scholarly journals EP.WE.913Evaluation of upper GI cancer diagnosis in suspected patients referred for OGD directly by GP vs Two Week Referral pathways

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Ahmed Abdelwahed ◽  
Izabela Slezak ◽  
Sarah Witting ◽  
Narayanan Vinod Kumar ◽  
Rudolf Zach ◽  
...  
Keyword(s):  
Direct Access ◽  
P Value ◽  
Inclusion Criteria ◽  
Administrative Work ◽  
Upper Gi ◽  
Group A ◽  
The Difference ◽  
Upper Gi Cancer ◽  
Group B ◽  
Access Pathway

Abstract Aim To assess whether the new direct pathway (requested by GP) has improved OGD accessibility and time of diagnosis for patients with suspected UGI cancer. The new system aimed to bypass a formal referral to UGI clinic. Methodology Retrospective study, compared two groups of patients (total 329). Group A (173 patients, TWW referral to UGI clinic who had endoscopy between March and May 2017), and Group B (156 patients, Direct access pathway by the GP to have the endoscopy between March and May 2018). inclusion criteria includes patients referred directly by the GP between March and May 2018, TWW patients referred March-May 2017. Patients who had OGD with suspected diagnosis other than UGI cancer were excluded. Data was compared in terms of gender, age, interval time between referral and OGD, and cancer findings. Findings Time between presentation and diagnosis in patients referred via Direct Access pathway was shown to be significantly shorter compared to patients admitted via TWW. The difference was 7 days in favor of the Direct Access pathway which was statistically significant (p value 0.001). Recommendations Direct access pathway has decreased the waiting time, expedited the management, potential money saved, more available clinic space and less administrative work.

scholarly journals Variable use of amiodarone is associated with a greater risk of recurrence of atrial fibrillation in the critically ill

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
N A Fahmy ◽  
S M Alfawal ◽  
H S Abdelsamie ◽  
A M Hassan
Keyword(s):  
Atrial Fibrillation ◽  
Prospective Observational Study ◽  
P Value ◽  
Loading Dose ◽  
Inclusion Criteria ◽  
Reactive Protein ◽  
Group A ◽  
Group B ◽  
Af Recurrence ◽  
New Onset

Abstract Background Atrial fibrillation (AF) is the most common sustained arrhythmia affecting humans. It is an electrical disturbance that leads to rapid, disorganized, and asynchronous contraction of the atrial muscle. In clinical practice, it accounts for approximately one-third of hospitalizations for cardiac rhythm disturbances. The incidence of AF increases from less than 0.1% per year in those under 40 years old to exceed 1.5% per year in women and 2% per year in men older than 80 years. Aim of the Work: to discuss the effect of variation in amiodarone use (including dosage and duration) on dysrhythmia recurrence in patients with new-onset AF in ICU. Patients and Methods This was a prospective observational study conducted over 6 months, 60 patients who fulfilled inclusion criteria were included in the study divided in two groups according to amiodarone dosage, each group is 30 patients: Group (A): received a loading dose of amiodarone followed by an infusion (1200mg amiodarone). Group (B): received a loading dose of amiodarone not followed by an infusion (300mg amiodarone). Results a significant positive correlation was observed between level of C-reactive protein (CRP) and the rate of AF recurrence. As regard effect of CRP on AF recurrence; in AF recurrent patients, mean is (191±77.3) with range from 15 to 352 which significantly differed from Non-recurrent AF patients, mean is (89±63) with range from 20 to 223 (p value <0.001). AF recurrence was higher in group (B) than group (A),. In group (A) 8 patients had recurrent AF representing 26.7 % and in group (B) 19 patients had AF recurrence representing 63.3% (p value =0.004). Conclusion Patients with new-onset AF in (ICU) who are treated with amiodarone should receive a loading dose, immediately followed by an infusion.

Dexamethasone Versus Ondansetron in Preventing Postoperative Nausea and Vomiting In Laparoscopic Surgery

2021 ◽  
Vol 17 (3) ◽  
pp. 222-226
Author(s):  
Anum Malik ◽  
Arshad Shahani ◽  
Jawad Zahir ◽  
Hassam Zulfiqar ◽  
Tabassum Aziz
Keyword(s):  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
P Value ◽  
Inclusion Criteria ◽  
Significant Difference ◽  
Quasi Experimental ◽  
Group A ◽  
The Mean ◽  
Group B

Objective: To compare the efficacy of dexamethasone 8mg versus ondansetron 4mg in preventing postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic cholecystectomy Methodology: This quasi-experimental study was conducted at the Department of Anaesthesia and Intensive Care, Holy Family Hospital from 29th July 2018 to 28th January 2019.  Anesthesia was induced with propofol (2mg/kg IV) and Atracurium (0.5 mg/kg IV) was given to facilitate tracheal intubation. Nalbuphine (0.2mg/kg) was used as analgesic.Patients were randomly divided into two groups. Patients in Group A received 4mg ondansetron at end of surgery and Group B received 8mg dexamethasone at induction. Results: A total of 90 patients were included according to the inclusion criteria of the study. The mean age (years) in the study was 37.11+10.60 years. Frequency and percentage of nausea (up to 24 hours) among both the groups was 28 (62.2) and 28 (62.2) respectively (p-value = 1.0) while the frequency and percentage of vomiting (within 24 hours after extubation) was 28 (62.2) and 27 (60.0) respectively (p-value = 0.829) Conclusion: The study concluded that there was no significant difference dexamethasone and ondansetron in preventing postoperative nausea and vomiting.

scholarly journals Comparison of Salbutamol and Salbutamol with ipratropium bromide in children with exacerbation of Asthma in terms of peak expiratory flow rate (PEFR).

2021 ◽  
Vol 28 (11) ◽  
pp. 1611-1615
Author(s):  
Sadaf Minhas ◽  
Saqib Aslam ◽  
Muhammad Azhar Farooq ◽  
Ayesha Anwar ◽  
Farhan Zahoor ◽  
...  
Keyword(s):  
Peak Expiratory Flow ◽  
Ipratropium Bromide ◽  
Controlled Trial ◽  
P Value ◽  
Significant Difference ◽  
Group A ◽  
Expiratory Flow ◽  
The Difference ◽  
Group B ◽  
Trial Setting

Objective: To compare the Salbutamol alone and Ipratropium Bromide supplemented Salbutamol in children with exacerbation of asthma in terms of PEFR. Study Design: Randomized Controlled Trial. Setting: Pediatrics Emergency, KRL Hospital Islamabad. Period: 1st August 2016 to 31 January 2017. Material & Methods: Group A patients were given only Salbutamol (0.15mg/kg per dose with minimum 2.5 mg, maximum 5 mg/dose). Group B was given Ipratropium Bromide supplemented Salbutamol (250 mcg/dose for <20 kg while 500 mcg/dose for >20kg of Ipratropium Bromide with same dose of Salbutamol as prescribed for Group A). Baseline spirometry was performed on each patient and after measurement of baseline peak expiratory flow. The outcome was measured by Peak flow meter and reassessed at 60 minutes. Results: Comparison of salbutamol alone and ipratropium bromide supplemented salbutamol in children with exacerbation of asthma in terms of PEFR shows that 40.5 + 4.28 in Group-A and 59.5 +4.75 in Group-B, P-value was calculated as 0.0001, showing a significant difference between the two groups while the difference in increase was recorded as 19%. Conclusion: We concluded that salbutamol alone is significantly less effective when compared with Ipratropium Bromide supplemented Salbutamol in children with exacerbation of asthma in terms of PEFR.

scholarly journals Airway Clearance in Bronchiectasis: A Randomized Control Trial of N-Acetylcysteine with 3% hypertonic saline

2019 ◽  
Vol 8 (3) ◽  
pp. 146-150 ◽  
Author(s):  
Muhammad Imran Shehzad ◽  
Muhammad Atiq Ul Mannan ◽  
Masood Alam ◽  
Abdul Rauf ◽  
Muhammad Imran Sharif
Keyword(s):  
Acute Exacerbation ◽  
Hypertonic Saline ◽  
Control Group ◽  
P Value ◽  
Airway Clearance ◽  
Before And After ◽  
Group A ◽  
The Mean ◽  
The Difference ◽  
Group B

Background: N-Acetylcysteine and 3% hypertonic saline are being used effectively for sputum clearance in chronic cases of bronchiectasis for quite some time. However, their use in acute condition of the disease seems to be underexplored. The objective of our study is to compare the role of nebulized N-acetylcysteine and 3% hypertonic saline in clearing the airway in patients with acute exacerbation of bronchiectasis. Material and Methods: A total of 136 confirmed cases of bronchiectasis were enrolled in this study. This randomized controlled trial was done in chest ward of Nishtar Hospital Multan from January 2015 to March 2017. Sampling was done by non-probability consecutive sampling and patients were divided into two groups A and B by lottery method. Verbal informed consent was taken from all participants. Group A participants received nebulization of N acetylcysteine mixed in normal saline for ten minutes, while group B participants were nebulized with 10ml of 3% hypertonic saline for ten minutes. Group B was active control group in the study. Data was collected on pre-designed Proforma, and analyzed by SPSS version 22. Numerical variables such as saturation, weight of sputum, age and blood pressure was analyzed by using t test. These were considered significant if the p value was equal or less than 0 .05. For qualitative variables chi square test was applied. Results: The mean O2 saturation of Group A, before and after treatment, was 92.11±3.07% and 94.47±2.18%, respectively. The difference was statistically significant (p value =0.001). The sputum weight of Group A, before and after treatment, was 2.63±2.39 g and 7.41±1.38 g, respectively. The difference was statistically significant (p value =0.001). The frequency of rhonchi of Group A, before and after treatment, was 52% and 76%, respectively. The difference was statistically significant (p value =0.003). While, for Group B, the mean O2 saturation, before and after treatment, was 92.36±3.13% and 93.49±2.27%, respectively. The difference was statistically significant (p value =0.012). The sputum weight, before and after treatment, was 3.11±2.01 g and 5.56±1.02 g, respectively. The frequency of rhonchi, before and after treatment, was 45% and 74% respectively. Again, the difference was statistically significant. Conclusion: Both nebulized N-acetylcysteine and 3% hypertonic saline cause airway clearance by enhancing sputum expectoration in patients with acute exacerbation of bronchiectasis equally. Both these agents also improve oxygen saturation in acute exacerbation of bronchiectasis significantly.

scholarly journals Upper and Lower Gastrointestinal Endoscopic Lesions in Patients with Unexplained Iron Deficiency Anaemia- A Cross-sectional Study

2021 ◽  
Author(s):  
Shrigouri Reddy ◽  
Bhumika Vaishnav ◽  
Pragya Sharma ◽  
Tushar Tonde ◽  
Arvind Bamanikar ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Occult Blood ◽  
P Value ◽  
Peptic Ulcers ◽  
Cross Sectional ◽  
Gi Endoscopy ◽  
Upper Gi ◽  
History Of ◽  
Group A ◽  
Group B

Introduction: Anaemia, due to iron deficiency, is very common in India. In many cases, the underlying cause of iron deficiency remains unknown even after detailed laboratory investigations. It is often due to malabsorption of iron from the gut and occult blood loss from the Gastrointestinal (GI) tract. Bidirectional GI endoscopy can help in finding these causes. Aim: To study the upper and lower GI endoscopic lesions in patients with unexplained Iron Deficiency Anaemia (IDA). Materials and Methods: This was a cross-sectional observational study, conducted on 75 patients with unexplained IDA in Dr. DY Patil Medical College and Hospital, Pune, Maharashtra, India, between June 2019 to June 2020. Patients above the age of 18 years and with Haemoglobin (Hb) of less than 13 g/dL (males) and less than 12 g/dL (females) underwent upper GI endoscopy and colonoscopy with biopsies, after ethics committee approval and informed consent. Complete haemogram with blood indices, iron studies and faecal Occult Blood Test (OBT) were conducted for all the patients. The patients were divided into Group A, those with upper/lower GI endoscopy lesions thought to be responsible for IDA and Group B, those without GI endoscopic lesions. Statistical analysis was performed using IBM, Statistical Package for the Social Sciences (SPSS), version 21.0 and statistical tests (Chi-square test, Student’s t-test and multivariate logistic regression analysis, with 95% Confidence Interval (CI) and p-value <0.05 was taken as significant) were used when required. Results: There were 44 females and 31 males in the study, with the age range of 20-81 years. The mean age of patients in Group A (n=44) was 58.57±11.68 years and Group B (n=31) was 49.68±14.45 years. On multivariate analysis, advance age, history of weight loss and faecal occult blood were statistically significantly associated with the presence of GI endoscopic lesions responsible for IDA (p-value<0.05). Maximum lesions responsible for IDA were found in stomach (48%), erosive and inflammatory lesions causing IDA were more common in upper GI tract. Peptic ulcers were found in 12% cases. The GI malignancies were found in 14.66% subjects. Colorectal cancers (8%) were more common than upper GI cancers (6.66%). Conclusion: In patients with IDA, erosive oesophagitis and haemorrhagic gastritis were commonly found followed by peptic ulcers and malignant GI lesions on bidirectional endoscopy. GI endoscopy is a very important tool to diagnose the cause of IDA. All patients with advanced age, history of weight loss and a positive faecal OBT should undergo bidirectional GI endoscopy routinely.

scholarly journals A Comparative Clinical Study of Khanda Shunthi and Prasarni Avleha in the Management of Amavata with Special Reference to Rheumatoid Arthritis

2021 ◽  
pp. 20-26
Author(s):  
Anu Gupta ◽  
Kalpana Patni
Keyword(s):  
Comparison Group ◽  
Adult Population ◽  
Research Work ◽  
P Value ◽  
Inclusion Criteria ◽  
Significant Difference ◽  
Comparative Clinical Study ◽  
Group A ◽  
Group B ◽  
Walking Time

Background: Amavata is the most common form of inflammatory arthopathy seen in India. Among adult population below the age of 50 years this is the most common form of arthritis. For the present study, on Amavata as shaman therapy, Khanda Shunthi and Prasarni Avleha the Ushnaveeryadravya medicaments were chosen. Aims & Objective: The present research work aimed at to evaluate efficacy and establish safe use of Khanda Shunthi and Prasarni Aavaleha in Amavata. Materials & Methods: 40 subjects of Amavata fulfilling the inclusion criteria were selected from OPD and IPD of Desh Bhagat Ayurvedic Hospital, Mandi Gobindgarh, Punjab and randomly divided into two groups, group A and B, comprising each of 20 patients. Group-A subjects received Khanda Shunthi for 60 days, Group-B subjects received Prasarni Avaleha for 60 days. Assessments were done on 0th and 60th day of treatment. Results and Conclusions: In both the groups, highly significant results were observed in all the cardinal parameters with P value for fever and Hb are greater than 0.05 hence there is no significant difference in effect of Group A and Group B on fever and Hb. P values for all other symptoms are less than 0.05 hence we conclude that there is significant difference in effect of group A and group B on pain, swelling, stiffness, fever, ESR, walking time and grip strength. On comparison group A treatment is more effective than group B for all assessment criteria.

scholarly journals Aesthetic Appearance of External Dacryocystorhinostomy Scar: A Comparison between W and C Shaped Incision

2021 ◽  
Vol 37 (3) ◽  
Author(s):  
Zeeshan Kamil ◽  
Qirat Qurban ◽  
Khalid Mahmood
Keyword(s):  
Case Series ◽  
Sampling Technique ◽  
Nasolacrimal Duct ◽  
P Value ◽  
Aesthetic Appearance ◽  
Group A ◽  
External Dacryocystorhinostomy ◽  
The Difference ◽  
Incision Technique ◽  
Group B

Purpose:  To compare the post-operative appearance of external Dacryocystorhinostomy scar resulting from W and C shaped incisions. Study Design:  Interventional case series. Place and Duration of Study:  Khalid eye clinic, Karachi, from July 2018 to June 2019. Methods:  We recruited ninety-six patients of nasolacrimal duct obstruction by convenience sampling technique. Age ranged from 20 to 50 years and both genders were included. Two groups were made. Group A comprised of patients who underwent external Dacryocystorhinostomy (Ex-DCR) surgery through W shaped incision and group B patients underwent Ex-DCR with curvilinear C shaped incision. Main outcome measure was to observe minimal to no visible scarring at wound site after six months of follow up. All patients were explained about the difference in incision technique and consent was obtained from each patient. Results:  Mean age was 34.3 ± 6.897 years. There were thirty-six (37.5%) males and sixty (62.5%) females. Right side was affected in forty-six (47.9%) cases whereas left side was involved in fifty (52.1%) cases. In Group A, 20 (41.6%) out of 48 patients, whereas in Group B, 38 (79.2%) out of 48 patients had no visible scar at all and it was statistically significant with a p-value of < 0.05. Suture abscess developed in four (8.3%) patients in group A, no other serious complications were observed in either group. Conclusion:  Curvilinear C shaped incision in Ex-DCR has better cosmetic outcome. Key Words:  External dacryocystorhinostomy, C shaped incision, W shaped incision.

scholarly journals CLIPPED OR CLIPLESS CHOLECYSTECTOMY

2018 ◽  
Vol 25 (06) ◽  
pp. 805-809
Author(s):  
H. Sabiha Akhtar ◽  
Zia Farooq ◽  
Hassan Rathore ◽  
Muhammad Umar Farooq ◽  
Arooj Ahmad
Keyword(s):  
Treatment Options ◽  
P Value ◽  
Surgical Removal ◽  
Biliary Leakage ◽  
Group A ◽  
The Difference ◽  
Group B ◽  
Trial Setting ◽  
Selection Of

Background: Cholecystectomy is the surgical removal of the inflamedgallbladder. Advancement in technology has led to many treatment options and methods ofcholecystectomy but the selection of right method depends upon severity of disease alongwith available resources and expertise. Objective: To compare the frequency of biliary leakagewith clipless versus clipped laparoscopic cholecystectomy for management of cholecystitis.Material & Methods: Study design: Randomized control trial. Setting: Unit 1, Departmentof Surgery, Jinnah hospital, Lahore. Duration: It was conducted for a period of six monthsfrom July 2016 to January 2017. Data collection: A total of 130 patients were included in thestudy using nonprobability consecutive sampling and were randomly divided in two groups byusing lottery method. In group A, clip-less Harmonic scalpel was used along with Ultrasonicshear. In group B, the conventional instruments were used with the application of clips. Patientswere called for follow-up in OPD after 1 week to assess biliary leakage through MRCP. All thedata was collected through a pre-designed proforma. The data was entered and analyzed inSPSS version 20. Results: The mean age of patients was 42.97±10.77 years with 68 (52.31%)patients were male and 62 (47.69%) patients were females. The biliary leakage was noted in29 cases i.e. 9 from clipless group and 20 were from clipped group and the difference wasstatistically significant (p-value=0.020) Conclusion: It can be concluded from this study thatthe frequency of biliary leakage is significantly higher in the clipped LC for management ofCholecystitis. Thus it is encouraging to use clipless method to avoid such complication andimprove surgical outcomes.

scholarly journals A comparative study between early enteral feeding (within 24 hours) versus conventional enteral feeding after enteric anastomosis

2012 ◽  
Vol 11 (4) ◽  
pp. 273-283 ◽  
Author(s):  
Souvik Chatterjee ◽  
Sujoy Kumar Bala ◽  
Partha Chakraborty ◽  
Rajesh Dey ◽  
Santanu Sinha ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Wound Infection ◽  
Enteral Feeding ◽  
P Value ◽  
Early Enteral Feeding ◽  
Post Operative Period ◽  
Group A ◽  
The Difference ◽  
Group B ◽  
Post Operative Nausea

Background: Traditionally, enteric feeds are withheld for a period of 48-72 hrs, sometimes even more following enteric anastomosis depending upon return of full peristaltic sounds. This results in a period of nonstimulation   of gut –‘Gut Rest’, which was supposed to result in better anastomotic healing. But this same also deprives the intestinal mucosa of surface nutrients as well as prolongs parenteral fluid therapy, thereby   depriving the patients of adequate nutrition. Along with it, prolonged parenteral therapy also keeps the  patients bound to bed with its resultant complications like, prolonged hospital stay and increased cost of   therapy. Objectives: To compare the benefits of early enteral feeding over conventional enteric feeding following  enteric anastomosis with special regards to patients recovery and complications. Methods and  materials: The selection of patients into group A (60) and group B (60) was done after having fulfilled inclusion and exclusion criteria. Informed consent was obtained. The patients of group A were fed via   enteral route within 24 hrs of enteric anastomosis. The patients of group B were fed via enteral route after 48-72 hrs or appearance of full peristaltic sounds following enteric anastomosis. These patients were followed   in post operative period for their drain output, any nausea, vomiting or significant abdominal distension, prolonged ileus, post operative duration of shospital stay, post operative infective complications (e.g. wound infection, UTI, RTI), and different haematological and biochemical examinations. Results: This   study shows that post operative nausea-vomiting, anastomotic leakage rate, re-exploration, wound infection and RTI rates are higher in group A than those of group B. In this study, the incidence of UTI in post operative period is higher in group B. But the differences in above mentioned variables are not statistically significant. Whereas appearance of intestinal peristaltic sound is earlier in group A (42.8 ± 10.68 hours)   compare to that of group B (52.6 ± 13.46 hours). Here, the difference is statistically significant (p value = 0.000022) The duration of post operative hospital stay is shorter in group A (8.45 ± 5.143 days) than that of group B (10.533 ± 4.952 days). The difference of duration post operative hospital stay is statistically significant (p value = 0.0257). Removal of nasogastric tube, resumption of oral feeding, and passage of first flatus and/or defecation were earlier in the group A than that of the group B; the differences were statistically significant. The post operative day-5 albumin level is better in group A (3.147 ± 0.4409 gm/dl) than that of group B (2.935 ± 0.3124 gm/dl). This difference is also statistically significant (p value = 0.0029). There are three mortalities in group Awhereas one mortality in group B. This difference in mortality in two   groups is not statistically significant. DOI: http://dx.doi.org/10.3329/bjms.v11i4.12597 Bangladesh Journal of Medical Science Vol. 11 No. 04 Oct’12

scholarly journals Efficacy of growth hormone in improving the pregnancy rate in poor responders in ART

2017 ◽  
Vol 6 (7) ◽  
pp. 2883
Author(s):  
Nisha E. ◽  
Sunitha H. B. ◽  
Vidya V. Bhat ◽  
K. M. Guddy
Keyword(s):  
Growth Hormone ◽  
Pregnancy Rate ◽  
Statistical Significance ◽  
Pregnancy Rates ◽  
P Value ◽  
Poor Responders ◽  
High Dose ◽  
Group A ◽  
The Difference ◽  
Group B

Background: Poor responders impose a great challenge to ART clinicians. Research to improve their pregnancy rate is going on. This study was conducted to analyze the effect of growth hormone in poor responders in ART.Methods: This study was done from January 2015 to December 2015. It was a retrospective, single centre, cohort study in which 36 poor responders were selected and allotted into group A (18) with growth hormone and group B (18) without growth hormone. High dose of gonadotrophins was used for ovarian stimulation and antagonist protocol was followed in all patients. Group A received 4 IU of growth hormone along with usual treatment from day 2 till ovulation trigger with HCG injection, group B usual protocol.Results: Statistical analysis was done with independent T test, and p value <0.05 was considered significant. Higher number of mature oocytes and pregnancy rates were observed in growth hormone group. Number of MII oocytes was 5.8, on an average in group A and 3.7 in group B, the difference was statistically significant (p 0.0000001).  Clinical pregnancy rates were 27.7% in group A and 16.6% in group B, statistical significance (p 0.02).Conclusions: Addition of growth hormone shows increase in number of oocytes retrieved and pregnancy rates in poor responders in ART patients.

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