Gastrointestinal Bleeding in Patients With Acute Respiratory Distress Syndrome: A National Database Analysis.

BACKGROUND: The goal of our study was to determine the impact of gastrointestinal bleeding (GIB) on in-hospital outcomes among acute respiratory distress syndrome (ARDS) patients, and subsequently determine the potential risk factors for the development of GIB. METHODS: ARDS patients with and without GIB were identified using the National Inpatient Sample (2002 - 2012). Linear regression analysis was used to assess impact of GIB on in-hospital mortality, length of stay and total charges. Univariate logistic regression was used to determine associated odds ratios (OR) for causes of ARDS and common comorbid conditions. RESULTS: We identified 149,190 ARDS patients. The incidence of GIB was the highest among patients > 60 years (P < 0.001). GIB was associated with longer hospitalization days (7.3 days versus 11.9 days, P < 0.001), higher mortality (11% versus 27%, P < 0.001) and greater economic burden ($82,812 versus $45,951, P < 0.001). GIB was common in cirrhosis (OR: 8.3), peptic ulcer disease (OR: 3.7), coagulopathy disorders (OR: 3.003), thrombocytopenia (OR: 2.6), anemia (OR: 2.5) and atrial fibrillation (OR: 1.5). ARDS secondary to aspiration pneumonia (OR: 2.0), pancreatitis (OR: 2.0), sepsis (OR: 1.6) and community acquired pneumonia (OR: 0.8) was more likely to have GIB. CONCLUSION: Our study demonstrates that GIB in ARDS patients is associated with significant increased mortality, hospitalization and health care cost.

Histopathological features of coeliac disease in a sample of Sudanese patients.

INTRODUCTION: Coeliac disease can occur at any age but is more common in children. Its diagnosis requires correlation between clinical presentations, serological results, endoscopic findings and histopathological classification using the modified Marsh grading system. This study of coeliac disease with biopsies received in the department of histopathology at Soba University Hospital, and Fedail Hospital aimed to gain insight into the demographic profile, clinical presentations and histopathological classification of patients with coeliac disease. METHODS: This was a descriptive study carried out at Soba University Hospital and Fedail Hospital during the period from January 2010-December 2013. Haematoxylin & Eosin and CD3-stained slides of small intestinal biopsies of coeliac disease patients were reviewed for various histological features (1) intraepithelial lymphocytes (IEL) count per 100 enterocytes, (2) crypt hyperplasia and (3) degree of villous atrophy. Based on the histopathological findings, the cases were categorized according to the modified Marsh classification. Demographic and clinical data were obtained from the patient request forms. The data were analyzed using Statistical Package for Social Sciences Software (SPSS). RESULTS: The study included 60 patients. Their age ranged from 2 to 70 years with a mean of 19.5 years (±15.7 SD). The most common age group was below 10 years old (41.6%). Male and female are equally affected. The most common clinical presentation was chronic diarrhoea (55.0%), followed by iron deficiency anemia (41.7%). The degree of villous atrophy ranged from complete atrophy (45.0%), marked atrophy (38.3%) to mild atrophy (16.6%). Marsh grade IIIC was the most common grade. The younger age-groups had a higher prevalence of iron deficiency anaemia and higher Marsh grade.

American Society for Gastrointestinal Endoscopy guidelines for appropriate use of colonoscopy: are they suitable for African patients?

This study investigates the appropriateness and diagnostic yield of colonoscopy referrals in an African setting using the American Society of Gastrointestinal Endoscopy guidelines: a prospective, descriptive, cross-sectional hospital-based study. A total of 311 patients were included in the study; 228 referrals (73.3%) were considered appropriate and clinically significant pathology was found in 157 patients, giving an overall diagnostic yield of 50.5%. Diagnostic yield in those with appropriate referrals was 58.8% and 27.7% (P = 0.004) in those with inappropriate referrals. In our setting these guidelines are useful in improving diagnostic yield and reducing the rate of inappropriate referrals for colonoscopy. However, patients above the age of 50 presenting with lower gastrointestinal symptoms should undergo a colonoscopy even if the indication was inappropriate, especially in countries which are not implementing colorectal cancer screening programmes for average risk patients.

Use of endoscopy in diagnosis and management of patients with dysphagia in an African setting.

The objectives of this study were to define the utility of esophagogastroduodenoscopy in the diagnosis and management of patients presenting with dysphagia and to determine the relative incidence of the various causes of dysphagia in Sudan. This is a prospective, cross-sectional, descriptive, hospital-based study carried out at the endoscopy unit of Soba University Hospital, Khartoum, Sudan. All patients complaining of dysphagia underwent upper gastrointestinal endoscopy with therapeutic intervention when necessary. A total of 114 patients were enrolled in the study, with a mean age of 47 years SD +/- 19 and a male to female ratio of 1 : 1.04. A benign condition was diagnosed in 56% of the cases; this included esophageal strictures in 21% of the cases and achalasia in 14%. Malignant causes were mainly due to esophageal cancer (40.4%) and cancer of the stomach cardia (3.5%). Therapeutic intervention was attempted in 83% of the cases. Risk factors predictive of a malignant etiology were age over 40 years (P < 0.000), dysphagia lasting between 1 month and 1 year (P < 0.000), and weight loss (P < 0.000). A barium study was performed in 35 cases (31%) prior to endoscopic examination and proved to be inaccurate in three cases (8.6%). Upper gastrointestinal endoscopy in our African setting is an accurate and useful investigation in the diagnosis and management of patients presenting with dysphagia. Patients over the age of 40 years presenting with dysphagia and weight loss are more likely to have a neoplastic disease and should be referred for urgent endoscopy.

Paediatric gastrointestinal endoscopy: experience in a Sudanese university hospital.

We investigated the indications for and findings of gastrointestinal (GI) endoscopy in all children < or = 16 years old referred for the procedure to the endoscopy unit at Soba University Hospital, Khartoum from January 2004 to January 2006. Thus 113 children were enrolled; 73% underwent upper GI endoscopy, 27% lower GI endoscopy (15% colonoscopy, 12% flexible sigmoidoscopy). Indications for upper GI endoscopy included haematemesis (24%), portal hypertension (21%), abdominal pain (16%) and vomiting (15%). Diagnoses included oesophageal varices (16%), gastritis (7%) and hiatus hernia (6%). Indications for lower GI endoscopy included rectal bleeding (87%), diarrhoea (19%) and anaemia (10%).

Paediatric gastrointestinal endoscopy: experience in a Sudanese university hospital

We investigated the indications for and findings of gastrointestinal [GI] endoscopy in all children </= 16 years old referred for the procedure to the endoscopy unit at Soba University Hospital, Khartoum from January 2004 to January 2006. Thus 113 children were enrolled; 73% underwent upper GI endoscopy, 27% lower GI endoscopy [15% colonoscopy, 12% flexible sigmoidoscopy]. Indications for upper GI endoscopy included haematemesis [24%], portal hypertension [21%], abdominal pain [16%] and vomiting [15%]. Diagnoses included oesophageal varices [16%], gastritis [7%] and hiatus hernia [6%]. Indications for lower GI endoscopy included rectal bleeding [87%], diarrhoea [19%] and anaemia [10%]

Effects of pH on the microhardness of resin-based restorative materials.

This study determined the effect of pH on the microhardness of commonly used resin-based restorative materials which included a resin composite (Esthet-X, Dentsply), a new generation compomer (Dyract Extra, Dentsply) and a giomer (Beautifil, Shofu). Fifty-four specimens (3-mm wide x 3-mm long x 2-mm deep) were made for each material. The specimens were divided into six equal groups and conditioned in the following solutions at 37 degrees C for one week: 0.3% citric acid at pH 2.5, sodium hydroxide-buffered citric acid at pH 3, 4, 5, 6 and 7. After conditioning, the specimens were subjected to hardness testing using a digital microhardness tester (load 500gf; dwell time 15 seconds). Data was analyzed using one-way ANOVA and Scheffe's test at a significance level of 0.05. The effects of pH on the microhardness of resin-based restoratives were material dependent. The compomer and giomer materials were more affected by acids of low pH than the composite material that was evaluated.

Effects of pH on the surface texture of glass ionomer based/containing restorative materials.

This study determined the effect of pH on the surface texture of commonly used posterior glass-ionomer based/containing restorative materials. The materials evaluated included a compomer (Dyract AP), a giomer (Beautifil) and two highly viscous glass ionomer cements (Fuji IX and Ketac Molar). A resin composite (Esthet-X) was used for comparison. Forty-two specimens (3-mm wide x 3-mm long x 2-mm deep) were made for each material. The specimens were divided into six groups and conditioned in the following solutions at 37 degrees C for one week: Citric acid (pH 2, 3, 4, 5 and 6) and distilled water (pH 7). After conditioning, the surface roughness (Ra, microm) of each specimen was measured using a surface profilometer (Surftest, Mitutoyo Corp, Tokyo, Japan). Data was analyzed using one-way ANOVA and Scheffe's test at a significance level of 0.05. The effects of pH on the surface texture of glass-ionomer based/containing restoratives were material dependent. Ra values ranged from 0.02 microm to 0.15 microm and 0.03 microm to 4.40 microm for pH 7 and 2, respectively. With the exception of the composite, the surface roughness of all materials evaluated was significantly affected by acids of low pH. The surface texture of highly viscous glass ionomer cements deteriorated significantly when conditioned in solutions of low pH, which makes them more susceptible to clinical failure.

Informed consent: optimism versus reality.

OBJECTIVE: To determine whether parents of children attending the outpatient general anaesthesia (OPGA) session at the Eastman Dental Hospital, London fully understand the proposed treatment. DESIGN: Observational study supported by structured questionnaires and interviews. SETTING: Casualty service in the Department of Paediatric Dentistry and the Victor Goldman Unit (a day-stay general anaesthetic unit) of the Eastman Dental Hospital. MAIN OUTCOME MEASURES: The parents' understanding of the consent was assessed based on their knowledge of the actual treatment procedure, the type of anaesthesia to be used and the number and type of teeth that would be extracted. RESULTS: Fifty-two of the 70 subjects (74%) approached completed both parts of the survey (interviews one and two). Results showed that 40% of the written consent obtained from the parents were not valid. The subjects' knowledge of the proposed treatment improved on the day of the actual treatment although 19% of them still did not fully understand the procedure. There was a statistically significant increase in the proportion of valid consent on the day of the actual treatment. Many of the subjects had no knowledge of the type of anaesthesia that would be used for their children but were more aware of the number and type of teeth that were going to be extracted. The time interval between the consent process and the actual treatment did not have any significant effect on the subjects' understanding of the consent, but it implied that with time the subjects' knowledge improved. CONCLUSION: A proportion of subjects did not fully understand the proposed treatment procedure even after being adequately informed. Appropriate measures should be taken to ensure that the patients or their guardians truly understand the proposed treatment.

Distribution of HLA-DQA1, polymarker, CSF1PO, vWA, TH01, TPOX, D16S539, D7S820, D13S317, and D5S818 alleles in East Bengali and West Punjabi populations from Indo-Pak Subcontinent.

Blood samples were collected from 115 individuals residing in the Pakistani state of West Punjab and 81 Bengali individuals residing in the state of East Bengal, India. These samples were analyzed for the loci HLA-DQA1, PM (LDLR, GYPA, HBGG, D7S8, and GC) and eight short tandem repeats: CSF1PO, TPOX, THO1, vWA, D16S539, D7S820, D13S317, and D5S818. Departures from Hardy-Weinberg (HWE) were observed in Punjabi population at LDLR, THO1, D13S317, D5S818, and D16S539 and at CSF1PO and THO1 in Bengali population.

DNA typing of samples for polymarker, DQA1, and nine STR loci from a human body exhumed after 27 years.

A body was exhumed from the ground after 27 years. Samples of femur bone, tooth, and a fingernail were collected and successfully subjected to DNA extraction, quantitation, amplification, and subsequently typed for DQA1, polymarker, and nine STR loci. All three types of samples were typed for D3S1358, vWA, FGA, D8S1179, D21S11, D18S51, D5S818, D13S17, D7S820, and amelogenin using ABI Prism 377 DNA sequencer.

Allelic distribution of nine short tandem repeat (STR), HLA-DQA1, and polymarker loci in an Omani sample population.

Allele frequency distributions of nine short tandem repeat (STR) loci, D3S1358, vWA, FGA, D8S1179, D21S11, D18S51, D5S818, D7S820, and D13S317, HLA-DQA1 and polymarker (PM) loci were studied in a sample population from Sultanate of Oman, Middle East. Blood samples were collected from 162 unrelated individuals. For all STR, HLA-DQA1 and PM loci, no deviations from Hardy-Weinberg equilibrium, based on the exact test, were observed. The most discriminating loci were D18S51 (PD=0.966) and FGA (PD=0.964), while the least informative locus is GYPA (PD=0.585). The allele frequency data may be useful in forensic case work.

Distribution of D1S80 alleles in the Bahrainian population.

This study demonstrates that the locus D1S80 is highly polymorphic in the Bahrainian population. There were 24 different D1S80 alleles and 51 distinct genotypes observed in 198 Bahrainians. There was one allele observed that was smaller than the 14 repeat allele. This data set meets the Hardy-Weinberg expectations (HWE) and could be a useful marker for parentage testing and forensic applications.

Typing of eight short tandem repeat (STR) loci in a Saudi Arabian population.

Allele frequency data for eight short tandem repeat (STR) loci, HUMF13A01, HUMFESFPS, HUMF13B, HUMLPL, HUMCSF1PO, HUMTPOX, HUMTHO1 and HUMvWA, were obtained for unrelated individuals in a Saudi Arabian population. All loci, except F13B (P = 0.037) and LPL (P = 0.035), meet Hardy-Weinberg expectations, based on the exact test. The most informative locus is HUMvWA (PD = 0.936) and the least discriminating is the HUMTPOX locus (PD = 0.820). There was only one observation of a departure from expectation from pairwise locus comparisons. These data can be used for estimating the frequency of STR profiles in a Saudi Arabian population.

Distribution of HLA-DQ alpha and polymarker (LDLR, GC, GYPA, HBGG, and D7S8) alleles in Arab and Pakistani populations living in Abu Dhabi, United Arab Emirates.

Randomly collected blood samples from 100 Arabs and 100 Pakistanis residing in Abu Dhabi were analyzed using the HLA-DQ alpha and polymarker (LDLR, GC, GYPA, HBGG, D7S8) PCR based reverse dot blot systems. Allelic frequencies for each allele and observed heterozygosity for each locus were calculated. Departures from Hardy-Weinberg expectations (HWE) were determined using the unbiased estimate of the expected homozygote/ heterozygote frequencies, the likelihood ratio test and the exact test. No significant departures from HWE expectations were detected.