This study aimed to characterize Crohn's disease (CD) in patients undergoing colonoscopy at an Indonesian hospital between 2007-2008. Of 921 colonoscopies, 19 (2.1%) patients were diagnosed with CD. The mean age was 47.7 years with most patients presenting between 51-60 years. The main complaints were diarrhea (42.1%) and lower gastrointestinal bleeding (36.8%). Colonoscopic findings most commonly included hyperemia (94.7%), ulcerations (89.5%), and erosions (63.2%). The dominant site of involvement was pancolitis (57.9%), followed by ileocolitis (36.8%) and isolated left colon involvement (26.3
This study aimed to develop a pre-operative risk scoring system to predict post-operative sepsis in HIV-infected surgical patients. The researchers analyzed data from 762 HIV-infected surgical patients in China. They developed a scoring system using five predictive variables: CD4 count, incision scale, surgical grade, opportunistic infections, and organ function. When validated on a separate dataset of 182 patients, the scoring system predicted post-operative sepsis with 95% sensitivity and 93.6% specificity. The researchers concluded the risk scoring system had high predictive accuracy and could help surgeons evaluate sepsis risk before operating on HIV-infected patients.
Helicobacter pylori infection is associated with increased risk of gastric cancer development. A prospective study of 1526 Japanese patients found:
1) Gastric cancer developed in 36 (2.9%) of infected patients but none of 280 uninfected patients over 7.8 years of follow up.
2) Infected patients with severe gastric atrophy, corpus-predominant gastritis, or intestinal metaplasia were at highest risk.
3) Gastric cancer risk was highest in infected patients with nonulcer dyspepsia (4.7%), gastric ulcers (3.4%), or gastric polyps (2.2%) but none in those with duodenal ulcers.
- The document describes a study that used multispectral cystoscopy with different light wavelengths to examine bladder mucosa and tumors.
- When green light was used, blood vessels in the bladder mucosa and submucosa showed up clearly in 3D. Blue light also made vessels visible but less clearly. Under red light, the mucosal surface appeared completely red and vessels could not be distinguished.
- For bladder tumors, green light allowed observation of tumor vessels and assessment of invasion depth, while white light showed intact muscle layer after tumor resection but not blood vessels.
This study analyzed 107 cases of acute pancreatitis treated at a hospital in Islamabad, Pakistan over one year. Gallstones were found to be the most common cause, accounting for 36.5% of cases. Alcohol was a factor in 11.2% of cases. In 46.7% of cases, no clear cause was identified. Based on the Ranson score, 35.5% of cases were considered severe. The average hospital stay was 8.9 days and mortality rate was 8.4%, with all deaths occurring in severe cases. The authors conclude that while the causes and severity of acute pancreatitis in Pakistan are generally similar to other countries, gallstones are a relatively more common cause than alcohol compared to Western
1) A 17-year-old girl presented with chronic epigastric pain and was found to have a large trichobezoar in her stomach.
2) During surgery to remove the bezoar, the doctors also found extensive pneumatosis intestinalis (intramural gas within the bowel walls) in her small intestine.
3) This case presents a rare association between trichobezoar and pneumatosis intestinalis that has not been previously reported. As the pneumatosis was not causing symptoms, no treatment was needed for it.
This study analyzed 200 cases of typhoid intestinal perforation (TIP) in children seen over a 10-year period at a teaching hospital in Nigeria. The researchers found that TIP accounted for 35.7% of pediatric surgeries during this period, with most cases occurring in males aged 6-15 years old. Common presenting symptoms were fever, abdominal pain, and distension. Surgical findings typically included a single perforation in the terminal ileum. The most common procedure was primary closure of the perforation. Post-operative complications and a mortality rate of 8.5% highlighted that TIP remains a significant problem in developing countries due to poor sanitation and access to clean water.
This study analyzed 52 pediatric patients who underwent intestinal resection over a 10-year period at a hospital in Nigeria. The most common indication for resection was gangrenous or irreducible intussusception (28 cases, 53.8%). Other common reasons included strangulated hernia (7 cases) and typhoid intestinal perforation (6 cases). Most patients were infants under 1 year old. Complications occurred in 38.4% of patients, most commonly surgical site infection. The mortality rate was 15.4%. The study concluded that late presentation and lack of awareness contributed significantly to the high number of intestinal resections required in this patient population.
This document summarizes a study of 233 cases of abdominal tuberculosis treated at a hospital in Pakistan from 2003-2008. Some key findings include:
- The average age was 28 years and most patients were from poor families.
- The most common presentation was acute abdomen (67%), requiring emergency surgery. Common surgical findings included intestinal strictures (69%).
- Most cases involved the ileocecal region and presented as intestinal obstructions.
- The majority of cases were considered primary abdominal tuberculosis, though some had a history of pulmonary TB.
- Most patients required hospitalization, with an average stay of 19.5 days. The in-hospital mortality rate was 2.1%.
This study aimed to develop a pre-operative risk scoring system to predict post-operative sepsis in HIV-infected surgical patients. The researchers analyzed data from 762 HIV-infected surgical patients in China. They developed a scoring system using five predictive variables: CD4 count, incision scale, surgical grade, opportunistic infections, and organ function. When validated on a separate dataset of 182 patients, the scoring system predicted post-operative sepsis with 95% sensitivity and 93.6% specificity. The researchers concluded the risk scoring system had high predictive accuracy and could help surgeons evaluate sepsis risk before operating on HIV-infected patients.
Helicobacter pylori infection is associated with increased risk of gastric cancer development. A prospective study of 1526 Japanese patients found:
1) Gastric cancer developed in 36 (2.9%) of infected patients but none of 280 uninfected patients over 7.8 years of follow up.
2) Infected patients with severe gastric atrophy, corpus-predominant gastritis, or intestinal metaplasia were at highest risk.
3) Gastric cancer risk was highest in infected patients with nonulcer dyspepsia (4.7%), gastric ulcers (3.4%), or gastric polyps (2.2%) but none in those with duodenal ulcers.
- The document describes a study that used multispectral cystoscopy with different light wavelengths to examine bladder mucosa and tumors.
- When green light was used, blood vessels in the bladder mucosa and submucosa showed up clearly in 3D. Blue light also made vessels visible but less clearly. Under red light, the mucosal surface appeared completely red and vessels could not be distinguished.
- For bladder tumors, green light allowed observation of tumor vessels and assessment of invasion depth, while white light showed intact muscle layer after tumor resection but not blood vessels.
This study analyzed 107 cases of acute pancreatitis treated at a hospital in Islamabad, Pakistan over one year. Gallstones were found to be the most common cause, accounting for 36.5% of cases. Alcohol was a factor in 11.2% of cases. In 46.7% of cases, no clear cause was identified. Based on the Ranson score, 35.5% of cases were considered severe. The average hospital stay was 8.9 days and mortality rate was 8.4%, with all deaths occurring in severe cases. The authors conclude that while the causes and severity of acute pancreatitis in Pakistan are generally similar to other countries, gallstones are a relatively more common cause than alcohol compared to Western
1) A 17-year-old girl presented with chronic epigastric pain and was found to have a large trichobezoar in her stomach.
2) During surgery to remove the bezoar, the doctors also found extensive pneumatosis intestinalis (intramural gas within the bowel walls) in her small intestine.
3) This case presents a rare association between trichobezoar and pneumatosis intestinalis that has not been previously reported. As the pneumatosis was not causing symptoms, no treatment was needed for it.
This study analyzed 200 cases of typhoid intestinal perforation (TIP) in children seen over a 10-year period at a teaching hospital in Nigeria. The researchers found that TIP accounted for 35.7% of pediatric surgeries during this period, with most cases occurring in males aged 6-15 years old. Common presenting symptoms were fever, abdominal pain, and distension. Surgical findings typically included a single perforation in the terminal ileum. The most common procedure was primary closure of the perforation. Post-operative complications and a mortality rate of 8.5% highlighted that TIP remains a significant problem in developing countries due to poor sanitation and access to clean water.
This study analyzed 52 pediatric patients who underwent intestinal resection over a 10-year period at a hospital in Nigeria. The most common indication for resection was gangrenous or irreducible intussusception (28 cases, 53.8%). Other common reasons included strangulated hernia (7 cases) and typhoid intestinal perforation (6 cases). Most patients were infants under 1 year old. Complications occurred in 38.4% of patients, most commonly surgical site infection. The mortality rate was 15.4%. The study concluded that late presentation and lack of awareness contributed significantly to the high number of intestinal resections required in this patient population.
This document summarizes a study of 233 cases of abdominal tuberculosis treated at a hospital in Pakistan from 2003-2008. Some key findings include:
- The average age was 28 years and most patients were from poor families.
- The most common presentation was acute abdomen (67%), requiring emergency surgery. Common surgical findings included intestinal strictures (69%).
- Most cases involved the ileocecal region and presented as intestinal obstructions.
- The majority of cases were considered primary abdominal tuberculosis, though some had a history of pulmonary TB.
- Most patients required hospitalization, with an average stay of 19.5 days. The in-hospital mortality rate was 2.1%.
This research article studied preoperative predictive factors of occult and frank intrabiliary rupture of liver hydatid cysts. The study reviewed 56 patients with 82 liver hydatid cysts who underwent surgery. Cysts were divided into three groups: no rupture, occult rupture with bile in cyst but no passage into bile duct, and frank rupture with passage into bile duct. Multivariate analysis identified jaundice, cyst size >6.5cm, and symptoms >45 days as predictors of frank rupture. Predictors of occult rupture included cyst size >6.5cm, ≥3 recurrences, type II/III cyst, leukocytosis >9,000/mm3, and eosinophilia >5.5
Background: The incidence of abdominal tuberculosis is increasing. Preoperative diagnosis continues to
be the biggest challenge. Diagnosis is established only after histopathological examination. The modes of presentation
and therapeutic options need to be assessed. Objectives: To study the patterns of presentations, the extent of organ
involvement and therapeutic options. Materials and methods: Fifty histopathologically proven cases of abdominal
tuberculosis were studied. In addition, epidemiologic data, clinical patterns of presentation, diagnostic and various
surgical options, including outcomes, were studied. Results: The mortality in the study was 8%. The disease was
commonly seen in 21 to 40 years old and commonly seen in females. HIV positivity, anaemia and hypoproteinaemia
were associated with poor outcomes. Four types of presentations were observed. Diagnostic laparoscopy enabled early
histopathological diagnosis of biopsy specimens. Chemotherapy is the mainstay of treatment Surgery is a significant
adjunct in diagnosing and managing complications. Patients presenting with perforative peritonitis had a poor prognosis
Conclusion: Critical evaluation of chronic abdominal pain is essential. Supportive evidence such as the history of TB or
contact with a patient suffering from TB is highly suggestive of abdominal tuberculosis. Radiological tests are highly
suggestive but not diagnostic. Diagnostic laparoscopy enables tissue diagnosis. Chemotherapy accompanied by surgical
intervention for complications is the mainstay of treatment.
This study evaluated 52 cases of pediatric peritonitis treated via laparotomy over 5 years at a hospital in Nigeria. The most common cause of peritonitis was found to be typhoid intestinal perforation (48% of cases). Other common causes included ruptured appendix (17.3% of cases) and perforated intussusception (15.4% of cases). Post-operative complications occurred in 46.2% of patients, with surgical site infection being most common (23.1% of cases). The mortality rate was 13.5%. The study concludes that typhoid intestinal perforation is a major cause of peritonitis in children in this setting.
This document summarizes 4 studies related to endoscopic treatments for GERD:
1. A randomized controlled trial is evaluating the Gatekeeper therapy which implants hydrogel prostheses in the LES to reduce GERD symptoms. Over 200 patients have been enrolled so far.
2. A study of endoscopic suturing for GERD found that while it improved symptoms in 50% of patients at 1 year, over 50% of the sutures had failed, indicating it may not be a reliable long-term alternative to medication.
3. A trial evaluated ablation of non-neoplastic Barrett's epithelium with argon plasma coagulation but found a high risk of complications and incomplete response
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) initially presented with respiratory symptoms like cough and fever but has since been found to involve other organ systems. The document reports 3 cases of gastrointestinal perforation in COVID-19 patients treated at a hospital in India. Case 1 involved a 60-year-old woman with rectal perforation. Case 2 was a 24-year-old postpartum woman with caecal perforation. Case 3, a 21-year-old man, presented with gastric perforation. The document reviews theories for how SARS-CoV-2 may cause gastrointestinal tract perforation, including via ACE2 receptors in the GI tract, coagulation disorders, viral replication in GI cells
This document describes a study that aimed to determine the prevalence of various non-variceal diseases causing upper gastrointestinal bleeding and the various treatment modalities. A total of 47 patients presenting with upper GI bleeding over 3 years were studied. Erosive gastritis was found to be the most common cause, present in 61.7% of cases. Most cases were managed conservatively, though surgery was required in some cases of duodenal and gastric ulcers that did not respond to other treatments. The study helps provide information on the causes and management of non-variceal upper GI bleeding.
This document summarizes a study on cervical lymph node enlargement. It analyzed 70 patients with enlarged cervical lymph nodes. Tuberculosis was found to be the most common cause, affecting females more than males. Lymph node enlargement was most common in patients under 40 years old. Histopathological examination was required for accurate diagnosis. The upper cervical lymph nodes were most frequently involved. The study concluded that tuberculosis was a major factor for cervical lymphadenopathy in younger patients, while secondary cancers were more common in older patients above 50 years old.
This study analyzed 1,145 patients who underwent ERCP at a regional hospital in Mexico from 2002-2011. The complication rate was 2.1%, with hemorrhage being the most common complication at 1.2%. Precut/sphincterotomy was found to increase the risk of complications by 1.4 times compared to those without. The study concluded the complication rate was similar to other reports but could be reduced by only performing ERCP for therapeutic purposes and by highly qualified endoscopists.
1. This study evaluated the diagnostic accuracy of fine needle aspiration cytology (FNAC) for thyroid gland lesions by analyzing 300 patients.
2. The most common lesions found on FNAC were colloid goiter (65%) and thyroid cyst (15.34%). Rare malignancies identified included papillary carcinoma (0.66%) and anaplastic carcinoma (0.33%).
3. Histopathological examination of 36 surgical specimens showed high accuracy of FNAC, with a sensitivity of 100%, specificity of 97.61%, and accuracy of 97.72%.
This document discusses the challenges in differentiating between Crohn's disease (CD) and intestinal tuberculosis (ITB). Several diagnostic approaches are presented:
1. Clinical features can provide clues but are nonspecific. CD more often affects younger patients and presents with perianal disease or fistulas. ITB presents with longer duration of symptoms and high fevers.
2. Laboratory tests such as interferon-gamma release assays have higher sensitivity than tuberculin skin tests but cannot distinguish between active and latent TB. Serologic markers for IBD like ASCA and pANCA are not reliable for differentiating CD from ITB.
3. Endoscopy findings per Lee's criteria provide good predictive value,
Development and validation of a novel diagnostic nomogram to differentiate be...Hidert Chusi Huamani
This study developed and validated two novel diagnostic nomograms to differentiate between intestinal tuberculosis (ITB) and Crohn's disease (CD) using data from 310 patients across six hospitals in China. Eight variables were identified as valuable for establishing diagnostic models, including age, transverse ulcer, rectum involvement, skipped involvement of small bowel, target sign, comb sign, and interferon-gamma release assays or purified protein derivative test results. Two highly accurate nomograms were developed, with one showing 87.8% accuracy and the other showing 87.8% accuracy in differentiating CD from ITB. The nomograms provide a practical tool for clinicians to identify difficult cases of CD or ITB.
This document summarizes a study on nasopharyngeal carcinoma (NPC) conducted at a Nigerian tertiary hospital. The study found that NPC accounted for 8.33% of head and neck cancers seen over 14 years. Most patients were male, with a mean age of 54.5 years. The most common presentations were neck swelling, nasal obstruction, and epistaxis. 75% of patients presented with late stage 4 disease. Treatment was primarily radiotherapy, but 46.88% of patients defaulted treatment due to financial constraints. Prognosis was very poor, with 1-year and 5-year survival rates of 21.9% and 9.25% respectively. The study concluded that late presentation and inability to
This document provides an overview of gastrointestinal manifestations and treatment in scleroderma. It discusses how 60-90% of scleroderma patients experience GI involvement, most commonly affecting the esophagus, stomach, small intestine, and colon. For the esophagus, it covers GERD, dysphagia, and their diagnostic tests and treatments like PPIs. For the stomach, it discusses gastroparesis, GAVE, and treatments like prokinetic agents and APC. It reviews SIBO, CIPO, and treatments for the small intestine. For the colon and anus, it covers constipation, fecal incontinence, diagnostic tests, and treatments including laxatives, bio
This study examined the clinical course of 73 patients with intermittent exotropia over an average follow-up period of 10 years. The mean exodeviation decreased from 17.2 degrees at distance and 17.6 degrees at near initially, to 13.7 degrees at distance and 13.5 degrees at near at the final visit. However, these changes were not associated with any specific treatment and occurred regardless of follow-up time, suggesting the improvements may be partly due to statistical regression toward the mean. Overall, intermittent exotropia either improved or remained stable over time for many patients in this study.
Management of Fournier’s Gangrene in a Low Resource Settingasclepiuspdfs
external genitalia and perineum. Although the condition is rare in absolute terms, over 1726 cases have been reported in English literature, with a male/female ratio of 10:1. There have been 502 cases from Africa, which ranks second to the USA/Canada. At present, there is only one published literature on the management of FG in Liberia. Objective: This study highlig hts the late presentation and the challenges in the management of FG at the John F. Kennedy Medical Center. Methodology: This is a retrospective study of 30 patients with FG who were admitted and managed by our division of urology, from January 2018 to May 2019. The patient’s records were retrieved and reviewed for age, sex, onset of disease, sites of the disease, management, duration of stay, and outcome. The frequency and percentage of various parameters were displayed in tables.
This document discusses the diagnosis and management of choledocholithiasis (CBD stones). Key points include:
- CBD stones occur in 3-10% of patients undergoing cholecystectomy and may be discovered preoperatively, intraoperatively, or postoperatively.
- Preoperative evaluation involves laboratory tests, ultrasound, CT, and MRCP to detect CBD stones. Elevated liver enzymes and bilirubin or a dilated CBD on imaging increase the likelihood of stones.
- The most common intervention for CBD stones is ERCP. Other options include intraoperative exploration or percutaneous transhepatic removal of stones. The optimal timing and approach depends on the individual clinical situation.
This document discusses the use of ultrasound in diagnosing scrotal pathologies. It summarizes a study of 75 patients who underwent scrotal ultrasound exams. The most common sonographic finding was varicocele (37.33%), followed by hydrocele (16%). Varicocele most commonly affected men ages 21-30 and was usually found on the left side. Masses like cysts were most common in men ages 51-60 and usually affected the right testis. Hydroceles were most common in men ages 51-60. Epididymitis/orchitis mostly affected men ages 11-20. The study concludes that ultrasound is an effective tool for diagnosing various scrotal abnormalities.
Adult intussusception is rare, accounting for 1% of small bowel obstructions. It is usually caused by an underlying pathological lead point like a tumor. CT imaging is the most sensitive test for diagnosis and can identify potential lead points. Presenting symptoms are nonspecific like abdominal pain but complications from delay in diagnosis or treatment include bowel ischemia, perforation and sepsis. Surgical intervention is usually required for definitive treatment and pathology diagnosis given the high incidence of malignancy as the lead point.
Changing pattern of mechanical bowel obstruction and management outcome in no...BRNSSPublicationHubI
This study reviewed 94 patients treated for mechanical bowel obstruction over 5 years in North-Eastern Nigeria. Tumor was the most common cause of obstruction (27.66%), surpassing hernias which had previously been most common. Bowel resection was the most common procedure (54.26%). Post-operative complications included surgical site infections (22.34%) and enterocutaneous fistulas (3.19%). Mortality was 15.96%, primarily due to metastatic colon tumors. The rising incidence of colon tumors and availability of elective hernia repair have led to tumors becoming the predominant cause of mechanical bowel obstruction.
This document summarizes a study on the clinico-demographic characteristics of colorectal carcinoma in Bangladeshi patients. The study found that the mean age was 47 years, with most patients between 50-59 years of age. Males were slightly more affected than females. The most common presenting symptoms were per rectal bleeding, abdominal pain, and altered bowel habits. Histological examination found that 88% of cases were adenocarcinoma. The study concludes that middle-aged males in Bangladesh are most at risk for colorectal carcinoma, which commonly presents with bleeding, pain, or changes in bowel habits.
This study describes the clinical profiles and treatment outcomes of 18 adult patients diagnosed with eosinophilic gastroenteritis (EG) at a large tertiary hospital in Singapore over an 8-year period. EG is a rare disease characterized by eosinophilic infiltration of the gastrointestinal tract. The most common symptoms were diarrhea and abdominal pain. The small intestine was the most commonly involved site. Prednisolone was found to be an effective treatment for most patients, though relapses were common once treatment was tapered. This study helps add to the limited data on EG in Southeast Asia.
This research article studied preoperative predictive factors of occult and frank intrabiliary rupture of liver hydatid cysts. The study reviewed 56 patients with 82 liver hydatid cysts who underwent surgery. Cysts were divided into three groups: no rupture, occult rupture with bile in cyst but no passage into bile duct, and frank rupture with passage into bile duct. Multivariate analysis identified jaundice, cyst size >6.5cm, and symptoms >45 days as predictors of frank rupture. Predictors of occult rupture included cyst size >6.5cm, ≥3 recurrences, type II/III cyst, leukocytosis >9,000/mm3, and eosinophilia >5.5
Background: The incidence of abdominal tuberculosis is increasing. Preoperative diagnosis continues to
be the biggest challenge. Diagnosis is established only after histopathological examination. The modes of presentation
and therapeutic options need to be assessed. Objectives: To study the patterns of presentations, the extent of organ
involvement and therapeutic options. Materials and methods: Fifty histopathologically proven cases of abdominal
tuberculosis were studied. In addition, epidemiologic data, clinical patterns of presentation, diagnostic and various
surgical options, including outcomes, were studied. Results: The mortality in the study was 8%. The disease was
commonly seen in 21 to 40 years old and commonly seen in females. HIV positivity, anaemia and hypoproteinaemia
were associated with poor outcomes. Four types of presentations were observed. Diagnostic laparoscopy enabled early
histopathological diagnosis of biopsy specimens. Chemotherapy is the mainstay of treatment Surgery is a significant
adjunct in diagnosing and managing complications. Patients presenting with perforative peritonitis had a poor prognosis
Conclusion: Critical evaluation of chronic abdominal pain is essential. Supportive evidence such as the history of TB or
contact with a patient suffering from TB is highly suggestive of abdominal tuberculosis. Radiological tests are highly
suggestive but not diagnostic. Diagnostic laparoscopy enables tissue diagnosis. Chemotherapy accompanied by surgical
intervention for complications is the mainstay of treatment.
This study evaluated 52 cases of pediatric peritonitis treated via laparotomy over 5 years at a hospital in Nigeria. The most common cause of peritonitis was found to be typhoid intestinal perforation (48% of cases). Other common causes included ruptured appendix (17.3% of cases) and perforated intussusception (15.4% of cases). Post-operative complications occurred in 46.2% of patients, with surgical site infection being most common (23.1% of cases). The mortality rate was 13.5%. The study concludes that typhoid intestinal perforation is a major cause of peritonitis in children in this setting.
This document summarizes 4 studies related to endoscopic treatments for GERD:
1. A randomized controlled trial is evaluating the Gatekeeper therapy which implants hydrogel prostheses in the LES to reduce GERD symptoms. Over 200 patients have been enrolled so far.
2. A study of endoscopic suturing for GERD found that while it improved symptoms in 50% of patients at 1 year, over 50% of the sutures had failed, indicating it may not be a reliable long-term alternative to medication.
3. A trial evaluated ablation of non-neoplastic Barrett's epithelium with argon plasma coagulation but found a high risk of complications and incomplete response
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) initially presented with respiratory symptoms like cough and fever but has since been found to involve other organ systems. The document reports 3 cases of gastrointestinal perforation in COVID-19 patients treated at a hospital in India. Case 1 involved a 60-year-old woman with rectal perforation. Case 2 was a 24-year-old postpartum woman with caecal perforation. Case 3, a 21-year-old man, presented with gastric perforation. The document reviews theories for how SARS-CoV-2 may cause gastrointestinal tract perforation, including via ACE2 receptors in the GI tract, coagulation disorders, viral replication in GI cells
This document describes a study that aimed to determine the prevalence of various non-variceal diseases causing upper gastrointestinal bleeding and the various treatment modalities. A total of 47 patients presenting with upper GI bleeding over 3 years were studied. Erosive gastritis was found to be the most common cause, present in 61.7% of cases. Most cases were managed conservatively, though surgery was required in some cases of duodenal and gastric ulcers that did not respond to other treatments. The study helps provide information on the causes and management of non-variceal upper GI bleeding.
This document summarizes a study on cervical lymph node enlargement. It analyzed 70 patients with enlarged cervical lymph nodes. Tuberculosis was found to be the most common cause, affecting females more than males. Lymph node enlargement was most common in patients under 40 years old. Histopathological examination was required for accurate diagnosis. The upper cervical lymph nodes were most frequently involved. The study concluded that tuberculosis was a major factor for cervical lymphadenopathy in younger patients, while secondary cancers were more common in older patients above 50 years old.
This study analyzed 1,145 patients who underwent ERCP at a regional hospital in Mexico from 2002-2011. The complication rate was 2.1%, with hemorrhage being the most common complication at 1.2%. Precut/sphincterotomy was found to increase the risk of complications by 1.4 times compared to those without. The study concluded the complication rate was similar to other reports but could be reduced by only performing ERCP for therapeutic purposes and by highly qualified endoscopists.
1. This study evaluated the diagnostic accuracy of fine needle aspiration cytology (FNAC) for thyroid gland lesions by analyzing 300 patients.
2. The most common lesions found on FNAC were colloid goiter (65%) and thyroid cyst (15.34%). Rare malignancies identified included papillary carcinoma (0.66%) and anaplastic carcinoma (0.33%).
3. Histopathological examination of 36 surgical specimens showed high accuracy of FNAC, with a sensitivity of 100%, specificity of 97.61%, and accuracy of 97.72%.
This document discusses the challenges in differentiating between Crohn's disease (CD) and intestinal tuberculosis (ITB). Several diagnostic approaches are presented:
1. Clinical features can provide clues but are nonspecific. CD more often affects younger patients and presents with perianal disease or fistulas. ITB presents with longer duration of symptoms and high fevers.
2. Laboratory tests such as interferon-gamma release assays have higher sensitivity than tuberculin skin tests but cannot distinguish between active and latent TB. Serologic markers for IBD like ASCA and pANCA are not reliable for differentiating CD from ITB.
3. Endoscopy findings per Lee's criteria provide good predictive value,
Development and validation of a novel diagnostic nomogram to differentiate be...Hidert Chusi Huamani
This study developed and validated two novel diagnostic nomograms to differentiate between intestinal tuberculosis (ITB) and Crohn's disease (CD) using data from 310 patients across six hospitals in China. Eight variables were identified as valuable for establishing diagnostic models, including age, transverse ulcer, rectum involvement, skipped involvement of small bowel, target sign, comb sign, and interferon-gamma release assays or purified protein derivative test results. Two highly accurate nomograms were developed, with one showing 87.8% accuracy and the other showing 87.8% accuracy in differentiating CD from ITB. The nomograms provide a practical tool for clinicians to identify difficult cases of CD or ITB.
This document summarizes a study on nasopharyngeal carcinoma (NPC) conducted at a Nigerian tertiary hospital. The study found that NPC accounted for 8.33% of head and neck cancers seen over 14 years. Most patients were male, with a mean age of 54.5 years. The most common presentations were neck swelling, nasal obstruction, and epistaxis. 75% of patients presented with late stage 4 disease. Treatment was primarily radiotherapy, but 46.88% of patients defaulted treatment due to financial constraints. Prognosis was very poor, with 1-year and 5-year survival rates of 21.9% and 9.25% respectively. The study concluded that late presentation and inability to
This document provides an overview of gastrointestinal manifestations and treatment in scleroderma. It discusses how 60-90% of scleroderma patients experience GI involvement, most commonly affecting the esophagus, stomach, small intestine, and colon. For the esophagus, it covers GERD, dysphagia, and their diagnostic tests and treatments like PPIs. For the stomach, it discusses gastroparesis, GAVE, and treatments like prokinetic agents and APC. It reviews SIBO, CIPO, and treatments for the small intestine. For the colon and anus, it covers constipation, fecal incontinence, diagnostic tests, and treatments including laxatives, bio
This study examined the clinical course of 73 patients with intermittent exotropia over an average follow-up period of 10 years. The mean exodeviation decreased from 17.2 degrees at distance and 17.6 degrees at near initially, to 13.7 degrees at distance and 13.5 degrees at near at the final visit. However, these changes were not associated with any specific treatment and occurred regardless of follow-up time, suggesting the improvements may be partly due to statistical regression toward the mean. Overall, intermittent exotropia either improved or remained stable over time for many patients in this study.
Management of Fournier’s Gangrene in a Low Resource Settingasclepiuspdfs
external genitalia and perineum. Although the condition is rare in absolute terms, over 1726 cases have been reported in English literature, with a male/female ratio of 10:1. There have been 502 cases from Africa, which ranks second to the USA/Canada. At present, there is only one published literature on the management of FG in Liberia. Objective: This study highlig hts the late presentation and the challenges in the management of FG at the John F. Kennedy Medical Center. Methodology: This is a retrospective study of 30 patients with FG who were admitted and managed by our division of urology, from January 2018 to May 2019. The patient’s records were retrieved and reviewed for age, sex, onset of disease, sites of the disease, management, duration of stay, and outcome. The frequency and percentage of various parameters were displayed in tables.
This document discusses the diagnosis and management of choledocholithiasis (CBD stones). Key points include:
- CBD stones occur in 3-10% of patients undergoing cholecystectomy and may be discovered preoperatively, intraoperatively, or postoperatively.
- Preoperative evaluation involves laboratory tests, ultrasound, CT, and MRCP to detect CBD stones. Elevated liver enzymes and bilirubin or a dilated CBD on imaging increase the likelihood of stones.
- The most common intervention for CBD stones is ERCP. Other options include intraoperative exploration or percutaneous transhepatic removal of stones. The optimal timing and approach depends on the individual clinical situation.
This document discusses the use of ultrasound in diagnosing scrotal pathologies. It summarizes a study of 75 patients who underwent scrotal ultrasound exams. The most common sonographic finding was varicocele (37.33%), followed by hydrocele (16%). Varicocele most commonly affected men ages 21-30 and was usually found on the left side. Masses like cysts were most common in men ages 51-60 and usually affected the right testis. Hydroceles were most common in men ages 51-60. Epididymitis/orchitis mostly affected men ages 11-20. The study concludes that ultrasound is an effective tool for diagnosing various scrotal abnormalities.
Adult intussusception is rare, accounting for 1% of small bowel obstructions. It is usually caused by an underlying pathological lead point like a tumor. CT imaging is the most sensitive test for diagnosis and can identify potential lead points. Presenting symptoms are nonspecific like abdominal pain but complications from delay in diagnosis or treatment include bowel ischemia, perforation and sepsis. Surgical intervention is usually required for definitive treatment and pathology diagnosis given the high incidence of malignancy as the lead point.
Changing pattern of mechanical bowel obstruction and management outcome in no...BRNSSPublicationHubI
This study reviewed 94 patients treated for mechanical bowel obstruction over 5 years in North-Eastern Nigeria. Tumor was the most common cause of obstruction (27.66%), surpassing hernias which had previously been most common. Bowel resection was the most common procedure (54.26%). Post-operative complications included surgical site infections (22.34%) and enterocutaneous fistulas (3.19%). Mortality was 15.96%, primarily due to metastatic colon tumors. The rising incidence of colon tumors and availability of elective hernia repair have led to tumors becoming the predominant cause of mechanical bowel obstruction.
This document summarizes a study on the clinico-demographic characteristics of colorectal carcinoma in Bangladeshi patients. The study found that the mean age was 47 years, with most patients between 50-59 years of age. Males were slightly more affected than females. The most common presenting symptoms were per rectal bleeding, abdominal pain, and altered bowel habits. Histological examination found that 88% of cases were adenocarcinoma. The study concludes that middle-aged males in Bangladesh are most at risk for colorectal carcinoma, which commonly presents with bleeding, pain, or changes in bowel habits.
This study describes the clinical profiles and treatment outcomes of 18 adult patients diagnosed with eosinophilic gastroenteritis (EG) at a large tertiary hospital in Singapore over an 8-year period. EG is a rare disease characterized by eosinophilic infiltration of the gastrointestinal tract. The most common symptoms were diarrhea and abdominal pain. The small intestine was the most commonly involved site. Prednisolone was found to be an effective treatment for most patients, though relapses were common once treatment was tapered. This study helps add to the limited data on EG in Southeast Asia.
Abdominal Tuberculosis Revisited–A single institutional experience of 72 case...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Comparison of endoscopic ultrasonography and magnetic resonance cholangiopanc...Ginna Saavedra
This study compared the diagnostic value of endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP) in diagnosing diseases of the pancreatobiliary system. 135 patients were prospectively evaluated with both EUS and MRCP and assigned to one of two groups - those with an unexplained dilated biliary tree and those with a nondilated biliary tree suspected of having gallstones. EUS and MRCP accurately diagnosed or ruled out malignancy and gallstones in most patients. The study found that both techniques are extremely useful for diagnosing or excluding diseases of the pancreatobiliary system in patients with dilated or nondilated biliary trees.
1. The document examines fibronectin expression in renal cell carcinoma (RCC) tissue samples and its relationship to clinical tumor stage.
2. Methods describe taking tumor tissue samples from 21 RCC patients undergoing partial or radical nephrectomy and using SDS PAGE to identify fibronectin protein levels.
3. Results show generally higher fibronectin expression in RCC samples compared to normal tissue, but a remarkable decrease in later-stage versus early-stage tumors.
This document summarizes a study investigating the association between the endothelial nitric oxide synthase (eNOS) gene polymorphism rs2070744 and risk of gastric cancer in the South Indian population. The study compared 150 gastric cancer patients to 150 healthy controls. Results found that individuals with the C/C genotype had a 10% increased risk of gastric cancer compared to the T/T genotype. Risk was further increased among those who smoked, drank alcohol, or were infected with H. pylori bacteria. The study concludes that the eNOS gene polymorphism may influence gastric cancer risk in the South Indian population.
This study compared the diagnostic accuracy of ultrasound (US) and computed tomography (CT) in evaluating non-traumatic acute abdomen in 55 patients. US was performed first followed by CT in US positive or symptomatic negative cases. CT was found to have higher sensitivity than US for many conditions including ureteric calculi, intestinal perforation, pancreatitis, and liver abscess. However, both US and CT demonstrated 100% sensitivity for acute cholecystitis, splenic infarcts, and gynecological cases. The study concluded that while US is preferred for its lack of radiation, CT provides higher accuracy in the diagnostic workup of acute abdominal pain due to its ability to detect alternative diagnoses.
Austin Journal of Clinical Case Reports is an open access scholarly journal. The goal of this journal is to provide a platform for scientists and academicians all over the world to promote, share, and discuss various new issues and developments by publishing case reports in all aspects of Clinical Medicine. Case Reports is an open access journals. The goal of this journal is to provide a platform for scientists and academicians all over the world to promote, share, and discuss various new issues and developments by publishing case reports in all aspects of Clinical Medicine.
The aim of this open access journal is to offer service for scientists and academicians to promote, share, and discuss various new issues and developments by publishing clinical case reports in all aspects.
Austin Journal of case repots are a reflective analysis of one, two, or three clinical cases. All clinical case reports submitted must have been approved by an ethics committee or institutional review board.
Austin Journal of Clinical Case Reports is an open access scholarly journal. The goal of this journal is to provide a platform for scientists and academicians all over the world to promote, share, and discuss various new issues and developments by publishing case reports in all aspects of Clinical Medicine. Case Reports is an open access journals. The goal of this journal is to provide a platform for scientists and academicians all over the world to promote, share, and discuss various new issues and developments by publishing case reports in all aspects of Clinical Medicine.
1) A randomized controlled trial examined the impact of a second examination of the proximal colon on adenoma detection rates during colonoscopy.
2) The trial found that performing a second examination of the proximal colon significantly increased both the proximal colon and whole colon adenoma detection rates, compared to a single examination.
3) Additional adenomas detected on the second examination were mostly small and non-advanced, but the second look led to changes in surveillance recommendations for some patients based on updated risk levels.
Colonoscopy to find colon cancer in asymptomatic adultGil Lederman
Colonoscopy is a procedure that allows direct visualization of the colon to screen for colon cancer. A recent large study found that colonoscopy identified pre-cancerous polyps and early-stage colon cancers in 37.5% of asymptomatic men who underwent the procedure. While generally safe, serious complications occurred in 0.3% of patients. The study concluded that colonoscopy screening can detect advanced lesions that may be treatable, and that over half of advanced cancers in the upper colon would be missed by less invasive sigmoidoscopy screening. Colonoscopy appears to be a generally safe and effective screening tool for colon cancer in asymptomatic adults.
Role of Diagnostic Laparoscopy in Chronic Abdominal Conditions with Uncertain...Dr. Ashvind Bawa
A Study by Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab and Department of Neurosurgery, Govind Ballabh Pant Hospital, New Delhi, India
Dyspepsia, or indigestion, is a common condition affecting 20-30% of the world's population. It includes symptoms like epigastric pain, burning, fullness, and early satiety. While most cases are functional, endoscopy is recommended for patients over age 40, those with red flag symptoms, or a family history of GI cancer to check for potential organic causes like ulcers or cancer. Studies show clinically significant findings in over 90% of dyspeptic patients undergoing endoscopy, including gastritis, ulcers, and rare cases of cancer. Long term PPI use for uninvestigated dyspepsia can increase risks of malabsorption and infections. Thus, thorough evaluation is
Intussusception in adult population is quite uncommon. It is usually seen in the pediatric age group. A wide range of causes can predispose to intussusception in adults. Majority of them are benign especially in cases of small bowel intussusception. However malignancy is quite often encountered in cases of colonic intussusception. Diagnosis in adults is difficult due to vague symptoms and intermittent nature. Computerized tomography is diagnostic. However majority of cases in adults are diagnosed at laparotomy. Surgical resection assuming the lesion to be malignant is the treatment of choice.
The document summarizes a study on the surgical treatment of idiopathic esophageal achalasia. 32 patients with idiopathic esophageal achalasia underwent various surgical procedures based on their disease stage. For non-advanced stages (I/II), 22 patients underwent cardiomyotomy with fundoplication, with only one patient experiencing postoperative complications. For advanced stages (III/IV), seven patients underwent esophageal mucosectomy preserving the muscle layer, with one experiencing complications. The remaining three advanced stage patients underwent transmediastinal esophagectomy, with two experiencing hydropneumothorax and one an anastomotic fistula, all resolving with treatment. Overall, the surgical strategies achieved low postoperative morbidity
This study examined 162 patients with cirrhosis who underwent endoscopic variceal band ligation to treat esophageal varices. The study aimed to determine the frequency and risk factors associated with the development of secondary gastric varices after eradicating esophageal varices. The results found that secondary gastric varices developed in 38 patients (23.5%) after eradicating their esophageal varices. Factors associated with an increased risk of developing secondary gastric varices included having more advanced liver disease (based on Child-Pugh class), larger esophageal varices at initial presentation, requiring more sessions of band ligation to eradicate the esophageal varices, and already having gastric varices present at initial presentation.
This document summarizes a study on Pap smear screening conducted in Bagalkot, India between 2015-2016. 240 women ages 20-60 received Pap smears. The most common finding was reactive cellular changes associated with inflammation (75.8% of cases). Other findings included low-grade squamous intraepithelial lesions (4.5%), atypical squamous cells of undetermined significance (3.3%), high-grade squamous intraepithelial lesions (2.1%), and atrophy (1.3%). The average age of women with epithelial abnormalities was 40 years old. Cases with abnormal findings received follow-up colposcopy and biopsy. This study aims to increase awareness of Pap smears and
Similar to Volume 12, issue 2, august 2011 prevalence of crohn’s disease in endoscopic unit cipto mangunkusumo hospital (20)
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Volume 12, issue 2, august 2011 prevalence of crohn’s disease in endoscopic unit cipto mangunkusumo hospital
1. ORIGINAL ARTICLE
Prevalence of Crohn’s Disease in Endoscopic Unit
Cipto Mangunkusumo Hospital
Nata Pratama*, Murdani Abdullah**, Dolly Dolven Kansera*,
Jane Estherina*, Rizki Yaruntradhani*, Fransiska Hardi*, Raden Nur Ista*
Marcellus Simadibrata**, Achmad Fauzi**, Daldiyono**,
Abdul Aziz Rani**, Diah Rini Handjari***, Pamela Abineno***
*Department of Internal Medicine, Faculty of Medicine, University of Indonesia
Dr. Cipto Mangunkusumo General National Hospital, Jakarta
**Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine
University of Indonesia/Dr. Cipto Mangunkusumo General National Hospital, Jakarta
***Department of Anatomical Pathology, Faculty of Medicine, University of Indonesia
Dr. Cipto Mangunkusumo General National Hospital, Jakarta
ABSTRACT
Background: The cumulative number of inflammatory bowel disease patients in Asia has raised three times
since early 1990s, although Crohn’s disease is still less common than ulcerative colitis. The objective of this
study was to provide clinical and demographic data of Crohn’s disease patients seen in Endoscopic Unit Cipto
Mangunkusumo Hospital and compare the results with other Asian countries.
Method: This study was done retrospectively cross-sectional descriptive from medical records of all patients
underwent colonoscopy at Endoscopic Unit, Cipto Mangunkusumo Hospital, and histological evaluation in
the Department of Anatomical Pathology, Faculty of Medicine, University of Indonesia, between 2007 and 2008.
Data was analyzed using SPSS version 17.
Results: Of 921 patients who underwent colonoscopy, 19 (2.1%) patients were diagnosed with Crohn’s
disease. There was no sex preponderance. The mean age was 47.7 years with a peak age at presentation between
51 and 60 years. The main clinical complaints were diarrhea (42.1%), lower gastrointestinal bleeding (36.8%),
abdominal pain (10.5%) and upper gastrointestinal bleeding (5.3%). Colonoscopic findings were hyperemia
in 94.7%, edema in 57.9%, erosions in 63.2%, ulcerations in 89.5%, pseudopolyp in 31.6%, fragile lesion in
10.5%, stenosis, fistulation, and cobblestone appearance in 5.3%. Involvement of isolated left colon was 26.3%;
other manifestations were isolated right colon (10.5%), pancolitis (57.9%), ileitis (5.3%), ileocolitis (36.8%)
and skip lesion (5.3%).
Conclusion: The prevalence of Crohn’s disease in this study was similar to the findings in previous studies
in Asian countries, with diarrhea as the main clinical complaint, and pancolitis as the dominant finding in
colonoscopy examination.
Keywords: Crohn’s disease, prevalence, clinical complaints, colonoscopy description
ABSTRAK
Latar belakang: Kejadian penyakit inflamasi kolon di Asia semakin meningkat hingga tiga kali lipat sejak
awal tahun 1990, walaupun kejadian penyakit Crohn lebih jarang ditemukan bila dibandingkan dengan kolitis
ulseratif. Tujuan penelitian ini adalah untuk mengetahui data klinis dan demografi penyakit Crohn pada pasien
yang menjalani kolonoskopi di Unit Endoskopi Rumah Sakit Cipto Mangunkusumo dan membandingkannya
dengan epidemiologi di negara Asia lain.
Metode: Penelitian ini dilakukan secara potong lintang deskriptif retrospektif dari rekam medis semua
pasien yang menjalani pemeriksaan kolonoskopi di Unit Endoskopi Rumah Sakit Cipto Mangunkusumo dan
Volume 12, Number 2, August 2011
85
2. Nata Pratama, Murdani Abdullah, Dolly Dolven Kansera, et al
pemeriksaan histopatologi di Departemen Patologi Anatomi, Fakultas Kedokteran Universitas Indonesia pada
tahun 2007-2008. Data dianalisis dengan menggunakan SPSS versi 17.
Hasil: Dari 921 pasien yang menjalani prosedur kolonoskopi, 19 (2.1%) pasien didiagnosa menderita
penyakit Crohn. Rata-rata usia pasien yaitu 47,7 tahun dengan onset gejala terbanyak pada usia 51-60 tahun
dan tidak terdapat perbedaan proporsi jenis kelamin. Keluhan utama pasien adalah diare (42.1%), perdarahan
saluran cerna bagian bawah (36.8%), nyeri perut (10.5%), dan perdarahan saluran cerna bagian atas (5.3%).
Pada hasil kolonoskopi pada pasien ditemukan hiperemis (94%), edema (57%), erosi (63.2%), ulserasi (89.5%),
pseudopolip (31.6%), lesi mudah berdarah (10.5%), serta stenosis, fistulasi, dan cobblestone appearance 5.3%.
Keterlibatan kolon bagian kiri saja sebesar 26.3%, kolon bagian kanan saja sebesar 26.3%, pankolitis 57.9%,
ileitis 5.3%, ileokolitis 36.8%, dan skip lesion 5.3%.
Kesimpulan: Prevalensi penyakit Chron pada penelitian ini serupa dengan epidemiologi pada negara-negara
Asia. Pada penelitian ini diare merupakan keluhan utama terbanyak dan pankolitis merupakan temuan yang
dominan dari pemeriksaan kolonoskopi.
Kata kunci: penyakit Crohn, prevalensi, keluhan klinis, deskripsi kolonoskopi
INTRODUCTION
Crohn’s disease (CD) is common for Caucasian
populations in Northern Europe and North America.
In South America, Asia, and Africa, this disease remains
uncommon but appears to be increasing.1 This perception
was changed in the middle of the last century from Central
and Western Europe. The changing epidemiology of
inflammatory bowel disease (IBD) in Asia is important
since the three most populous countries in the world, i.e.
China, India and Indonesia, reside in Asia. The cumulative
number of IBD patients has raised three times since early
1990s, although CD is still less common than ulcerative
colitis (UC).1 In Indonesia, the prevalence of Crohn’s
disease in patients underwent endoscopic evaluation was
1.4% in the year 1991–1995 and 5.2% in the year 2000.2
The objective of this study was to provide clinical and
demographic data of CD patients seen in Endoscopic Unit
Cipto Mangunkusumo Hospital and compare the results
with other Asian countries. Data obtained will be a basis
for further evaluation to monitor the prevalence of CD in
Indonesia and to confirm the demographic characteristic
of CD and its development in previous years.
METHOD
This study was a retrospective descriptive study
using medical records of patients who underwent
colonoscopy. Medical records obtained were data of all
patients who underwent colonoscopic examination at
Endoscopic Unit, Cipto Mangunkusumo Hospital, Jakarta
and histopathological evaluation in the Department of
Anatomical Pathology, Faculty of Medicine, University
of Indonesia, between January 2007 and December 2008.
The inclusion criteria were patients with colonoscopic
findings that resemble CD and confirmed with
histopathological evaluation. Data obtained were sex,
86
age at presentation, symptoms indicated for colonoscopic
examination, appearance of CD on colonoscopic
examination and site of involvement. Data was analyzed
using computer program statistical package for social
sciences version 17 (SPSS Inc., Chicago, IL, USA)
descriptively as means and proportions.
RESULTS
From January 2007 to December 2008, there
were 921 patients who underwent colonoscopy. From
those patients, 19 (2.1%) patients had colonoscopic
appearance that resembles CD. The mean age was
47.7 years with standard deviation 18.44 years, and
a peak age at presentation was 51-60 years.
The main clinical complaints were diarrhea 42.1%
patients. The characteristics could be seen in Table 1.
The most colonoscopic finding was hyperemia in 94.7%
patients. Most patients had pancolitis 57.9%, whereas
involvement of isolated left colon was 26.3% and
isolated right colon 10.5% (Table 2).
Table 1. Characteristic of Crohns’ disease patients
Characteristics
Age (years)
< 30
31-40
41-50
51-60
61-70
> 70
Mean ± SD
Sex
Male
Female
Clinical complaints
Diarrhea
Lower gastrointestinal bleeding
Abdominal pain
Upper gastrointestinal bleeding
Fever
Constipation
n (%)
3 (15.8)
3 (15.8)
4( 21.1)
5 (26.3)
2 (10.5)
2 (10.5)
47.77 ± 18.44
9 (47.7)
10 (52.3)
8 (42.1)
7 (36.8)
2 (10.5)
1 (5.3)
0 (0)
0 (0)
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
3. Prevalence of Crohn’s Disease in Endoscopic Unit Cipto Mangunkusumo Hospital
Table 2. Colonoscopic findings and site involvement of Crohns’
disease patients
n (%)
Colonoscopic findings
Hyperemia
Ulcerations
Erosion
Edema
Pseudopolyp
Fragile lesion
Stenosis, fistulation, and cobblestone appearance
Site of involvement
Pancolitis
Ileocolitis
Isolated left colon
Isolated right colon
Ileitis
Skip lesion
18 (94.7)
17 (89.5)
12 (63.2)
11 (57.9)
6 (31.6)
2 (10.5)
1 (5.3)
11 (57.9)
7 (36.8)
5 (26.3)
2 (10.5)
1 (5.3)
1 (5.3)
DISCUSSION
This study found the prevalence of CD was 2.1%.
This prevalence was similar to other studies in Asia,
but compared to prevalence in Indonesia previously,
it seemed to be decreasing. Possibly, the reason was
the different settings, such as prevalence of 1.4% was
from total colonoscopy done, and 5.2% from total
cases of chronic, bloody diarrhea and abdominal pain.
So, the prevalence of CD relatively does not change
over years. These results were similar to the findings
in previous studies in Asian countries.1,2,3
The prevalence of CD is 35-100/100,000 for
Caucasian populations in Northern Europe and North
America. In South America, Asia, and Africa, CD
remain uncommon but appear to be increasing. 1
The incidence of CD ranges from 0.5 to 1.0 per 100,000
person year.4,5 A study in Japan reported the annual
incidence rates of CD was 0.514/100,000 population,
whereas prevalence rates was 5.85/100,000 in 1991.
The Korean Association for Study of Intestinal Disease
(KASID) found the mean annual incidence rates of CD
increased from 0.05 per 100,000 inhabitants in 19861990 to 1.34 per 100,000 inhabitants in 2001-2005
and the adjusted prevalence rates of CD per 100,000
inhabitants was 11.24 (95% CI = 9.29–13.18).6 A study
in the Philippine General Hospital (PGH) found 18 CD
patients in 1999-2004. The mean annual incidence of
IBD was 2.05 new cases per 100,000 new consults per
year.7 In Indonesia, the prevalence of CD in patients
underwent endoscopic evaluation was 1.4% in the year
1991-1995 and 5.2% in the year 2000.2,3
The Asia-Pacific region once thought to be
free from IBD has been changed by the finding of
significant numbers of publications emerging in
literature. The perception changed in the middle of
the last century from Central and Western Europe.
Volume 12, Number 2, August 2011
Important demographic changes likely to be followed
in Asia include an exponential increase in IBD in
industrialized nations and an increase in the incidence
of UC precedes that in CD with a time lag of 15-20
years.1,8
Descriptive epidemiological data on IBD, both
cross sectional and over time periods are abundant
in the West countries, whereas only little information
are available in Asia. Problematic issues related to
IBD study in Asia include lack of population based
registries, limited access to health care facilities,
limited availability of diagnostic tests and infectious
diseases especially diarrhea confounding the diagnosis
of IBD.1,8 These conditions might be the reason for
the difference incidence of IBD from the Western
countries.
The peak age of onset for CD that has a bimodal
age of presentation in the West, is not observed in
Asian countries.1 But the PGH study found mean age
of presentation was 41 years and a bimodal peak in
the age at presentation was noted during 21-30 years and
51-60 years.7 There is some weak and inconclusive
evidence of a bimodal age of onset of IBD in Asian
patients.9 In this study, the peak age of CD was during
51-60 years, with no bimodal peak found. These
findings were quite similar to the common presentation
of CD in Asian population.
In European and North American studies,
the distribution of IBD is roughly equal across sex or show
a modest female predominance but in Japanese, Chinese
and case series from India, CD was more commonly
seen in males.1 The PGH study found there was male
predominance with a male/female ratio of 2.1 : 1.7 Male
appeared to have greater risk for CD.10,11 There was no
sex preponderance in the prevalence of CD in this study.
Clinical features that are common of CD include
fever, abdominal pain, weight loss, signs of malnutrition,
and abdominal mass. Other symptoms such as
diarrhea, rectal bleeding and perianal disease are fairly
common.12 The PGH study found abdominal pain
(45.4%), diarrhea (22.7%) and lower gastrointestinal
bleeding (18.1%) were the main reasons for medical
consultation.7 Clinical presentation of CD in this
study was also quite similar, whereas diarrhea, lower
gastrointestinal bleeding, and abdominal pain as
the main symptoms that lead the patients to consult
the doctor. One difference was upper gastrointestinal
bleeding was the main symptom that leads patients to
colonoscopic evaluation. Because data obtained were
from endoscopic unit, there was lack of other clinical
data such as weight loss, abdominal mass or signs of
malnutrition.
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4. Nata Pratama, Murdani Abdullah, Dolly Dolven Kansera, et al
Frequent site of involvements are in colon and
ileum, while jejunum, stomach or duodenum and
esophagus are infrequent.12 The PGH study found that
CD patients have a significant predilection to ileocecal
involvement (55.6%). Only 6 (33.3%) patients
presented with pure colitis and 2 (11.1%) with isolated
small intestinal involvement. In Japan, however,
the isolated small intestinal type predominates.7 This
study found that most patients (57.9%) had pancolitis
while ileocolitis was 36.8%, isolated left colon and
isolated right colon were 26.3% and 10.5%, ileitis
5.3%, and skip lesion 5.3% respectively. These findings
were also similar to the common findings in CD.
Common colonoscopic findings are aphtous, linear
ulcers, and cobblestone appearance, while friability,
pseudopolyps and rectal involvement are fairly
common.12 Findings of the colonoscopic appearance
was dominated by hyperemia, ulcerations, erosions,
edema, that were the common findings. Different
findings are the low proportion of cobblestone
appearance (5.3%).
In Korea, Kim et al, found some clinical and
genotypic characteristics unique in Korean IBD
patients, and the clinical course that seems milder and
has better response to medical management.6 These
differences might provide significant clues about
the etiology and pathophysiology of IBD. In Indonesia
we have not had the genomic data and treatment
response of IBD patients. Further comprehensive
population based studies are required to provide more
information about IBD in Indonesia that might be
useful for the management of IBD patients.
CONCLUSION
The prevalence of Crohn’s disease in this study
was similar to the findings in previous studies in
Asian countries. Diarrhea was the main clinical
complaint, while pancolitis was the dominant finding
in colonoscopy examination. The observed increase in
CD in Asia during the past decade was not observed in
this study. Despite globalization of IBD, especially CD,
there remains a difference in the disease prevalence
between developed and developing countries,
particularly Western and Asian countries. Greater
awareness and better availability of health care and
improved study methods must be applied to monitor
the prevalence of CD and evaluate the development
in the future.
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Correspondence:
Murdani Abdullah
Division of Gastroenterology, Department of Internal Medicine
Dr. Cipto Mangunkusumo General National Hospital
Jl. Diponegoro No. 71 Jakarta 10430 Indonesia
Phone: +62-21-3153957 Facsimile: +62-21-31424254
E-mail: murdani08@yahoo.com
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The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy