Mannich bases derivatives of 2-Phenyl-5-Benzimidazole sulfonic acid; Synthesis, Characterization, Computational studies and Biological evaluation

Abstract A new series of N-Mannich bases of 2-Phenyl-5-benzimidazole sulfonic acid have been synthesized through amino methylation reaction with secondary amines. The two moieties were held together through a methylene bridge, which comes from formaldehyde (Formalin Solution 37%) used in the reaction. Chemical structures of the newly synthesized compounds have been confirmed using FT-IR, 1HNMR and 13CNMR. Different in vitro assays including Anti-oxidant, Enzyme inhibition, Anti-microbial and Cytotoxicity assay were performed to evaluate the biological potential with reference to the standard drug. Among the synthesized library, compound 3a shows maximum alpha-glucosidase inhibition with an IC50 value of 66.66 µg/ml, compound 3d was found most toxic with LC50 value of 10.17 µg/ml. ADME evaluation studies were performed with the help of Molinspiration online software. Docking calculations were also performed. Given the importance of the nucleus involved, the synthesized compound might find extensive medicinal applications as reported in the literature.

Extraction optimization, Total Phenolic-Flavonoids content, HPLC-DAD finger printing, antimicrobial, antioxidant and cytotoxic potentials of Chinese folklore Ephedra intermedia Schrenk & C. A. Mey

Abstract Plants from genus Ephedra are commonly used by the Chinese people as folk medicine for treatment of various diseases. The current study was designed to explore the ethno-pharmacological based pharmacological potentials of Ephedra intermedia Schrenk & C.A. Mey. (E. intermedia). Plant aerial parts were extracted using ten solvent systems with increasing order of polarity. Samples were analyzed for total phenolic and flavonoid contents, HPLC-DAD analysis, antibacterial, antifungal, HepG2 cell line cytotoxicity, hemolysis and antioxidant potentials following standard procedures. Highest percent extract recovery was observed in Eth+WT (25.55 % w/w) solvent system. Flavonoid and phenolic contents were higher in chloroform and Met+WT fractions respectively. Considerable antibacterial activity was shown by Eth+Met extract against B. subtilis and K. pneumonia (MIC of 11.1μg/mL for each). Eth extract exhibited high antifungal activity against A. fumigates (15±0.31 mm DIZ). Met+WT extract showed significant cytotoxicity against HepG2 cell lines with IC50 of 13.51+0.69 μg/mL. Substantial free radical scavenging activity (74.9%) was observed for Met+Eth extract. In the current study, several solvent systems were used for more effective extraction of fractions and can be useful in the isolation of phytochemicals. Various fractions exhibited considerable antimicrobial, antioxidant and cytotoxic potentials. Biological potentials of E. intermedia signify its potential uses in microbial, cancer and degenerative disorders and thus warrant further detailed studies.

Copy Number Profiling of MammaPrint™ Genes Reveals Association with the Prognosis of Breast Cancer Patients / 한국유방암학회지

PURPOSE: The MammaPrint™ gene signature, currently used in clinical practice, provides prognostic information regarding the recurrence and potential metastasis in breast cancer patients. However, the prognostic information of the 70 genes included can only be estimated at the RNA expression level. In this study, we investigated whether copy number information of MammaPrint™ genes at the DNA level can be used as a prognostic tool for breast cancer, as copy number variations (CNVs) are major contributors to cancer progression. METHODS: We performed CNV profiling of MammaPrint™ genes in 59 breast cancer cell lines and 650 breast cancer patients, using publicly available data in The Cancer Genome Atlas (TCGA) database. Statistical analyses including Fisher exact test, chi-square test, and Kaplan-Meier survival analyses were performed. RESULTS: All MammaPrint™ genes showed recurrent CNVs, particularly in TCGA cohort. CNVs of 32 and 36 genes showed significant associations with progesterone receptor and estrogen rector, respectively. No genes showed a significant association with human epidermal growth factor receptor 2 status and lymph node status. In addition, only six genes were associated with tumor stages. RFC4, HRASLS, NMU, GPR126, SCUBE2, C20orf46, and EBF4 were associated with reduced survival and RASSF7 and ESM1 were associated with reduced disease-free survival. CONCLUSION: Based on these findings, a concordance of CNV-based genomic rearrangement with expression profiling of these genes and their putative roles in disease tumorigenesis was established. The results suggested that the CNV profiles of the MammaPrint™ genes can be used to predict the prognosis of breast cancer patients. In addition, this approach may lead to the development of new cancer biomarkers at the DNA level.

First report on molecular characterization of Leishmania species from cutaneous leishmaniasis patients in southern Khyber Pakhtunkhwa province of Pakistan

OBJECTIVE@#To report presence of Leishmania major in Khyber Pakhtunkhwa of Pakistan, where cutaneous leishmaniasis (CL) is endemic and was thought to be caused by Leishmania tropica only.@*METHODS@#Biopsy samples from 432 CL suspected patients were collected from 3 southern districts of Khyber Pakhtunkhwa during years 2011-2016. Microscopy on Giemsa stained slides were done followed by amplification of the ribosomal internal transcribed spacer 1 gene.@*RESULTS@#Leishmania amastigotes were detected by microscopy in 308 of 432 samples (71.3%) while 374 out of 432 samples (86.6%) were positive by ribosomal internal transcribed spacer 1 PCR. Subsequent restriction fragment length polymorphism confirmed L. tropica in 351 and L. major in 6 biopsy samples.@*CONCLUSIONS@#This study is the first molecular characterization of Leishmania species in southern Khyber Pakhtunkhwa. It confirmed the previous assumptions that anthroponotic CL is the major CL form present in Khyber Pakhtunkhwa province. Furthermore, this is the first report of L. major from a classical anthroponotic CL endemic focus identified in rural areas of Kohat district in southern Khyber Pakhtunkhwa.

First report on molecular characterization of Leishmania species from cutaneous leishmaniasis patients in southern Khyber Pakhtunkhwa province of Pakistan

Objective To report presence of Leishmania major in Khyber Pakhtunkhwa of Pakistan, where cutaneous leishmaniasis (CL) is endemic and was thought to be caused by Leishmania tropica only. Methods Biopsy samples from 432 CL suspected patients were collected from 3 southern districts of Khyber Pakhtunkhwa during years 2011–2016. Microscopy on Giemsa stained slides were done followed by amplification of the ribosomal internal transcribed spacer 1 gene. Results Leishmania amastigotes were detected by microscopy in 308 of 432 samples (71.3%) while 374 out of 432 samples (86.6%) were positive by ribosomal internal transcribed spacer 1 PCR. Subsequent restriction fragment length polymorphism confirmed L. tropica in 351 and L. major in 6 biopsy samples. Conclusions This study is the first molecular characterization of Leishmania species in southern Khyber Pakhtunkhwa. It confirmed the previous assumptions that anthroponotic CL is the major CL form present in Khyber Pakhtunkhwa province. Furthermore, this is the first report of L. major from a classical anthroponotic CL endemic focus identified in rural areas of Kohat district in southern Khyber Pakhtunkhwa.

Outcomes of laparoscopic cholecystectomy in acute cholecystitis

Objective: To study the morbidity and mortality of early laparoscopic cholecystectomy in acute cholecystitis by comparing its results with laparoscopic cholecystectomy in chronic cholecystitis and simple cholelithiasis

Study Design: Quasi-experimental study

Place and Duration of Study: Pakistan Naval Ship [PNS] Shifa Hospital Karachi and Combined Military Hospital [CMH] Lahore Pakistan, from Nov 2009 to Jan 2013

Material and Methods: Total 398 patients with symptomatic gall stone disease were included in the study after exclusion of patients with upper abdominal surgery, perforated gallbladder with abscess formation, cardiopulmonary disease, equipment failure and those with choledocholithiasis. Cholecystectomy was performed using a three port technique in most of the cases. On the basis of per-operative findings regarding degree of inflammation of gallbladder, all patients were divided into three groups irrespective of duration of symptoms i.e. acute cholecystitis group, chronic cholecystitis group and no inflammation group. The collected data included age, sex, diagnosis, history of previous surgery, co-morbidities, conversion to open surgery and its reasons, operative time, post-operative hospital stay and complications. Statistical comparison was performed using the chi square test. Statistical significance with value of p was less than 0.05 was considered significant

Result: Out of 398 patients, 31.2% had acute cholecystitis, 10.1% had chronic cholecystitis and 58.8% had no inflammation of gall bladder. Complication rates and conversion rates were higher in chronic cholecystitis group as compared to acute cholecystitis group and no inflammation group. Similarly, mean hospital stay was also highest in chronic cholecystitis group

Conclusion: Early laparoscopic cholecystectomy was found safe in acute cholecystitis in expert hands and should be performed in all cases of acute cholecystitis rather than delayed interval cholecystectomy

Complexation of ibuprofen with water soluble p-sulfonatocalix [4]arene: a potential candidate for drug delivery application

Complexation of ibuprofen with water soluble p-sulfonatocalix[4]arene [3] was evaluated. Both molecules exhibit a host and guest type complexation. pH, complex stoichiometry and binding constant were determined by UV-Vis and FT-IR spectroscopy. The maximum complexation of 3 with ibuprofen occurs at pH 2. Stability constant values [9.897] show that there is favorable complex formed due to vital role of p-sulfonatocalix[4]arene, while the thermodynamic parameters, i.e. [Delta]G, [Delta]H and [Delta]S have been found as -24.09 KJ/mol, 0.012 KJ/mol and 0.12 KJ/mol. K, respectively. The results show that 3 has efficiency to carry the drug at particular conditions and can be used for drug delivery as a carrier

Phenolic compounds and antioxidant activity of Calligonum polygonoides stem and buds

In the present study we demonstrate the identification of phenolic compounds and the phenolic contents of the methanol extracts from stem and buds of Calligonum polygonoides with antioxidant activity. Eleven and nine phenolic compounds were identified and quantified from stem and buds, respectively by high-performance liquid chromatography [HPLC]. p-Coumaric acid was predominant in stem and gallic acid in buds. In general, the samples with the highest phenolic contents had the highest antioxidant activities. Stem and buds sparked attention due to their high phenolic contents and antioxidant activities. The Results from present study reveal that the C. polygonoides could be considered as a promising source of antioxidant phytochemicals

Designing and molecular docking of cyclic peptides against HCV NS3 protease

Hepatitis C Virus [HCV] infection is a worldwide serious health issue which contributes towards most of the hepatic morbidities. So far no prophylaxis is available to prevent this virus; therefore, development of antiviral compounds to fight HCV infection is the need of time. Chemically synthesized peptides that are potent immunogenic antigens are being pursued as candidate vaccines against HCV. The present study was planned to identify peptide inhibitors having potential to block the activity of NS3 protein of HCV that will ultimately arrest HCV multiplication. Docking of NS3 with peptides revealed that the majority of the peptides have strong binding affinity for active sites of NS3. Peptide 1, 2, 3 and 6 were found interactive with NS3 active residues while the active sites of NS3 had hydrophobic contact with the rest of peptides. Thus, these peptides bear therapeutic potential of a candidate drug for the prevention of HCV replication. Post docking analysis revealed important binding abilities of peptides with the active sites of NS3 protein, showing the efficiency of peptides as potential peptide inhibitors against HCV. The study revealed that HCV replication can be inhibited by these peptides. HCV replication inhibition potential of these peptides can contribute in reducing the burden of HCV infection and its associated complications worldwide

Frequency of nutritional vitamin D deficiency in children 6 months to 5 years of age presenting with rickets at civil hospital, Karachi

Objective: to determine the frequency of Vitamin D deficiency in children presenting with rickets

Methods: descriptive case series was conducted at the department of Paediatrics Unit III, Dow University of Health Sciences and Civil Hospital Karachi in children 6 months to 5 years of age presenting with clinical rickets. Children taking vitamin D were excluded. The subjects fulfilling inclusion criteria were enrolled after informed consent. Blood samples were taken from each patient and were sent to the laboratory for vitamin D [25[OH] D] level. Serum level of vitamin D less than 20ng/ml was labeled as vitamin D [25[OH] D] deficiency rickets. The data was collected on pre-designed performa by the principal researcher. The data was analyzed using SPSS version 10

Results: the age of enrolled participants was 1.5 +/- 1 year. Of 159 enrolled participants, 91 [57.2%] were male and 68 [42.8%] were female. Frequency of sun exposure of 2-3 days a week was 97 [61.01%] and using vitamin D fortified foods were 34 [21.38%]. The frequency of vitamin D deficiency was 120 [75.47%] cases

Conclusion: in this study the frequency of vitamin D deficiency in children 6 months to five years with rickets was 75%

Intestinal obstruction caused by postoperative adhesions: 5 years'experience at a teaching hospital

Objective: The objective of this study was to determine the common abdominal surgical procedure causing postoperative adhesive intestinal obstruction, and outcome of its surgical management

Study Design: Retrospective as well as prospective analysis

Place and Duration of Study: This study was conducted in the Department of Surgery, Khawaja Muhammad Safdar Medical College, Sialkot from June 2010 to November 2015

Materials and Methods: Patients operated on for intestinal obstruction with at least one abdominal surgical scar were included in the study. A total of 152 patients were eligible, all ages were eligible irrespective of gender. A minimum of 6 months follow up was set for inclusion in the study. Patients with intestinal obstruction presenting with surgical scars for renal, ureteric and urinary bladder surgery were not included as these surgeries did not involve opening of peritoneum. Patients with Crohn's disease, ulcerative colitis, known malignancies, a past history of abdominopelvic irradiation were excluded. Patients with less than 6 months follow up were excluded from the study

Results: Out of 152 patients, 74 [48.68%] surgeries for appendicular pathologies, 18 [11.84%] lower segment caesarean section and 9 [5.92%] total abdominal hysterectomy were the main pathologies causing obstruction; while patients had recurrence in 11[7.23%] and 8[5.26%] mortality

Conclusion: Operated adhesive postoperative intestinal obstruction proves to be a clinical entity with high incidence and specific risk factors of recurrence: age <40 years, presence of adhesion or matted adhesion, and postoperative surgical complications. Infected cases of appendicitis, enteric perforations, lower segment caesarean section and total abdominal hysterectomy are the main causes and the treatment may lead to stoma formation, recurrence and mortality

Relationship of oxidative stress with elevated level of DNA damage and homocysteine in cardiovascular disease patients

Amounts of DNA damage and homocysteine [Hcy] in heart patients blood may have strong function in the causation of cardiovascular disease [CVD]. The main objective of this work was to know experimentally the role of total oxidants [produced by Reactive Oxygen species [ROS], clinical biochemical indices, their oxidized products and total antioxidant status [TAS] among such patients to find the association of homocysteine, total oxidation status [TOS] and oxidative DNA damage with other clinical parameters in sixty positive CVD patients compared with those of 60 normal subjects. As compared to healthy individuals, CVD patients had significantly higher concentrations of homocysteine [p<0.0001], total oxidants stress [TOS] [p<0.0001], serum total lipids [p<0.04], malondialdehyde [MDA] [p<0.001], high density lipoprotein-cholesterol [HDL-C] [p<0.0001], and low density lipoprotein cholesterol [LDL-C] [p<0.01], than those of healthy individuals. Plasma Hcy content, TOS and amount of DNA were positively and significantly associated with cholesterol, triglycerides, systolic blood pressure, urea, and albumin [p values<0.01]. TOS, Hcy and oxidative DNA damage were negatively correlated with HDL-c, TAS and proteins. It is suggested that these parameters have pivotal role in diagnostic process of determining severity in CAD patients. Oxidized products of macromolecules in blood of CVD patients impart major functions in causing CVD disease

Anti-bacterial activity and qualitative phytochemical screening of fagonia cretica l.

Fagonia cretica L.is traditionally used against many diseases including gastrointestinal and respiratory ailments. The present study reports its minimal inhibitory concentration against bacterial strains, Thus crude methanolic extracts of F. cretica was evaluated against 17 bacterial pathogenic strains and effective only against 17% of bacterial cultures as reflected by Proteus vulgaris, Micrococcus luteus and Staphylococcus ,saprophyticus which showed minimal inhibitory concentration of 50 microg/ml, 50 |ng/ml and 100 |ig/ml, respectively with possibly due to synergistic actions of chemical composition but selectivity towards M. Luteus and Proteus vulgaris. Further fractionation of F. cretica crude methanolic extracts with hexane, ethyl acetate and water enhanced bactericidal activity [MIC 25 ng/ml] of the respective plant fractions against P. vulgaris. Similar magnitude of response with hexane and ethyl acetate fractions against Salmonella typhimurium were also noted, whereas crude extract was ineffective. A qualitative phytochemical screening revealed that F. cretica methanolic extract coumarins and diterpenes predominates while in water fraction it is saponins and hence are possibly be associated with antibacterial activity. On the other hand leucoanthocyanins and diterpenes were absent. Thus present study provides a scientific rational for medicinal use of F. cretica L. to treat gastrointestinal, urinary tract and respiratory tracts infections in humans. Further studies are required to isolate and identify the active coumarins, diterpenes and saponins-based lead molecules

Shisha-smoking; popularity and familiarity among university students of Jamshoro and Hyderabad, Sindh, Pakistan

Worldwide, annual rate of 4.9 million deaths have been reported due to the tobacco abuse and this rate might rise to 10 million in the next 20-30 years. Seventy percent of these deaths take place in developing countries. To determine the prevalence and knowledge of shisha-smoking among the university students of Jamshoro and Hyderabad Sindh, Pakistan. A Questionnaire-based cross-sectional study was conducted from December 2013 to August 2014. A convenient sampling of 400 participants was done from three universities at Jamshoro and one at Hyderabad i.e., Liaquat University of Medical and Health Science [LUMHS], University of Sindh and Mehran University of Engineering and Technology [MUET] Jamshoro and Isra University, Hyderabad. Undergraduate male students, age ranging between 18-23 years, were included whereas females, postgraduate students and house officers were excluded. Data were analyzed using SPSS [Statistical Package for the Social Sciences] version 16. Ninety-two percent students were aware of shishasmoking whereas 8% had no knowledge. Thirty-six percent have ever smoked shisha while 64% of students never smoked it. Of the smoking students, 45% mentioned smoking shisha rarely, 25% of students smoked sometimes, 13% smoked always, 6% smoked it often and 10% smoked just once. Most of the students [92%] knew the hazards associated with shisha smoking. According to 48% participants, shisha-smoking is far more dangerous than cigarette -smoking. Prevalence of shisha-smoking in the educated youth is high; however, only half were aware of its harmful effects

Attitude, behavioural improvement and preferences; in medical students as they move up to the next higher class

Present study endeavoured to assess medical student's ethical behaviour, preferences and improvements one year later. Cross-sectional, questionnaire-based. Liaquat University of Medical and Health Sciences Jamshoro. Sindh. Pakistan. October 2013 - Jan 2014. First year [FY] and second year [SY] MBBS students [n = 122 each year] of both genders, were randomly selected and a questionnaire administered. Fifty six percent male and 40% female students of FY marked proxy attendance; 72% males and 65% female would mark proxy attendance if given a chance. Percentages increased in SY. Significant co-relation existed between gender and proxy attendance [p = 0.01]; self-financed or hostlers showed no association with marking proxy attendance. Sense of responsibility in females and courteous behavior in both genders improved in SY. Teacher's behaviour affected student's conduct; and improvement in understanding English was noted in both genders in both years, however, the small% of students finding English as a barrier were prone to mark proxy attendance [p = 0.05]. Males preferred physiology whereas female preferred anatomy in both years. In FY, subject of choice was anatomy, substituted for Physiology in SY. Majority students preferred chalk and black board vs. multimedia based teaching. Cheating behaviour and sense of responsibility, but civilised behaviour, did not improve after one year education

Burden of disease among inpatient urban and rural referrals in surgical and medical wards of Jinnah Hospital Lahore

Background: Hospital admission data can be a valuable tool for assessing the epidemiology of diseases within populations. With a minimum amount of data collection, substantial insight can be had into the types of diseases, the age at which conditions present, and their burden on inpatient service. And although these data are inevitably referral and access biased, they can provide useful information on morbidity in the community. Little is known about the surgical and medical diseases burden in tertiary care hospitals in Pakistan. Incomplete information has made it difficult to define an appropriate role for tertiary health care hospitals and the objectives of this research is to determine the referral profile of patients who are attending medical and allied OPD in Jinnah Hospital Lahore and compare disease burden from local and peripheral areas in surgical and medical units of Jinnah Hospital Lahore

Methods: Cross sectional study in medical and surgical wards of Jinnah Hospital, Lahore

Results: In our study, it was found that public Tertiary Care Hospitals, such as Jinnah Hospital Lahore, has much more patients referred to it from rural cities compared to urban population with a referral burden of 63.01% subjects from rural areas or outside city versus 36.99% subjects belonging from urban areas or within city. Many of these patients, 35.6%, obtaining this facility equipped with all modalities in single setting belonged to poor socio economic status. 72.6% had a total family income of < Rs.20, 000/- per month. And the interesting fact causing the demise of Health Care Facility system is that 72% of the subjects were self-referred without any referral profile and diverting burden of Primary and Secondary Health Care facilities on the Tertiary Health Care setup

Conclusion: The disease burden from peripheral/rural areas is far greater than local/urban areas in surgical and medical units of Jinnah Hospital Lahore, and the most of the subjects are self-referred

Pre-analytical errors in a peripheral hospital laboratory

To analyse pre-analytical errors which account for the major contribution towards laboratory errors. Cross-sectional descriptive study. Combined Military Hospital Kohat, Pakistan from 1[st] January to 30[th] June 2012. For six months laboratory staff was asked to register rejections and causes for rejection of all samples; including in-patient samples from wards as well as out-patient samples collected in the laboratory. In addition all samples where disparity was noted by the clinicians in the laboratory results were also included for analysis. Suspected samples were reanalyzed, tests were also repeated on fresh samples of the patients and a critical appraisal was made. Among a total of 328418 analyses, clinicians/laboratory staff notified 350 questionable findings, 270 of which were confirmed errors. Out of total 270 errors, 77% were pre-analytical, 8% were analytical, 15% were post analytical errors. Out of total pre-analytical errors 8% were incorrect samples, 21% were misidentifications, 51% were faulty sampling techniques and 20% were incomplete/illegible laboratory request forms. The pre-analytical phase in the total testing process currently appears to be more vulnerable to errors than the other phases. Consequently, the pre-analytical phase should be the main target for further quality improvement. Therefore identifying the critical steps in the pre-analytical phase is a prerequisite for continuous quality improvement, further error reduction and thus for improving patient safety

Detection of osteoporosis by dual energy X-ray absorptiometry

An early detection of osteoporosis through DEXA procedure will not only improve the disease management practices but also would help in impeding national productivity losses by mass screening and awareness. Our objective was to measure efficacy of DEXA procedure in early detection of osteoporosis and prevention of its complications. This case series observational study was designed to confirm the bone mineral density by dual energy x-ray absorptiometery [DEXA]. The duration of study was three years from November 2010 to October 2013. Subjects aged between 30 [when the risk of osteoporosis is low] to 60 [when osteoporosis is almost sure to be found]. Three hundred thirty patients were evaluated. There were 23 [6.96%] male and 307 [93.03%] female. Normal male were 09 [39.10%], osteopenia 11 [47.80%] and osteoporosis 3 [13%]. Normal females were 72 [23.50%], osteopenia 140 [45.60%] and osteoporosis 95 [30.90%]. P-value was more then 0.005 and not significant. Mean age was 48.73, minimum 30, maximum 60 and SD 7.247. Population category distribution was 243 [76.6%] from urban and 87 [26.4%] rural. In urban areas normal were 56 [23%], osteopenia 113 [46.50%] and osteoporosis 74 [30.50%]. In rural areas normal 25 [28.70%], osteopenia 38 [43.70%] and osteoporosis 24 [27.60%]. P-value was 0.567. Out of 330 there were 81 [24.54%] normal, 98 [29.69%] osteoporosis and 151 [45.75%] osteopenia. Osteopenia was the most common diagnosis mostly in younger age group and early diagnosis of this problem can help prevent osteoporosis

Leadership styles of dental college principals in Lahore, Pakistan

Leadership has many dimensions. Bolman and Deal synthesized the diverse body of leadership theory into four cognitive perspectives, or frames, which they labeled structural, human resource, political and symbolic. Effective educational leaders use multiple frames according to need, and consistently use the political frame. This study was undertaken to determine leadership styles of dental college principals in Lahore, using Bolman and Deal's leadership frames model, and to relate the leadership style to effectiveness of leadership and management. A questionnaire was administered to 43 faculty members in two dental colleges. Scores for the four leadership frames were calculated and related to effectiveness of leadership and management. Faculty perceived dental college principals to be strongest in the structural frame, followed closely by the human resource and symbolic frames, suggesting a multi-frame leadership orientation. The political frame was perceived as the weakest, but with high variance in ratings. The principals were perceived to be significantly more effective in management compared to leadership. There were no significant relationships between leadership frames and effectiveness of leadership and management

RIPASA score: a new diagnostic score for diagnosis of acute appendicitis

To determine the usefulness of RIPASA score for the diagnosis of acute appendicitis using histopathology as a gold standard. Cross-sectional study. Department of General Surgery, Combined Military Hospital, Kohat, from September 2011 to March 2012. A total of 267 patients were included in this study. RIPASA score was assessed. The diagnosis of appendicitis was made clinically aided by routine sonography of abdomen. After appendicectomies, resected appendices were sent for histopathological examination. The 15 parameters and the scores generated were age [less than 40 years = 1 point; greater than 40 years = 0.5 point], gender [male = 1 point; female = 0.5 point], Right Iliac Fossa [RIF] pain [0.5 point], migration of pain to RIF [0.5 point], nausea and vomiting [1 point], anorexia [1 point], duration of symptoms [less than 48 hours = 1 point; more than 48 hours = 0.5 point], RIF tenderness [1 point], guarding [2 points], rebound tenderness [1 point], Rovsing's sign [2 points], fever [1 point], raised white cell count [1 point], negative urinalysis [1 point] and foreign national registration identity card [1 point]. The optimal cut-off threshold score from the ROC was 7.5. Sensitivity analysis was done. Out of 267 patients, 156 [58.4%] were male while remaining 111 patients [41.6%] were female with mean age of 23.5 +/- 9.1 years. Sensitivity of RIPASA score was 96.7%, specificity 93.0%, diagnostic accuracy was 95.1%, positive predictive value was 94.8% and negative predictive value was 95.54%. RIPASA score at a cut-off total score of 7.5 was a useful tool to diagnose appendicitis, in equivocal cases of pain