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Objective: To find out the underlying causes of chronic diarrhea in soldiers and how it differs from general population. Study Design: Prospective comparative study. Place and Duration of Study: Combined Military Hospital (CMH) Multan and Pak Emeritus Military Hospital (PEMH) Rawalpindi, from Dec 2017 to Jan 2020. Methodology: All soldiers in active service, having diarrhea more than 4 weeks in study and non-soldiers of the same age were included in the control group. There were inquired in details about the diarrhea symptoms and investigations carried out accordingly to find out the underlying cause. The two groups were compared to find out any differences. The data were analyzed by SPSS version 22. Results: Seventy one in study and 50 patients in control had their mean ages of 34.61 ± 8.35 and 32.42 ± 10.28 years. Mean duration of symptoms were 18 and 15 months in study and control groups respectively. Irritable Bowel Syndrome (IBS) was more common in both groups i.e. 14 (20%) and 20 (40%) in study and control groups respectively but frequency was more in second one. Seropositive celiac disease 13 (18.5%), seronegative villous atrophy 10 (14%) in study and Inflammatory Bowel Disease IBD 6 (12%) in control group were second most common conditions. Conclusions: Irritable bowel syndrome is common in this age group. Celiac and seronegative villous atrophy is second common conditions in the study group. [ABSTRACT FROM AUTHOR]

Objective: To find out association of gender and age with compliance of H Pylori eradication therapy. Study Design: Cross sectional comparative study. Place and Duration of Study: Combined Military Hospital, Multan and Pak Emirates Military Hospital, Rawalpindi, from Sep 2017 to Feb 2020. Methodology: Two hundred and fifty patients with dyspepsia were included through convenient sampling after getting informed consent. The patients already under H Pylori eradication therapy were excluded from the study. Diagnosis of H Pylori infection was done by histopathology report of gastric mucosal biopsy on upper GI endoscopy in some individuals and H Pylori antigen on stool examination in others. They were placed in eight different groups keeping in mind their previous history of use of antibiotics and known side effects with the particular antibiotic. Results: There were 154 (61.60%) males and 96 (38.40) females with mean age of 36.71 ± 13.23 years. The frequency of male patients who complied to treatment (130/84.4%) was significantly higher as compared to the frequency of female patients (71/74.0%) at p-value of 0.04 and odds ratio of 1.9 (1.01-3.58). The study also showed that the difference of mean age between the patients who completed and those who did not complete the treatment was statistically not significant (36.33 ± 12.78 vs 38.24 ± 14.94 years). Conclusion: Compliance to H Pylori eradication therapy is associated with gender but not with age. [ABSTRACT FROM AUTHOR]

Objective: To compare the outcomes of three-port versus four-port laparoscopic cholecystectomy (LC) and assess the safety and efficacy of three-port LC as routine procedure. Study Design: Retrospective comparative study. Place and Duration of Study: Combined Military Hospital Kohat/CMH Multan, from Oct 2013 to Dec 2016. Methodology: Total of 403 patients were selected and were divided into two groups based on the principles of non-randomized clinical trial; group A having three-port laparoscopic cholecystectomy (LC) and group B having four-port laparoscopic cholecystectomy (LC). Fourth port in right axillary line at umbilicus level was not established in group A. Outcomes were recorded in terms of operating time, complications, pain assessment/analgesic requirement and hospital stay. Results: A total of 218 (54.09%) patients in group A and 185 (45.91%) patients in group B were assessed. The difference in terms of verbal pain score, analgesic requirement and duration of hospital stay/return to activity were significant statistically, all being less in group A. Cosmetic outcome as perceived by patients was also better in the group A because of less numbers of scars. Operative time (minutes) was less in group A in our study (35.59 ± 10.75) as compared to group B (50.17 ± 10.14). Results of other variables including intra-operative/postoperative complications were comparable among the two groups. Conclusion: Three-port LC has advantages of being less painful, with less analgesics requirement and reduced hospital stay without compromising the safety and efficacy. It is more acceptable to patients due to less numbers of scars and better cosmesis. [ABSTRACT FROM AUTHOR]

Objective: To determine the demographic variance in location and histopathological findings of esophageal carcinoma in Punjab-Pakistan. Study Design: Observational cross sectional study. Place and Duration of Study: This study was conducted in Multicentre Tertiary Care Hospitals of Combined Military Hospital/Pak Emirates Military Hospital/Army Medical College Rawalpindi, Combined Military Hospital Kharian and Combined Military Hospital Multan from 2010 to 2017. Methodology: Patients with dysphagia and histopathology proven malignancy were included in this study. All patients had undergone flexible upper gastrointestinal endoscopy. Patients with lesions other than carcinoma, causing dysphagia and those with inconclusive histopathology were excluded from our study. The morphological site of the carcinoma were divided into upper, middle, lower and at gastro-esophageal junction. Histo pathologically proven carcinoma of esophagus was reviewed for subtype of grading differentiation. Statistical analysis was done using IBM version SPSS 22. Results: Out of 150 patients, 85 (57%) were males and 65 (43%) were females. Their age ranged between 30 to 85 ± 12.33. Among one hundred and fifty patients 107 (71.33%) had Squamous Cell Carcinoma, 42 (28%), Adenocarcinoma and metastasis in two cases. Frequency of distribution of esophageal carcinoma in North, East and South Districts of Punjab was 73%, 18% and 9% respectively. Esophageal Carcinoma in upper, middle, lower and Gastroesophageal junction was 22.5%, 35%, 15% and 27.5% respectively. Frequency of well differentiated SCC was 46 (30.6%) and well differentiated AC 31 (20.7%) respectively. Conclusion: SCC with male preponderance is more common in North of Punjab. Lower 1/3rd and GE junction esophageal tumor are the commonest sites in all North, East and South Punjab. Histopathological differentiation revealed Well Differentiated SCC along with significant rise in Adeno-carcinomas compared to previous national studies. [ABSTRACT FROM AUTHOR]

Objective: To find out the frequency of diabetes mellitus (DM) and its complications in serving soldiers. Study Design: Observational cross sectional study. Place and Duration of study: This was carried out at the medicine department of CMH Multan, from Oct 2016 to Sep 2017. Material and Methods: Admitted in active service soldiers with polyuria, polydipsia, polyphagia, weight changes and delayed wound healing in the Medical ward during this period meeting the criteria of DM according to American diabetic association (ADA) guidelines were included in this study. Non active soldiers, civilian employees and not meeting the DM criteria were excluded from the study. They were inquired in detail about the symptoms, examined and investigated thoroughly according to pre designed Performa, to find out their number and DM associated complications. The results were analyzed on IBM SPSS version 22. Results: Out of seven hundred and seventy-two, 55 (7.12%) had diabetes mellitus. The age ranged from 25 to 50 years with mean age of 36.15 ± 5.542. 39 (71%) had type 2 and 16 (29%) type 1 DM. Twenty (36%) had DM associated complications, commonest being nephropathy, retinopathy i.e. 8 (14.5%) and 7 (12.7%) respectively; others were macro vascular, peripheral neuropathy with foot ulcer, diabetic ketoacidosis and hyperosmolar non ketotic coma (HONK), other associated complications were hypertriglyceridemia in 21 (38%) and 6 (11%) hypertension. About 22 (40%) had family history of DM and only one was obese. Conclusion: Diabetes Mellitus and associated complications are not uncommon in young active soldiers. [ABSTRACT FROM AUTHOR]

Objective: To see the pattern of endoscopic findings in patients with non-ulcer dyspepsia. Study Design: Observational cross sectional study. Place and Duration of Study: Department of Gastroenterology, Combined Military Hospital Kharian Pakistan, from Jan 2015 to Dec 2015. Material and Methods: Two hundred and seventy seven patients were included in the study. Patients presenting with dyspeptic symptoms at outpatient Gastroenterology Department were included in this study. Upper GI endoscopy was carried out and those having ulcers or any structural lesion were excluded from the study. Endoscopic findings were interpreted with IBM SPSS version 22. Results: Out of 277 patients, 146 were male and 131 female. Their minimum age was 12 and maximum age was 86 years with 44 ± 15.5 (mean ± SD). Maximum numbers of patients were between ages of 31 to 50 years. Endoscopy was normal in 112 (40.4%) patients, showed mild gastritis in 118 (43.7%), moderate gastritis in 17 (6.1%), duodenitis in 19 (6.9%), and mixed findings in 8 (2.9%) patients. Bile was present in 144 (52%) and absent in 133 (48%) of the endoscopies. Conclusion: Mostly patients have either normal findings or mild gastritis on upper GI endoscopy. Gastric bile reflux was a common observation. [ABSTRACT FROM AUTHOR]

Objective: To measure and characterize pain in post esophageal variceal band ligation patients. Study Design: Cross sectional observational study. Place and Duration of Study: This study was carried out in Combined Military Hospital Kharian which is a tertiary care hospital, from Dec 2014 to Aug 2015. Material and Methods: All patients of esophageal varices due to any underlying pathology requiring esophageal variceal band ligation (EVBL) were included in this study. Patients unwilling for EVBL were excluded from the study. Their EVBL was done with the help of Upper Gastrointestinal Pentax High definition 90i series Video Endoscope and subsequently they were inquired about the details of pain till next session of banding. Results: Out of 86 patients 63 (73%) were males and 23 (27%) were females. Their mean age was 54 years with SD ± 12. Pain was present in 47 (54%) patients and 39 (46%) were pain free. It was severe in 3 (7%), moderate in 34 (72%) and mild in 10 (21%) patients. Out of post EVBL pain group 30 (65%) patients experienced pain after first EVBL session, 12 (25%) in subsequent and 5 (10%) after all the sessions. Conclusion: Post EVBL pain is a common complication. Mostly it is mild to moderate in intensity and needs attention in almost half of the patients to relief the suffering. [ABSTRACT FROM AUTHOR]

Objective: To find out the pattern of gastric mucosal histopathological findings in gastric biopsies of patients with non ulcer dyspepsia. Study Design: Prospective descriptive study. Place and Duration of Study: Histopathology department Combined Military Hospital (CMH) Kharian Pakistan from Jan to Dec 2015. Material and Methods: One hundred patients presenting at outpatient gastroenterology department with dyspepsia having no endoscopic lesion were included in the study. Two gastric mucosal biopsies from antrum and two from corpus were taken. The specimens were processed and examined histologically to see the changes. Results: Gastric biopsies of 100 patients including 65 males and 35 females presenting with non ulcer dyspepsia were studied. Most of the patients were between the age group of 31-50 years. Histological examination of gastric biopsies revealed 70% of patients having histological features of gastritis, while 30% having no significant histological finding. Chronic inflammation was seen in 70 cases (70%), activity in 15 cases (15%), glandular atrophy in 2 cases (2%) and intestinal metaplasia in 2 cases (2%). H.Pylori were identified in 25 cases (25%) based on haematoxylin and eosin (H & E) staining and modified giemsa staining. Conclusion: Most the cases of non ulcer dyspepsia show histological evidence of gastritis, however a significant number of patients showed no gastric mucosal histological abnormality. A significantly low frequency of H. Pylori in gastric biopsies noted in non ulcer dyspepsia cases may be due to more frequent use of antibiotics and acid suppressant drugs used by general practitioners at some stage of disease. [ABSTRACT FROM AUTHOR]