Predicting which patients can undergo upper endoscopy comfortably without conscious sedation

Intradermal hepatitis B vaccination: a systematic review and meta-analysis

Fractional dose of intradermal compared to intramuscular and subcutaneous vaccination - A systematic review and meta-analysis.

Hepatitis B is a major health problem globally casting an enormous burden on health care system and a major source of patient's misery. Chronic hepatitis B is a serious clinical problem in Pakistan.1,2 It is also an important cause of hepatocellular carcinoma.3 Pakistan remains in the intermediate HBV prevalence area with a carrier rate of 3-4%.4 Encouraged by the recent developments in this field and appreciating in particular the limitation of resources, various social practices and reservations about the health care system, Pakistan Society of Gastroenterology and G.I. Endoscopy (PSG) organized a consensus conference in order to prepare guidelines to deal with this problem in the local perspective. The task was technically difficult as the primitive health care system and lack of research facilities and orientation preclude the collection of exact national data regarding various aspects of the disease. Limited studies were available which provided a hazy picture of the magnitude of the problem. However the team of experts tried its level best to bridge the inherent gaps with their vast experience and technical inputs from all the available resources. An organizing committee developed an agenda and selected the relevant topics for the development of guidelines. The topics include prevalence, mode of transmission, natural history of the disease, diagnosis, treatment and prevention of hepatitis B. Eminent experts from all over the country delivered their deliberations on the selected topics with an insight of local perspectives. The panelists were asked to critically analyze the scientific data and feed their input. Based on this work next day was devoted by all the participants to draft the consensus guidelines for the management of hepatitis B.

PGS consensus statement on management of hepatitis B virus infection--2003.

https://www.giendo.theclinics.com/article/S1052-5157(04)00012-1/pdf

Efficacy, safety, and limitations in current practice of sedation and analgesia.

Background— A young medical student developed severe toxicity, including seizures, respiratory distress, hypotension, and asystole, and died after gargling with lidocaine before upper gastrointestinal endoscopy. Upper gastrointestinal endoscopy is usually a safe outpatient procedure before which the throat is often anaesthetised.

Case report— A 21 year old medical student presented with the symptoms of acid peptic disease and was referred for outpatient oesophagogastroduodenoscopy. He was of average build, did not smoke, and did not take any drugs; he had no history of …

https://gut.bmj.com/content/gutjnl/46/3/435.full.pdf

Lidocaine toxicity in a student undergoing upper gastrointestinal endoscopy.

Efficacy of low-dose, intra-dermal hepatitis B vaccination was assessed among sixty-one doctors and paramedical staff of Chandka Medical College Hospital, Larkana. Subjects were randomly divided into two groups. Group-A (n = 25) received 20 micrograms of purified Hepatitis B Surface Antigen (Euvax B, LG Chemicals) by i.m. injection in the deltoid by 0, 1 and 6 schedule while group B (n = 36) received 5 micrograms intra-dermally by same schedule. The mean value of HBsAb titers checked 4 weeks after the last dose in group A were 158.6 +/- 51.8 mlU/ml and that in Group B were 68.2 +/- 26.6 mlU/ml (p < 0.0001; 95% C.I. 69.2 and 111.5). Number of subjects attaining the protective titers of 10 mlU/ml in group A was 95.7% and that in group B was 90.9% (p = 0.5). We conclude that 5 micrograms intradermal hepatitis B vaccination is effective.

N.-U.-N. Jatoi

Papers

Lidocaine toxicity in a student undergoing upper gastrointestinal endoscopy.

Efficacy of low dose intra-dermal hepatitis B vaccination schedule.