Time to endoscopy for acute upper gastrointestinal bleeding: Results from a prospective multicentre trainee-led audit.

Background: Endoscopy within 24 h of admission (early endoscopy) is a quality standard in acute upper gastrointestinal bleeding (AUGIB). We aimed to audit time to endoscopy outcomes and identify factors affecting delayed endoscopy (>24 h of admission). Methods: This prospective multicentre audit enrolled patients admitted with AUGIB who underwent inpatient endoscopy between November and December 2017. Analyses were performed to identify factors associated with delayed endoscopy, and to compare patient outcomes, including length of stay and mortality rates, between early and delayed endoscopy groups. Results: Across 348 patients from 20 centres, the median time to endoscopy was 21.2 h (IQR 12.0-35.7), comprising median admission to referral and referral to endoscopy times of 8.1 h (IQR 3.7-18.1) and 6.7 h (IQR 3.0-23.1), respectively. Early endoscopy was achieved in 58.9%, although this varied by centre (range: 31.0-87.5%, p = 0.002). On multivariable analysis, lower Glasgow-Blatchford score, delayed referral, admissions between 7:00 and 19:00 hours or via the emergency department were independent predictors of delayed endoscopy. Early endoscopy was associated with reduced length of stay (median difference 1 d; p = 0.004), but not 30-d mortality (p = 0.344). Conclusions: The majority of centres did not meet national standards for time to endoscopy. Strategic initiatives involving acute care services may be necessary to improve this outcome.

An experience with a rare diagnosis of isolated tuberculosis of sternum at JNMC Hospital, Aligarh, India.

OBJECTIVE: To diagnose isolated tuberculosis of the sternum in patients presenting with signs and symptoms suggestive of tuberculosis. METHODS: A prospective study conducted at Jawaharlal Nehru Medical College JNMC Hospital, Aligarh, India from July 2000 to July 2006 of 2512 patients presenting with a suspected case of tuberculosis. Cases were confirmed using different investigations along with treatment of the patients with antitubercular treatment ATT, with further follow up for next 2 years. RESULTS: Nineteen patients were suffering from isolated tuberculosis of sternum. The main presenting feature was retrosternal discomfort 100% while 14 73.6% patients presented with a cold abscess of sternum. All the patients were treated successfully with 12 months of ATT and followed up for 2 years for any relapse. CONCLUSION: Although tuberculosis of sternum is rare, it should be considered as an important differential diagnosis in patients presenting with chronic lesions of the sternum, particularly in endemic/developing countries. Twelve months of treatment with ATT is optimal for achieving cure without any risk of relapse.