Commonest Presenting Complaint Research Articles

Extradural spinal arachnoid cysts: Management and outcome in five children

Abstract Background: Spinal extradural arachnoid cysts (SEACs) are rare lesions, which may become symptomatic due to mass effect or nerve root compression. They are discrete pockets of cerebrospinal fluid (CSF) communicating with subarachnoid space. These cysts may be single or multiple. Multiple cysts in the pediatric population are very rare, of which a few are reported to date. Materials and Methods: Here, we present a case series of five pediatric patients diagnosed with symptomatic SEACs and operated in our institute between the period of October 2017 and January 2021. The patients underwent surgery for excision of the cysts and closure of dural defects. The results were analyzed in terms of the clinical symptoms, location of cyst, surgical procedure performed, and outcome after surgery. Result: The mean age of presentation was 12 years. Common presenting complaints were lower limb weakness, pain, and bladder involvement. The median duration of symptoms before surgery was 7.8 months (mean 3 ± 12 months). Excision of cyst wall with closure of dural defect was done in all cases except one, in which the dural defect was not found. All cases gained near-normal muscle strength of lower extremities over a variable period of time after surgery. Conclusion: Pathogenesis of SEAC is not completely understood. Intraoperative localization and closure of the dural defect is the single most important step for excellent outcome.

Spectrum of Nasopharyngeal Cancers Seen in the Department of Radiation Oncology University College Hospital, Ibadan

Background: Nasopharyngeal cancer was initially thought to be an uncommon disease in Nigeria, but recent studies have shown a steady increase in the incidence of the disease with an associated increase in morbidity and mortality due to late presentation. Method: This was a retrospective review of patients with nasopharyngeal cancer seen in the department of Radiation Oncology U.C.H. Ibadan from 2000 to 2009. Patient's bio-data, clinical-pathologic presentation and site of referral were retrieved using data extraction form and subsequently analysed using Micrsoft Exel (2013). Results: A total of 205 patients with histologically confirmed nasopharyngeal cancer seen during the study period were analysed. The mean age of the patients was 41.7 years with 144 (70.2%) males and 61(29.8%) females. The commonest presenting complaint was cervical lymphadenopathy in 98.5% of patients followed by nasal blockade, nasal discharge and epistaxis with 82.0%, 78.0% and 51.2% respectively. Undifferentiated carcinoma was the commonest histologic type (68.8%). Majority of patients were civil servants (33.2%). The habit of smoking and alcohol ingestion were unspecified in majority of patients (43.4%). Ingestion of smoked fish has been found in majority of patients 122(59.5%) with the disease in this study. Most of the patients came from southern part of the country which coincide with geographic distribution of Burkitt lymphoma, hence the possibility of Ebsteinbarr virus (EBV) as one of the likely causative agents. Conclusion: Nasopharyngeal cancer is common. Cervical lymphadenopathy, nasal blockade with undifferentiated histology and late presentation were the norm. Referrals were from all the regions of the country.

Emergency Department Utilisation by Palliative Patients in a Regional Australian Setting.

Many palliative care patients attend emergency departments (EDs) in acute Hospital. However, very limited studies inform about their presentations and appropriateness. This study explored the reasons and appropriateness of palliative care presentations in a regional Australian ED setting. A retrospective, single-centre observational study was conducted in a regional Australian hospital. All patients between January and December 2018 known to palliative care services presented to ED were included. Appropriateness of presentations was determined based on urgency of tests and treatments received, and practicability of obtaining these in a different setting. A total of 35 patients made 85 presentations to the ED in 2018. The most common individual presenting complaints were shortness of breath (18.9%) followed by pain (14.1%), fever (11.8%), fall (8.2%), reduced oral intake or dehydration (8.2%), and bleeding (8.2%). The patients were brought by an ambulance in 56.5% presentations, and 63.5% presentations were admitted. About 93% presentations were referred by community healthcare professionals or required urgent investigation or management. This study found the majority of presentations were appropriate since their management could not be delivered at other primary care settings. This study adds value to the growing body of evidence and supports future multi-site longitudinal studies.

ETIOPATHOGENESIS OF VOCAL CORD PARESIS AND PALSY IN A TERTIARY CARE CENTRE- A PROSPECTIVE STUDY

The purpose of this study was to identify the patients with vocal cord paresis and palsy and to establish the etiology based on the study performed in a tertiary care centre. The study was done prospectively in the Department of ENT in Mahatma Gandhi Medical College & Hospital, Jaipur, for 1 year, from September 2020 to August 2021. 50 patients with vocal cord paresis and palsy were identied and examined by using exible or rigid laryngoscopy to make the etiological diagnosis. The etiology of vocal cord immobility was determined by history and complete head and neck examination. Patients in whom no cause was found, a CT scan from base of skull upto thorax was done before labelling them as idiopathic. Most patients presented with complaints of change in voice (92%). Other common presenting complaints included difculty in breathing, difculty in swallowing, vocal fatigue and cough. Unilateral vocal cord paralysis (88%) was more common than bilateral paralysis (12%), of which left (58%) was more commonly affected than right (42%) vocal cord because of longer intrathoracic course of left recurrent laryngeal nerve. The most common age group affected was 51–60 years (26%) followed by 61–70 years (18%). Males (60%) were affected more than females (40%) in a ratio of 3:2 and among the affected males 80% were known smokers. The most common cause of vocal cord paresis and palsy was found to be malignancy larynx (36%), followed by idiopathic (28%). Other causes included carcinoma of lung, thyroid and oesophagus, inammatory, traumatic, systemic diseases like Rheumatoid Arthritis and Hypertension leading to stroke. Identifying the exact etiopathogenesis of vocal cord paresis and palsy in patients has been a challenge and is very important in order to establish a proper diagnostic and treatment protocol for these patients.

Clinical Profile of Children with Acute Kidney Injury in a Tertiary Care Hospital, Dhaka, Bangladesh

Introduction: Acute Kidney Injury (AKI), formerly known as Acute Renal Failure, is defined by a reversible rise in creatinine and nitrogenous waste product concentrations in the blood, as well as the kidney's inability to control fluid and electrolyte balance correctly. Whether the cause of AKI differs in different regions of the world, the incidence of AKI in children appears to be growing. Over the last several decades, the etiology of AKI in hospitalized children has changed from primary renal disease to multiple reasons, particularly in hospitalized children. As a result, research is required to identify the most current trends in AKI in this region. Because it continues to be associated with significant mortality and morbidity in poor nations with inadequate resources, including renal replacement treatment. Aim of the study: The aim of the study was to observe the clinical profiles of hospitalized acute kidney injury children. Methods: This prospective longitudinal study was performed in the Department of Pediatrics, Dhaka Shishu Hospital, Dhaka, during the period of 12 months from January 2015 to December 2015. A total of 50 children were selected from the ones admitted into the hospital following the inclusion and exclusion criteria. A detailed history was taken, thorough physical examination and relevant laboratory investigations were done in all enrolled patients. All underwent necessary supportive care as needed until discharge or death. Result: In the present study, the mean age of the children was 2.8 ± 1.9 years, with the youngest one being 4 days and the oldest, 12.5 years. Male: female ratio was 1.8:1. Children in the age group of 1-5 years were most commonly affected. The most common clinical feature was oliguria 88%. Diarrhea and peripheral edema were other common presenting complaints. Etiology of AKI was mainly pre-renal 64%, followed by renal 26% and post-renal 10% causes. The overall mortality rate was 22%. Conclusion: It was observed ..........

PRIMARY THYROID LYMPHOMA: A CASE SERIES

OBJECTIVE: To find out about the disease characteristics of primary thyroid lymphoma in Pakistani patients. METHODS: In this retrospective study of 20 years duration, we reviewed five diagnosed and/or treated cases of primary thyroid lymphoma at the Aga Khan University Hospital (AKUH), Karachi, Pakistan. Each patient’s medical records were reviewed and studied. RESULTS: Mean age of the participants was 62.8±10.2 years with 3 males and 2 females. Two patients presented at the age of 69 and 70 years, and two patients presented at ages of 47 and 58 years. All our patients presented with a rapidly progressing neck mass and dysphagia. Other common presenting complaints in our study subjects included dyspnea, hoarseness of voice, stridor and feeling of globus in the throat. Average duration of presentation of our cases was 3 months, with 2 patient’s presenting after a month of development of symptoms, while the remaining two participants presented at four and six months after onset of signs and symptoms. All patient’s histopathology was consistent with Diffuse B cell Lymphoma subtype. Out of the five patients, one patient died as a result of complications, one patient opted out of treatment at AKUH due to financial constraints and three patients are doing well with no active complaints and followed-up regularly. CONCLUSION: Primary thyroid lymphoma is a rare condition and can present with neck swelling and compressive symptoms. Diagnosis is based on the histological findings. Larger studies are needed to study the prognosis of the patients.

EP.WE.330The role of computerized tomography scan in 2 week wait colorectal pathway during COVID-19 pandemic

AimsThe standard way to investigate patients referred on the two week wait colorectal cancer (2WW) pathway is to do a colonoscopy when patients are deemed fit. Due to limited endoscopy services during the COVID-19 lockdown period, we performed computerized tomography scan of thorax, abdomen and pelvis (CT TAP) for all fast-track colorectal referrals in addition to colonoscopy when service restarted. The aim of this study is to assess the benefit of CT scan in this group of patients.MethodsAll 2WW patients referred to our district general hospital from April 1, 2020 to July 31, 2020 were included in the study. The data were collected retrospectively from GP referral forms and the electronic patient records. Patient demographics, presenting complaints, investigations, diagnosis and treatment were recorded.ResultsA total of 658 patients were included in the study. The commonest presenting complaint was change in bowel habit (62.5%). A total of 414 colonoscopies, 347 CT TAP, 89 flexible sigmoidoscopies and 37 CT colonography were performed. 194 patients had both CT TAP and colonoscopy and another 32 patients had both CT TAP and flexible sigmoidoscopy showing that 34% of patients had both CT TAP and endoscopy. 41 patients were diagnosed with colorectal malignancy (6.2%) and 120 had polyps (18%). CT TAP missed 3 colorectal cancers but picked up 28 patients (4.3%) diagnosed with extra-colonic tumours.ConclusionsColonoscopy remains the gold standard for investigating colorectal cancer. However, CT scan have their value in diagnosing extra-colonic tumours in this specific group of patients.

Cytomegalovirus retinitis in patients of non-Hodgkin\u2019s lymphoma: clinical presentations and outcomes

BackgroundCytomegalovirus (CMV) retinitis in patients with Non-Hodgkin’s Lymphoma (NHL) can occur even in the presence of high CD 4 counts and can behave differently when compared to CMV retinitis in human immunodeficiency (HIV) patients. It, therefore, becomes important to understand its varied presentations and the challenges in management of these cases. The aim of this study was to analyse the various patterns of presentations and outcomes of CMV Retinitis in patients with NHL.Study designA retrospective chart review of seven eyes of four patients of NHL presenting with CMV retinitis between June 2017 and May 2020 was done.MethodsClinical patterns of CMV Retinitis, CD4 counts at the time of presentation and the duration of treatment along with recurrences and time for recurrence of retinitis were assessed.ResultsGranular or indolent retinitis (6 out of 7 eyes) was the commonest form of CMV retinitis in patients of NHL. Three patients had a presenting CD4 count above 150 cells/mm3 and none of them were below 50 cells/mm3. Floaters were the commonest presenting complaint. All patients had vitritis and majority of the patients (3 out of 4) had anterior chamber (AC) inflammation. Two out of the 4 patients had a recurrence (mean time 33.8 days) after stopping the maintenance phase of ganciclovir and one patient had significant myelosuppression related to oral valganciclovir which required discontinuation of the drug.ConclusionCMV retinitis in NHL patients is usually of an indolent or granular type and can occur even in the presence of high CD4 counts as compared to patients with HIV. These patients may require a long term maintenance in view of frequent recurrences after discontinuation of treatment.

Predicting Outcome in Skull Base Osteomyelitis: An Assessment of Demographic, Clinical, and Pathological Attributes.

Objective Skull base osteomyelitis (SBO) is an enigmatic clinical diagnosis which is difficult to decipher and is associated with poor outcomes. The study aims to examine the demographic and clinical characteristics of patients with SBO and its outcomes. Materials and Methods Medical records of 30 patients with diagnosis of SBO over past 5 years were assessed for demographic and clinical characteristics, type of SBO, radiological parameters, treatment received, procedure performed, microbiological profile, comorbidities, and complications including cranial nerve (CN) palsies. These factors were analyzed for prediction of outcome (death or survival). Statistical Analysis Microsoft Office Excel 2010 SAS 10.0 for Windows was used. Student's t -test for continuous variables (age, duration of symptoms, number of days of hospitalization, and treatment duration) and chi-square test for categorical variables (imaging findings, symptomatology, presence of comorbidities, surgical procedure, complications, and type of antibiotics) were utilized. Results We found SBO was the disease of elderly population (64.07 ± 6.13 years) with male predominance (83.3%) highly associated with uncontrolled diabetes status (93.3%). Headache (100%) and CN palsy (80%) were the most common neurological presenting complaints followed by stroke (17%) and encephalopathy (10%). Pathological and radiological correlation showed that fungal infection ( Aspergillus ) was associated with anterior SBO (10%), while bacteria ( Pseudomonas ) was cultured from posterior SBO (30%). Fifty per cent of patients were alive after 1 year out of which 33% had good functional outcome. The mortality rate was 33.3% in our cohort and multiple lower CN palsies ( p = 0.04), suboptimal duration of medical treatment ( p = 0.03), surgical intervention during clinical course ( p = 0.02), and development of intracranial or extracranial complications ( p = 0.03) were the predictors of mortality. Conclusion Early diagnosis including identification of pathogenic organisms and optimal duration of treatment are crucial factors for improved outcomes in SBO.

Common Presenting Complaints and Predisposing Factors among Adult Ophthalmic Patients with Low Vision and Blindness in Aba

Aim: To determine the common complaints and predisposing factors of low vision and blindness among adult ophthalmic patients in Abia State University Teaching Hospital, (ABSUTH), Aba, Nigeria.
 Study Design: A retrospective, descriptive study.
 Methodology: An institutional-based study involving 457 patients who attended Abia State University Teaching Hospital eye clinic between April and September 2018 was undertaken. The patients’ biodata, clinical history, ophthalmic examination findings, and results of ancillary investigations were obtained from patients’ hospital records within the period under study and analyzed using IBM SPSS version 25.0. AP-value of < 0.05 was taken to be statistical significant.
 Result: A total of 457 patients comprising of 206 males and 251 females, aged 18-85 years were seen in the study period. Based on World Health Organization (WHO)’s definition of low vision and blindness, two hundred and eighty-four (62.1%) patients had normal vision, 25(5.5%) patients had low vision while 32(7%) patients were blind. The most common complaint was blurring of vision, 136 (23.5%) followed by itching of the eye, 91 (15.7%) and tearing, 86 (14.9%). Forty percent of the respondents’ complaints had lasted for over 12 months before presentation at the clinic. Common predisposing factors for low vision and blindness observed in this study were hypertension (24.1%), previous drug use (5%), previous use of traditional medication (1.3%) and family ocular history (3.7%). No statistically significant association was found between diagnostic data and family ocular history, previous use of traditional medication and previous drug use. Statistically, significant relationship was found between diagnostic data and blood pressure (P< 0.001).
 Conclusion: There are various presentations of low vision and blindness in Aba. Routine eye check, early referral and appropriate treatment is advocated for the populace.

The association between presenting complaints and clinical outcomes in emergency department patients of different age categories.

Although aging societies in Western Europe use presenting complaints (PCs) in emergency departments (EDs) triage systems to determine the urgency and severity of the care demand, it is unclear whether their prognostic value is age-dependent. To assess the frequency and association of PCs with hospitalization and mortality across age categories. An observational multicenter study using all consecutive visits of three EDs in the Netherlands Emergency department Evaluation Database. Patients were stratified by age category (0-18; 19-50; 51-65; 66-80; >80 years), in which the association between PCs and case-mix adjusted hospitalization and mortality was studied using multivariable logistic regression analysis (adjusting for demographics, hospital, disease severity, comorbidity and other PCs). We included 172 104 ED-visits. The most frequent PCs were 'extremity problems' [range across age categories (13.5-40.8%)], 'feeling unwell' (9.5-23.4%), 'abdominal pain' (6.0-13.9%), 'dyspnea' (4.5-13.3%) and 'chest pain' (0.6-10.7%). For most PCs, the observed and the case-mix-adjusted odds for hospitalization and mortality increased the higher the age category. The most common PCs with the highest adjusted odds ratios (AORs, 95% CI) for hospitalization were 'diarrhea and vomiting' [2.30 (2.02-2.62)] and 'feeling unwell' [1.60 (1.48-1.73)]. Low hospitalization risk was found for 'chest pain' [0.58 (0.53-0.63)] and 'palpitations' [0.64 (0.58-0.71)]. Frequency of PCs in ED patients varies with age, but the same PCs occur in all age categories. For most PCs, (case-mix adjusted) hospitalization and mortality vary across age categories. 'Chest pain' and 'palpitations,' usually triaged 'very urgent', carry a low risk for hospitalization and mortality.

Tribal Odisha Eye Disease Study (TOES). Report # 8. Childhood cataract surgery and determinants of visual outcome in tribal districts.

Purpose:The purpose of this study is to describe the demographic profile, clinical features, visual outcomes, and follow-up patterns after successful cataract surgery in children from the tribal community in Odisha, India.Methods:We retrospectively reviewed records of tribal children aged 4 months–16 years, who underwent public health financed cataract surgery at our institute from January 1, 2015, to December 31, 2019. Collected data included demographic profile, clinical features, outcomes, and follow-up. Univariate and multivariate linear regression identified factors affecting the visual outcome at a 6-week follow-up.Results:During this period, a total of 352 children [536 eyes; mean age: 9.11 ± 4.4 years, 219 boys (62%)] underwent cataract surgery. The most common etiology and presenting complaints were idiopathic congenital cataract and decreased vision, respectively. In 304 children (86%), presenting best-corrected visual acuity (BCVA) was <20/200 (1.0 LogMAR), 113 (32%) had associated strabismus, and 57 (16%) had associated nystagmus. The public health agency did not sponsor postoperative follow-up, and only 195 (56%) and 61 (17.3%) children completed a 6-week and a 3-month follow-up, respectively. Median BCVA at 6-week and 3-month review was 20/125 (0.8, interquartile range [IQR], 0.2–2 LogMAR) and 20/60 (0.5, IQR, 0.25–1.35 LogMAR), respectively.Conclusion:This study showed that children from the tribal community presented late with poor presenting VA and had suboptimal visual outcomes with inconsistent follow-ups. Greater advocacy, delivery of care closer to the place of residence, and financial support for follow-up care could improve early detection, regular evaluation, and outcomes.

The demographics of Tolosa-Hunt syndrome in Qatar.

BackgroundTolosa Hunt syndrome (THS) is a rare disease that manifests mainly as painful unilateral ophthalmoplegia. It is caused by an inflammatory process of unknown aetiology within the cavernous sinus with a rare intracranial extension. The International Classification of Headache Disorders (ICHD)- 3 diagnostic criteria aids in its diagnosis. There is limited literature on its varied presentations, diagnosis, and management. Steroids are used in the treatment of THS with varied success.MethodsWe conducted a single-center-retrospective-study and included all patients admitted with a diagnosis of THS from January 2015 to December 2020. Descriptive and summary statistics were used to describe the study cohort's socio-demographic parameters.ResultsAmong 31 THS patients (predominantly Asians (18) and Arabs (9)), visual disturbance was commonest presenting complaint. Third-nerve paralysis was seen in 70.9% cases. Magnetic-resonance-imaging (MRI) was abnormal in 64.5%. 93.5% patients received steroids, with a response-rate of 70.9% and a recurrence-rate of 9.7%. A previous history of THS and female gender were associated with recurrence (p-value 0.009 and 0.018). Recurrence was seen in 66.7% fully recovered and 33.3% partially recovered cases (p-value 0.04). Among the benign and inflammatory subtypes of THS, the ICHD-3 criteria were applicable in 85% of inflammatory THS.ConclusionsTHS is a rare disease with ethnic variation in presentation and response to treatment. In our cohort female gender and a previous history of THS were associated with recurrence. ICHD-3 diagnostic criteria had a higher validity in our patients compared to prior studies, especially among the inflammatory THS.

Knowledge and practice regarding menstrual hygiene among urban adolescents- A cross-sectional study

Adolescence is the significant period in the life of a woman. Menstrual disturbances are the commonest presenting complaint in adolescent age group and unhygienic practices during menstruation can lead to untoward consequences like pelvic inflammatory disease and even infertility.To study the knowledge and practice regarding menstrual hygiene among adolescents.This is a cross-sectional study conducted from October 2018 to December 2018 among 100 adolescent girls who attended adolescent clinics at Urban Health Training centre of KBNU Medical College, Kalaburagi.The mean age of participants was 16.2 ± 2.1 SD. only 26% of participants were aware about menstruation before menarche. Majority (91%) of participants had knowledge about use of sanitary pads during menstruation but only 78% used them. The most common reason for non usage was the cost of pads (68%). The method of disposal was satisfactory among 62% of participants and 84% of participants change their pads /cloth pieces 2-3 times per day. Restriction of diet during menstruation was seen in 40% and 30% missed school during their periods.Although there was good knowledge regarding menstrual hygiene among adolescent girls, practice needs to improve. Health education sessions at urban health clinics and schools involving mothers of these adolescent girls can aid to overcome socio cultural practices of restricting movement and diet restrictions during menstruation.

Medico-social factors associated with late presentation in women with cancer of the cervix in Northern Nigeria

Cancer of the cervix is the commonest gynecological cancer and the leading cause of cancer mortality among women in Africa.Certain social behaviors have been associated with an increased risk of high-risk Human Papillomavirus (HPV) infection, which is responsible for virtually all cases of Invasive Cervical Cancer (ICC). Retrospective review of the medico-social and histo-pathologic patterns of cases of cancer of the cervix at the Gynecology Oncology Unit, Aminu Kano Teaching Hospital, Kano between January 2006 to December 2010 was conducted. The socio-demographic, medical and histological data of each patient were extracted and analyzed. A total of 91 cases of cancer of the cervix were identified. The mean age of the respondents was 48 years (SD±10.2years), mean parity was 7 (SD±3.2) and mean age at first marriage was 15.2 years (SD±1.9years). Most of the patients had being married more than once in their lifetime. Majority of the women were unemployed and over half had no formal education. The commonest presenting complaint and complication respectively was vaginal bleeding (72.5%) and anaemia (45.1%). Most of the patient had advanced stages of the disease (86.8%). Only 18 out of the 91 had undergone HIV testing, with 28% testing positive to the virus. The commonest histologic type of cervical cancer (85.7%) was Squamous Cell Carcinoma (SCC). There were statistically significant associations between advanced disease and age, parity and number of lifetime marriages. Patients with cancer of the cervix seen at our institution are within the reproductive age group. They are mostly grandmultiparous, have no formal education and have more than one life time marriages. They usually present with late stage disease and of SCC histologically.

Quackery as a Cause of Maxillofacial Infections and Its Implications.

Background:In recent times, the prevalence of quackery in oral and maxillofacial practice has become rampant with complications, one of which is odontogenic infections. This study was aimed to identify how common quackery is among our patients with odontogenic infections and the outcome of the patients.Materials and Methods:The study was a descriptive cross-sectional study of all patients presenting with odontogenic infections seen at the accident and emergency unit and the oral and maxillofacial surgery clinics of a tertiary hospital in North Central Nigeria from January 2017 to December 2021. Information obtained included sociodemographic characteristics, presenting complaints, duration of illness, prehospital care, diagnosis, duration of hospital stay, where the patient was first managed, what is the “doctor/dentist” status, and outcome.Results:A total of 237 patients were recruited with a male to female ratio of 1:1.3. The commonest presenting complaints were toothache and jaw swelling with patients been ill for up to 2 weeks before presenting. About 41.8% of the patients have a co-existing health condition, and 46.4% of the patients had tooth extraction by a quack, with 82.7% taking antibiotics prescribed by a chemist before presentation. About 11.0% of the patients died; 96.2% of those that died had their tooth extracted by quacks. Patients with preexisting health conditions and preadmission tooth extraction were more likely to die with odds ratio (OR) = 2.230; 95% confidence interval (CI) = 1.06–4.71 and OR = 28.9; 95% CI = 3.97–209.6, respectively.Conclusion:Quackery is very common in our society. The odds of death are increased in patients with odontogenic infection if the patient has a preexisting health condition and even more significant if they had their tooth extracted by quacks.

SPECTRUM OF FINDINGS IN PATIENTS PRESENTING FOR UPPER GASTROINTESTINAL ENDOSCOPY AT A TERTIARY CARE HOSPITAL AND THE INFLUENCE OF AGE AND GENDER

Objective: To determine the spectrum of findings in patients presenting for upper gastrointestinal (UGI) endoscopy and investigate role of age and gender.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of Gastroenterology &amp; Internal Medicine, Combined Military Hospital Kharian, from Jul 2017 to Mar 2019.&#x0D; Methodology: The data regarding 638 consecutive patients who underwent upper gastrointestinal endoscopy in the department were collected from the computer-based database and patients were stratified into two groups according to their age: ≤50 and &gt;50 years.&#x0D; Results: The mean age was 50.2 ± 17.4 (range: 7-100) years. There were 431 males and 207 females. The commonest presenting complaint was decompensated chronic liver disease (CLD) 162 (25.4%). The upper gastrointestinal endoscopy was normal in 306 (48%) and abnormal in 332 (52%) patients. The commonest abnormality seen on upper gastrointestinal endoscopy was esophageal varices seen in 167 (26.2%) followed by non-specific gastropathy, and hiatal hernia seen in 28 (4.4%) and 21 (3.3%) patients respectively. No significant differences were observed among males and females for a positive upper gastrointestinal endoscopy. Significantly large number of patients of age &gt;50 years had an abnormal upper gastrointestinal endoscopy (p&lt;0.001). The commonest upper gastrointestinal endoscopic abnormalities were similar in both genders and age-groups.&#x0D; Conclusion: The commonest finding on upper gastrointestinal endoscopy were esophageal varices and non-specific gastropathies. Females and patients ≤50 years had a higher prevalence of a normal upper gastrointestinal endoscopy. The commonly observed upper gastrointestinal endoscopy findings were generally similar among the genders and the age-groups.

Previously undiagnosed scoliosis presenting as pleuritic chest pain in the emergency department \u2013 a case series and a validating retrospective audit

BackgroundChest pain is one of the commonest presenting complaints in urgent/emergency care, with a lifelong prevalence of up to 25% in the adult population. Pleuritic chest pain is a subset of high investigation burden because of a diverse range of possible causes varying from simple musculoskeletal conditions to pulmonary embolism.Case seriesAmong otherwise fit and healthy adult patients presenting in our emergency department with sudden onset of unilateral pleuritic chest pain, within 1 month we identified a cohort of five patients with pin-point tenderness in one specific costo-sternal joint often with referred pain to the back. All cases had apparent and, previously undiagnosed mild/moderate scoliosis.MethodsTo confirm and validate the observed association between scoliosis and pleuritic chest pain, a retrospective audit was designed and performed using the hospital’s electronic medical record system to reassess all consecutive adult chest pain patients.ResultsThe Odds Ratio for having chest pain with scoliosis was 30.8 [95%CI 1.71–553.37], twenty times higher than suggested by prevalence data.DiscussionIn scoliosis the pathologic lateral curvature of the spine adversely affects the functional anatomy of both the spine and ribcage. In our hypothesis the chest wall asymmetry enables minor slip/subluxation of a rib either in the costo-sternal and/or costovertebral junction exerting direct pressure on the intercostal nerve causing pleuritic pain.ConclusionThorough physical examination of the anterior and posterior chest wall is key to identify underlying scoliosis in otherwise fit patients presenting with sudden onset of pleuritic pain. Incorporating assessment for scoliosis in the low-risk chest pain protocols/tools may help reducing the length of stay in the emergency department and, facilitate speedy but safe discharge with increased patient satisfaction.

Spectrum of ovarian tumors in a tertiary care hospital

Ovarian tumors are heterogeneous group of neoplasms with wide range of histopathological patterns. It is one of the leading causes of mortality in females. Often difficult to detect until they are advanced in stage or increased in size as symptoms are vague and insidious. Treatment and prognosis is based upon accurate surgical staging and thorough pathological evaluation. A total 150 cases were studied from June 2014 to May 2017. Their age, clinical presentation and histopathological findings were reviewed and analyzed. Out of 150 cases of ovarian tumors studied 119(79.3%) were benign, 9 (6.0%) borderline and 22 (14.6%) malignant. Age ranged from 9 to 80 years. The commonest presenting complaint in malignant and benign cases was pain in abdomen and in borderline cases abdominal distension. CA125, CEA and LDH were most commonly raised in 53.8%, 23% and 100% malignant cases respectively. Surface epithelial tumors were 68% followed by germ cell tumors 28% and sex cord stromal tumors 4%.

ACUTE PANCREATITIS IN PATIENTS WITH DIABETIC KETOACIDOSIS PRESENTING AT A TERTIARY CARE UNIT

Objective: To determine the frequency of acute pancreatitis among the patients diagnosed with diabetic ketoacidosis at our tertiary care hospital.&#x0D; Study Design: Co-relational study.&#x0D; Place and Duration of Study: Medicine department, Pak Emirates Military Hospital Rawalpindi, from Jun to Dec 2019.&#x0D; Methodology: A total of 40 cases presenting with diabetic ketoacidosis were included in our study. Diabetic ketoacidosis was diagnosed by consultant medical specialist. All patients underwent baseline investigations including serum amylase, lipid profile and CT scan abdomen in order to diagnose acute pancreatitis. Relationship of age, gender, duration of diabetes mellitus and triglyceride levels was assessed with the presence of acute pancreatitis among the patients of diabetic ketoacidosis.&#x0D; Results: A total of forty patients were managed as diabetic ketoacidosis in our hospital during the study period. Out of them 8 (20%) had acute pancreatitis while 32 (80%) were not diagnosed with acute pancreatitis. Confusion (55%) was the commonest presenting complaint followed by abdominal pain (25%). With binary logistic regression analysis, we found that female gender and raised triglyceride levels had a statistically significant relationship with presence of acute pancreatitis among the patients of diabetic ketoacidosis included in this study.&#x0D; Conclusion: Considerable number of patients were diagnosed with acute pancreatitis who presented with diabetic ketoacidosis. Special attention should be paid towards female patients and those with raised triglyceride levels to look for the sign and symptoms of acute pancreatitis in order to diagnose and manage this condition.