A novel homozygous frameshift variant in DNAH8 causes multiple morphological abnormalities of the sperm flagella in a consanguineous Pakistani family / 亚洲男科学杂志(英文版)

Multiple morphological abnormalities of the sperm flagella (MMAF) is a severe form of asthenozoospermia categorized by immotile spermatozoa with abnormal flagella in ejaculate. Whole-exome sequencing (WES) is used to detect pathogenic variants in patients with MMAF. In this study, a novel homozygous frameshift variant (c.6158_6159insT) in dynein axonemal heavy chain 8 (DNAH8) from two infertile brothers with MMAF in a consanguineous Pakistani family was identified by WES. Reverse transcription-polymerase chain reaction (RT-PCR) confirmed DNAH8 mRNA decay in these patients with the DNAH8 mutation. Hematoxylin-eosin staining and transmission electron microscopy revealed highly divergent morphology and ultrastructure of sperm flagella in these patients. Furthermore, an immunofluorescence assay showed the absence of DNAH8 and a reduction in its associated protein DNAH17 in the patients' spermatozoa. Collectively, our study expands the phenotypic spectrum of patients with DNAH8-related MMAF worldwide.

A recurrent homozygous missense mutation in CCDC103 causes asthenoteratozoospermia due to disorganized dynein arms / 亚洲男科学杂志(英文版)

Asthenoteratozoospermia is one of the most severe types of qualitative sperm defects. Most cases are due to mutations in genes encoding the components of sperm flagella, which have an ultrastructure similar to that of motile cilia. Coiled-coil domain containing 103 (CCDC103) is an outer dynein arm assembly factor, and pathogenic variants of CCDC103 cause primary ciliary dyskinesia (PCD). However, whether CCDC103 pathogenic variants cause severe asthenoteratozoospermia has yet to be determined. Whole-exome sequencing (WES) was performed for two individuals with nonsyndromic asthenoteratozoospermia in a consanguineous family. A homozygous CCDC103 variant segregating recessively with an infertility phenotype was identified (ENST00000035776.2, c.461A>C, p.His154Pro). CCDC103 p.His154Pro was previously reported as a high prevalence mutation causing PCD, though the reproductive phenotype of these PCD individuals is unknown. Transmission electron microscopy (TEM) of affected individuals' spermatozoa showed that the mid-piece was severely damaged with disorganized dynein arms, similar to the abnormal ultrastructure of respiratory ciliary of PCD individuals with the same mutation. Thus, our findings expand the phenotype spectrum of CCDC103 p.His154Pro as a novel pathogenic gene for nonsyndromic asthenospermia.

Genomic characterization of velogenic avian orthoavulavirus 1 isolates from poultry workers: Implications to emergence and its zoonotic potential towards public health

Objective: To carry out the genetic characterization and evolutionary analysis of three avian orthoavulavirus 1 (AOAV-1) isolates from poultry workers with respiratory symptoms. Methods: Using Illumina MiSeq, whole-genome sequencing was carried out to assess the evolutionary dynamics of three AOAV-1 isolates. A phylogenetic and comparative analysis of all coding genes was done using bioinformatics tools. Results: Phylogenetic analysis and genetic distance estimation suggested a close relationship among human- and avian-originated velogenic strains of genotype XIII, sub-genotype XIII.2.1. Several substitutions in the significant structural and biological motifs were exclusively identified in the human-originated strains. Conclusions: To our knowledge, this is the first report of a velogenic AOAV-1 isolate from natural infection of the human upper respiratory tract. Our findings highlight the evolution and zoonotic potential of velogenic AOAV-1 in a disease endemic setting.

Novel biallelic loss-of-function mutations in / 亚洲男科学杂志(英文版)

Multiple morphological abnormalities of the sperm flagella (MMAF) is a specific type of asthenoteratozoospermia, presenting with multiple morphological anomalies in spermatozoa, such as absent, bent, coiled, short, or irregular caliber flagella. Previous genetic studies revealed pathogenic mutations in genes encoding cilia and flagella-associated proteins (CFAPs; e.g., CFAP43, CFAP44, CFAP65, CFAP69, CFAP70, and CFAP251) responsible for the MMAF phenotype in infertile men from different ethnic groups. However, none of them have been identified in infertile Pakistani males with MMAF. In the current study, two Pakistani families with MMAF patients were recruited. Whole-exome sequencing (WES) of patients and their parents was performed. WES analysis reflected novel biallelic loss-of-function mutations in CFAP43 in both families (Family 1: ENST00000357060.3, p.Arg300Lysfs*22 and p.Thr526Serfs*43 in a compound heterozygous state; Family 2: ENST00000357060.3, p.Thr526Serfs*43 in a homozygous state). Sanger sequencing further confirmed that these mutations were segregated recessively in the families with the MMAF phenotype. Semiquantitative reverse-transcriptase polymerase chain reaction (qRT-PCR) was carried out to detect the effect of the mutation on mRNA of the affected gene. Previous research demonstrated that biallelic loss-of-function mutations in CFAP43 accounted for the majority of all CFAP43-mutant MMAF patients. To the best of our knowledge, this is the first study to report CFAP43 biallelic loss-of-function mutations in a Pakistani population with the MMAF phenotype. This study will help researchers and clinicians to understand the genetic etiology of MMAF better.

Bacterial contamination of Pakistani currency notes from hospital and community sources

Objective: We determined the bacterial contamination and antibiotic resistance profile of circulating Pakistani currency notes collected from hospital and community sources

Methods: This prospective study was organized from July to December 2015 in the Microbiology Department of The Children's Hospital and The Institute of Child Health Lahore. It was done on one hundred currency notes of four different denominations collected from various groups of people in sterile polythene bags. Gram staining, colony morphology and various biochemical tests were used to identify the bacterial isolates. Kirby Bauer disc diffusion method was used to observe the antibacterial drug resistance

Results: There were 11 different types of bacterial species which contaminated 97 [97 percent] currency notes. The bacterial isolates discovered from paper currency notes included Klebsiella spp. [26.0 percent], Coagulase-negative Staphylococci [CoNS] [18.3 percent], E. coli[14.5 percent], Pseudomonas spp. [13.7 percent], Citrobacter spp. [11.5 percent], Enterobacter spp. [5.3 percent], Acinetobacter spp. [5.3 percent], Streptococcus spp. [2.3 percent], Shigella spp. [1.5 percent], Salmonella spp. [0.8 percent] and Pantoea spp. [0.8 percent]. Most of the Gram-positive isolates were resistant to penicillin and ampicillin. None of the Gram-negative isolates found to be resistant to amikacin, cefoperazone-sulbactam and piperacillin-tazobactam

Conclusion: The currency notes circulating in hospital and community are contaminated with highly pathogenic and some multi-drug resistant bacteria. These currency notes could be a potential source of nosocomial and community-acquired infections

Scenario of dengue infection & its control in Pakistan: An up-date and way forward

Dengue fever is one of the major health problems in tropical and subtropical areas throughout the world. The causative agent of dengue fever is the dengue virus which is an enveloped single stranded RNA virus belongs to the family Flaviviridae and has five distinct serotypes (DENV-1, DENV-2, DENV-3, DENV-4 and DENV-5). Dengue virus is transmitted to human via bite of Aedes aegypti and Aedes albopictus mosquitoes. The clinical symptoms of dengue fever ranging from mild to severe form as dengue hemorrhagic fever and dengue shock syndrome. Pakistan is dengue endemic since 1994 but from 2006, Pakistan faced the worst condition regarding dengue in which thousands of people affected by the disease and hundreds of people lost their lives. DENV-2, DENV-3 and DENV-1 are the prevalent serotypes in Pakistan. Common diagnostic techniques are being used in Pakistan such as enzyme-linked immunosorbent assay, polymerase chain reaction and rapid diagnostic tests, while differential diagnosis, limitations of diagnostic methods and poor health care system are the real challenges in dengue diagnosis. Favorable climatic conditions, unplanned urbanization, travelling etc., are major factors responsible for dengue epidemics in Pakistan. This presentation provides update about dengue circumstances in Pakistan and also describes the way how to improve dengue situation in Pakistan.

Cytomorphological spectrum of testicular fine needle aspiration cytology in cases of azoospermia

Objective: To determine the frequency of morphological spectrum of FNAC in cases of azoospermia

Study Design: Descriptive, cross sectional study

Setting: Department of Pathology, Combined Military Hospital, Multan, from 15th December 2016 to 15th June 2017

Materials and Methods: A total of 112 patients were selected according to inclusion and exclusion criteria, that is age range between 20-50 years with history of azoospermia for at least 1 month on the basis of semen analysis. Patients with already known diagnosis, patients with history of orchiectomy or patients with history of radiotherapy and chemotherapy were excluded. Patients were informed about the procedure, their consent for the procedure and for participating in our study were taken. Procedure was performed under spermatic cord block, slides were prepared and reported by consultant histopathologist

Results: Mean age was 31.6 years with standard deviation of +/- 5.91. All of the patients were married. Only 10 out of 112 patients had history of diabetes mellitus and only 5 out of 112 patients had family history of azoospermia. Mean BMI was 22.74 with standard deviation of +/- 2.95. The mean duration of marriage was 4.62 years with standard deviation of +/- 3.09 and mean duration of azoospermia was 2.69 years with standard deviation of +/- 2.23.Among the patients, 109 out of 112 patients had diagnostic FNAC finding while 3 out of 109 patients yielded unsatis factory results. Among the cytomorphological patterns, hypospermatogenesis was the most common pattern which was observed in 32.1% of the patients. Normal spermatogenesis was seen in 18.8 percent of patients, maturation arrest was seen in 19.6% patients, sertoli cells only was seen in 26.8% patients. 2.7% patients had unsatisfactory sample. A non-significant statistical association was seen among age, disease duration, diabetes and family history with p value > 0.05

Conclusion: This study was conducted to ascertain cytomorphological patterns of testicular tissue among targeted population and to determine the frequencies of these patterns in our population. This study concluded that FNAC testis is a satisfactory procedure for evaluating the cause of azoospermia and FNAC sample in 97.3% of the patient's was satisfactory for evaluation. Hypospermatogenesis was the most common cytomorphological pattern seen in 32.1% of the patients which was followed by sertoli cells examine only which was seen in 26.8% of the patients. Non significant association was found between patient's age, duration of disease, family history or diabetes mellitus with any of the cytomorphological pattern

Comparison of vaginal culture and pap smear in the diagnosis of bacterial vaginosis

Background: Amongst the myriad of physiological and pathological conditions presenting as vaginal discharge, bacterial vaginosis is the most frequently encountered complaint in women of child bearing age, all over the world. It involves the replacement of normally predominant hydrogen-peroxide producing lactobacilli, by an overgrowth of anaerobic bacteria. We want to examine the diagnostic efficacy of Pap-Smear and vaginal culture in the diagnosis of bacterial vaginosis, while Amsel's clinical criteria is used as the gold standard

Methods: It was a descriptive study expanding over a period of 5 months, from January 2013 to May 2013, enrolling 150 patients, from the outpatient's department of lady reading hospital and Hayatabad medical complex, Peshawar. All patients who complained of vaginal discharge were eligible for study. Patients using antibiotics, vaginal suppositories as well as those who were pregnant were excluded from the study. All patients were subjected to simultaneous testing for Amsel's criteria, vaginal culture, and Pap-staining. Sensitivity, specificity, positive predictive value and negative predictive values were calculated for vaginal culture and Pap smear, with amsel's criteria being the gold standard

Results: Sensitivity, specificity, positive and negative predictive values for culture was determined as 75%, 92.1%, 64.3% and 95.1%. Pap smear was found to be 62.5% sensitive, 93.7% specific, positive and negative predictive values being 65.2% and 92.9% respectively

Conclusion: Out of these two tests, vaginal culture was labeled as the more sensitive test for the diagnosis of bacterial vaginosis

Frequency and contributing factors for acute pancreatitis after endoscopic retrograde cholangiopancreatography in patients with obstructive jaundice

Objective: To evaluate the frequency and contributing factors for acute pancreatitis after endoscopic retrograde cholangio-pancreatography in patients with obstructive jaundice. Study Design: Descriptive case series. Place and Duration of Study: A descriptive case series conducted at department of Gastroenterology, Shaikh Zayed Hospital, Lahore in the period of six months

Material and Methods: Two hundred and thirty patients diagnosed as having obstructive jaundice and undergoing ERCP who fulfilled the inclusion criteria were included in the study from the outpatient and indoor department of Gastroenterology-Hepatology Shaikh Zayed Hospital Lahore. Informed consent was taken. After the selection of the cases, patients were evaluated for the presence or absence of contributing factors like age, gender, cannulation attempts, cannulation time, percutaneous papillotomy, pancreatic duct contrast injection and previous history of post ERCP pancreatitis. Data was analysed by using the statistical software for social sciences [SPSS] version 15

Results: In our study, mean age was 44 +/- 14.12 years. Out of 230 patients 42.17% [n=97] were male and 57.83% [n=133] were females. Frequency of acute pancreatitis after ERCP in patients with obstructive jaundice was 4.78% [n=11] while 95.22% [n=219] had no findings of acute pancreatitis after ERCP. Frequency of factors for acute pancreatitis after endoscopic retrograde cholangiopancreatography in patients with obstructive jaundice was recorded which shows that out of 11 cases, 45.45% [n=5] were females, 36.36% [n=4] had previous history of Post ERCP Pancreatitis, 27.27% [n=3] had >5 attempts of cannulation, 36.36% [n=4] had >5 minute time for cannulation, 54.55% [n=6] had pre-cut papillotomy while 63.64% [n=7] had pancreatic duct contrast injection

Conclusion: We concluded that frequency of acute pancreatitis after endoscopic retrograde cholangiopancreatography in patients with obstructive jaundice was found not very high in our practice. Female gender, precut papillotomy and pancreatic duct contrast injection were the most important risk factors for the development of acute pancreatitis

outcome of combination of low dose oral prednisolone with propranolol for the treatment of infantile haemangioma

Objective: To determine the outcome of combination of low dose oral Prednisolone with oral propranolol for the treatment of infantile hemangioma

Methods: The patients fulfilling the inclusion criteria were registered through outpatient department. Diagnosis was confirmed clinically and on Color Doppler ultrasonography [CD]. All the patients were given oral prednisolone in a dose of 1mg/kg/day and propranolol in a dose of 0.5mg/kg/day twice a day and increased up to 1.5mg/kg/day BID within three days with close monitoring of heart rate, blood pressure and blood glucose as inpatient. Treatment was given for three months then titered down for two weeks before cessation of treatment. The follow-up of patients were performed at 7[th] day, at 1[st] month and finally at 3[rd] month. Treatment compliance was checked during each visit along with outcome parameters i.e. response which was excellent, good, moderate slight improvement and no effect. All the information's were collected. Data was analyzed by using SPSS version 10

Results: Out of total 73 patients, 36.99% [n=27] were one year of age, 32.88% [n=24] were two years of age and 30.13% [n=22] were three years of age, mean +/- SD: 1.96 +/- 0.54 years, 53.42% [n=39] were male and 46.58% [n=34] were females, frequency of response of the treatment was recorded as 56.16% [n=41] had excellent, 23.29% [n=17] had good, 15.07% [n=11] had moderate response, 4.11% [n=3] had slight improvement and 1.37% [n=1] had no effect while frequency of acceptable outcome revealed as acceptable in 79.45% [n=58] while 20.55% [n=15] had not acceptable outcome

Conclusion: The frequency of acceptable outcome of combination of low dose oral Prednisolone with oral propranolol for the treatment of infantile hemangioma is higher

Pharmacokinetic evaluation of anticancer drugs in Hodgkin's lymphoma patients after their simultaneous administration

A pharmacokinetic study of anticancer drugs was carried out in 18 Hodgkin's lymphoma male patients. The anticancer drugs were administered to the patient by a standard procedure and a validated HPLC method was used for plasma concentration determination. Maximum plasma concentration [C[max]] of Adriamycin, Bleomycin, Vinblastine and Dacarbazine [ABVD] were 7.71, 4.32, 7.95 and 6.51 micro g/ml respectively. Adriamycin and Dacarbazine exhibited longer T[max] compared to Bleomycin and Vinblastine. Area under the curve values of ABVD were 118.30, 82.11, 245.54 and 86.62 micro g/ml h. The elimination rate constant of Dacarbazine was highest. Vinblastine exhibited highest half-life and mean residence time. Clearances of ABVD were 346.69, 2499.44, 45.90 and 5800.05ml/h. The apparent volume of distribution was highest for Dacarbazine and lowest for Vinblastine. The pharmacokinetic parameters can be utilized for monitoring of plasma concentrations, therapeutic drug monitoring and dosage adjustments to optimize anticancer efficacy in patients of Hodgkin's lymphoma

Squamous cell carcinoma arising in background of mature cystic teratoma

Mature cystic teratoma of ovary is a common benign adnexal tumor in females. Malignant transformation in a mature cystic teratoma of the ovary occurs in only 1 - 2% of cases. Most common malignant transformation is squamous cell carcinoma [70-80% of cases], occurring mostly in postmenopausal women with large sized cysts. Here, we report a case of 46-year lady who presented with pain in lower abdomen. Ultrasound and CT scan revealed complex adnexal mass measuring 16x9 cm. Size and older age of the patients should be regarded as important predictors of malignant transformation in mature cystic teratoma. Adequate sampling followed by histopathological examination has important role in diagnosis of such rare tumor

Safe electrosurgery use: knowledge, attitudes and practices of surgical trainees

To determine the knowledge, attitudes and practices of general surgical trainees regarding safe use of diathermy. In this cross-sectional Survey, 47 surgical trainees of the Civil Hospital Karachi, comprising PGY 1 through 4, were interviewed by questionnaires made up of five close-ended and three open-ended items. Majority of the trainees belonged to the first two years of training. More than 80% had no formal training in diathermy use. Most of them were found lacking in core knowledge and evidence-based practice of electrosurgery. There was a high level of ignorance regarding current and established principles of diathermy use among surgical trainees at the Civil Hospital Karachi

Medico-genetics of oculocutaneous albinism; An updated study with Pakistani perspective

Albinism is a rare genetic disease associated with reduced melanin pigment biosynthesis in eyes, skin or hair. Clinically it is categorized, based on the affected tissue, into two types i.e ocular albinism [OA]; when hypopigmentation influence the retinal pigment epithelium leaving skin and hair unaffected, and oculocutaneous albinism [OCA]; when hypopigmentation occur in hair, skin and eye. Various genetic studies to date identified six genes [TYR, TYRP1, OCA2, SLC45A2, SLC24A5, C10orf11] and a locus [OCA5] for whom the candidate gene is yet to be known. All these reported genes, at the molecular level, are involved in melanin pigment biosynthesis. Among these reported genes, TYR and OCA2 are the most prevalent genetic factors of OCA in Pakistani population. The study will assist in understanding the molecular factors of OCA and melanin synthesis pathway to reduce its prevalence rate. The review aims to systematically reread and analyze the oculocutaneous albinism and its various types in the context of developed world as well as Pakistani community

Effects of benzalkonium chloride on the microanatomy of corneal stroma

Benzalkonium chloride [BAC] is a commonly used preservative in topical ophthalmic preparations. It is a cytotoxic compound. The mechanism of action involves dissociation of bilaminar plasma membrane and its tendency to dissolve cholesterol, phospholipids and the proteins in the cell membrane. The indiscriminate use of eye drops containing BAC, quackery and self-medication may increase the incidence of corneal disorders particularly in those having a pre-existing corneal pathology

Objective: The present in vivo study was carried out to investigate the effects of BAC ons corneal stroma

Methods: Two different concentrations [0.02% and 0.0075%] of BAC solution comparable to those present in the commercially available eye drops were prepared in isotonic saline. Right eye of each animal was treated with BAC solution while left eye of the same animal served as a control treated with normal saline alone

Results: The analysis of the results revealed significant [p<0.05] histological changes in the corneal stroma

Conclusion: This study has provided the convincing evidence that BAC is toxic to the corneal stroma and is a factor contributing towards visual impairment

rural trauma team development course in Pakistan - potential for improving trauma care

To determine the feasibility, acceptability and potential for improving trauma care in Pakistan through the Rural Trauma Team Development Course [RTTDC]. Mixed method approach. Pre and post test, Questionnaire based survey. The course was held at the College of Physicians and Surgeons Pakistan in Karachi over a 2-day period in year 2012. Input from participants in one RTTDC instructor course and one provider course conducted in Pakistan was reviewed. On the first day a course for instructors who trained providers on the second day, was conducted. t-test was used to compare pre and post MCQ scores of both instructors and participants. A 5-point Likert scale was used to assess the educational value of the course based on a 16 item questionnaire. Relevance and applicability of the Performance Improvement and Patient Safety [PIPS], Communication and Scenario Modules were also assessed through questionnaires. General Comments on the applicability and potential for trauma care improvement in Pakistan through the program were solicited and analyzed. Mean percent scores in the MCQs improved for both instructors and participants but both pre and post RTTDC scores were higher in the instructor group [p=.006]. On 5-point Likert scale 75% faculty and 100% participants strongly agreed/agreed that the course educational content was relevant to their needs. PIPS was graded "very relevant" by 100% faculty and 35% participants with 65% student grading PIPS as "relevant". Communication module was rated "very relevant" by 100% faculty and 68% participants. Scenarios were "very relevant" to 100% faculty and 50% participants. Both faculty and providers recommended widespread promulgation of RTTDC training in Pakistan to improve trauma outcome. Assessment showed improvement in knowledge and a very positive attitude towards the program

Diagnostic yield of D-dimer in pulmonary embolism

To determine the diagnostic yield of D-dimer in combination with multi-detector computed tomography [MDCT] in patients with clinical symptoms and signs of acute pulmonary embolism. Cross sectional observational study. This study was carried out in Radiology Department Rashid Hospital Dubai UAE, from October 2011 to September 2012. In patients with clinical symptoms and signs of acute pulmonary embolism, D-dimer and MDCT were performed. Pulmonary angiography was performed to compare the results. For descriptive purpose the patients were divided into four groups. The sensitivity, specificity, false positive rate, false negative rate, positive predictive value and negative predictive value were calculated. There were total of 151 patients of whom 97 [64.2%] were males and 54 [35.8%] females. The mean age of the patients was 47.26 +/- 16.16 year. Shortness of breath was noted in 104 [68.9%, p = 0.000], chest pain in 88 [58.3%, p = 0.042] and cyanosis in 57 [37.7%, p= 0.061] patients. The D-dimer test was positive in 80 [53.0%] patients while CT angiogram in 56 [37.1%] patients. In 52 patients both D-dimer and MDCT angiogram were positive, while 65 patients had normal D-dimer and CT angiogram. The sensitivity of D-dimer in combination with CT angiogram was 92.85%, specificity 68.42%, false positive rate 31.57%, false negative rate 7.14%, positive predictive value 63.41%, negative predictive value 94.20% and accuracy 77.48%. D-dimer is an easy, non-invasive, safe, efficient and cost effective method of diagnosis in clinically suspected cases of pulmonary embolism

Pharmacokinetic studies of metformin and glibenclamide in normal human volunteers

The study was aimed to evaluate various pharmacokinetic parameters of a commercially available fixed dose combination of oral antidiabetics [Metformin/Glibenclamide 500/5mg tablets] in plasma sample of normal healthy adult male volunteers by applying an accurate, selective, and reproducible HPLC-UV analytical method for quantification of Metformin HCL and Glibenclamide simultaneously in a single chromatographic run. Previously no HPLC-UV analytical method for simultaneous estimation of Metformin/Glibenclamide has been reported in Pakistan. The human plasma samples were evaluated by using an isocratic High Performance Liquid Chromatography [HPLC] system of Sykam consisted of a pump with a column of Thermo Electron Corporation USA [ODS hypersil C[18] 4.6 mm x 250 mm], a UV-detector with data processing Clarity software. The mobile phase of 0.040M Potassium dihydrogen phosphate containing 0.25mL/L triethylamine at pH 3.5 [adjusted with 1:1 phosphoric acid] and acetonitrile [465: 535v/v] was delivered with injection volume of 100microL at flow rate of 1 mL/min at 25degreeC temperature. The detection was performed at lamda[max]230 nm. By applying this method, important pharmacokinetic parameters C[max], T[max], AUC[0-infinity], AUMC[0-infinity], t[1/2], Ke, MRT, V[d] and Cl[T] are calculated. Maximum plasma concentrations C[max] was 131.856 +/- 8.050ng/ml for Glibenclamide [Mean +/- SEM] and 511.106 +/- 12.675 ng/ml for Metformin HCl [Mean +/- SEM].

Diagnostic accuracy of leukocytosis in prediction of acute appendicitis

An analytical study was conducted to find out the diagnostic accuracy of leukocytosis in predicting acute appendicitis in patients undergoing emergency appendicectomy. The degree of inflammation of the resected specimens was grossly assessed and graded into acute inflammation, acute inflammation with complications [such as gangrene, perforation, abscess] and un-inflamed appendix. The operative findings were correlated with leukocyte counts using 2 x 2 table. Out of 233 appendicectomies, with exclusion of the negative appendicectomies [17.59%, n = 41], there were 67.38% patients [n = 157] with elevated leukocyte count. The overall sensitivity, specificity, positive predictive value and negative predictive value of elevated leukocyte counts for inflamed appendix were 91.81%, 43.55%, 81.77% and 65.85% respectively

Validity of early parathyroid hormone assay as a diagnostic tool for sub-total thyroidectomy related hypocalcaemia

To determine the validity of early [one hour postoperatively] parathyroid hormone [PTH] assay [[2] 10 pg/ml], keeping gold standard as the serum ionic calcium level, for predicting sub-total thyroidectomy-related hypocalcaemia and to calculate the sensitivity and specificity of latent signs of tetany. Cross-sectional validation study. Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad from August 2008 to August 2010. Patients undergoing sub-total thyroidectomy were included by convenience sampling. PTH assay was performed 1 hour post sub-total thyroidectomy. Serum calcium levels were performed at 24 and 48 hours, 5th day and 2 weeks after surgery. Cases that developed hypocalcaemia were followed-up for a period of 6 months with monthly calcium level estimation to identify cases of permanent hypocalcaemia. Symptoms and signs of hypocalcaemia manifesting in our patients were recorded. Data was analyzed through SPSS version 10. 2 x 2 tables were used to calculate sensitivity and specificity of PTH in detecting post-thyroidectomy hypocalcaemia. Out of a total of 110 patients included in the study, 16.36% [n=18] developed hypocalcaemia including 1.81% [n=2] cases of permanent hypoparathyroidism. The sensitivity of one hour postoperative PTH assay as a predictive tool for post-thyroidectomy related hypocalcaemia was 94.4% while its specificity was 83.6% with 53% positive predictive value and 98.7% negative predictive value. One hour post sub-total thyroidectomy PTH assay can be helpful in predicting post sub-total thyroidectomy hypocalcaemia. Moreover, it can be useful in safe discharge of day-care thyroidectomy patients