Irritable bowel syndrome (IBS) is a chronic gastrointestinal disease, which adversely affects the quality of life. Its prevalence has been reported to be around 10-15 % in North America and constitutes the most common cause for gastroenterology referral. Unfortunately, the pathophysiology of IBS is not completely understood. Not surprisingly, the management strategies can leave the patients with inadequate symptom control, making IBS a debilitating gastrointestinal syndrome. Dietary interventions as a treatment strategy for IBS have been recently evaluated. One such intervention includes dietary restriction of fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs). FODMAPs define a group of short-chain carbohydrates that are incompletely absorbed in small intestine and later fermented in the colon. Evidence in the form of randomized controlled trials and observational studies have evaluated the mechanism of action and efficacy of low-FODMAP diet. This dietary intervention has showed promising results in symptom reduction in IBS patients. However, latest trials have also shown that the low-FODMAP diet is associated with marked changes in gut microbiota specifically reduction in microbiota with prebiotic properties. Implications of such changes on gastrointestinal health need to be further evaluated in future trials.
A 41-year-old female with Down's syndrome on peritoneal dialysis (PD) presented with PD-related peritonitis which was not responding to guideline-directed antimicrobial therapy. Computed tomography scan revealed air in the peritoneal cavity initially suspected to be secondary to her PD. Multiple enteric bacteria were identified in the PD fluid which raised suspicion for perforation. A perforated diverticulum was eventually diagnosed with exploratory laparotomy. Spontaneous perforated viscus in patients undergoing PD is rare, but without prompt and aggressive intervention may be associated with significant morbidity and mortality. We discuss the case and review the literature highlighting the delay in the diagnoses of such cases and the role of imaging and exploratory laparotomy. Finally, recovery of multiple enteric pathogens in the workup of PD-associated peritonitis should raise the suspicion of possible viscus perforation.
OBJECTIVES:
To determine correlation of zero coronary artery calcium score (CACS) with non-significant coronary artery stenosis by using computed tomography coronary angiography (CTCA).
METHODOLOGY:
62 patients with suspected coronary artery disease (CAD) underwent CACS test and CTCA from April 2018 to November 2020. Patients were examined with 160 slice multidetector CT and grouped according to their age, gender, CACS, and maximum coronary luminal stenosis. CACS was assessed using Agatston scoring and degree of stenosis was assessed by automatic software and severity was scored according to CAD-RADS. The correlation between these two main variables was calculated using Spearman rank correlation.
RESULTS:
The 62 patients were divided into four groups according to CACS, using the Agatston Unit (AU). Group 1; 0 AU (41 patients, 66.13%), Group 2; 1-100 AU (13 patients, 20.97%) Group 3; 101-400 AU (4 patients, 6.45%), Group 4; 401-1000 AU (4 patients, 6.45%). In 41 patients with zero calcium score (32 males and 9 females), 38 patients (92.68%) were found to have no coronary artery stenosis, 2 patients (4.87%) had mild coronary artery stenosis and 1 patient (2.43%) had moderate coronary artery stenosis. Total 35 patients presented for screening purpose out of which 25 (71%) had zero calcium score and no significant coronary artery disease.
CONCLUSION:
In high risk patients, zero calcium score excludes significant coronary artery stenosis (50%), hence coronary calcium score is a good screening tool before subjecting patients to coronary angiography.
Cystic teratoma is a germ cell tumor, which usually involves the gonads. However, it can be located occasionally in other organs. The most common extragonadal sites for germ cell tumors include midline structures such as the retroperitoneum, mediastinum, pineal body, and supra-sellar space. Here, we describe a case of a patient who presented with a cystic teratoma involving the anterior aspect of the neck. The chief complaints of the patient consisted of a large swelling in front of the neck, difficulty in breathing, and frequent regurgitation of milk during feeding. Initially, a diagnosis of cystic hygroma was instituted for which the patient underwent sclerotherapy utilizing bleomycin. However, no improvement was observed in the patient’s condition. A detailed evaluation was planned, starting with a CT scan of the head and neck that suggested cystic teratoma as the likely etiology. Surgical excision of the mass was performed, and an excisional biopsy for histopathological examination was taken. A final diagnosis of cervical cystic teratoma was established based on the histopathological findings. The purpose of reporting this case is to raise awareness among fellow healthcare professionals that cystic teratoma can also present with a large swelling in the anterior neck with obstructive features.
To evaluate the successful management of intussusception through ultrasound guided hydrostatic reduction with respect to duration of symptoms in children up to 6 years of age. METHODS: Retrospective analysis was done for 68 paediatric patients in the age range from 2.5 months to 6 years at Radiology & Paediatrics departments, Medical Teaching Institution Lady Reading Hospital, Peshawar. Children primarily diagnosed as intussusception, based on ultrasound ndings & managed conservatively with ultrasound guided hydrostatic reduction from January 2014 to December 2017 were included in the study. Their management was analyzed with respect to duration of symptoms. Children who were primarily managed surgically were excluded from study. RESULTS: A total of 68 patients in the age range from 2.5 months to 6 years were included in the study. Male to female ratio was 3.25/1 with 52 males (≤1 year=45 & >1year=7) and 16 females (≤1 year=11 & >1 year=5). Abdominal pain was reported in all (100%) cases, followed by bleeding per rectum in 35.2% and abdominal mass in 13.2% cases. Classic triad of abdominal pain, abdominal mass and bleeding per rectum was reported only in 8.8% of cases. Overall rate of success of hydrostatic reduction was 89.70% (n=61/68). Success rate in cases presented ≤48 hours was 97.56% and in cases presented >48 hours was 77.77% (p<0.05). CONCLUSION: Hydrostatic reduction for intussusception in paediatric patients under ultrasound guidance has a good outcome. Success rate for patients presenting presented ≤48 hours was better than patients presenting presented ≥48 hours.
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