Dysphagia among Middle-Aged Females

Objective: To assess the association of dysphagia with iron deficiency anemia in female patients. Study Design: Descriptive Study Setting & Duration: Department of ENT at Fauji Foundation Hospital Rawalpindi from April 2019 to April 2021. Material and Methods: Approval of the study was obtained from the Hospital Ethical Committee and then Informed Consent was obtained from all the patients. A total of 42 female patients with dysphagia were selected by Consecutive convenient sampling. After detailed history and physical examination, Complete Blood Count and X-ray Barium Swallow were done in all these patients, followed by Rigid Endoscopy under GA. Tissue biopsy was done in all the patients from suspicious areas. The data was analyzed for frequencies by SPSS 24. Results: 42 female patients were included in this study. The mean age of these patients was 46.30 years, ranging from 32 to 65 years. 40 (95%) of these patients showed Esophageal webs in the cricopharyngeal region, while 2 (5%) of them had irregular strictures in the post cricoid region of Hypopharynx. Iron deficiency anaemia was found in 32 (76.19%) patients. Histopathology report showed Squamous Cell Carcinoma in 2 patients with post cricoid strictures, while the rest 40 with webs showed chronic inflammation with fibrosis. Rigid esophagoscopy with web dilatation was highly effective procedure for treatment in 40 (95%) patients. Repeated dilatations were needed in 14 (33%) of the patients. The 2 patients with malignancy underwent Chemo-radiotherapy. Conclusion:  Iron deficiency anemia has a strong association with dysphagia in middle age female patients and is a potential risk factor for malignant transformation. Timely diagnosis and prevention of anaemia may result not only in decrease in PVS but also a decreased incidence of hypopharyngeal carcinoma in the vulnerable population. Key words: Dysphagia, Iron deficiency anemia, Post cricoid Carcinoma

Dysphagia among Middle-Aged Females

Objective: To assess the association of dysphagia with iron deficiency anemia in female patients. Study Design: Descriptive Study Setting & Duration: Department of ENT at Fauji Foundation Hospital Rawalpindi from April 2019 to April 2021. Material and Methods: Approval of the study was obtained from the Hospital Ethical Committee and then Informed Consent was obtained from all the patients. A total of 42 female patients with dysphagia were selected by Consecutive convenient sampling. After detailed history and physical examination, Complete Blood Count and X-ray Barium Swallow were done in all these patients, followed by Rigid Endoscopy under GA. Tissue biopsy was done in all the patients from suspicious areas. The data was analyzed for frequencies by SPSS 24. Results: 42 female patients were included in this study. The mean age of these patients was 46.30 years, ranging from 32 to 65 years. 40 (95%) of these patients showed Esophageal webs in the cricopharyngeal region, while 2 (5%) of them had irregular strictures in the post cricoid region of Hypopharynx. Iron deficiency anaemia was found in 32 (76.19%) patients. Histopathology report showed Squamous Cell Carcinoma in 2 patients with post cricoid strictures, while the rest 40 with webs showed chronic inflammation with fibrosis. Rigid esophagoscopy with web dilatation was highly effective procedure for treatment in 40 (95%) patients. Repeated dilatations were needed in 14 (33%) of the patients. The 2 patients with malignancy underwent Chemo-radiotherapy. Conclusion:  Iron deficiency anemia has a strong association with dysphagia in middle age female patients and is a potential risk factor for malignant transformation. Timely diagnosis and prevention of anaemia may result not only in decrease in PVS but also a decreased incidence of hypopharyngeal carcinoma in the vulnerable population. Key words: Dysphagia, Iron deficiency anemia, Post cricoid Carcinoma

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Verbal Autopsy of Maternal Mortality in Rawalpindi District

Objective: To identify the causes and risk factors leading to maternal mortality through verbal autopsy in the District of Rawalpindi, Pakistan. Study Design: A retrospective, descriptive study. Place and Duration of Study: The study was carried out in Community Department of Foundation University Medical College Islamabad from January 05, 2019, to December 25, 2019. Materials and Methods: Data of 105 women died of causes related to death during pregnancy/ delivery between 01 April 2013 and 30 April 2018 was retrieved from the office of District Health Officer (DHO) Rawalpindi. A Verbal Autopsy was conducted to determine cause of death and the possible risk factors, through a structured questionnaire that was filled by close relatives of the deceased women. Analysis of data was done using SPSS version 25.0. Results: The Mean age of the patients was 31 years, and it ranged from 15 to 49 years. In 26.7% of mothers cause of death could not be determined. Overall, the major and most obvious cause of maternal death was delivery related hemorrhage in 58% cases. Out of these, antepartum hemorrhage was the commonest cause occurring in 43.8% of the total cases. Postpartum hemorrhage occurred in 11.4% cases, while fatal hemorrhage during the delivery occurred in 2.8% mothers. Eclampsia was the next common cause that occurred in 11.4% mothers. Difficult and prolonged labour was found to be cause of death in 2.8% cases, while 0.95% died of Sepsis. Among the risk factors, lack of antenatal care emerged as the leading risk factor, present in 62% mothers, followed by anemia being present in 46.6% mothers. Multi-parity was found to be the next common risk factor being present in 26.6% mothers. Reduced interval in successive pregnancies was found in 21% cases. Systemic medical disorders like hypertension, renal disorders, Diabetes Mellitus, Pneumonia, hepatic failure, were found in 6.66% mothers. History of complications in previous pregnancies was present in 3.8% cases. History of lack of proper medical services in the hospital as possible factor leading to death was present in only 5 (4.8%) cases. Conclusion: Hemorrhage related with delivery, especially the antepartum hemorrhage emerged as the commonest cause of maternal mortality, followed by eclampsia. At the same time, lack of antenatal care and anaemia emerged as the commonest risk factors in this regard