RESUMO
Left-sided acute appendicitis is a diagnostic dilemma. Because the appendix is located in an abnormal position there are two different anatomic anomalies attributed to a left-sided appendix: situs inversus and malrotation of the midgut loop. In case of abnormal anatomical site of appendix as in situs inversus or gut malrotation, atypical presentation begins with epigastric pain radiating to left lower quadrant of abdomen along with tenderness confusing with diverticulitis. There has been an increasing use of imaging modalities, such as USG and CT, in the diagnosis of acute appendicitis. Diagnostic laparoscopy is the gold standard in cases with complicated differential diagnosis. Clinical assessment/judgment has no match in diagnosis and avoiding serious complications. This is a case report of 25 years old young male who presented initially with pain epigastrium and vomiting with diagnosis of acute gastritis. Later on pain localized to lower abdomen more on left side than right lower side. It was initially treated conservatively, later on due to persistence of pain abdomen and increase in intensity clinical diagnosis of acute appendicitis was made and appendicectomy was planned via traditional incision. Per-operatively, left-sided acutely inflammed appendix along with caecum and ascending colon were found in left lower abdomen, operation was completed via lower midline abdominal incision. The main aim was to stress on clinical assessment/judgment where highly sophisticated diagnostic facilities are not available
RESUMO
Objectives: To see the pulmonary functions in students of 1st year and 4th year MBBS, SIMS and to compare them with each other considering the Environmental and stress related factors affecting Pulmonary functions on both groups
Methods: 30 students from each 1st and 4th year were taken from Services Institute of Medical Sciences Lahore. Consent in written was taken, participants were questioned and spirometery tests were performed. Data was analyzed using SPSS version 20
Result: Age and BMI of both groups were comparable. The mean values of FEV1 was better in 4th year students [3.2830 +/- 0.7677 V/S 3.2357 +/- 0.8223] and it was not statistically significant [p =0.819]. Values of FVC and FEV1 were better among 4th year students who exercise daily with values of 4.2323 +/- 0.5078 and 4.2343 +/- 0.3070 respectively than those of 1st year students have values of FVC and FEV1 as 4.0057 +/- 0.5022 and 3.7629 + 0.5268. The difference is statistically significant [p= 0.043 and 0.028 respectively]. The mean values of Forced Volume Capacity and Forced Expiratory Volume 1 of students residing in hostels were better in 4th year students [4.0171 +/- 0.8698 and 3.4129 +/- 0.9089 respectively] but it was not statically significant
Conclusion: Pulmonary functions were slightly better in 4th year students. It was due to their resistance to cope up with the environment, stress related to studies and better life styles regarding exercise and less numbers of smokers