H. Pylori Fecal Antigen Detection taking endoscopic biopsy as gold standard in Dyspeptic Patients

Introduction: There are several invasive and non-invasive techniques used to diagnose H. pylori infection, each having its own advantages and disadvantages. Invasive methods require biopsy samples from stomach and duodenum and can be tested by various methods such as histology, Rapid urease test (RUT), microbiological culture and Polymerase chain reaction (PCR) whereas non-invasive tests include stool antigen test, serology and Urea breath test Objectives: To determine the diagnostic accuracy of H. Pylori Fecal Antigen Detection taking endoscopic biopsy as gold standard in dyspeptic Patients (18-65 years). Materials & Methods: Descriptive, cross-sectional study was conducting during 30th April 2019 to 30th October 2019 in Gastroenterology Unit, Holy Family Hospital, Rawalpindi. A total of 85 patients irrespective of gender having age 18-65 years having symptoms of dyspepsia were included. Patients having gall stones, celiac disease, pancreatic disease, Diabetes Mellitus, thyroid disease and any other patients on PPI or H2 receptors. Patients with history of alcoholism, diagnosed cases of H. Pylori infection or treatment history of H Pylori. Patients diagnosed for pancreatitis, cholecystitis, Hepatitis B or C Virus positive cases of Chronic Liver Diseases, HIV, malignancy or Ischemic Heart Disease or being pregnant were excluded. H. Pylori on Fecal Antigen Detection and endoscopic biopsy were noted. Results: Fecal Antigen Detection found that 42 were True Positive and 04 were False Positive. Among 39, Fecal Antigen negative patients, 04 (False Negative) had H. Pylori on endoscopic biopsy whereas 35 (True Negative) had no H. Pylori involvement on endoscopic biopsy (p=0.0001). Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of H. Pylori Fecal Antigen Detection taking endoscopic biopsy as gold standard in dyspeptic Patients was 91.30%, 89.74%, 91.30%, 89.74% and 90.59% respectively. Conclusion: This study concluded that diagnostic accuracy of H. Pylori Fecal Antigen Detection in dyspeptic Patients is quite high. Keywords: helicobacter pylori, Fecal Antigen Detection, endoscopic biopsy.   &nbsp

Hypomagnesaemia in Acute Exacerbation Chronic Obstructive Airway Disease; Association with Anthonisen’s Levels of Exacerbation

Background: COPD is major public health issue causing morbidity and mortality. Lower serum magnesium levels are seen in patients with acute exacerbations compared to stable COPD patients. This study aims at identifying hypomagnesemia as predictor of COPD exacerbations that may help reduce the burden of readmissions and mortality. Material and Methods: The Descriptive cross-sectional study was conducted –removed for blind review---from 16 July 2016 to 15 Jan 2017 after the ethical approval and informed consent. The indoor adult (>18years) diagnosed cases of COPD exacerbation were included by consecutive sampling. Patients with malignancy, pregnancy and receiving magnesium supplements were excluded.  Demographic details documented and after complete clinical evaluation, serum Magnesium levels of were assessed. Serum Magnesium < 1.80 mg/dl labeled hypomagnesaemia.  Data was analyzed by SPSS with significant p< 0.05. Results: Amongst 176 patients; there were 93(52.8%) males and 83(47.2%) females. Mean age was 56+7 years. Mean duration of COPD was 6.56 + 5.24 years (2-10 years).  Mean height in the study was 181 +12 cm and mean weight was 56.06 + 7.08 kg. The mean serum magnesium level was 1.5 + .49mg/dl. Low serum magnesium (<1.8 mg/dl) observed in 103(58.5%), gender wasn’t associated with hypomagnesaemia (p=0.294). Hypomagnesaemia in accordance to types of Anthonisen’s criteria was observed in 19(44.2%) with Type I, 37(57.8%) with Type II and 47(68.1%) with Type III COPD exacerbation. Hypomagnesaemia had significant association with Anthinosen’s levels of exacerbation (p=0.043). The mean age in patients with hypomagnesaemia was 56.61+6.78 Vs.  55.30+7.47 in patients without hypomagnesaemia (p=0.228). Conclusion: The study concludes mean serum magnesium levels are significantly lower in patients with acute exacerbation of COPD (58.5%), particularly in type II and III. Magnesium levels should be performed in all COPD exacerbations irrespective of gender and age. Replacement of magnesium may be helpful in alleviating symptoms and reducing frequency of exacerbations. KEYWORDS:   COPD.   Acute exacerbation.  Serum Magnesium levels. Hypomagnesaemia

Clinical skills in undergraduate program and Curricular change – does it make a difference?

Background Clinical Skills Laboratory (CSL) was established at Foundation University Medical College (FUMC) in year 2009 with the introduction of integrated modular teaching program. A structured integrated curriculum was introduced from the Class of year 2013 for learning of clinical skills at CSL. This study was conducted to evaluate the effect of introducing the new curriculum on student’s performance in CSL. Methods A comparative analytical study was conducted. The OSCE scores of group A (Class of year 2011) were compared with group B (Class of 2013). Data collection tool was institutional checklist. The OSCE stations were of General Physical Examination (GPE), history taking, systemic examination of Gastrointestinal tract and communication skills. Reliability of the scores was estimated through Cronbach α. Mean scores of the two groups were compared using the independent sample t test and Mann Whitney U-test. Chi-square test was used to compare variables (years, gender and educational background). Comparison of student scores at different components of OSCE using Analysis of Variance (ANOVA) was done.   Results Reliability of scores was 0.65 for group B and 0.52 for group A. comparison of overall scores of the two groups reflected improved performance in the group B (p 0.001). Comparison of scores at different components of OSCE using ANOVA also reflected better performance of group B (p<0.01). OSCE scores of both the groups were also correlated for gender and educational background. No difference was found in the two groups on the basis of gender and educational background. Conclusion To enhance the value of clinical skills training and to make it more effective, skill lab curriculum must be structured and integrated within the undergraduate curriculum. Key words;Clinical skills laboratory, undergraduate integrated curriculum, clinical skills training&nbsp

Can “HINTS” aid the Diagnosis of Posterior Circulation Stroke among patients with Acute Vestibular Syndrome?

Introduction: Identifying posterior circulation stroke in patients with AVS without obvious focal neurological deficits poses a difficult diagnostic challenge. It is estimated that about 10% to 20% of patients who present with acute dizziness to the Emergency department have AVS7. Most AVS patients have a benign peripheral vestibular cause (vestibular neuritis or nonbacterial labyrinthitis), but about 25% have brainstem or cerebellar strokes7, 9-10. Rapid, accurate diagnosis of posterior stroke is important for early management as well as prevention of devastating complications. HINTS is a clinical three-step bedside oculomotor exam, that has been suggested of high diagnostic accuracy in identifying posterior circulation stroke in patients with isolated continuous vertigo. Methods: A comprehensive systematic search of literature was done using the NHS Evidence healthcare databases Medline, EMBASE, CLINIL, Google scholar and Cochrane. Results: 10 relevant articles were identified, combining the results of all six prospective studies showed a total of 338 patients on which Clinical HINTS exam was performed. The overall Hints exam sensitivity was 96.86% 95%CI (92.8-99), specificity 96.09% 95%CI (92.1-98.4) and negative predictive value was 0.03 95%CI (0.01-0.08). ROC analysis was done in which area under curve was found to be 0.965. Conclusion: Delay in diagnosis of posterior stroke can result in 8-fold increase in mortality7. HINTS is a useful clinical bed side oculomotor exam, which if done appropriately by trained ED doctors, could aid in the early recognition of a subtly presenting posterior stroke with “acute isolated continuous vertigo”. Hence, will improve the overall diagnostic evaluation of acute vestibular syndrome

H. Pylori Fecal Antigen Detection taking endoscopic biopsy as gold standard in Dyspeptic Patients

Introduction: There are several invasive and non-invasive techniques used to diagnose H. pylori infection, each having its own advantages and disadvantages. Invasive methods require biopsy samples from stomach and duodenum and can be tested by various methods such as histology, Rapid urease test (RUT), microbiological culture and Polymerase chain reaction (PCR) whereas non-invasive tests include stool antigen test, serology and Urea breath test Objectives: To determine the diagnostic accuracy of H. Pylori Fecal Antigen Detection taking endoscopic biopsy as gold standard in dyspeptic Patients (18-65 years). Materials & Methods: Descriptive, cross-sectional study was conducting during 30th April 2019 to 30th October 2019 in Gastroenterology Unit, Holy Family Hospital, Rawalpindi. A total of 85 patients irrespective of gender having age 18-65 years having symptoms of dyspepsia were included. Patients having gall stones, celiac disease, pancreatic disease, Diabetes Mellitus, thyroid disease and any other patients on PPI or H2 receptors. Patients with history of alcoholism, diagnosed cases of H. Pylori infection or treatment history of H Pylori. Patients diagnosed for pancreatitis, cholecystitis, Hepatitis B or C Virus positive cases of Chronic Liver Diseases, HIV, malignancy or Ischemic Heart Disease or being pregnant were excluded. H. Pylori on Fecal Antigen Detection and endoscopic biopsy were noted. Results: Fecal Antigen Detection found that 42 were True Positive and 04 were False Positive. Among 39, Fecal Antigen negative patients, 04 (False Negative) had H. Pylori on endoscopic biopsy whereas 35 (True Negative) had no H. Pylori involvement on endoscopic biopsy (p=0.0001). Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of H. Pylori Fecal Antigen Detection taking endoscopic biopsy as gold standard in dyspeptic Patients was 91.30%, 89.74%, 91.30%, 89.74% and 90.59% respectively. Conclusion: This study concluded that diagnostic accuracy of H. Pylori Fecal Antigen Detection in dyspeptic Patients is quite high. Keywords: helicobacter pylori, Fecal Antigen Detection, endoscopic biopsy.   &nbsp

Skin Changes in Newly Diagnosed Cases of Hypothyroidism

Introduction: Thyroid disorders are frequent in our population that leads to variety of cutaneous manifestations. Aim of our study was to determine the frequencies of skin changes of hypothyroidism and their association with gender. Methodology: This observational study was conducted at RIHS Islamabad (Ist Jun to 31st Dec 2019) after ethical approval. 105 patients (>18years age) of both genders. Confirmed to have hypothyroidism on the basis of thyroid function tests were included. Secondary hypothyroidism, sick thyroid disease, pregnant women, receiving thyroxin therapy, carcinoma of thyroid, critically ill cases, post-thyroidectomy and iatrogenic thyroid cases were excluded. After informed consent, demographic details were documented. Patients were clinically evaluated and examined in detail including dermatological examination for cutaneous manifestations. Various skin findings are studies with respect to gender. Data was analysed by SPSS version 21 with Chi-square test as a test of significance, significant p<0.05. Results: Among 105 cases of hypothyroidism (62% females and 38% males, mean age was 38.04+12.61 years. Mean TSH level was found to be 32.08 + 33.96 (mean TSH was 35.31+37.31 in females Vs. 26.96 + 27.19 in males; p=0.001). Common skin findings were dry skin in 69.5%, diffuse hair loss in 58%, coarse skin in 57%, pruritis in 51.4%, madarosis 37%, seborrheic dermatitis 34%, coarse scalp hairs 27% and slow nail growth in 23%. The brittle nails, alopecia areata, chronic urticaria, acanthosis nigricans, ivory yellow skin, purpura ecchymosis, ichthyosis, herpes simplex and certain other findings were found in <20% cases. Obesity was observed in 53(50.5%) cases, Type 2 diabetes in 20(19%), hypertension in 23(21.9%), dyslipidaemia in 12(11.4%) and anaemia in 9(8.6%). Obesity, diabetes, dyslipidaemia had no association with gender (p>0.05). However, hypertension and anaemia were significantly frequent amongst females (p<0.05). The dry, coarse skin, diffuse hair loss and seborrheic dermatitis were associated with female gender (p>0.05). Slow nail growth, brittle nails, acne vulgaris, acrochordons, vitiligo, xanthelasma were more common in males however the difference wasn’t statistically significant. Conclusion: Skin acts as an important diagnostic window to diseases affecting internal organs including thyroid disorders. Authors recommend screening for thyroid functions, diabetes, hypertension, dyslipidaemia, obesity and anaemia in patients presenting with suggestive dermatological manifestations irrespective of age and gender. KEYWORDS:  Hypothyroidism.  Thyroid Diseases.  Skin Changes. Thyroid Stimulating Hormone. Thyroid Gland

Hypomagnesaemia in Acute Exacerbation Chronic Obstructive Airway Disease; Association with Anthonisen’s Levels of Exacerbation

Background: COPD is major public health issue causing morbidity and mortality. Lower serum magnesium levels are seen in patients with acute exacerbations compared to stable COPD patients. This study aims at identifying hypomagnesemia as predictor of COPD exacerbations that may help reduce the burden of readmissions and mortality. Material and Methods: The Descriptive cross-sectional study was conducted –removed for blind review---from 16 July 2016 to 15 Jan 2017 after the ethical approval and informed consent. The indoor adult (>18years) diagnosed cases of COPD exacerbation were included by consecutive sampling. Patients with malignancy, pregnancy and receiving magnesium supplements were excluded.  Demographic details documented and after complete clinical evaluation, serum Magnesium levels of were assessed. Serum Magnesium < 1.80 mg/dl labeled hypomagnesaemia.  Data was analyzed by SPSS with significant p< 0.05. Results: Amongst 176 patients; there were 93(52.8%) males and 83(47.2%) females. Mean age was 56+7 years. Mean duration of COPD was 6.56 + 5.24 years (2-10 years).  Mean height in the study was 181 +12 cm and mean weight was 56.06 + 7.08 kg. The mean serum magnesium level was 1.5 + .49mg/dl. Low serum magnesium (<1.8 mg/dl) observed in 103(58.5%), gender wasn’t associated with hypomagnesaemia (p=0.294). Hypomagnesaemia in accordance to types of Anthonisen’s criteria was observed in 19(44.2%) with Type I, 37(57.8%) with Type II and 47(68.1%) with Type III COPD exacerbation. Hypomagnesaemia had significant association with Anthinosen’s levels of exacerbation (p=0.043). The mean age in patients with hypomagnesaemia was 56.61+6.78 Vs.  55.30+7.47 in patients without hypomagnesaemia (p=0.228). Conclusion: The study concludes mean serum magnesium levels are significantly lower in patients with acute exacerbation of COPD (58.5%), particularly in type II and III. Magnesium levels should be performed in all COPD exacerbations irrespective of gender and age. Replacement of magnesium may be helpful in alleviating symptoms and reducing frequency of exacerbations. KEYWORDS:   COPD.   Acute exacerbation.  Serum Magnesium levels. Hypomagnesaemia