Prevalence of statin induced myopathy in Lahore, Pakistan

Cardiovascular diseases are considered to be the leading cause of disability and deaths in the whole world. The major cause behind this disease is the formation of lipid plagues in the form of thrombus. The statins [HMG-CoA reductase inhibitors] are used for the treatment and prevention of hyperlipidemia. Myopathy is the major side effect caused by statins. The purpose of this study was to determine the prevalence of statin induced myopathy. A crosssectional study design was adopted using convenient random sampling technique at Punjab Institute of Cardiology, Lahore Pakistan from November 2016 to February 2017. A total of 300 male and female patients were included having age range of 40-80 years. Data was collected directly from the patients and prevalence of myalgia was determined by the symptoms of the patients. Creatine Phospho Kinase levels were obtained of those patients showing symptoms. Data was analyzed by using SPSS version 21. The results showed that 51% patients were myalgic with mean+/-SEM, 1.49+/-0.29. Myalgia was more prevalent in age range 40-50, with females 57% and males 47%. Significant relation was found between myalgia and type of statin [p=0.05], duration of use of statin [p=0.036] and dose of statin [p=0.031]. The study concludes that the prevalence of myalgia was not significant but females were more prone to myalgic symptoms as compared to males. It was further concluded that myalgic symptoms were directly related to dose and duration and type of statin use

False negativity of ziehl-neelsen smear microscopy: is the scale-up the worth it in developing countries?

Objective: To evaluate the false negative results of Ziehl-Neelsen [ZN] smear microscopy

Study Design: Descriptive study

Place and Duration of Study: Mycobacteriology Laboratory, Allama Iqbal Medical College [AIMC] and Jinnah Hospital, Lahore [JHL], Pakistan, from February 2014 to August 2016

Methodology: A total of 3,951 [pulmonary 2,773 and extra-pulmonary 1,178] samples were collected from strong TB suspected patients attending JHL Lahore. Follow-up cases were excluded. Every specimen was processed for ZN smear microscopy, Lowenstein Jensen [LJ] culture. SPSS 21.0 was used; false negative and positive results of ZN smear were calculated keeping LJ culture as gold standard

Results: Out of total 3,951 samples, sputum was most freqently found pulmonary sample 48.4% [n=1915], extrapulmonary samples, pleural fluid and pus samples were most commonly observed samples 12.0% [n=476] and 8.3% [n=329], respectively. Overall false negativity was 23.1% [pulmonary=19.6%, extra-pulmonary=29.2%] [p<0.001], Maximum false negative results were observed in pericardial, synovial, pleural fluids, and pus samples as 40.0%, 38.0%, 33.0% and 32.0%, respectively

Conclusion: ZN smear microscopy is not a very efficient tool in case of patients with the low mycobacterial load. Therefore, National TB Control programs should consider extending their diagnostic approaches from ZN microscopy to more advanced techniques

Acinetobacter Spp: Resistance and therapeutic decisions at the turn of the novel millennium

This study was planned to evaluate sample wise isolation and antimicrobial resistant trends of Acinetobacter spp in different departments of a tertiary care hospital. This was a transversal descriptive study, carried out in the clinical microbiology laboratory of the Allama Iqbal Medical College/ Jinnah Hospital, Lahore, Pakistan, during the period of January 2015 to December 2016. Every clinical specimen was processed for bacterial culture and antimicrobial susceptibly testing. A total of 3590 [2015=1780, 2016=1810] clinical specimens were processed. Of the total, only 54.7% were gram-negative, among these Acinetobacter spp were isolated from 10.1% and 16.5% samples respectively in 2015-16 with an overall rate of 24.3%. The highest occurrence of Acinetobacter spp isolates was reported from Intensive care units [ICU] [54%] followed by surgical units [25%] and medical units [16%]. It is noteworthy that ICU and internal medicine showed the highest resistance rates, whereas, lower resistance rate was observed for the outdoor patients [OPD]. Although collistin showed 0% resistant while ceftriaxone, ciprofloxacin, gentamicin, and tigecycline showed 90%, 68%, 66%, 66% and 62% resistance against Acinetobacter spp. respectively. An alarming increase in the resistance rate of meropenem, cefoperazone/sulbactam, piperacillin/ tazobactam, ciprofloxacin, and imipenem was observed from the year 2015 to 2016. This startling resistance acquired by Acinetobacter spp. within a period of one year, represent very limited therapeutic options left for the infections caused by Acinetobacter spp. Unavailability of effective drugs and limited therapeutic options enforce the health care practitioners to prescribe expensive and broad range antibiotics, which may cause harm to the patient. Therefore, it is need of an hour to better understand the antimicrobial patterns and optimize antimicrobial prescription policies for the control of multidrug-resistant Acinetobacter spp

Pharyngeal Pouch co-existing with Thyroid Mass: a rare presentation

A 60-year male presented with a 4-year history of a mass in the lower third of the neck, which had gradually increased in size. On initial examination, it was considered a thyroid mass. On detailed examination, another mass was found in the upper neck which was doughy in consistency and reducible in size. With available investigations, he was diagnosed as a thyroid mass associated with pharyngeal pouch. On exploration of the neck, the whole mass revealed to be a pharyngeal pouch. We have discussed the patho-physiology of the pharyngeal pouch and reviewed the literature in detail

Patient's influx at outpatient medical laboratory [OPML]; Forecasting of patient's influx at Mayo hospital, Lahore using arima model

Uni-variate time series data analysis has been reported in medical literature for prediction the patients volume, emergency overcrowding, stay length in hospital on surgical procedure and bed occupancy in hospital wards, patients influx or patients arrival, moreover to estimate the cost of hospital stay or any medical or surgical procedure. The present study was designed to fit an appropriate uni-variate ARIMA model [Box-Jenkin methodology] to forecast the patient's incoming at OPML, Mayo Hospital, Lahore. Mayo Hospital Lahore, September 2009 to December 2013 were used for fitting the best model. Time series data of male, female and peads patients coming/reporting in OPML, OPD. The appropriate model for male and female data was found as ARIMA [1, 0, 1] and for peads as ARIMA [1, 1, 1] after residuals diagnostic checks. The estimated number of male patients for Month of January2014 is 632 whereas the actual incoming of male patients in the month of January, 2014 was 649, which shows that the estimated model has ability to forecast the number of incoming patients accurately. It is now concluded that the fitted ARIMA model can be used to forecast the patients incoming to OPD Medical Laboratory for future planning and management

Pattern of torso-trauma in road traffic accidents in KSA

To study the pattern and severity of abdominal injuries due to road traffic accidents [RTA] in KSA. Retrospective descriptive. This study was conducted in the Department of Surgery, King Fahad Hospital Al-baha, Kingdom of Saudi Arabia during one year from 2012 to 2013. Materials and Methods: This is retrospective study of all patients admitted with torso-trauma in Department of Surgery KFH Al-Baha from the period of Aug. 2012 to Aug. 2013. In the 01 year period, 2520 patients were admitted following an RTA. Out of these, 537 were admitted due to torso trauma.120 patients were admitted in SICU, 280 in intermediate dependency unit while remaining 137 admitted in surgical ward. 27 patient died due to torso trauma with multiple injuries. 3 patients died of pure liver trauma while 2 patients died of splenic injury. Lot of burden over the hospital because of RTA related injuries. There was very severe and fatal injuries faced because of accidents happened in youth and male preponderance

Anaesthesia perspective of combat injuries at South Waziristan agency-a field experience of war on terrorism

To determine the presentation form of combat injuries, different aspects of anaesthesia management and methods of effective pain control inside the field hospital. A descriptive study. South Waziristan Scouts Hospital, South Waziristan Agency, Iltiana, Khyber Pakhtun Khawa province from March 2007 to August 2009. A descriptive review of the type of injuries sustained by the troops including local civil population reporting to South Waziristan Scouts [SWS] Hospital from March 2007 to Aug 2009. All patients of combat related injuries reporting to SWS Hospital were included in this study excluding elective surgical cases, gynaecological cases and routine medical patients. Initial anaesthesia management, pain control in anaesthetized patients or analgesia provided without anaesthesia in injured patients and evacuation process of emergencies to tertiary care hospital are discussed. The data was collected from hospital records including operation theatre and was analyzed in the SPSS version 14 for windows in the form of frequency of patients. A total of 149 male [age 30 +/- 15] patients were managed at SWS hospital after sustaining combat related injuries. General anaesthesia was given to 61% patients whereas 26% were operated under spinal anaesthesia. Deaths reported were 12.75% comprising 1.3% brought in dead during combat, 2.68% after cardiopulmonary resuscitation inside the hospital, 2.68% homicides by miscreants, 0.67% suicide, 0.67% of bomb disposal squad during mines search operation and 4.69% due to helicopter crash due to snow fall. Firearm and splinter injuries were the commonest in active encounter followed by IED linked injuries. Stray bullets injured a soldier in the chest causing pneumothorax and minor injuries to other 2%. Suicide 0.67% of permanent residing troop and homicides of 2.68% soldiers by the miscreants were documented. The time for casualty arrival in the hospital was 15 min to 10 hours depending upon the distance of incidence from the hospital. Ketamine was the drug of choice for induction and pain management followed by thiopentone either alone or in combination with ketamine. nalbuphine IV and diclofenac sodium IM were given to all patients for analgesia. Full stomach and lower limb emergent cases were operated under spinal anaesthesia using hyperbaric 7.5% bupivacaine. Poor supply of medicines, deficient staff and skilled workers, inefficient chain of evacuation and geographical problems were the major difficulties in that area. Active initial management and team work in a fully equipped setup have the added advantage. Extreme cold, poor team work, hitches in the evacuation, support and supplies were the major problems which if covered can possibly help to manage wounded persons at source

Microbiology of bile in symptomatic uncomplicated gallstone disease

To determine the microbiology of the bile culture and antimicrobial susceptibility in patients with symptomatic gallstone disease in our setup. A descriptive study. Surgical Department Combined Military Hospital [CMH] Kharian from Oct, 2010 to Jun, 2011. A total of 106 patients underwent cholecystectomy due to symptomatic gallstones and their bile was cultured for aerobic and anaerobic bacteria and culture sensitivity was performed. Data was analysed by using statistical package for social sciences [SPSS] version 13. Bile culture was negative in 81 patients [76.4%] and was positive in only 25 patients [23.6%]. Escheria Coli was the most common cultured organism in 10 [40%] patients, Klebsiella in 5 [20%] patients, Pseudomonas in 5 [20%] patients, Proteus in 2 [8%] patients, Staphlococcus aureus in 2 [8%] patients and mixed organisms were cultured in 1 patient [4%]. Cefoperazone with sulbactum and Amikacin were the most effective prophylactic antibiotics. Bile in majority of patients with symtomatic uncomplicated gallstone disease is sterile. E. coli is the most commonly cultured organism and cefoperazone with sulbactum and amikacin are the most appropriate antibiotics in our setup

Priority of spinal versus general anesthesia for caesarian-section in the eyes of gynaecologists and patients

To study the Priority of Spinal versus general anesthesia for Caesarian-Section In the eyes of gynecologist and patient in Islam Teaching Hospital Sialkot, Shahina Jamil Hospital Abbottabad and CMH Mangla. Retrospective study. This study was carried out at the Islam Teaching Hospital Sialkot, Shahina Jamil Teaching Hospital Abbottabad and CMH Mangla from 1[st] January 2010 to 28 Feb 2014. 250 cases each for Caesarian Section were taken from government hospitals and private hospitals these were analyzed for type of anesthesia with its preference in the eyes of gynecologists and patients. Fully informed written consent had already been taken for type of anesthesia. Permission was also taken from authorities of above mentioned hospitals for the study. In government hospitals the gynecologist preferred [74%] spinal anesthesia for Cesarion section as compared to private hospitals where he/she preferred general anesthesia [85.6%]. It was concluded that the Gynaecologist in the government sector prefers spinal Anesthesia for Caesarian Section but in private practice she / he prefers general anesthesia for Caesarian section. It was seen that the religious women prefer general anesthesia for caesarian section due to modesty reasons but women of modern society listen to the counseling for spinal anesthesia with open mind. The Anesthetist preferred spinal anesthesia for Caesarian section in most of the cases

Nonalcoholic fatty liver disease in nonworking / dependent class using ultrasonography and liver function tests: as a cost effective tool

Objective: To evaluate utility of gray scale abdominal ultrasound and liver function tests in the prevalence of Nonalcoholic Fatty Liver Disease in non-working / dependent class of Faisalabad

Study Design: Screening study

Setting: Department of Radiology Allied Hospital, Faisalabad

Duration of Study: 6 months, from December 1 2012 to July 2013

Sample Size: 300. Study Participants -Demographics

Material and Methods: Patients, who denied regular alcohol drinking, were included in the study. A pre-designed study pro forma was filled with relevant parameters i.e. body mass index [BMI], ultrasound, and LFT, s, WHR, lipid profile, clinical assessments were carried out in all cases along with real-time gray scale abdominal ultrasonography as established diagnostic tool. We compared the results of LFT, s and hepatic ultrasound of suspected and non-suspected and are statistically analyzed by SPSS 12

Results: Out of three hundred patients, 200 [67%] female and 100 [33%] were male suspected. Mean age of the patients was 38.93 +/- 8.57 years. The prevalence of fatty liver in males younger than 35 years old was significantly higher [71.7%] where as it markedly increased in females younger than 48 years [65.25%]. Multiple factors analysis reveals that the prevalence of fatty liver was positively correlated to several risk factors, including female, age [>50yr], hyperlipidemia, impaired glucose tolerance/diabetes mellitus, hypertension and overweight/obesity. Fifty one [54%] patients with symptoms like obesiy, fatigue, generalized, weakness, and pain RUQ had fatty liver where as 23.2% had raised Liver enzymes, 20.0% with cholelithiasis and 16.92% with D.M

Conclusions: Routine hepatic ultrasonography and LFT in every suspected patient with symptoms of fatigue, generalized weakness, and pain in RUQ, is able to detect NAFLD as it is cheap and easily available facility in our country

Finding effectiveness of teaching basic life support to paramedics

To determine the impact of single setting basic life support courses to paramedics by analyzing their responses. Cross sectional analytical study. Combined Military Hospital Gujranwala and PNS Rahat Hospital, Karachi, Pakistan from Jan 2010 to Jan 2013. This study consisted of printed questionnaire of 10 questions from cardiopulmonary resuscitation [CPR] basics prepared according to latest guidelines of American Heart Association [AHA] given to paramedics of two hospitals participating in basic life support [BLS] course from Jan 2010 to Jan 2013. The courses were run by a single person while distributing questionnaire to all participants of both genders performing duties at different departments of the hospital on rotation. Groups of similar education level were selected for these courses. The assessment of all participants was done after each course completion as per the questionnaire and data was collected for statistical analysis. In a study of 300 individuals the consistent response of performing chest compression was seen in a large no of participants [97.3%] which was followed by checking responsiveness [75%], checking carotid pulse [66.6%], effective chest compressions [76.6%], mask ventilation first attempt was successful in [33.3%], and second attempt [96.6%]. Only 45 [15%] out of 300 had seen all types of available defibrillators [monophasic, biphasic, automated external defibrillator], monophasic defibrillator was seen by majority [83.3%] followed by biphasic [23.3%]. Automated external defibrillator [AED] was seen by few [16.6%] out of 300. Mouth to mask ventilations was difficult in first attempt for majority with small success rate [33.3%] and improved in second attempt [290%]. Checking responsiveness [75%] and feeling carotid pulse was poor in first attempt [33.3%]; however it improved following practice [83.3%]. Defibrillator paddle placement was easily mastered after practice. The defibrillation skills and knowledge of abbreviations taken from CPR guidelines was easily remembered by many participants. BLS is simple to teach but mastering skills is difficult for everyone. The outcomes of training sessions over the time can be improved with customized repeated courses to maximum individuals while stressing on practical application. Furthermore prevalent teaching methods of this skill in our hospitals need purposeful modification keeping in view the participant's capacity

Evaluation of laryngoscopes decontamination practices in different hospitals

To find disinfection and sterilization practices of laryngoscope in different hospitals. Descriptive study. Combined Military Hospital Gujranwala, from Jan 2010 to Jan 2011. laryngoscope decontamination practices in different hospitals were evaluated in this study which was based on a telephonic structured questionnaires. Preset questions were asked on phone from operation room technicians of 50 different hospitals. For clarification and confirmation of procedure anesthesiologist of the hospital was contacted. Laryngoscope decontamination practices were asked as per questionnaire and data collected was recorded and analyzed. Results were documented and compared with studies regarding laryngoscope decontamination practices of different countries. Most exercised methods were manual decontamination with simple gauze [50%], alcohol gauze [11%] or tap water [27%]. The use of disposable blades and sheathing of blades was not practiced by any of the hospitals. Similarly chemical disinfectants were used rarely [2%]. Rinsing laryngoscopes with water [always 27%, sometime 23%] was very common while, autoclaving or sheathing of blades was not done in any of the hospital. The rate of different postoperative infections is on the increase in our hospitals and one likely contributing source in contaminated laryngoscopes. Lack of awareness and poor practices among health care professionals, over work and economic constraints are the major contributing factors which need to be controlled by adhering to international standards

Electrical shock survival after prolonged cardiopulmonary resuscitation

Electrical shock is typically an untoward exposure of human body to any source of electricity that causes a sufficient current to pass through the skin, muscles or hair causing undesirable effects ranging from simple burns to death. Ventricular fibrillation is believed to be the most common cause of death following electrical shock. The case under discussion is of a young man who survived following electrical shock after prolonged cardiopulmonary resuscitation [CPR], multiple defibrillations and artificial ventilation due to poor respiratory effort. Early start of chest compressions played a vital role in successful CPR

Incidence of appendicitis with relation to age, sex, occupation, socio-economic status, dietary habits and urban or rural area of district sialkot

To study the incidence of appendicitis with relation to age, sex, occupation, socio economic status, dietary habits and urban or rural area of district Sialkot. Retrospective study. This study was conducted at the Islam Teaching Hospital Sialkot from 1[st] January 2012 to 31 December 2012. 100 cases of appendicitis were randomly selected from the patients attending to OPD and emergency of Islam Teaching Hospital Sialkot and its peripheral Districts. The data was collected on written pro forma and analyzed for results. In this study the incidence of appendicitis was the highest 39 % at the age 11 - 20 years and the lowest at the age of 71 - 80 years [03 %] It was seen that incidence of appendicitis was 52 % [52 cases] in male and 48 % [48 cases] in female as shown in Table No.2. The incidence was the highest in students 36 % [36 cases] as compared to business man 03 % [03 cases] as shown in Table No.3. In this study the incidence of appendicitis was 37 % [37 cases] in people having high fiber diet as compared to those people who had low fiber diet 63 % [63 cases] as shown in Table No 4. The incidence of appendicitis was 62 % [62 cases] in people living in urban area has compared to people living in rural area 38 % [38 cases] which was half of the urban area as shown in Table No 5. At the last it was seen that the incidence was 60 % [60 cases] in lower class and 40 % [40 cases] high gentry as shown in Table No 6. The incidence of appendicitis is much more in 11-20 year of age and Males were more prone as compare to Female. Students and laborers were more prone as compared to other groups of patients. Low fiber dietary habits were more in percentage as compared to patient having high fibre dietary habits and percentage of patients of appendicitis were double in Urban area as compared to rural area. The incidence of appendicitis was more in patients of low socio economic status as compared to high socio economic status

Incidence of inguinal hernia with relation to age, sex, occupation, socio-economic status, dietary habits and urban or rural area of district Sialkot

To study the incidence of Inguinal Hernia with relation to age, sex, occupation, socio economic status, dietary habits and urban or Rural area of District Sialkot and its peripheral districts. Original study. This study was conducted at Islam Teaching Hospital Sialkot from 1[st] January 2012 to 31[st] December 2012. 100 cases of Inguinal Hernia were selected randomly from patients attending to OPD and emergency of Islam Teaching Hospital Sialkot. The result are shown in the Table No. 1 to Table No. 6. There was maximum percentage of Inguinal Hernia in age group 10-20 years [24%] and minimum in age group 81-90 years [04%] [Table No. 1]. The incidence of Inguinal Hernia was maximum in male [80%] as compared to female [20%] as shown in Table No. 2. There was maximum incidence of Inguinal Hernia in students [28%] and in factory workers, laborers, farmers was [20%] in each group and minimum in shop keepers and service men [06%] in each group as shown in Table No. 3. The incidence of Inguinal Hernia was maximum in people of low socio economic status [50%], [35%] in middle class and [15%] in people of high class as shown in Table No. 5. The incidence of Inguinal Hernia was [66%] in patients on low fibre diet and [34%] in patients on normal fibre diet as shown in Table No. 4. The incidence of Inguinal Hernia was [70%] in patients coming from rural area and [30%] in patients coming from Urban area as shown in Table No. 6

Effect of skimmed milk on the absorption and metabolism of5-fluorouracil [5-fu] in animals

Several modalities of drug administration have been investigated to improve bioavailability and to reduce 5-FU related toxicity. The aim of present study was to evaluate the effect of skimmed milk on the absorption and metabolism of 5-FU in rabbits, mice and dogs. It was further aimed to determine its route related toxicity in rabbits. Plasma concentration of both 5-FU and its metabolite 5-Fluoro-2-deoxyuridine [5-Fdurd] was determined using HPLC. The absorption of 5-FU co-administered with skimmed milk was significantly higher as compared to its co-administration with water in rabbits and mice [p < 0.001], whereas no significant difference was observed in dogs. The plasma concentration of 5-Fdurd a major metabolite of 5-FU was significantly higher in water group when compared with skimmed milk group in rabbits and mice [p < 0.05], whereas no significant difference was observed in dogs. Route related toxicity was also determined in rabbits. Various hematological parameters were studied at 4[th] and 7[th] day after oral and intravenous administration of 5-FU. WBCs count was significantly decreased in intravenous group as compared to control and oral groups [p < 0.001]. It was concluded that co-administration of skimmed milk with 5-FU increases its absorption and reduces its metabolism. Skimmed milk also reduces 5-FU related toxicity in rabbits

Spectrum of dermatological conditions in a ruralcommunity

Objective: To determine the prevalence ofdermatological conditions in a rural community

Study Design: Cross-sectional descriptive study

Place and Duration of study: Study was conductedin Tehsil Headquater Hospital Bhawhana in May,2011

Materials and Methods: 300 patientsbelonging to Tehsil Bhawana and surroundingvillages reported in the camp. Forty three patientsboth male and female had dermatological conditionsand were included in the study. They wereevaluated, diagnosed and given treatment forvarious dermatological conditions

Results: Meanage of patients was 24.48 +/- 14.48. Out of thesePatients 17 patients [39.53%] had Scabies,6[13.95%] had Acne Vulgaris, 5[11.6%] hadurticaria, 4 patients [9.3%] had contact dermatitis, 2[4.6%] had pemphigus vulgaris [PV], 2 [4.6%]hadburn injuries, 2 [4.6%] had seborrhic dermatitis and1 patient [2.3%] each of vitiligo and Helmenthicinfections, 3 patients [6.9%] had lichen planus [LP]

Conclusion: Scabies is the most prevalentdermatological condition in rural communities andthe scenario can be improved by improvement in thehygienic conditions and the general publicawareness

Incidental appendectomy benefits at the time of total abdominal hysterectomy

To determine the benefits of incidental appendectomy during abdominal hysterectomy in terms of post-operative complications and cost of operation. [5 years] 2003 to 2008. Retrospective study. 171patients who did [n: 73] or did not [n: 98] undergo elective incidental appendectomy at the time of uncomplicated total abdominal hysterectomy from 2003 to 2008 at three different hospitals by a single surgeon. The data was obtained about age, operation time, hospital stay, postoperative complications like [fever, wound infection, abscess formation, wound collection, wound dehiscence]. Post-operative follow up was done for 5 years. Data was analyzed with chi square test using SPSS 16. Seventy three incidental appendectomies were performed in this study of 171 patients [43%]. The procedure was most commonly performed with total abdominal hysterectomy. Bilateral salpingo oophorectomy was performed in 27 [16%] while unilateral in 13 cases [7.6%]. Histopathology was done in 114 cases of uterus [70%], all the ovarian samples [100%], and 14 of appendixes [19%]. Only 06 appendixes out of 14 were reported inflamed [42.8%]. Sixteen patients [16.3%] out of remaining 98 patients reported for appendectomy within 3 to 5 years following TAH. P value <0.05 was considered significant and results of both groups were compared with mean and P value. The data from current study and review of literature affirms incidental removal of the appendix. The two groups are comparable to each other in all parameters and perforation. The decision to perform an elective coincidental appendectomy at the time of an unrelated gynecologic surgical procedure should be based on individual clinical scenarios and patient characteristics and preferences

Validity of rockall scoring system in determining in-hospital rebleeding among cirrhotic patients with acute esophageal/gastric variceal hemorrhage using endoscopy as gold standard

The rate of rebleeding of esophageal varices remains high after cessation of acute esophageal variceal hemorrhage. Rockall scoring system primarily developed for patients with non variceal source of bleeding

Objective: To determine the validity of Rockall scoring system in determining in-hospital re-bleeding among cirrhotic patients with acute esophageal/gastric variceal haemorrhage using endoscopy as gold standard. The study was conducted in Allied hospital and Liver Centre Allied/DHQ Hospitals, Faisalabad

Study Period: Study was carried out from 28-06-2010 to 27-12- 2010

Patients and Methods: Total 176 cases were include in this study. The subjects were scored using Rockall scoring system and placed under observation for re-bleed in 10 days

Results: The mean age of patients was 50.99 +/- 12.47 years. Out of 87 positive cases on Rockall score, 82 cases were true positive. Out of 89 cases, that were negative, 81 were true negative. Sensitivity, Specificity and diagnostic accuracy of Rockall score was found to be 91.1%, 94.1% and 92.6%, respectively. Positive predictive value [PPV] of Rockall score was 94.2% and negative predictive values [NPV] was 90.0%

Conclusion: The risk scoring system developed by Rockall and coworkers is a clinically useful scoring system among cirrhotic patients with acute esophageal/gastric variceal haemorrhage

Testicular torsion of undescended testis in a child

The children presenting with acute scrotum have many diseases in differential diagnosis and testicular torsion in undescended testis and normal testis is an important consideration. Torsion of the testis, or more correctly, torsion of the spermatic cord, is a surgical emergency because it causes strangulation of gonadal blood supply with subsequent testicular necrosis and atrophy. In most of cases history and physical examination are sufficient to make an accurate diagnosis. While other causes may require simple treatment but torsion require immediate exploration to save the testis. Early diagnosis and prompt treatment is essential to help such children