24 months [range 1-72 months], 13/20 [65%] of the UUT units remained cancer-free, 3 [15%] UUT units developed stricture and were treated with endoscopic dilatation, only 1 [5%] of these developed long-term complications. None of the patients developed postoperative renal impairment or systemic side-effects. Using a set standard protocol, MMC can safely be instilled into the UUT after TCC ablation with minimal complications or side effects, good preservation of renal function, and with a low recurrences rate comparable to the literature.

Significance of hypercholesterolemia in hypthyroid patients

Lipid and lipoprotein is influenced by thyroid hormone. Global distribution thyroid disease is very common in Indo- Pak. Hypercholesterolemia is common finding in hypothyroid patients. This study was conducted to know the prevalence of thyroid dysfunction and its relationship with dyslipidemia. Cross Sectional Study. The study was conducted at the Department of Pathology Jinnah Medical College Warsak Road Peshawar for the period from December 2012 to May 2013. 300 patients suspicious of thyroid element were included in study group. 100 healthy control subjects with no history of any thyroid and other chronic illness were included in control group, serum FT4, TSH and total cholesterol was estimated by Elisa and colorimetric method respectively and Results were analyzed by applying "student T test" and Chi-square". Out of 300 sera tested 78 [260] had thyroid dysfunction Hypothyroid patients serum showed significantly raised cholesterol level, however no significant association between total cholesterol and raised thyroxin level observed. Hypercholesterolemia was noted significantly in hypothyroid patients indicating need for monitoring the cholesterol level in thyroid dysfunction to avoid the risk of development of cardiovascular disease

Management of esophageal atresia and tracheoesophageal fistula - review of 05 years

To analyze the morbidity and mortality in 38 patients with variants of esophageal atresia and trachea-esophageal fistula who were treated between January 2007 and January 2012. This is a retrospective study. Data were collected from hospital records. The study was conducted at the Children Hospital Quetta from January 2007 to January 2012. The records of 38 patients of esophageal atresia and trachea-esophageal fistula were reviewed. The mean birth weight was 2.5 kg and mean gestational age was 38 weeks [range 30 to 38 weeks]. The risk classification was based on Waterston's classification and included 18 case of type[A] 12 cases of type [B] and 8 cases of type [C.] There were associated anomalies in many patients that included, cardiac, skeletal neurological and renal and anorectal defects. There was an anastomotic leak in 8 patients [21.05%], sepsis in 12 [13.5%], pneumothorax was recorded in 3 patients [7.8%].The results of this congenital malformation requiring surgical treatment, is less than optimal in our setup. The likely reasons are late presentation, and less than ideal neonatal services

Lung contusion: a clinico-pathological entity with unpredictable clinical course

Lung contusion is an entity involving injury to the alveolar capillaries, without any tear or cut in the lung tissue. This results in accumulation of blood and other fluids within the lung tissue. The excess fluid interferes with gas exchange leading to hypoxia. The pathophysiology of lung contusion includes ventilation/perfusion mismatching, increased intrapulmonary shunting, increased lung water, segmental lung damage, and a loss of compliance. Clinically, patient's presents with hypoxiemia, hypercarbia and increase in laboured breathing. Patients are treated with supplemental oxygen and mechanical ventilation whenever indicated. Treatment is primarily supportive. Computed tomography [CT] is very sensitive for diagnosing pulmonary contusion. Pulmonary contusion occurs in 25-35% of all blunt chest traumas

Pulmonary tuberculosis presenting with acute respiratory distress syndrome [ARDS]: a case report and review of literature

Tuberculosis is a very highly prevalent disease particularly in the developing world. In India one person dies of tuberculosis every minute. It can be a differential diagnosis of any disease ranging from infections to malignancies. But tuberculosis as a primary cause of respiratory failure requiring mechanical ventilation is an uncommon occurrence. Among patients with pulmonary tuberculosis, those with miliary or disseminated disease or having comorbidities like acquired immunodeficiency syndrome [AIDS] are especially prone to develop acute respiratory distress syndrome [ARDS]. We present a case of a young female with no comorbidities or immuno suppression who presented with ARDS to us. We initially managed with mechanical ventilation and broad spectrum antibiotics, but there was no improvement. Only after anti tubercular therapy [ATT] and corticosteroids the patient recovered

Addressing social determinants of health in Pakistan: moving from theory to practice in the pursuit of better health

The major proportion of the global burden of disease and causes of health inequities arise from the conditions in which people are born, grow, live, work, and age. These conditions are referred to as Social Determinants of Health [SDH], a term used to encompass the social, economic, political, cultural, and environmental determinants of health. The most important of these are distribution of income, discrimination on the basis of gender, class, ethnicity, disability, or sexual orientation, and political and governance structures that reinforce rather than reduce inequalities in economic power. It necessarily follows that addressing SDH will reduce health inequities and improve health outcomes. To highlight this important aspect of health, Pakistan carried out a national consultation on SDH from 27 to 29 April 2012 in Bhurban and intends to carry forward the process at provincial level as well in order to improve its low human development ranking and bring about better health outcomes. Despite a sub-optimal track record of inter-sectoral collaboration, there is every hope that this robust initiative of the country's Planning Commission, provincial governments and the World Health Organization will reap good dividends. Certain suggestions have been made to catalyze the process.

Incidence of colorectal cancer in Kashmir valley, India.

Background There is wide variation in the incidence of colorectal cancer globally and also within the same country among different racial or ethnic groups. The present population-based study was undertaken to determine the incidence of colorectal cancer in Kashmiri population which is non-migratory and ethnically homogeneous having stable food habits. Methods Over a period of one year, all newly diagnosed and histological proved cases of colorectal cancer in all possible areas, where such patients are diagnosed and treated were prospectively registered. Results A total of 212 cases of colorectal cancers were registered; of them 113 (53.3%) originated in the colon and other 99 (46.7%) in rectum. Male to female ratio was 1.2:1. The crude incidence rate of colorectal cancer was 3.65/ 100,000; it was 3.78 in males, and 3.50/100,000 in females. The incidence rates for colorectal cancer in Muslims and Hindus were different. The crude incidence rate for colorectal carcinoma was highest for district Srinagar 6.19/100,000 (urban area) and lowest for district Kupwara (rural area) 1.59/100,000. The highest numbers of cases were detected in the age group 55–59 years (n=34). The agespecific rate for colorectal carcinoma was highest in the age group 55–59 years (17.21/100,000), followed by 65–69 years (14.86/100,000). The age standardized incidence rate was 4.52/100,000 per year. The truncated age adjusted incidence rates in age group 35–64 years was 8.31/100,000; while that for colorectal carcinoma was 8.77/100,000 in males and 7.66/100,000 in females. Conclusion We conclude that the incidence of colorectal cancer in Kashmir valley is similar to that reported in the rest of India.

Validity of pneumonia severity index and CURB-65 severity scoring systems in community acquired pneumonia in an indian setting.

Background. Little information is available from India regarding prognostic factors in patients with community acquired pneumonia (CAP). Methods. Hospital-based prospective study to test the validity of pneumonia severity index (PSI) and the confusion, urea, respiratory rate, blood pressure, age over 65 years (CURB-65) risk scoring systems in patients with CAP (n=150). Results. Although both CURB-65 class ³III and PSI class ³IV were 100% sensitive in predicting death, CURB-65 class ³III had a higher specificity (74.6%) than PSI class ³IV (52.2%) when used to predict death. In both PSI and CURB-65 risk scoring systems, mortality rate, need for intensive care unit (ICU) admission, prolonged need for intravenous (I.V.) antibiotics, prolonged duration of hospital stay and need for admission to ICU increased progressively with increasing scores. The PSI class ³IV was more sensitive in predicting ICU admission than CURB-65. The duration of hospital stay was found to have a weak but significant correlation with PSI and CURB-65 criteria. Defervescence time also had a very weak but significant correlation with PSI and CURB-65 criteria. Duration of I.V. antibiotics had a moderately strong correlation with CURB-65 criteria but a weak correlation with PSI criteria. Conclusions. Both PSI and CURB-65 were found to have equal sensitivity to predict death from CAP. Specificity of CURB- 65 was higher than that of PSI. However, PSI was more sensitive in predicting ICU admission than CURB-65.