Comparison of harmless acute pancreatitis score with Ranson's score in predicting the severity of acute pancreatitis

Objective: To determine the predictability of harmless acute pancreatitis score [HAPS] in determining the severity of acute pancreatitis [AP] and compare it with Ranson's score

Study Design: Prospective cohort study

Place and Duration of Study: King Saud Medical City, Riyadh, Kingdom of Saudi Arabia, between January 2012 and December 2015

Methodology: All patients admitted with AP at King Saud Medical City, Riyadh, during 2012 - 2015 were studied prospectively. Patients were assessed by HAPS and Ranson's score. Predictability values of the two systems were analysed and compared

Results: Out of 116 patients studied, 104 [89.6%] were HAPS positive and predicted to have mild disease. Pancreatitis was mild in 101 [87%] but severe in 3 [2.6%] patients who scored >/= 3 Ranson's criteria. Among 12 HAPS negative patients, 10 scored >/= 3 Ranson's criteria and developed severe pancreatitis while 2 [1.7%] with 2 positive Ranson's criteria developed mild pancreatitis. HAPS correctly predicted the disease severity in 101 [87%] patients, a sensitivity of 98% specificity of 77% and accuracy of 96%. Ranson's system predicted correctly in all but took 48 hours for assessment. Statistical analysis showed moderate agreement [Kappa = 0.776, p < 0.001], and positive relation [rs = 0.777, p < 0.001] between the two scores

Conclusion: HAPS is effective in rapid identification of patient who will run non-severe course of AP. Assessment can be completed within one hour from presentation. Ranson's score, although more accurate, takes 48 hours to complete

Impact of weekend admission on the outcome of patients with acute gastro-esophageal variceal hemorrhage

Objectives: To evaluate the impact of weekend admission on the outcome of patients with acute variceal hemorrhage [AVH] Design: Retrospective study Setting: Department of Surgery, College of Medicine, King Saud University, KSA Main Outcome Measures: AVH, weekend admission and clinical outcome

Subjects: Nine hundred and thirty-seven admitted during the period 1[st] January 2005 to 31[st] July 2013 and documented to have AVH. The selected patients were divided into two groups based on the admission day [weekday or weekend admission]. The data regarding patients characteristics and outcome in both the groups were retrieved from medical records and compared by using c2 test / Fisher's exact and student T- test

Results: Weekday admissions included 685 patients, while the weekend group comprised of 252 patients. The demographic, clinical and laboratory characteristics of patients admitted with AVH in both the groups were comparable. Statistically, there was no significant difference in the need for blood transfusion [46% versus 48%, p = 0.5868], and surgical intervention [5.4% versus 4.7%; p = 0.6595] between the groups. There was a little, but statistically significant delay in endoscopic intervention in the weekend group [7.56 +/- 7.8 hours versus 9 +/- 2.32; p = < 0.0001]. However, this delay did not lead to adverse outcome for patients [mortality rate 6.8% versus 5.25%; p = 0.389]

Conclusions: The weekend admissions were not associated with increased mortality in patients with AVH. Moreover, the length of hospital stay, need for blood transfusion, and rate of surgical intervention were similar in weekdays and weekend admissions

Role of postoperative antibiotics after appendectomy in non-perforated appendicitis

To determine the role of postoperative antibiotics in reducing the surgical site infections [SSIs] after open appendectomy in patients with non-perforated appendicitis [NPA]. Randomized controlled trial. The Department of Surgery, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia, from January 2010 to July 2011. Three hundred and seventy seven patients, who underwent appendectomy for NPA and fulfilled the selection criteria, were randomized into two groups. The patients in group A received a single dose of pre-operative antibiotics [cefuroxime sodium and metronidazole], while the group B patients received one more dose of the same antibiotics postoperatively. Patients of both the groups were followed-up for 30 days to assess the postoperative infective complications. Group A had 195, while group B comprised of 182 patients. The groups were comparable in the baseline characteristics. Statistically there was no significant difference in rates of SSIs between both the groups [p = 0.9182]. Mean hospital stay was 2.29 +/- 0.81 and 2.35 +/- 0.48 days for group A and B respectively [p = 0.4403]. None of the patients developed intraabdominal collection. Single dose of pre-operative antibiotics [cefuroxime and metronidazole] was sufficient in reducing the SSIs after appendectomy for NPA. Postoperative antibiotics did not add an appreciable clinical benefit in these patients

Routine or selective interval appendectomy for non-surgically treated appendiceal mass

The purpose of this study was to evaluate the need for interval appendectomy after a successful conservative treatment of an appendiceal mass. This retrospective study was conducted on patients admitted with appendiceal mass at King Saud Medical City during between July-2004 to July-2009. Only patients who were successfully treated conservatively [non-surgical] were included in the study. Data on patient demography, clinical presentations, investigations1 follow up, relapse of symptoms and/or recurrent acute appendicitis were collected and analyzed. Seventy-three patients were successfully treated conservatively for appendiceal mass. After discharge from the hospital, all were followed up in an OPD clinic. Seven patients [9.6%] developed recurrent symptoms appendicitis and underwent appendectomy. Sixty six patients [90.4%] were discharged from the outpatient clinic as they remained asymptomatic. All were seen in OPD at least twice before discharge. At the time of data collection for this study, all of them were contacted and recalled for assessment in the outpatient department. Five patients [6.8%] had emergency appendectomy elsewhere after discharge from the OPD clinic. Overall, 12 patients [16.4%] needed appendectomy after a successful conservative treatment for appendiceal mass. Sixty one patients [83.6%] have remained asymptomatic since their discharge from the clinic. Routine interval appendectomy is unnecessary after a successful conservative treatment of an appendiceal mass. It should be recommended selectively to those who develop recurrent symptom or recurrent acute appendicitis

Abdominal wall abscess following laparoscopic cholecystectomy: an unusual late complication of lost Gallstones

Laparoscopic Cholecystectomy [LC] is associated with a significant risk of gallbladder perforation with spillage of bile and stones into the peritoneal cavity. The retrieval of the spilled stones is not always possible by laparoscopic technique. Majority of these cases do not have any problem in future but sometimes the lost stones lead to serious complications. The authors present a case of lost gallstones, which resulted into an abdominal wall abscess and discharging sinus 9 years after LC. This late presentation is among the very few reports after LC. Risk factors for gallbladder perforation, various techniques to avoid spillage of stones, possible complications and their management is discussed

Familial homocystinuria

Two cases of siblings diagnosed as cases of familial homocystinuria are reported. Both the cases have classical presentation of familial homocystinuria including history of dislocation of lens of the right eye. Brother had history of psychomotor retardation while sister had a significant history of deep vein thrombosis. Levels of plasma homocysteine were elevated and urinary homocysteine was positive in both the cases

Factors affecting hospital mortality in acute upper gastrointestinal bleeding

This retrospective analysis studied the records of 564 consecutive patients admitted to Gastrointestinal Bleeding unit of Riyadh Medical Complex with acute upper gastrointestinal bleeding over a 2-years period [May 1996-April 1998]. The purpose of the study was to analyze the mortality with an aim to identify the risk factors affecting mortality in these patients. Majority of patients were men [82%] and Saudis [54%]. Their mean age was 52.46 +/- 17.8 years. Esophageal varices [45%] were the main causes of bleeding followed by doudenal ulcers [24%]. Overall mortality in this series was 15.8% [89 patients]. Comorbid diseases were responsible for death in 68 [76%] patients, whereas, bleeding was considered to be directly responsible for death in 21 [24%] patients. On analysis of data from this study, old age [>60 years], systolic pressure <90 mm Hg on admission, comorbid disease, variceal bleeding and Child's grade C in patients with chronic liver disease were associated with adverse outcome

Efficacy of a home made quality control serum

Neurological disorders were studied in 18 patients diagnosed to have AIDS and their findings are analysed. Amongst the problems seen were toxoplasmosis [9], cryptococcal meningitis [5], tuberculous meningitis [1], AIDS dementia complex [3], peripheral neuropathy [2], vertebrobasilar stroke, and a possible AIDS myelopathy in one case each. Their findings are discussed, and literature on the neurological disorders in AIDS reviewed

Methotrexate clearance and clinical toxicity in osteosarcoma following high-dose methotrexate therapy

Two patients with osteogenic sarcoma were treated with high-dose methotrexate [MTX] followed by leucovorin 'rescue'. Profiles of MTX clearance from plasma and erythrocytes were obtained. Clearance of the drug from plasma during the first 36 hours appears to be biphasic with the first phase of elimination of the drug being appreciably more rapid than the second phase, The drug had also incorporated into the bone marrow precursor cells and reappeared after a few days in the circulating mature erythrocytes which may later serve as a slow-changing compartment for MTX. Nonspecific binding of the drug to plasma proteins may have been one of the causes of delayed clearance of plasma MTX observed in one of the patients. However, delayed clearance does not appear to correlate with the severity of clinical toxicity which was found to be more pronounced in a patient with a better clearance of the drug. Our results support the more recent concept that enhanced clinical toxicity may not be predictable by monitoring plasma MTX alone

Urinary tract infection

Over two years, 9892 mid-stream urine samples from patients attending the Aga Khan University Hospital, Karachi were cultured. Significant bacterial growth was seen in 23.5% samples. Further identification of these organisms revealed 40% of E. coli, 16% Pseudomonas aeruginosa, 11% Klebsiella aerogenes, 5.0% Enterobacter sp., 13% Prat sp., 4.0% Serratia liquifaciens, 1.0% Acinetobacter sp., 3.0% Citrobacter sp., 4.0% Enterococci, 0.5% Staphylococcus aureus. Results of sensitivity tests performed with antibiatics Ampicillin, Cotrimoxazole, Nitrofurantoin, Nalidixic acid, Gentamicin, Amikacin, Pipemedic acid, Cefotaxime, Azactam and Carbenicillin did not reveal any distinct pattern

Hemoglobin and packed cell volume - reference values for healthy Pakistani adults

For meaningful interpretation of laboratory results, it is essential to establish normal reference values. In Pakistan only a handful of studies have been conducted to achieve this purpose. This need was also felt at the Aga Khan University Hospital and we embarked on a project to establish these normal ranges for Pakistani population. As the first part of the project, the hemoglobin and packed cell volume [PCV] estimation were done on 300 males and 200 females from different socio-economic and ethnic strata. As regards these two parameters, there has been general misconcepetion that the general healthy Pakistan population's hemoglobin and PCV is lower than the developed countries. Our study negated this point of view and we found out that the normal ranges of hemoglobin and PCV for the general healthy Pakistan population is at par with other developed countries. Our results show that the mean hemoglobin for Pakistani males is 15.01 +/- 1.338 gm% and for females is 12.53 +/- 1.416 gm%. The mean PCV for males is 45.3 +/- 3.43 and for females is 38.7 +/- 3.34