Interspecies comparative morphological evaluation of the corneal epithelial stem cell niche:a pilot observational study

Background@#The corneal and limbal morphology relevant to corneal epithelial maintenance in ten different species was examined using histological methods. @*Objectives@#The presence of a Bowman’s layer, limbal epithelial cell, and superficial stromal morphology was examined in the following species to evaluate the differences in corneal thickness and epithelium: Java sparrows, frogs, macaws, spoonbills, red pandas, penguins, horses, Dobermans, orangutans, and humans. @*Methods@#Corneal sections (4 µm) were obtained from ten ocular globes from three different animal classes: Aves, Amphibia, and Mammalia. All sections were stained with hematoxylin and eosin and periodic acid-Schiff reaction. After microscopy, all stained slides were photographed and analyzed. @*Results@#Significant morphological differences in the corneal and limbal epithelia and their underlying stroma between species were observed. The number of corneal epithelial cell layers and the overall corneal epithelial thickness varied significantly among the species.The presence of a Bowman’s layer was only observed in primates (orangutans and humans).Presumed supranuclear melanin caps were noted in four species (orangutans, macaws, red pandas, and horses) in the limbal basal epithelial layer (putative site of corneal epithelial stem cells). The melanin granules covered the apex of the cell nucleus. @*Conclusions@#Supranuclear melanin capping has been described as a process within the epidermis to reduce the concentration of ultraviolet-induced DNA photoproducts. Similarly, there may be a relationship between limbal stem cell melanin capping as a protective mechanism against ultra-violet radiation.

Evaluation of GeneXpert MTB/RIF assay for detection of pulmonary tuberculosis on sputum samples

Objective: To analyse the diagnostic performance of MTB/RIF assay for the diagnosis of pulmonary tuberculosis and detection of rifampicin resistance using sputum samples

Study Design: Observational cross-sectional study

Place and Duration of Study: Provincial TB Reference Laboratory [PTRL], Hayatabad Medical Complex, Peshawar, Pakistan, from January to October 2015

Methodology: A total of 268 participants were consecutively enrolled in the study after meeting the inclusion criteria. Their sputum samples were collected and processed by N-acetyl-L-cysteine-sodium hydroxide [NALC-NaOH] method and GeneXpert MTB/RIF assay

Results: This study determined the overall sensitivity and specificity of MTB/RIF assay, it was 92.4% [86/93] and 97.1% [138/142], respectively. The sensitivity was 98.4% [60/61] in culture proven smear positive samples, whilst sensitivity in culture proven smear negative samples was 93.7% [30/32], using culture as reference standard

Conclusion: GeneXpert MTB/RIF assay could greatly improve early diagnosis of PTB in smear negative cases as well as multidrug resistant tuberculosis

Outcome of chronic kidney disease patients on the basis of referral to nephrologist: a one-year follow-up study

Objective: To determine the outcome of chronic kidney disease [CKD] patients presenting for dialysis on the basis of referral to nephrologist. Study Design: Observational study. Place and Duration of Study: Nephrology Department of King Edward Medical University/Mayo Hospital, Lahore, from January 2014 to January 2016

Methodology: All patients who were presented in nephrology outpatients department and with the indication of dialysis were included in study. Patients who refused dialysis, and with acute kidney failure were excluded from the study. Proforma was designed for demographics, vital signs, volume status, and laboratory data [hemoglobin, urea, creatinine, albumin, bicarbonate etc.] of all the patients. On the basis of referral, patients were divided into two groups, i.e. early referral and late referral. Early referrals were those patients who were referred to a nephrologist more than three months before dialysis initiation. Late referrals were those patients who were referred to a nephrologist less than three months before dialysis initiation. Patients were followed up at one, three, six, and 12 months for outcome, i.e. still on dialysis or died

Results: One hundred and seventy-six patients were enrolled in the study, and 141 were followed up to one year. Seventy two [51.1%] patients were male, 69 [48.9%] were female and most [n=69, 48.9%] were in the middle age group. Major causes of end-stage renal disease [ESRD] were hypertension 70 [49.6%] and diabetes mellitus 66 [46.8%]. Seventy-six [53.9%] patients were in fluid overload and acidotic [n=123, 87.2%]. Twenty-seven [19.1%] patients were referred early and 114 [80.9%] were referred late. Overall mortality was 78 [55.3%] at one year. Factors affecting mortality were financial status and metabolic acidosis, but not referral. Temporary access for hemodialysis has 1.38 times more risk for mortality than the patients with permanent access

Conclusion: There is no difference on the outcome of dialysis patients on the basis referral to nephrologist. Factors affecting overall mortality in both groups were financial status, metabolic acidosis, and temporary access for dialysis. Most of the patients were referred late to the nephrologists

Effectiveness of platelets rich plasma versus corticosteroids in tennis elbow treatment

Background: Tennis elbow is a common condition causing discomfort and pain on the lateral aspect of the elbow especially during gripping activities

Objective: To compare the treatment with injection Platelets Rich Plasma and injection corticosteroid for tennis elbow in terms of symptoms relief. Methodology: This randomized controlled study was conducted in the Department of Orthopedics and Spine Unit, Hayatabad Medical Complex, Peshawar from 27th July 2016 to 26th July 2017. A total of 52 cases of tennis elbow were selected in OPD and randomly allocated in two groups to receive corticosteroids [Group A] and Platelets Rich Plasma [PRP] [Group B] and followed up to determine the effectiveness of either intervention. All information was recorded on a proforma. Pain intensity was recorded using VAS after three weeks postoperatively. Data analysis was done using SPSS 16 version

Results: A total of 52 patients with tennis elbow were selected and divided in two equal groups. There were 11 male and 15 females in steroid [group A] and 12 male and 14 female patients in PRP [group B]. In group A, the mean baseline VAS was 6.5 +/- 1.2 and in group B it was 6.7 +/- 1.4 but the difference was statistically not significant with a p-value of 0.71. All patients were subjected to standard therapy as per their allocated groups and were again assessed on 3 weeks follow up. On follow up, the mean pain scores using Visual Analogue Scale in group A was 4.19 +/- 2.6 and in group B was 3.42 +/- 2.61. We observed that of the overall sample of 52, the improvement was observed in 71 % of patients. Group A showed effectiveness in 54 % of patients and group B showed effectiveness in 88 % of patients. This difference was statistically significant having a p value of 0.001

Conclusion: Platelets Rich Plasma [PRP] is an effective alternative to corticosteroid in the treatment of tennis elbow

CD10 expression in ameloblastoma variants

Although benign ameloblastomas tend to behave aggressively with a high rate of recurrence. CD10 expression can help in predicting the behavior of these tumors. The aim of this study was to determine CD10 expression in variants of ameloblastomas. The data of thirty already diagnosed cases of ameloblastomas were taken. They were examined microscopically for selecting the sections with maximum epithelial content for immunohistochemical staining for CD10. A semi-quantitative scoring for determining the expression was used. In the present study, the follicular variant of ameloblastoma was the commonest [76.7%] followed by unicystic variant [13.3 %] and plexiform variant [10 %]. In the epithelial component CD10 expression was strongly positive in [76.2 %] and [80 %] showed moderate positivity. All the three cases of plexiform variant showed strong positivity. In unicystic variant [9.5%] were strongly positive and [20 %] were moderately positive. In the stromal component 50 % cases of follicular variant were strongly positive and 85.7 % were moderately positive. In the plexiform variant 25 % were strongly and 14.3 were moderately positive. In the unicystic variant strong CD10 positivity was seen in 25 % of cases. The present study concludes that all variants of ameloblastomas express CD10 positivity which may indicate their biological behavior

DPPH, ABTS free radical scavenging, antibacterial and phytochemical evaluation of crude methanolic extract and subsequent fractions of Chenopodium botrys aerial parts

We investigated antioxidant, antibacterial potentials and secondary metabolites of Chenopodium botrys aerial parts to rationalize its effectiveness in free radicals induced disorders and infectious diseases. Antioxidant activity of plant extracts were investigated using DPPH and ABTS free radicals scavenging assays. Antibacterial potential was studied using well diffusion method. Phytochemical analysis was performed for the presence of secondary metabolites. In DPPH assay chloroform fraction [CHF], ethyl acetate fraction [EAF] and n-hexane fraction [NHF] were most active causing average inhibition of 65.9, 59.2 and 55.9% at concentration of 1mg/ml with IC[50]values of 140, 30 and 590 micro gml respectively. EAF, CHF and aqueous fraction [AQF] revealed highest scavenging effect against ABTS free radicals causing 85.46, 82.73 and 68.80% inhibition with of IC[50]of 75, 94 and 530 micro g/ml respectively. In antibacterial assay, CHF was found most effective against S. aureus presenting an inhibitory zone of 19 mm whereas; EAF, CHF and NHF were most active against K. pneumoneae with inhibitory zones of 27.1 mm, 25.4 and 18.7 mm respectively. C. botrys was tested positive for flavonoids, anthraquinones, saponins and tannins. Current findings revealed that that C. botrys is rich source of natural antioxidant and antibacterial bioactive compounds and may be further investigated

Frequency of spontaneous bacterial peritonitis in hospitalized patients with cirrhosis and hypoalbuminemia

Background: Spontaneous bacterial peritonitis [SBP] is one of the complications in patients of cirrhosis. These patients when exposed to infection are likely to develop SBP. Various studies refer its frequency to around 30%, yet no study has estimated its frequency in hospitalized cirrhotic patients with serum albumin <3.5 g/dl

Objectives: To find out the frequency of SBP in hospitalized patients with cirrhosis and hypoalbuminemia

Methodology: This cross sectional study was conducted in Medical wards of Mayo hospital, Lahore from August 2010 to January 2011. A total of 110 cirrhotic patients recently hospitalized and having serum albumin < 3.5 g/dl in their initial investigations were investigated. Relevant history, examination and investigations were carried out and recorded in the proforma

Results: Of 110 patients under study, 60 were males[54.5%] and 50 were females[45.5%]. Total 54 patients [49.1%] had SBP. Patients having SBP were older [52.6 +/- 12.8 years] compared to others [45.4 +/- 10.2 years]. Among those having SBP, 38[70%] patients were > 40 years of age. The mean ascitic fluid white cell count in SBP patients was 884 +/- 260 cells/uL versus 236 +/- 108 cells/uL. The mean neutrophil count in ascitic fluid was 643 +/- 181 cells/uL versus 137 +/- 65 cells/uL. HCV was the commonest etiology of cirrhosis 59 [54%], HBV in 29 [26%], combined HBV and HCV in 10 [9%], and non-viral in 12 [11%]

Conclusion: SBP is a common complication of cirrhosis and its frequency is higher in those cirrhotic patients who also have hypoalbuminemia [<3.5gm/dl]

Carum copticum and Thymus vulgaris oils inhibit virulence in Trichophyton rubrum and Aspergillus spp

Emergence of drug-resistant strains has demanded for alternative means of combating fungal infections. Oils of Carum copticum and Thymus vulgaris have long been used in ethnomedicine for ailments of various fungal infections. Since their activity has not been reported in particular against drug-resistant fungi, this study was aimed to evaluate the effects of oils of C. copticum and T. vulgaris on the growth and virulence of drug-resistant strains of Aspergillus spp. and Trichophyton rubrum. The gas chromatography-mass spectrometry analysis revealed thymol constituting 44.71% and 22.82% of T. vulgaris and C. copticum, respectively. Inhibition of mycelial growth by essential oils was recorded in the order of thymol > T. vulgaris > C. copticum against the tested strains. RBC lysis assay showed no tested oils to be toxic even up to concentration two folds higher than their respective MFCs. Thymol exhibited highest synergy in combination with fluconazole against Aspergillus fumigatus MTCC2550 (FICI value 0.187) and T. rubrum IOA9 (0.156) as determined by checkerboard method. Thymol and T. vulgaris essential oil were equally effective against both the macro and arthroconidia growth (MIC 72 µg/mL). A > 80% reduction in elastase activity was recorded for A. fumigatus MTCC2550 by C. copticum, T. vulgaris oils and thymol. The effectiveness of these oils against arthroconidia and synergistic interaction of thymol and T. vulgaris with fluconazole can be exploited to potentiate the antifungal effects of fluconazole against drug-resistant strains of T. rubrum and Aspergillus spp.

Role of all Pakistan newspapers society [APNS]: call for a change

This study explores the institutional role of the All Pakistan Newspapers Society [APNS] employing the methodology of document study and survey to collect the relevant data from media professionals. The paper finds that APNS as the main organization of newspaper publishers in Pakistan, only apparently seems to be committed to the cause of press freedom and maintenance of high professional standards in the country. The APNS' best efforts were seen only to safeguard the financial interests of the newspapers in case a government tries to introduce a new tax or whenever the APNS wants government to raise the rates of govt. advertisements for newspapers. Not only this, the APNS has also kept mum over the violation of labour laws by its member organizations i.e. large media houses in the newspaper industry

Assisted breech delivery with transverse vaginal septum

The incidence of vaginal septum is rare. The infrequency of this anomaly makes accurate estimates of the true incidence very difficult to obtain. Diagnosis is based on careful history and examination. This is the case of a patient who presented with transverse vaginal septum in labour and breech presentation. The septum was resected and the foetus delivered normally. Careful vaginal examination should be performed in pregnant women at term before labour to detect such manageable abnormalities.

Differential Diagnosis of Autism and Mental Retardation: Issues and possible solutions

Co-morbidity of Autism and Mental Retardation [MR] makes it difficult to differentiate the two disorders. The current study was aimed at identifying the key features that separate the two conditions and those which create confusion. To explore the phenomenology, ten parents of children with each disorder were interviewed on 9 major domains [social, communication, stereotypical movements, cognitions, self-care, behavioral problems, interests/routines/ sensory issues, neurotic traits and developmental milestones]. After validation from 10 experts, the final list of 66 features was administered on a sample of 40 children with Autism and MR [20 each]. Mann Whitney U test found that 35 features were significant in differentiating the two disorders, whereas 31 features were not statistically significant. The findings were discussed within diagnostic relevance and suggestions were made to improve the efficiency of diagnosis by utilizing the dubious features appropriately

Screening of certain medicinal plants from India for their anti-quorum sensing activity.

Discovery of quorum sensing (QS) system to coordinate virulence and biofilm formation in bacterial pathogens has triggered search for safe, stable and non-toxic anti-QS compounds from natural products. Ethanolic extracts of 24 Indian medicinal plants were tested by agar well and disc diffusion assay for anti-QS activity using Chromobacterium violaceum (CV12472 and CVO26) reporter strains. AHL from C. violaceum CV31532 was isolated and partially purified for its use in CVO26 based bioassay. Effect on swarming-motility of Pseudomonas aeruginosa (PAO1) was also recorded at sub-MIC concentrations of extracts. Of the 24 medicinal plants screened Hemidesmus indicus (L.) Schult (root), Holarrhena antidysenterica (Roth)A.DC. (bark), Mangifera indica L. (seed) Punica granatum L. (pericarp) and Psoralea corylifolia L. (seed) demonstrated varying level of inhibition of violacein production in the reporter strains. Moreover, a significant reduction in swarms was recorded over control. The inhibition of violacein production and swarming motility may be due to direct or indirect interference on QS by active constituents or the interactive effect of different phytocompounds present in the extracts. These plant extracts may be selected for activity guided fractionation to identify and characterize the active principle

Percutaneous nephrostomy for the relief of upper urinary tract obstruction: an experience with 200 cases

To assess the role of Percutaneous Nephrostomy in upper obstructive uropathy. This was a descriptive study, conducted at Department of Urology, Lady Reading Hospital and Institute of Kidney Diseases, Hayatabad Medical Complex Peshawar from January 2006 to December 2008 on 200 patients of upper obstructive uropathy undergoing Percutaneous Nephrostomy. Fluoroscopy and Ultrasonography were used as guiding tools for accurate puncture of the renal tract. The patients were kept in the ward and their renal function tests were checked daily. All the data was collected on a structured proforma and analysis was done on SPSSv 10. A total of 200 Percutaneous Nephrostomy were attempted in 200 patients. The mean age of the sample was 41.6 +/- 12.68 years. Male to female ratio was 2.3:1. The causes included Stone disease in 104 [52%], Pyonephrosis in 52 [26%], Malignancy in 20 [10%], Renal tract tuberculosis in 12 [6%], Obstetrical trauma in 8 [4%] and Ureteric Injury due to Fire Arm in 4 [2%] patients. It was successful in 192 patients, while there was a failure in 8 cases [4%]. Considerable relief in terms of symptoms and renal biochemistry was observed with in a week. The mean blood urea level of 265 mg/dl before PCN dropped to 37 mg/dl and mean serum creatinine of 10.5 mg/dl dropped to 1.2 mg/dl respectively in all patients except 12 who were declared to have End Stage Renal Disease [ESRD]. Percutaneous Nephrostomy improves the patient's condition both in terms of urinary output and renal parameters

Laparoscopic Cholecystectomy: An early experience at Ayub Teaching Hospital Abbottabad

Laparoscopic Cholecystectomy first introduced in 1987, is becoming more and more popular and now it has become gold standard in symptomatic gallstone disease. The current descriptive study is carried out in Department of General Surgery, Ayub Teaching hospital, Abbottabad to evaluate the result of Laparoscopic Cholecystectomy in symptomatic gallstones disease in our set up with special emphasis on complication rate, morbidity and mortality. The data of all patients who underwent Laparoscopic Cholecystectomy form January to December 2007 was entered in standardized proforma and analysed on SPSS 10. Out of 60 patients, 51 [85%] were female and 9 [15%] were males; the age range from 17 to 65 years mean age being 40.30 years, majority were in age 30-40 years group. Two [3.3%] patients had bile leak, 1 [1.3%] patient developed port site wound infection 1 [1.3%] patient developed collection in pouch of Morrison and in 1 [1.3%] patient stone were recovered from the epigastric port site wound. There was no bile duct or colonic injuries. The conversion rate was 5%. There was no mortality. Laparoscopic cholecystectomy is a safe and effective treatment for gall stone disease and is up to the accepted standard in our set up as compared to national and international data

Conservative management of mesh site infection in ventral hernia repair

Mesh Hernioplasty is the preferred surgical procedure for abdominal wall hernias and infection remains one of the most common complications of this technique. In some patients the mesh may need removal to overcome infection, where as others may be salvaged by conservative treatment. This study was conducted to assess the outcome of conservative management for mesh site infection in abdominal wall hernia repairs. This study was carried out in Ayub Teaching Hospital Abbottabad Pakistan from Jan 2006 to Dec 2007. Thirteen consecutive cases were included, who developed mesh site infection after abdominal wall hernia repair. Pus or purulent fluid was sent for culture and sensitivity. All patients were treated by intravenous antibiotics and local wound care. Treatment was taken as successful when there was complete resolution of infection and healing of the wound. There were 7 inguinal [53.84%], 4 para-umbilical [30.76%] and 2 incisional hernias [15.38%]. Eight patients were males [61.53%] and 5 females [38.46%]. Median age of the patients was 40 years [range 28 to 52 years]. Staphylococcus aureus was the most commonly found organism causing infection in 8 patients, [76.9%]. Mean hospital stay was 22 days [range 18-26 days]. All cases were effectively treated conservatively without removing the mesh. Polypropylene mesh was used in all of these cases. Conservative management is likely to be successful in mesh site infection in abdominal wall hernia repairs

Assessment of health services provided to the prisoners with pulmonary tuberculosis at central jail hospital, Multan

Prisoner department of the Punjab consist of 28 jails, out of which two are situated in Multan. Currently 52,596 prisoners confined in a space with official accommodation capacity of 17,413. To assess, health services provided to the prisoners with pulmonary tuberculosis at central jail hospital Multan, a descriptive cross sectional study was conducted involving 35 prisoners. A semi structured interview questionnaire was designed to determine client's satisfaction. A checklist was designed to assess health facilities and TB case management. Study was conducted in December 2000. All patients who were present at the time of interview were included in this study. Thirty-five prisoners were included in the study and were interviewed. Health facilities being provided to the inmates were assessed to study the current practices and factors affecting the management of sick inmates confined in the jail. Almost 65.7% of the prisoners belonged to the age group ranging from 21-40. Only male prisoners were included in the study. Majority of these prisoners 78% were facing still trials in their concerned courts. Majority belonged to labour and fanner's class and 51.3% were held under section 302. According to conservative estimates one third of the world's Population is infected with the T.B. Bacillus. There are 15 - 20 millions cases of infectious tuberculosis in the word. This infectious pool is maintained by the occurrence of 4 - 5 million new cases[1]. The magnitude of the problem is such that WHO declared it a global emergency in 1993. More recently during 1996, estimated 7.4 million people developed tuberculosis bringing the global suffers to about 22 millions[2]. La Pakistan out of approximately 130jnillion Populations, about 15 millions suffer from T.B. More than 210,000 new cases occur each year[3]. Tuberculosis affects almost every stratum of the society including prisoners visiting the Jails. Due to some unavoidable circumstances prisoners carry a much greater burden of various diseases than other members of society. Like other developing countries prisoners in Pakistan are suffering from a lot of health and social problems. The incidence of T.B. among prisoners has long been recognized as a significant problem. Since 1985 the problem of active T.B. has been exacerbated by the increasing prevalence of HIV. The prevalence tuberculosis of prisoners was 30% and the incidence of new infection attributable to incarceration was 5.9 per 100 inmates per year[4]. The basic health facilities such as adequate supply of essential medicines, necessary diagnostic facilities, provision of specialized care to the needy prisoners and their timely referral to the tertiary care facility, are not upto the required standard to maintain harmony in the prison health services. At times, the prisoners are not being provided with the proper emergency care[5]

Parathyroid carcinoma

Parathyroid carcinoma is a very rare cause of primary hyperparathyroidism and these tumors are usually hyper-functioning as compared to other malignant endocrine tumors. Surgery is the only effective primary treatment. We report a patient, who presented with pathological fracture of femur, hypercalcemia, bilateral renal stones, markedly raised Parathormone levels and palpable mass in the neck. Parathyroid adenoma was initially diagnosed and localized at left lower gland by Sestamibi scan and ultrasonography. She underwent surgery and enlarged parathyroid gland was removed. Intra operatively there was no evidence of local invasion or lymph nodes involvement but biopsy report suggested malignancy

audit of patients satisfaction after adult day - case surgery at Ayub teaching hospital, Abbottabad

Day-case surgery has become an important component in the provision of surgical care in the Western countries. This study was done to introduce the concept of day-case surgery and assess the patients' satisfaction after day case general surgery in our set up with vast rural communities lacking medical facilities and no day-case surgery units in the hospitals. All those patients suitable for day-case surgery and who accepted day-case surgery for general surgical procedures in General Surgical 'A' unit of Ayub Teaching Hospital, Abbottabad were interviewed after the operation on follow up visits. Questions were asked about their satisfaction with day-case surgery. If they were not satisfied, the reasons for dissatisfaction were noted. Direct admissions and re-admissions after day-case surgery were recorded. Any complications in the postoperative period were also noted. The patient's preference for a similar procedure as day-case in future was also recorded. There were 122 patients in this study. 60[49%] were operated under general anesthesia and 62[51%] under local anesthesia. Fourty Nine [40%] patients were satisfied while 73[60%] were not satisfied with day-case surgery. Six [5%] patients were admitted directly after day-case surgery while 7[5.7%] patients were admitted after discharge. Complications occurred in 41[33.6%] patients at home. Wound complications and pain were the most common morbidity encountered by the patients. Twenty eight [23%] patients contacted a hospital or a doctor in the early postoperative period. Sixty two [51%] patients would prefer operation as in-patient while 74 [60.6%] would prefer an overnight stay after the operation next time. Conclusions: Patients satisfaction with day-case surgery in Ayub Teaching Hospital is not high. Short-stay surgery would be more appropriate in our set up

Pattern of carcinoma of oral cavity reporting at dental department of Ayub medical college

Carcinoma of oral cavity is amongst the first ten commonest malignancies in Pakistan. Districts of Hazara [NWFP] and Northern Areas of Pakistan are among the high risk. areas. Here we present a report of oral cancers received in this center over a period of 10 years. This clinicopathological study consists of cases of carcinoma of oral cavity presenting to dentistry department of Ayub Medical College Abbottabad during 1993-2003. All cases were clinically examined and provisionally diagnosed. Biopsy was taken from all the lesions and the tissues submitted to histopathology department of Ayub Medical College. There were 50 carcinoma cases in the study, including 30 [60%] males and 20 [40%] females. Among these, 47 [94%] were diagnosed as squamous cell carcinomas, that consisted 30 [63.82%] males and 17 [36.17%] females. The other 6% lesions were histologically diagnosed as malignant melanoma, adenocarcinoma and acinar cell carcinoma. The age of squamous cell carcinoma cases was 41-71 years. The maximum number of squamous cell carcinomas [34%] effected buccal mucosa. The other common sites were lip [26%], tongue [21%] and gums [19%]. The results of this study are comparable with other such studies done in Pakistan and else where in the world showing commonality of factors associated with the development of the disease in this region of the country, which necessitates a detailed prospective study

Accuracy of surgeon - performed abdominal utrasound for gallstones

Gallstone disease is common in Pakistan. It is primarily diagnosed by ultrasonography, which is traditionally done by radiologists. If surgeons could perform ultrasonography, it would enable early diagnosis in one-stop clinic. This study was done to evaluate the accuracy of surgeon-performed abdominal ultrasonography to detect gallstones. This study was carried out at Surgical A and Surgical C units of Ayub Teaching Hospital, Abbottabad from July. 2000 to December, 2002. One hundred fourty two patients with signs and symptoms of gallstone disease who had ultrasonography performed by a surgeon, trained in ultrasonography were exclusively studied. These patients were referred for further scanning by the radiologists who were unaware of the surgeons interpretation. The results of surgeon and radiologist performed ultrasonography were compared. The interpretation of surgeon-performed ultrasonography was correct in 100 patients and incorrect in 42 patients. There were 100 True Positive. 41 True Negative, One False Negative and Zero False Positive scans yielding 99%, Sensitivity, 100% Specificity and 99.3% Accuracy. Sensitivity of surgeonperformed ultrasonography in detecting gallstones compared to operative findings was 100%,. Conclusions: Abdominal ultrasonography performed by an ultrasonography trained surgeon can detect gallstones as accurately as by a radiologist