combined role of alvarado score and ultrasonography for the diagnosis of acute appendicitis

Objectives: Objective of the study was to evaluate use of Alvarado score and ultrasonography in diagnosis of acute appendicitis

Study Design: Cross sectional study

Place and Duration of Study: This study was conducted at Department of Surgery along with Department of Radiology at Shaikh Zayed Hospital Lahore from 1[st] January 2013 to 31[st] August 2013

Materials and Methods: 250 patients of Alvarado Score were enrolled for the diagnosis of acute appendicitis attending out-patient, accident and emergency departments

Results: There were 184 [74%] were males and 66 [26%] were females with mean age of 35.27 +/- 12.57 years. One hundred and seventy patients had anorexia while 76 patients had no anorexia. 49.6% patients while in 50.4% were reported anorexia. Right iliac fossa was noted in all patients. 95% patients had rebound tenderness 203 patients have elevated temperature

Conclusion: Alvarado score is a simple and reliable non-invasive diagnosis modality without any extra cost and complication. It has also proved to be handy for our peripheral hospital settings where backup facilities not available. By application of Alvarado scoring system with non-invasive ultrasonography improves diagnosis accuracy by reducing negative appendicectomies hence reducing complications rate in our settings

Role of physiotherapy in managing pressure ulcers: physiotherapists' perspective

Background: Pressure ulcers, although being very common, are still a neglected field of study in Pakistan. They can result in debilitating complications if not tre9ted early and properly. Proper medical care along with prompt physiotherapy is the idealistic choice in managing pressure ulcers

Objectives: Assess the awareness among doctors about the role of physiotherapy in management of pressure ulcers

Methods: The cross sectional survey involved 200 doctors selected by convenience sampling from government and private hospitals of Karachi. Doctors were interviewed through a structured questionnaire and p value <0.05 was considered as significant

Results: Awareness of physiotherapy among doctors, in managing pressure ulcer patients was83.5% [n=167]. "Usual practice" followed by doctors in their hospital settings, involved the application of various physical agents to enhance pressure ulcer healing such as HVPCs [high voltage pulse current] 18.0% [n=36],US [ultrasound] 28.5% [n=57] and cold laser 11.0% [n=22]. Practices to prevent ulceration included health education sessions only up to 44.5% [n=89]

Conclusion: Our study results showed that there was awareness among doctors about the role of Physiotherapy in management of pressure ulcers, but even after realizing not all the doctors were referring patients for physiotherapy. Further awareness sessions are required for spreading more knowledge among the doctors and the patients and their families to prevent pressure ulceration

Frequency of secretory otitis media in children of age 3 to 5 years in Rawalpindi and Islamabad

To determine the frequency of secretary otitis media [OME] in the region of twin city and to determine variations related to gender, environment and socioeconomic status. This comparative cross sectional study was carried out for one year from July 2010 to July 2011 at Social Security Hospital, Islamabad and at Holy Family Hospital, Rawalpindi and included 600 children [3-5 years] from schools of Rawalpindi and Islamabad. Schools were divided into three socioeconomic groups, 200 children in each group. Written permission and history of clinical features was taken from parents, two days before visit. Complete examination was done by ENT consultant and Pediatrician. OME was diagnosed clinically and confirmed with tympanometry. Chi- square test was used for analysis. Mean age was 4 years. 73 children were bottle fed. Two children had cleft lip and palate repair. 49 were mouth breather, rhinitis was in 203 children. 18 were with delayed speech and hearing loss and acute upper respiratory tract infection [AURTI] in 63 children. 11 cases were excluded from study due to perforation in tympanic membrane. Tympanometry confirmed OME with type B curve in 69 [11.5%] and with hearing loss of 35-40 dB [mean 37.5dB]. Frequency of OME was 11.5%. OME is a common disease may result in serious morbidity in the form of delayed speech development and poor performance at school due to hearing loss in 3-5 years age group

Response of anti-D in a case of immune thrombocytopenic purpura secondary to acute hepatitis A

Acute hepatitis A is usually a benign and self-limiting disease. Although many viral infections such as hepatitis B virus, Parvovirus, and Epstein-Barr virus are associated with extrahepatic autoimmune phenomena, such manifestations are rare in patients with acute hepatitis A infection. Immune thrombocytopenia is a benign, self-limiting disease in children, responding well to treatment and generally associated with viral infections. Immune thrombocytopenic purpura [ITP] is rarely reported as a manifestation of acute hepatitis A. We report a case of four and a half years old boy with immune thrombocytopenic purpura as a manifestation of acute hepatitis A infection which responded to Anti-D. Acute hepatitis A should be included in the differential diagnosis of immune thrombocytopenic purpura

Orf in a patient of toxic epidermal necrolysis during hospital stay: an unusual scenario

Orf is a zoonotic infection seen in livestock handlers. We report a case of human to human transmission of orf infection in a patient of toxic epidermal necrolysis and his caretakers. To the best of our knowledge this is the first case of orf infection in the patient of toxic epidermal necrolysis