Diagnostic accuracy of alvarado scoring for diagnosis of acute Appendicitis in children

Objective: To determine the diagnostic accuracy of Alvarado scoring for diagnosis of acute appendicitis in children

Study Design: This was a cross sectional validation study

Place of Study: Department of Pediatric Surgery, Services Hospital. Lahore

Duration: July 2017 to December 2017

Methodology: In this study the cases of both gender with age range 2 to 12 years were included. The diagnosis of acute appendicitis was made on the basis of fever, vomiting and right sided abdominal pain with raised total leucocyte count. True positive was labelled when there were inflammatory cells found on histopathology. The detailed Alvarado scoring was used and to label the cut off value of 6 was used

Results: In the present study there were total 386 cases with mean age of 7.45+/-2.45 years. There were 208 males and 178 females. Alvarado score in cases who underwent appendectomy was 5 and maximum 8 with mean of 6.92 +/- 0.898. The mean Alvarado score was 5.76+/-2.77. Alvarado score 6 or above was seen in 286 cases while 280 cases were confirmed as acute appendicitis on histopathology. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of Alvarado score 6 or more was seen in 89.29 percent, 66.04 percent, 87.41 percent, 70 percent and 82.90 percent respectively with a significant p value of 0.001

Conclusion: Acute appendicitis is an acute emergency and Alvarado score 6 or above has shown significant better diagnostic accuracy in such cases

Study of tooth wear in canine guidance versus group function occlusion

The objective of this study was to determine tooth wear in canine guidance and group function occlusion in both genders. A cross sectional descriptive study with sample size of 84 having 42 in each gender was conducted at OPD of Sardar Begum Dental College Peshawar from February 2013 to March 2014. Patients of both genders having all permanent teeth present except third molar were included in the study. Patient's age, gender and occlusion type [canine guidance or group function] were recorded. All posterior teeth wear were graded according to Eccles and Jenkins index. Mean age of patients was 23.9 +/- 3.27 years. Twenty seven [32.1%] patients were reported with no wear and 57[67.9%] were observed with tooth wear. Patients having canine guidance occlusion were 53[63.1%] and group function were observed in 31[36.9%]. Tooth wear in group function was reported in 53% and 15% in canine guidance. Canine guided occlusion was common in both males and females as compared to group function. This study revealed that group function occlusion is more prone to tooth wear and the observed population has more frequency of canine guidance occlusion

JAK2 mutation-negative essential thrombocythemia in a child presenting with cerebral venous thrombosis

Essential thrombocythemia [ET] is a rare myeloproliferative disorder occurring predominantly in the elderly population. Its occurence in the pediatric age group is even more rare. We report a 1 3-year-old girl who presented with isolated cerebral venous thrombosis and was diagnosed with essential thrombocythemia. Family screening for any thrombocytosis was 20 negative. With no secondary cause apparent for persistent thrombocytosis, we looked for the JAK2 mutation, but the result was negative. In contrast to linkage of JAK2 mutation positivity with increased thrombotic risk, our case showed that thrombosis can occur in the absence of JAK2 mutation in a case of essential thrombocythaemia. The indications for treatment and the best treatment of children with ET are currently not known, and guidelines for the management of children with ET are needed. Adult patients have near-normal life expectancy because of the low rate of leukemic conversion, but no child has been monitored long enough to assess prognosis

Granuloma formation in discoid lupuserythematosus: a novel microscopic feature

Lupus erythematosus is an autoimmune disease with marked pleotropism. If several systems are involved then the disease is named as systemic lupus erythematosus [SLE] and if skin is exclusively involved the term discoid lupus erythematosus [DLE] is used. One of the several histopathological features of DLE includes periappendageal inflammation. This may at times ; completely wipe out sebaceous glands forming sebaceous granulomas. To determine the frequency of sebaceous granulomas formation in discoid lupus erythematosus. In this prospective observational study was conducted at the Departments of Dermatology and Pathology, Pakistan Institute of Medical Sciences, Islamabad. 100 cases of DLE spanning over two years and with the age range of 3 years to 70 years were examined for the presence of sebaceous granuloma. Other features of DLE like hyperkeratosis, follicular plugging, epidermal atrophy, basal layer vacuolization, basement membrane deposits, pigmentary incontinence, perivascular inflammation, periappendageal inflammation, and collagen damage were also noted., Out of these 100 cases, 8 cases contained sebaceous granulomas. These granulomas were,, . composed of epithelioid cells, foreign body giant cells containing partially digested sebaceous material and a few lymphoctytes. Sebaceous granulomas formation was seen in 8% cases of DLE cases. This feature must be recognized both by dermatologists and pathologist so that diagnosis of DLE may not be distracted and erroneous diagnosis due to presence of granulomas may not be rendered

Response to treatment of cutaneous leishmaniasis with intralesional chloroquine vs intralesional meglumine antimoniate

In Pakistan, cutaneous leishmaniasis [CL] is mostly caused by Leishmania major. For simple lesions which are few in number and where there is no risk of disfigurement or joint mobility restriction, topical application or local treatment e.g. intralesional antimony compounds are valuable. To compare the effect of intralesional chloroquine with meglumine antimoniate in the treatment of CL. In this quasi experimental study, 60 patients of CL with 1 to 3 lesions and aged >3years were divided into 2 treatment groups to receive either intralesional chloroquine [treatment group] or meglumine antimoniate [control group]. Both drugs were used Ice per cm[2] of lesion, once weekly for 8 weeks [8 injections]. 8 more injections were given to those who showed partial response. Both treatments showed 100% response; however, greater number of injections was required with meglumine antimoniate [p<0.05]. Both drugs were well tolerated. Intralesional chloroquine appears to be an effective, safe and cheap alternative to meglumine antimoniate in the treatment of CL

Sebaceous granulomas: a novel feature of discoid lupus erythematosus

To determine the frequency of sebaceous granulomas formation in discoid lupus erythematosus, Retrospective observational study. Departments of Dermatology and Pathology, Pakistan Institute of Medical Sciences, Islamabad. 100 cases of Discoid Lupus Erythematosus [DLE] spanning over two years and with the age range of 3 years to 70 years were examined for the presence of Sebaceous Granuloma. Other features of DLE like hyperkeratosis, follicular plugging, epidermal atrophy, basal layer vacuolization, basement membrane deposits, pigmentary incontinence, perivascular inflammation, periappendigeal inflammation, and collagen damage were also noted. Lupus erythematosus is an immune complex, type Ill hypersensitivity disease where antibodies are formed against native Deoxyribose Nucleic Acid [DNA]. The immune compexes are deposited in various organs and various sites causing marked pleotropism. If several systems are involved then the disease is named Systemic Lupus Erythematosus [SLE] and if skin is exclusively involve the term Discoid Lupus Erythematosus [DLE] is used. One of the several features of DLE includes periappengeal inflammation. This may at times completely wipe out sebaceous glands forming sebaceous granulomas. Out of these 100 cases 8 cases contained sebaceous granulomas. These granulomas were composed of epithelioid cells, foreign body giant cells containing partially digested sebaceous material and a few lymphoctytes. Sebaceous granulomas formation was seen in 8% cases of discoid lupus erythematosus. This feature must be recognized both by dermatologists and pathologist so that diagnosis of DLE may not be distracted and erroneous diagnosis due to presence of granulomas may not be rendered