Background:High-resolution manometry (HRM) is a gold standard for diagnosing achalasia and identification of its subtypes, but data regarding its correlation with clinical, endoscopic, and radiological features in low-resource settings like Pakistan are limited. This study aims to identify and compare manometric parameters with other diagnostic parameters among achalasia subtypes in Pakistani population. Methodology:A retrospective analysis of clinical, endoscopic, and radiological features of 381 patients who underwent HRM at Center for Liver and Digestive Diseases, Holy Family Hospital, Rawalpindi, Pakistan, from December 2015 to February 2024 was performed. Based on the HRM criterion, 213 patients were identified and categorized into subtypes: 132 cases for type I and 64 and 17 for type II and III, respectively. Results:Patient demographics were similar across subtypes except for sex (male-dominant in types I and II, female-dominant in type III). Symptom duration was longest in type III (8 years vs. 4.1 years). Almost all patients had dysphagia; 83% reported regurgitation/weight loss, 71% chest pain, and 64% vomiting. The endoscopy results were normal in 40% of patients, and barium swallow was inconclusive in just 13% of achalasia patients. Type III exhibited the highest EGJ relaxation pressure and lowest LES pressure. Notably, all subtypes displayed elevated IRP, with type I showing highest value. Conclusion:This study identified type I achalasia as the most prevalent subtype. While barium swallow and endoscopy showed limited diagnostic accuracy, HRM confirmed subtypes in all patients. Despite challenges with GERD-like symptoms and inconclusive findings, further research is warranted to investigate specific clinical features of each subtype, potentially attributing to personalized treatment strategies.
BACKGROUND:Achalasia, a rare esophageal disease marked by dysphagia, impacts health-related quality-of-life (HRQoL), measurable by disease-specific tools like achalasia-specific questionnaire (ASQ) that assess symptom severity and QoL. However, to ensure its reliability and validity across different populations, cross-cultural adaptation is necessary. So, for this reason, this study aimed to validate an Urdu-translated version of an ASQ in a Pakistani population of achalasia patients. METHODOLOGY:A prospective cross-sectional study involving 52 participants was conducted at the Center for Liver and Digestive Diseases, Holy Family Hospital, Rawalpindi. ASQ was translated into the Urdu language by a forward-backwards translation process with expert input. Validation included factor analysis, known-group techniques, Cronbach's alpha for reliability, and an independent t-test comparing ASQ scores with Eckardt scores for criterion validity. RESULTS:Among 52 participants (27 males, median age 30 years; 25 females, median age 48 years), 63.5% had Achalasia type I, 26.9% type II, and 9.6% type III. Factor analysis confirmed a well-defined construct with good validity, and internal consistency was strong (Cronbach's alpha = 0.89). The ASQ scores significantly correlated with Eckardt scores (p < 0.05), confirming its validity. 73.1% of participants found the translated version easy and completed in a short time duration. CONCLUSION:Urdu-translated ASQ proved to have good psychometric properties, with strong evidence of validity, reliability, and feasibility regarding health status in Pakistani achalasia patients. It can be recommended as a reliable QoL measure for clinical and research purposes. Future studies should explore its application in larger, more diverse cohorts and further refine its use in achalasia management.
ABSTRACT Barium sulfate is widely used as a radiographic contrast medium in upper gastrointestinal barium X‐ray radiography for cancer screening in Japan. Although generally considered safe, rare complications such as bowel obstruction due to impacted barium stools can occur. We report the case of a healthy 41‐year‐old woman who developed colonic obstruction following upper gastrointestinal barium X‐ray radiography. Endoscopic treatment was attempted using a snare and a long hood to fragment and remove the barium mass. The impacted stools were successfully removed endoscopically, and there were no serious complications such as bowel perforation or generalized peritonitis that would require surgery. This case demonstrates that endoscopic removal can be an effective and less invasive treatment option for barium impaction, which carries a risk of requiring surgical intervention. Although patients are usually advised to hydrate and take laxatives after the examination, this case highlights the importance of ensuring that patients fully understand the potential risk and the need to seek prompt medical attention.
Heart rate variability (HRV) can detect the onset of inflammation in ulcerative colitis (UC), a condition in which fatigue is an often-overlooked symptom that significantly affects patients’ quality of life. Here, the capability of a novel validated wearable vital signs patch measuring HRV to assess disease activity and fatigue severity was explored in UC patients. In a cross-sectional pilot study, HRV was remotely monitored for 72 hours using a noninvasive wearable device in patients with active and quiescent UC. Associations were explored between 2 time-domain, 3 frequency-domain, and 2 nonlinear HRV metrics and fatigue [multidimensional fatigue inventory (MFI)], anxiety and depression [hospital anxiety and depression scale (HADS)], quality of life (SF-12), clinical symptoms [simple clinical colitis activity index (SCCAI)], and biochemical disease activity [fecal calprotectin (Fcal), C-reactive protein (CRP), hemoglobin, HNP1-3 and S100A8/A9]. A total of 24 patients were included, of which 18 (75%) reported fatigue (MFI ≥60). No significant differences in HRV metrics were observed between clinically active and quiescent UC or between more and less fatigued UC patients. Two HRV metrics were associated with biochemical disease activity and all HRV metrics were significantly influenced by age, sex, and antidepressant use. There was a strong correlation between fatigue and depression. Although the wearable vital signs patch could not distinguish between active and quiescent UC or detect fatigue severity based on HRV differences, associations were found between HRV and biochemical markers of inflammation, underscoring the need for further research using larger patient cohorts.
On April 15, 2023, the people of Khartoum were woken up by the drums of war. An armed conflict trapped these innocent people into a prison of the unpredictable, with over 1,200 fatalities and 12,000 people being injured. The abdomen, with its unique anatomical properties housing vital organs and the absence of an outer bony surface, is particularly susceptible to injuries during combat. Recognising the critical importance of comprehending abdominal wound injuries, our study is dedicated to analysing the patterns and outcomes of such injuries in survivors of the Sudanese armed conflict. This retrospective cohort study was carried out at Wad Madni Teaching Hospital in Sudan, from the onset of the conflict to October 2023. Thirty-three survivors of the armed conflict, who presented with abdominal wound injuries, were admitted to the emergency department, excluding individuals with incomplete medical data. Data were extracted from medical records and subsequently analyzed. 33 patients were admitted with abdominal wound injuries resulting from the armed conflict, and all underwent exploratory laparotomy. Among them, 87.5% were civilians and, 12.5% were combatants. The primary mechanisms of injury were stabbing (54.5%) and gunshots (33.3%). Commonly affected organs were the small intestine (33.3%) and large intestine (30.3%). Intraoperative findings indicated that 66.7% of the cases involved visceral injuries. The mortality rate stood at 6.1%, with sepsis identified as a major complication. In Sudan's armed conflict, our study reveals the profound impact of abdominal injuries, emphasising unique challenges and the urgent need for customised surgical approaches.
