Predictive value of TLC and CRP in children with clinically suspected acute appendicitis

Acute appendicitis represents one of the most common abdominal emergencies in children. Initially inflammation is localized to appendix but if untreated can lead to generalized peritonitis. It is often difficult and challenging even for the most experienced surgeon to make a definite diagnosis in paediatric patients. Inflammatory markers like Total Leukocyte count [TLC] and C-reactive protein [CRP] can help in making an early and accurate diagnosis in difficult cases

Objective: To evaluate the predictive value of TLC and CRP in children with clinically suspected acute appendicitis in whom physical findings were equivocal

Study Design: Cross sectional analytical

Setting: This study was conducted in Pediatric Surgery Department of Shaikh Zayed Postgraduate Medical Institute, Lahore

Subjects and Methods: All patients from 5-14 years of age fulfilling the inclusion criteria were admitted for this study. Preoperative blood samples for total leukocyte count and CRP were collected and submitted to hematology and microbiology laboratories. Postoperatively, specimen of appendix was sent to histopathology laboratory of Shaikh Zayed Hospital. The histological results of report were differentiated into non-inflammcd and inflamed appendix

Results: The mean age of the patients was 9.9+/-2.2 years. The mean TLC of the patients was 14.1+/-6.4 [10[9]/L]. The mean CRP of the patients was 19.0+/-8.7 mg/dl. Histopathology showed that 70 [69.4%] patients had inflamed appendix. The sensitivity of TLC and CRP was 82%, specificity 75% and diagnostic accuracy was 79%. The positive predictive value of TLC and CRP was 83% and negative predictive value was 73%

Conclusion: It is concluded from the results of this study that TLC and C-reactive protein can provide help in making accurate diagnosis of acute appendicitis. There monitoring enhances the diagnostic accuracy of acute appendicitis thus reducing the morbidity associated with delay in diagnosis and negative explorations

Morphologial patterns in children with ganglion related enteric neuronal abnormalities

Background: Hirschsprung's Disease [HD] is a developmental disorder of enteric nervous system characterised by the absence of ganglion cells in submucosal [Meissner's] and myenteric [Aurbach's] plexuses of distal bowel. The purpose of the present study was to observe and report the morphological patterns of ganglion related enteric neuronal abnormalities in children presented with clinical features of [HD] in a Pakistani population. Methods: A total of 92 patients with clinical presentation of HD wereenrolled between March 2009 and October 2009. Among them, 8 were excluded according to the exclusion criteria. After detailed history and physical examination, paraffin embedded H and E stained sections were prepared from the serial open biopsies from colorectum. The data was analysed using SPSS-17. Frequencies and percentages are given for qualitative variables. Non-parametric Binomial Chi-Square test was applied to observe within group associations and p<0.05 was considered statistically significant. Results: Among 84 patients, 13 [15.5%] proved to be normally ganglionic whereas 71 [84.5%] showed ganglion related enteric neuronal abnormalities namely isolated hypoganglionosis 9 [12.7%], immaturity of ganglion cells 9 [12.7%], isolated hyperganglionosis [IND Type B] 2 [2.8%] and Hirschsprung's disease 51 [71.8%]. Among HD group, 34 [66.7%] belonged to isolated form and 17 [33.3%] showed combined ganglion related abnormalities. Conclusions: Hirschsprung's disease is common in Pakistani population, followed by hypoganglionosis, immaturity of ganglion cells and IND type B. The presence of hypertrophic nerve fibres was significant in HD, hyperganglionosis and hypoganglionosis, whereas, no hypertrophic nerve fibres were appreciated in immaturity of ganglion cell group. Keywords: Hirschsprung's disease [HD], hypoganglionosis, immaturity of ganglion cells [IGC], intestinal neuronal dysplasia [IND]

In-vitro concentration dependent linear effect of crude snake venom on protein disintegration

The effect of different concentrations [10 microg, 25 microg, 50 microg/ml] of crude snake venom on protein contents of different normal tissues of rabbit was studied. Our objective was to determine and compare the effectiveness of snake venom [SV] on normal tissues before its use in vivo for the treatment of different diseases, especially cancers. Surgical portions of normal tissues of liver, heart, and kidney were removed from rabbits and homogenized. All homogenate samples were incubated with and without SV for 30 minutes at 37°C and measured with the spectrophotometer [Spectron 21]. The in vitro effect of cobra snake venom on total proteins was quantitatively evaluated in different normal rabbit tissues. The different concentrations of SV i.e. 10 microg, 25 microg, and 50 microg/ml demonstrated a significant linear increase in protein concentrations against controls. Significant and linear increases in protein concentrations suggest multiple sites/receptors for venom to act and disintegrate the macromolecules of proteins. The increase in the numbers of small proteins/peptides provides evidence for the venom-specific actions. A concentration of 10 micro g/ml could be of therapeutic potential

Level of empowerment of women

To investigate the level of empowerment of women in accordance with human rights. A cross-sectional study. Residence Colony of Punjab Medical College, Faisalabad. Period: August-September 2007. There were 600 houses and 6 Blocks A, B, C, D, E and F in the colony. By Simple random sampling 10 houses were taken from each Block by drawing lots. Sixty married womens between the age of 25 -45 years [One from each house] were interviewed using a pre-tested structured questionnaire. The mean age of the respondents was 37.2 years. Among the total 60 [100%] women, 16 [26.6%] were illiterate, while 44 [73.3%] had primary education and above. Only 10 [22.2%] out of 44 educated women had graduate and above degree. Thirty-eight [63.3%] women had the opportunity to use the reproductive health services and family planning, while 22 [36.6%] could not utilize the family planning methods. A total of 40 [66.6%] women had good nutritional status, while 20 [33.3%] had imbalances in nutrition. Nineteen [31.6%] women were doing jobs in different public and private institutions, while 41[68.3%] had not got opportunity for jobs. Thirty-three [55%] women had monthly income less than Rs.10,000/- per month and 27[45%] had Rs.10,000/- and above. Forty [66.6%] women were given importance and active participation in decision making, in children marriages, house-hold and in political process [vote casting] at all levels, while 20[33.3%] were not given importance in decision making of above matters. Forty -three [71.6%] woman were given their right of inheritance / property. Fourteen [23.3%] women were forced to wear veil while going out of house. Forty [66.6%] woman admitted to have suffered from violence either psychological, physical or sexual in their life. Safe drinking water supply was available to 30 [50%] women, however sewage disposal, toilet facilities with in house were available to majority of the respondents. Atotal of 40 [66.6%] women were over all empowered. Women do have human rights as well. The results obtained from this study are encouraging but not up to the standards of International Human rights Principles, which are universal, inalienable; indivisible; interdependent and interrelated

Chronic renal failure; association of diabetes mellitus

To find the effect of diabetes mellitus on the development of Chronic renal failure [CRF]. Descriptive Cross-sectional study. Allied Hospital, Faisalabad. From May 2008 to June 2008. Forty-Five patients of CRF were selected for study by convenient method technique from admitted patients in dialysis unit of Allied Hospital Faisalabad. In our study, out of 45 patients of CRF, 25 [55.6%] were found to be diabetic. The effect of diabetes on the development CRF was highest in age group of 71-85 years that was 100%. In this study diabetes mellitus was found to be more prevalent among married CRF patients [62%] as compared to unmarried patients among whom it was [17%]. Among the male CRF patients 54% were diabetic, while among the female CRF patients 57% were diabetic. Percentage of CAF patients having diabetes mellitus was 55.6%. From the above results it is concluded that effect of diabetes mellitus on the development of CRF increases with age. Diabetes mellitus was found to be more prevalent among female CRF patients and also among the married CRF patients. The development of Chronic renal failure can be prevented by early diagnosis and treatment of diabetes mellitus

Hodgkins lymphoma in cervical lymphadenopathy

To determine the proportion of Hodgkins lymphoma in cervical lymphadenopathy. This is a prospective study conducted at Isra University Hospital, Hyderabad between January 2002 to December 2006. The data was collected for all patients presenting with cervical lymphadenopathy during the above mentioned period. All the patients with cervical lymphadenopathy were subjected to detailed history, clinical examination, investigations and histopathological examination. Out of 498 patients presenting with cervical lymphadenopathy, 40 patients were found to be having Hodgkin's lymphoma. The gender distribution was predominantly male making up about 80%. About 50% patients had mixed cellularity whereas about 37.5% patients had nodular sclerosis. Most of the patients were having stages II and III disease. The over all five years survival rate was about 75%. The proportion of Hodgkin's lymphoma in cervical lymphadenopathy is relatively low in our population as compared to the western world

Role of verapamil in acute opioid abstinence syndrome

To determine the effectiveness of calcium channel blocker, verapamil in the treatment of acute opioid withdrawal syndrome in patients with chronic dependence on opioid. A clinical study. The study was conducted at Psychological Medicine ward, Civil Hospital Karachi from January 1998 to April 1998. A total of twenty [20] patients were admitted for ten [10] days in hospital. No treatment was given during the first two days of admission after abrupt termination of opioid to observe the acute opioid withdrawal signs and symptoms. Then the verapamil was given orally to each patient in a 40mg dose thrice daily from day 3 to day 10 of admission. The intensity of signs and symptoms was recorded by using subjective and objective opiate withdrawal questionnaire. Urine analysis for opioids was done on day 1, 5 and 10 of admission. Verapamil significantly decreased the intensity of signs and symptoms of acute opioid withdrawal from day 4 to day 10 of admission. Urine analyses for opioids were positive on day 1 while zero on day 10. Verapamil was found to be safe and effective for the treatment of signs and symptoms of acute opioid withdrawal in in-door patients without any significant side effect