Modified Alvarado score for acute appendicitis in overweight patients

To find out the efficacy of Modified Alvarado [MA] scoring system in diagnosis of acute appendicitis in the overweight patients. All the patients with suspected acute appendicitis admitted in the surgical department at King Fahad Hospital, Hofuf, Al-Hassa, during the period from September 2004 to December 2006 were included in the study. Patients with score of 7 or more of modified Alvarado score were included, patients with score of 6 or less were excluded. All patients underwent diagnostic laparoscopy, and the diagnosis was confirmed by histopathological examination. There was total of 228 patients. Twenty -four percent were overweight and 12% patients were obese. Sixty percent of the patients had confirmed diagnosis of acute appendicitis. Modified Alvarado scoring system is an easy method for diagnosis for acute appendicitis. It can be used as complementary aid for supporting the diagnosis of acute appendicitis in overweight and obese patients

Osteoarthritis of knees and obesity in Eastern Saudi Arabia

To find out the prevalence and relation between osteoarthritis of knees and obesity in Al-Ahsa region, Kingdom of Saudi Arabia [KSA]. The study included 243 male and female patients diagnosed with osteoarthritis of knees between June 2001 to March 2003. All patients were recruited from the Physical Therapy Department, King Fahd Hofuf Hospital, Hofuf, KSA. The clinical diagnosis was supported by plain x-rays of knees, and of other joint if needed. The weight and height of all patients were taken using one standard weight and height scale, and body mass index was also calculated and recorded. More than 90.53% of the patients referred with osteoarthritis of the knees were obese or overweight. The mean body weight of all patients was 84.61 kg and the mean height was 1.59 meters. Osteoarthritis of the knees was more common in obese female than male patients with a female to male ratio of 2.37:1. Obesity is a disease. The aim of all health professionals and others in the community should be directed to the prevention of this disease and its risk to develop multiple complications

Prevalence of methicillin-resistant and methicillin-sensitive staphylococcus aureus nasal colonization among patients at the time of admission to the hospital

Methicillin-resistant Staphylococcus aureus [MRSA] is an important agent of hospital-acquired infection. The mode of entry of MRSA in the hospital might be on admission of patients with MRSA infection or nasal colonization. The present study was undertaken to determine the prevalence of MRSA nasal colonization among patients on admission to hospital. Six hundred patients were screened for nasal colonization of MRSA on admission to hospital. Nasal swabs were cultured on salt mannitol agar and blood agar. Age, sex, previous admission to hospital and antibiotic therapy were recorded. S. aureus was isolated from the nasal swabs of 122 patients [20.2%] on admission to hospital. MRSA was isolated from 7 patients [1.1%] and methicillin-sensitive S. aureus [MSSA] from 115 patients [19.1%]. Nasal colonization of S. aureus was higher in younger and elderly patients and significantly higher colonization was observed among females. The MRSA strains isolated from nasal swabs had a different antibiotic susceptibility pattern than those isolated from patients having hospital-acquired MRSA infection. Previous admissions to hospital, underlying disease antibiotic therapy were not risk factors for MRSA nasal colonization. MRSA nasal colonization of patients on admission to hospital is low in this region. The screening of every new admission would not be cost effective, but patients transferred form other institutions should be screened for MRSA. Standard infection control precautions should be strictly implemented to prevent the spread and control of MRSA infections

role of fine needle aspiration cytology and imprint cytology in cervical lymphadenopathy

To determine the diagnostic accuracy of cervical lymphadenopathy by fine needle aspiration [FNAC] and imprint cytology [IC]. This study included 94 patients with cervical lymphadenopathy. This study was carried out in the Departments of General Surgery and Pathology, King Fahad Hospital, Hofuf, Kingdom of Saudi Arabia, from June 2001 through to July 2002. They were subjected to clinical examination and FNAC of one of the enlarged lymph nodes. This was followed by IC and histological examination of this lymph node after its excision. Clinical examination was correct in 78% of the cases. The overall accuracy of fine needle aspiration was 93%. It was accurate on all cases of reactive hyperplasia, 93% of tuberculosis lymphadenitis, 90% in Hodgkin's lymphoma, 86% in non-Hodgkin's lymphoma, and 91% of metastasis lymphadenopathy. On the other hand, the overall accuracy of IC was higher than that of fine needle aspiration, being 97%. It diagnosed all cases of reactive hyperplasia and non-Hodgkin's lymphoma, 97% in tuberculosis lymphadenitis, 90% in Hodgkin's lymphoma and 95% in metastasis lymphadenopathy. These techniques proved to be reliable, rapid, and inexpensive procedures in diagnosis of lymphadenopathy. They can differentiate well between inflammatory and neoplastic lesions, in cases of lymphoma, cytological diagnosis should be followed by histological diagnosis for accurate classification and grading

Comparison of specimen adequacy in fine-needle aspiration biopsies performed by surgeons and pathologists

Background: Fine-needle aspiration biopsy [FNAB] may yield different results depending on its operator. We compared the proportions of unsatisfactory aspirates obtained by pathologists vs. surgeons

Methods: In a retrospective review, all FNAB reports and slides performed between March 2002 and February 2003 were grouped by organ/site and according to whether they were done by a pathologist or a surgeon. The proportions of unsatisfactory aspirates for pathologists and surgeons were compared

Results: Of 692 FNABs, 390 were performed by pathologists at the FNAC clinic and the remainder by surgeons. Overall, 15.5% of aspirates obtained were unsatisfactory [n=107]. Of aspirates obtained by surgeons, 29.5% were unsatisfactory, compared to 4.6% of those obtained by pathologists [P<0.001]. Pathologists had significantly lower proportions of unsatisfactory aspirates in all sites. A 33% reduction in the number of lymph node excisional biopsies has been reported subsequent to establishment of the FNAC clinic

Conclusion: The advantages of a pathologist performing FNAB are that a rapid evaluation can be rendered regarding specimen adequacy and the need for repeating the procedure. In addition, pathologists can direct the distribution of aspirated material for other tests such as culture study, flow cytometry and electron microscopy, as indicated by preliminary evaluation of the smears. These factors significantly lower the proportions of unsatisfactory specimens and improve the diagnostic accuracy of FNAB technique

Laparoscopic versus open appendectomy in females with a clinical diagnosis of appendicitis

Appendectomy can be performed using either a laparoscopic technique [LT] or an open technique [OT]. We compared the following items operative, anesthesia, length of stay, post-operative pain, medicine, wound healing, days to return to normal activity in both groups. This study was carried out at King Fahad Hospital, Hofuf, Al-Hassa, Kingdom of Saudi Arabia, from January 1999 to April 2000. We randomly assigned 60 female patients to appendectomy by LT or OT. The 2 groups were compared concerning demographic data. The differences were considered statistically significant at a P value < 0.05. The open group had shorter anesthesia and operative time [68, 50 versus 85, 65 minutes]. The laparoscopic group had a significant reduced postoperative narcotic requirement [P<0.05], quicker reintroduction of diet and quicker return to normal activity. Laparoscopic appendectomy in female patients with clinical diagnosis of appendicitis is the procedure of choice for the diagnosis and the management of acute appendicitis