Morphological and molecular characterization of Acanthamoeba isolated from contact lens paraphernalia in Malaysia: Highlighting the pathogenic potential of T4 genotype

Objective: To determine the morphological and molecular characterization of Acanthamoeba isolates from contact lens paraphernalia in Malaysia and to investigate their pathogenic potential based on the physiological tolerance. Methods: One hundred and eighty contact lens wearers donated their contact lens, lens storage cases and lens solutions between 2018 and 2019. The samples were inoculated onto 1.5% non-nutrient agar plates for 14 d. Polymerase chain reaction (PCR) was performed and the amplified PCR products were sequenced and compared with the published sequences in GenBank. The pathogenic potential of positive isolates was further tested using temperature-tolerance and osmo-tolerance assays. Acanthamoeba species were categorized into three distinct morphological groups established by Pussard and Pons. Results: Acanthamoeba was successfully isolated from 14 (7.8%) culture-positive samples in which 11 belong to morphological group II and 3 belong to morphological group III, respectively. The sequencing of 18S ribosomal RNA gene led to the identification of the T4 genotype in all the isolated strains. In vitro assays revealed that 9 (64.3%) Acanthamoeba isolates were able to grow at 42 °C and 1 M mannitol and were thus considered to be highly pathogenic. Conclusions: To the best of our knowledge, this is the first report identifying the Acanthamoeba genotype and their pathogenic potential among contact lens wearers in Malaysia. The potentially pathogenic T4 genotype isolated in this study is the most predominant genotype responsible for human ocular infection worldwide. Hence, increasing attention should be aimed at the prevention of contamination by Acanthamoeba and the disinfection of contact lens paraphernalia.

Comparison of Onlay versus Sublay mesh repair for ventral abdominal hernias. a randomized controlled trial

Objective: To compare onlay versus sublay mesh repair for ventral abdominal hernias in terms of mean operative team, frequency of post-operative wound infection, seroma formation and hematoma formation

Study Design: Randomized controlled trial

Place and Duration of Study: Department of General Surgery, Pak Emirates Military Hospital Rawalpindi, from Apr 2017 to Dec 2017

Material and Methods: A total of 78 patients [39 in each group] diagnosed as a case of ventral abdominal hernia meeting the inclusion and exclusion criteria were included in the study. Patients with complicated hernias, recurrent hernias and bleeding disorders were excluded. Group-A patients underwent mesh repair by the onlay method while group-B patients underwent mesh hernioplasty via the sublay technique. All patients were followed for wound infection, seroma formation and hematoma formation. Data was analyzed by SPSS ver. 23.0

Results: The mean operation time in group A was 46.10 +/- 7.25 minutes while in group B, the mean operation time was 77.82 +/- 9.97 minutes [p<0.001]. The frequency of wound infection was 5.13 percent vs 0 percent [p=0.49] and hematoma formation was 5.13 percent vs 7.69 percent [p=0.999] between the two groups respectively which were statistically insignificant. However, seroma formation between the two groups was 23.08 percent vs 5.13 percent, which was statistically significant [p=0.023]

Conclusion: Sublay mesh repair for ventral hernias is better than onlay mesh repair for ventral abdominal wall hernias in terms of frequency of complications. However, it requires a longer operative time

Frequency of prolonged corrected QT interval in child pugh class in patients of cirrhosis of liver

Objective: To determine the frequency of prolonged corrected QT interval [QTc] in Child Pugh Class in patients of liver cirrhosis presenting to Combined Military Hospital Peshawar. Study Design: Cross sectional study. Place and Duration of Study: Department of Medicine, Combined Military Hospital Peshawar, from Dec 2013 to Jun 2014

Material and Methods: One hundred and thirty three patients with liver cirrhosis fulfilling the inclusion criteria were included in the study using non-probability consecutive sampling after taking informed consent. All patients were assigned their Child's Class either A, B or C. Electrocardiogram [ECG] was done and QTc was calculated using Bazett's formula. QTc of more than 0.44 seconds was taken as prolonged

Results: Out of 133 patients, QTc was prolonged in 78 patients yielding frequency of QTc prolongation in cirrhosis of 58.64%. Frequency of QTc prolongation was 61.18% in males and 54.17% in females. QTc prolongation was 15% in Child Pugh grade A, 54.76% in Child Pugh grade B and 73.24% in Child Pugh grade C. There was a statistically significant association between QTc prolongation and the severity of cirrhosis [p<0.001]

Conclusion: This study concludes that there was a statistically significant increase in frequency of QTc prolongation with worsening of Child Pugh Class thereby indicating an association between QTc prolongation and the severity of cirrhosis

Comparison between the efficacy of pregabalin and amitriptyline in alleviating pain associated with painful diabetic peripheral neuropathy

Objective: To compare the efficacy of pregabalin and amitriptyline in alleviating pain associated with painful diabetic peripheral neuropathy [PDPN]. Study Design: Randomized controlled trial. Place and Duration of Study: Department of Medicine, Pakistan Naval Ship [PNS] Shifa Karachi, from May 2014 to Nov 2014

Material and Methods: Six hundred and sixty patients [330 in each group] with PDPN fulfilling the inclusion/exclusion criteria were randomized into groups A and B through consecutive non-probability sampling. Baseline pain scores on visual analogue scale [VAS] from 0-10 were recorded. Group-A was given pregabalin and group-B was given amitriptyline. Response was assessed after 6 weeks using VAS. A reduction of >50% on VAS was labeled efficacious

Results: Out of 660 patients, 46.36% [n=153] in group-A and 57.88% [n=191] in group-B had effective relief of pain whereas 53.64% [n=177] in group-A and 42.12% [n=139] in group-B had persistent pain. A p-value was calculated as 0.003

Conclusion: Amitriptyline was significantly more effective for alleviation of pain associated with PDPN when compared with pregabalin

Antibiotic therapy versus appendicectomy in uncomplicated acute appendicitis in terms of efficacy

Objective: To compare antibiotic therapy and appendectomy in uncomplicated acute appendicitis in terms of efficacy

Study Design: Randomized controlled trial

Place and Duration of Study: Surgical Ward Forward Treatment Centre [FTC], 5 Mountain Medical Battalion Forward Kahuta Azad Jammu Kashmir [AJK], from Oct 2011 to Mar 2013

Material and Methods: A total of 103 patients with clinical diagnosis of acute appendicitis [AA] were admitted during the duration of study and divided into two groups by consecutive sampling. The antibiotic group consisted of 51 patients who received intravenous antibiotics for 48 hours and oral antibiotics for another 8 days. The appendectomy group comprised of 52 patients who all underwent standard appendectomy. All the patients were followed up at 1 month and 1 year for assessing efficacy and post treatment complications

Results: The efficacy of antibiotic treatment is 90.625% as compared to appendectomy which was 88.46% [p=0.759] at 1 month follow up after treatment. At one year post treatment, the comparison between the efficacy of antibiotic therapy [71.87%] and appendectomy [87.14%] remains statistically insignificant [p=0.055]

Conclusion: Antibiotic therapy is comparable to appendectomy in AA in terms of efficacy at 1 month and 1 year post treatment

Antiacanthamoebic properties of natural and marketed honey in Pakistan

Objective To determine antiacanthamoebic activity of natural and marketed honey samples. Methods Natural honey samples were collected directly from the bee hive and marketed honey samples were purchased from the local market in Karachi, Pakistan. Both honey samples were tested for their flavonoid content (quercetin equivalent per gram of the extract) and phenolic content (gallic acid equivalent per gram). Furthermore, their antioxidant activity was determined by measuring 2,2-diphenyl-1-picrylhydrazyl. Using amoebistatic and amoebicidal assays, the effects of honey samples were tested against growth and viability of Acanthamoeba parasites. Results Natural honey exhibited potent amoebistatic and amoebicidal effects, in a concentration-dependent manner. Honey-treated Acanthamoeba castellanii showed loss of acanthopodia, following which amoebae detached, rounded up, reduced in size, decreased in cytoplasmic mass and they were observed floating in the culture medium. Importantly, honey-treated amoebae did not revive when inoculated in fresh growth medium, however, glycerol-treated amoebae exhibited viable trophozoite and active growth. In contrast, marketed honey samples varied in their efficacy against Acanthamoeba castellanii. The proportion of flavonoid, as determined by quercetin measurements and the proportion of phenolic, as determined by gallic acid measurements was higher in natural honey compared with marketed honey. Similarly, the antioxidant activity, as determined by 2,2-diphenyl-1-picrylhydrazyl scavenging activity was higher in natural honey vs. marketed honey. Conclusions This study shows that natural honey has antiacanthamoebic properties and possesses higher flavonoid, phenolic and antioxidant properties compared with the marketed honey. These findings are of concern to the public, health officials, and to the manufacturers regarding production of honey for medical applications.

Ocular complications of silicone oil

Objective: silicone oil [SO] is an invaluable tool in the management of complex retinal detachments [RDs]. Injection of silicone oil is associated with a variety of ocular complications specially when it is kept for a long time and its removal is endangering retinal re-detachment. The objective of this study was to determine the frequencies of different ocular complications associated with silicone oil injection in our setup

Study Design: case series

Place and Duration of Study: this study was conducted at Vitreo-retina division of Al-Shifa Trust Eye Hospital, Rawalpindi from January 2014 to June 2014

Material and Methods: a total of 30 patients were included in the study who underwent pars-planavitrectomy [PPV] with silicone oil injection for complex retinal detachments. The patients who had reached between 3 months and 6 months of their postoperative period and were presenting with some complications related to silicone oil injection were included in the study. Their records were reviewed and pre-operative data were collected regarding state of the eye preoperatively. Then the post-operative complications were noted. The descriptive and analytical statistics of different variables were measured using SPSS-17.0 software

Results: out of thirty patients included in our study 23 [76.7%] were male and 7 [23.3%] were female. The mean age was 21.53 +/- 16.004 years and range was 66 years. The mean pre-operative intra-ocular pressure [IOP] was 14.0 +/- 2.150 mmHg and range 8 mmHg and the mean post-operative IOP was 24.93 +/- 13.889 mmHg and range 45 mmHg [p=0.001. The pre-operative PVR grade-C was absent in 12 [40%] patients and was present in 18 [60%] patients and post-operative PVR grade-C was absent in 24 [80%] patients and was present in 6 [20%] patients [p=0.004; McNemar test]. Band keratopathy was seen in 8 [26.7%] and corneal decompensation in 2 [6.7%] patients. Emulsification of silicone oil was seen in 14 [46.7%] patients. Rubeosisiridis was present in 2 [6.7%] patients

Conclusion: apart from other complications, raised intraocular pressure is a significant postoperative complication of eyes with silicone oil injection, so should be kept in mind because if not addressed properly it may lead to irreversible blindness in these cases

Comparison of first morning void urine specimen for albumin to creatinine ratio comparing with 24-hour urinary albumin excretion in detecting microalbuminuria in type 2 diabetics

Objectives: To determine the accuracy of first morning void urine specimen for Albumin to Creatinine Ratio [ACR] comparing with 24-hour urinary albumin excretion in detecting trueroalburninuria in type 2 diabetics

Study Design: Cross Sectional study

Place and Duration of Study: Military Hospital Rawalpindi, from Apr 2013 to Oct 2013

Patients and Methods: One hundred and twenty patients with type 2 Diabetes Mellitus [DM] fulfilling the inclusion criteria were included in study using consecutive non-probability sampling. A standard protocol was followed for specimen collection. Urine collection was started from the next day of admission

Results: Mean random plasma glucose level was 174.54 +/- 33.06 mg/dL, mean HbAlc was 8.5 +/- 1.32%, mean urinary albumin 130.26 +/- 47.25 mg/24 hour and mean ACR was 104.30 +/- 51.56 mg/g. Area under ROC curve was 0.964 for microalbuminuria by ACR. Spearman's rank-order coefficient [rs] was 0.696 for ACR and 24 hour albumin excretion

Conclusion: ACR in first morning void urine accurately detected early microalbuminuria in type 2 diabetics

Pattern of bony injuries among civilian gunshot victims at tertiary care hospital in Karachi, Pakistan / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Firearm injuries impose a continuous economic burden on society and hospital resources. The aim of this study was to assess the pattern of bony injuries among victims of gunshots.</p><p><b>METHODS</b>A retrospective study was conducted in the Department of Orthopedics, Dow University of Health Sciences and Civil Hospital Karachi from January 2011 to December 2012. Patients with isolated bony injuries were included while patients with other systemic injuries were excluded.</p><p><b>RESULTS</b>There were 90 cases and the majority of them were male (84.4%). Mean age was (32.52 ± 10.27) years. Most of the patients (72.2%) belong to the younger age group. A low velocity weapon was used in 61 (67.8%) cases and a high velocity weapon was used in 29 (32.2%) cases. Armed robbery (64.4%) was the cause of conflict in more than half of the cases. Lower limb was involved in 72.2%. Fifty eight (64.4%) patients remained hospitalized for 15-20 days and others for more than 20 days. Internal fixation with intramedullary nailing was done in 35 patients while K-wire was used in 5 patients. Fifty patients were managed with external fixation, either uniplanar or multiplanar ilizarov. Deep wound infection and nonunion were observed more often in high velocity injuries.</p><p><b>CONCLUSION</b>Armed robbery was the leading cause of gunshot bony injuries in our hospital. Young males were victimized in a majority of cases. High velocity injuries were associated with more complications.</p>

Intra-articular distal radius fractures; functional outcome of percutaneous kirschner wire fixation and short arm cast in patients of 20-70 years

To determine functional outcome of percutaneous Kirschner wire fixation and short arm cast in intra-articular distal radius fractures in patients of 20-70 years. Descriptive case series. Department of Orthopedic Surgery, Dow University of Health Sciences / Civil Hospital Karachi. 1[st] April, 2013 to 30[th] September, 2013. A total of 62 patients with closed type III distal fractures according to Frykman classification were included in this study. Patient lying in supine position and after general anesthesia, closed reduction was done with the forearm in prone position, aiming to restore normal anatomical position. Two Kirschner wires were inserted from radial styloid process in parallel and oblique fashion to the medial cortex of the radius and one transversely from lateral to medial for intra-articular fragments. Final functional outcome was assessed after 12 weeks of surgery and recorded on pre-designed Proforma. Acceptable functional outcome of percutaneous Kirschner wire fixation and short arm cast in intra-articular distal radius fractures was observed in 80.65% [50/62] cases. It is concluded that functional outcome of percutaneous Kirschner wire fixation and short arm cast procedure is satisfactory in intra-articular distal radius fractures and it appears to be an easy, technically less demanding and effective method for stabilization, so this procedure can be applied for patients with these fractures

Pediatric forearm fractures; functional outcome managed with intramedullary rush nails - experience in a tertiary care hospital

Unstable forearm both bones fracture in children more than 10 years of age are difficult to manage with cast and surgical intervention is required. To determine the functional outcome of patients with unstable forearm fractures managed with intramedullary rush nail. This study was conducted at Department of Orthopedics, Civil Hospital Karachi from July 2011 to August 2013. All the patients with age in between 10 to 15 years, with close radius ulna unstable fracture presenting within 7 days of trauma or fall were included in the study. All the fractures were stabilized with intramedullary rush nails. Functional outcome was assessed at 12 weeks. There were 79 patients included in the study. Mean age was 13.17+/-2 years. There were 52 male patients [65.8%] and 27 females [34.2%]. There were 24 patients with history of road traffic accident, 29 patients with fall and 26 patients with blunt injury. Acceptable outcome was found in 64 [81%] patients and observed more in male children [p=0.001] and children above 13 years of age [p=0.027]. Union was achieved in all the patients. Six patients had pin site irritation and 2 had superficial infection. Intramedullary fixation with rush nail in unstable forearm fractures in the children appeared to be an effective method of fixation and provided acceptable outcome in 64 [81%] patients

Prevalence of needle stick injuries among doctors and nurses working in Sheikh Zayed hospital Rahim Yar Khan

Background: Needle stick injuries remains potential source of transmission of infections

Objective: To determine the prevalence of needle stick injuries among doctors and nurses working in Sheikh Zayed Hospital Rahim Yar Khan

Methodology: This cross sectional study was conducted from 1[st] June to 31[st] December 2014. All the nurses and medical officers who were listed in the medical superintendent office of the Sheikh Zayed Hospital Rahim Yar Khan were included in the study. A structured, self administered questionnaire was designed to describe the occurrence of needle-stick injuries among respondents. The questionnaire sought information about socio-demographic characteristics such as age, sex, marital status and years of experience. The questionnaire also included information about the frequency of being stuck by a needle or a sharp instrument while at work during the last six months. A yes/no response were used to assess whether the doctor/nurse reported the injury. The participants were asked about the reasons of needle stick injuries and how they managed the incident. Data analysis was performed using SPSS, version 17. The chi-square test was used to assess the association between duration of service and needle stick injuries

Results: Total of 308 health care workers [HCWs] participated in this study which included 173 medical officers and 135 nurses. About half of the medical officers were in the age category of 30 to 39 years while half of the nurses in 20 to 29 years of age. Among these HCWs 27.8% medical officers and 25.2% nurses had above 10 years of work experience. Needle stick injury was reported by 22.54% doctors and 37.78% nurses in the past six months and it was found significantly higher among nurses as compared to doctors [p=0.001]. Among perceived reasons of needle stick injuries the most frequently reported reason was workload [48.7% doctors, 56.9% nurses] followed by Recapping of needle [30,8% doctors, 21.6% nurses], hurriedness [12.8% doctors, 13.7% nurses] and non-cooperation of patient [7.7% doctors, 7.8% nurses]. After needle stick injury only 38.5% doctors and 25.5% nurses washed it with disinfectant. Duration of service was significantly associated with needle stick injury among doctors [p=0.000] and nurses [p=0.000]

Conclusion: In summary, we conclude that the frequency of Needle stick injury among Health Care Workers is high and duration of service was significantly associated with needle stilck injuries

Survey of Gram Negative and Gram Positive Bacteria in Drinking Water Supplies in Karachi, Pakistan.

More than 20,000 children die annually in the city of Karachi alone, majority of whose death are thought to be associated with waterborne pathogens. Drinking water and recreational exposure to polluted water pose a significant public health threat including gastroenteritis, paralysis, meningitis, hepatitis, respiratory illness and diarrhoea. The aim of this study was to determine the presence of bacterial contamination in drinking water supplies in Karachi, Pakistan. A total of fifty two domestic tap water samples were collected from different areas of Karachi, between May to June 2011 and analyzed for bacterial presence based on biochemical testing. The results revealed a high prevalence of Bacillus spp. (86.84%), followed by Pseudomonas spp. (57.14%), Citrobacter spp. (14.28%) Serratia spp., Enterobacteriaceae species (14.28%), Corneybacterium (10.52%), and Acinetobacter spp. (2.63%). These findings disclose bacterial contamination in drinking water supplies, many of which are pathogenic and can produce serious as well as life-threatening infections. Future studies will determine whether bacterial contamination of drinking water occurred post-source contamination. It is recommended that household water treatment interventions should be introduced to improve water quality.

Comparison of frequency of recurrence following aspiration and injection of steroid versus surgical excision in the treatment of wrist ganglion

To compare the frequency of recurrence following aspiration and injection of steroid versus surgical excision in the treatment of wrist ganglion. Randomized controlled trial. General surgical department, Combined Military Hospital, Rawalpindi, Pakistan, from Jan 2010 to Dec 2010. Sixty patients of clinically diagnosed wrist ganglia were randomized into groups A and 'B' with 30 patients in each group. After approval by the hospital ethical committee, patients in group 'A' were subjected to aspiration and injection of methyl-prednisolone acetate 40 mg/ml and those in group 'B' underwent surgical excision of the ganglion. Patients were explained the procedure they were subjected to and they were also counselled about the risk of recurrence after a particular procedure and after that informed written consent was obtained from them. Patients were followed up at intervals of 2 weeks, 6 weeks, 3 months and 6 months after the procedure to look for recurrence in both groups. On follow up at 6 months, 12 [40%] patients in group A while only 2 [6.66%] patients in group B had recurrence of the ganglion. No complications were noted. This difference was found to be statistically significant [p = 0.0023]. Recurrence of wrist ganglion is considerably less in patients treated with surgical excision and should be preferred over aspiration and steroid injection

Fracture shaft of femur; management outcome in children between 10 to 14 years of age treated by intramdullary rush nail

In school going children surgical treatment is favoured with the introduction of elastic intramedullary nails. The aim of this study was to determine the management outcome of fracture shaft of femur in children between 7-14 years of age by intra medullary rush nail. This study was conducted at department of orthopedic surgery, Dow University of health science and civil hospital Karachi. Duration of study was 12 months from 01-09-2011 to 31-8-2012. Children with closed fracture shaft of femur age 7-14 years of either sex meeting the inclusion criteria were included. Children were diagnosed clinically and confirmed on X ray, open reduction and internal fixation with appropriate size rush nail was done by senior orthopedic surgeon. Thereafter patients were followed every month and the final outcome was measured at the end of third month post operatively. Male were 58% while female were 42%, the average age of the patients were 11.78+/-1.40 years. Management outcome of fracture shaft of femur in children by intra medullary rush nail showed that 100% children fracture were healed. We found a very high success rate in the management of closed fracture shaft femur with intramedullary rush nail. This surgical procedure is simple, technically less demanding, and suitable in peripheral rural hospital in developing countries

Intramedullary nailing; gunshot comminuted femur fractures, experience in a tertiary care hospital at Karachi

Gunshot comminuted fractures of femoral shaft are complicated fractures to treat in orthopedic practice, resulting in prolonged morbidity and extensive disability. Intramedullary interlocking nail is a well-established operative procedure for the management of this entity. The objective of this study is to find out the healing of gunshot comminuted fracture of shaft of femur treated by interlocking nails. This study was conducted at Civil Hospital Karachi during July 2009 to December 2009.Forty three patients sustaining gunshot comminuted fracture of shaft of femur were selected. All patients then underwent fracture stabilization by locking intramedullary nail. The main outcome measure was fracture healing [i.e. callus formation] on X-ray at six months of follow-up. The SPSS version 13 was applied to the data. Majority of the patients [46.5%] were between 18-30 years of age group with mean age of 36.05[+12.53] years. Males were affected more than females with male to female ratio being 4.3:1. Healing [i.e. callus formation] was achieved in 39[90.7%] patients radiographically at the end of six-months. Intramedullary interlocking nail is safe and effective procedure in the management of gunshot comminuted fractures of femur shaft as it is associated with good healing

Management of type-II open fracture shaft of femur with intramedullary interlocking nail

To find out frequency of fracture healing with the use of interlocking intramedullary nailing in type-II open fracture shaft of femur. Descriptive case series. Orthopaedic Surgery, Unit I Civil Hospital, Karachi, from August 2009 to August 2010. Sixty-five patients who sustained type-II open fracture of shaft of femur, were selected. All patients underwent fracture stabilization by locking intramedullary nail. The main outcome measure was fracture healing [i.e. callus formation] on x-ray at six months of follow-up. The SPSS version 13 was applied used to analyze data. Majority of the patients [44.6%] were between 18-30 years of age. Males were affected more than females with male to female ratio of 4:1. Road traffic accidents were responsible for these fractures in 73.8% of cases. Healing [i.e. callus formation] was achieved in 61[93.8%] patients radiographically at the end of six-months. Mean time to union was 18.5 weeks. Intramedullary interlocking nail was safe and effective in the management of type-II open fractures of femur shaft with excellent healing rates

Assessment of the interappointment pain by using two different intracanal medicaments

The objective of this study was to assess the interappointment pain by using two different intracanal medicaments. Comparative study in the department of operative dentistry, Liaquat Medical University Hospital Hyderabad was carried out. 60 teeth either anterior or posterior of male and female patients of 14 to 60 years age diagnosed for root canal treatment were included. Following the routine access cavity preparation, canals were located with endodontic explorer. Working length was taken with 15# k-file, and then instrumentation was performed with proTaper hand files and shaping by the crown down technique along with irrigation by using Milton's [l%Naocl] solution. Canals were dried with paper points and Ledermix paste in Group I and Calcium hydroxide in Group II patients were inserted in random sequence. The patients were recalled, to record the degree of pain on the next day, third day and one week and for clinical evaluation and obturation if the tooth was asymptomatic. Out of 60 cases, 33[55%] were male and 27[45%] were female. Post operative next day, mild pain was observed in 25% [15/60] patients and moderate pain in 20% [12/60] while severe pain in 13.3% [8/60] patients. Similarly on third day, mild pain was observed in 3.3% [2/60] only. While after one week mild pain was found in only 1.6% [1/60] case. Severity of pain was significantly low in group I than group II [p=0.999] after one week. Treatment with Ledermix was significantly better than with Calcium hydroxide in controlling severity of interappointment pain

Alvarado score; validity in diagnosing acute appendicitis

To determine the validity of Alvarado score in diagnosing acute appendicitis keeping histopathology of appendix as gold standard. Cross sectional [Validation] study. Department of Surgery Combined Military Hospital Rawalpindi from April 2009 to October 2009. 90 patients with clinical suspicion/diagnosis of acute appendicitis were included in study. All were divided into two groups on the basis of Alvarado score. Group I with score 7-10, who underwent open appendicectomy. Group ll [a] with 5-6, who were observed in hospital. Group ll [b] with< 4 were discharged. In all operated cases appendix was sent for histopathology. Alvarado score was compared with histopathology [gold standard] Male to female ratio was 3.5 :1. Mean age was 25.34. Alvarado score had overall 88.13% sensitivity, 70.96% specificity, 85.24% PPV. 75.86% NPV and 16.90% negative appendicectomy rate. Whereas in male patients it had 90.74% sensitivity, 75% specificity, 92.45% PPV, 70.58%NPV and 6.89% negative appendicectomy rate. In female it had 60% sensitivity, 66.66% specificity, 37.5% PPV, 83.33%NPV and 38.46% negative appendicectomy rate. Alvarado score is very accurate for acute appendicitis in male patients. Patients with score 4 can safely be discharged home. USG should be performed routinely in female patients to improve the diagnostic accuracy of Alvarado score