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

Spectrum of ocular surface squamous neoplasia

To describe the pattern of ocular surface squamous neoplasia [OSSN], clinical presentations, the risk factors and treatment options. An observational case series. Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar, from April 2003 till August 2006. The study included 36 eyes of 35 patients with biopsy-proven ocular surface neoplasia. The details of patients regarding age, gender, laterally and risk factors were entered into a specially-designed proforma. Each patient was also assessed blomtcroscoplcally for type and complications of ocular surface neoplasia. The frequency of OSSN was 0.37 among admitted hospital patients. Among 36 cases of OSSN, squamous cell carcinoma of the conjunctiva was the most common type of OSSN seen in 63.9%, followed by carcinoma in situ of conjunctiva in 25% and carcinoma in situ of cornea in 11.1%. Male patients outnumbered female [65.7% vs 34.3%] with 71.42% of patients above 60 years of age. The risk factors identified were: old age, ultraviolet B exposure and xeroderma pigmentosa. Treatment consisted of local resection with or without adjuvant therapy in 61.1%, exenteration in 30.5%, enucleation in 5.5% and chemo/radiotherapy in 2.7%. Intraocular invasion was seen in 5.5% and orbital spread in 30.5%. The frequency of OSSN was 0.37% among admitted patients. Identification of exact etiological factors will enable to formulate strategies that are likely to decrease the incidence of this disease and the associated morbidity and mortality