Recurrent appendicitis of vermiform appendix after a prior appendectomy: A case report and review of the literature.

Introduction: Acute appendicitis is one of the leading causes of acute abdominal pain and surgical emergency. Stump appendicitis is a known complication of appendectomy whereby a retained appendiceal tip serves as a nidus for recurrent bouts of inflammation. Nevertheless, full-blown appendicitis of the vermiform appendix after a prior appendectomy remains a diagnostic conundrum. Case presentation: A 45-year-old woman presented with a six-month history of right iliac fossa pain. Pertinently, she had undergone a prior open appendectomy twelve years ago. Further investigative workup revealed full-blown appendicitis, which was not attributable to a retained appendiceal stump. A subsequent laparoscopic appendectomy was performed, and the resultant specimen was sent for further evaluation, confirming the diagnosis of recurrent appendicitis. Clinical discussion: Acute appendicitis is one of the most common life-threatening abdominal surgical emergencies worldwide, with 300000 appendectomies performed annually in the United States alone. Stump and chronic appendicitis are two separate and exceedingly rare clinical entities that may present simultaneously and develop serious complications unless promptly recognized and appropriately managed. The present paper prompts the clinicians to distinguish amongst the two at the initial surgery in order to thwart further exacerbations. Conclusion: While stump appendicitis is a rare but well-characterized complication of a prior appendectomy, full-blown appendicitis of vermiform appendix remains elusive. It is therefore imperative to distinguish between a duplicated and a recurrent appendix at the initial operative procedure to facilitate optimal patient management.

Current status of e-health awareness among healthcare professionals in teaching hospitals of Rawalpindi: a survey.

The purpose of this survey was to determine the number of healthcare professionals with knowledge about e-health and how many people would like to use e-health in their practice. A hospital-based cross-sectional study was conducted from September to November 2007 in Rawalpindi Medical College and allied hospitals. E-health survey questionnaires were designed and distributed among healthcare professionals, and their knowledge and attitudes toward e-health were assessed. Of 186 healthcare professionals, 41.4% were doctors, 31.7% were medical students, and 26.9% were nurses. Of this total, 57% had heard of e-health prior to the survey; 28% were of the opinion that healthcare professionals should hear about e-health in medical college; 50.5% believed that e-health services for developing countries were useful in general. According to 40.3%, more information on successful e-health projects would be necessary to introduce e-health services into medical practice. Self-education, and better diagnosis and treatments were the main motivational factors to use e-health. Of those surveyed, 67.2% had access to Internet but most of them had not used an online database for reaching a diagnosis, preferring other doctors as their main source of expert advice. Recommendation by doctors and respected medical experts was considered most important for buying an e-health service. The present study demonstrates a lack of adequate knowledge about e-health among healthcare specialists. However, a majority believed that e-health has a very important role to play in present and future healthcare.

Multitasking a telemedicine training unit in earthquake disaster response: paraplegic rehabilitation assessment.

The objective of this work was to provide computer and telecommunications skill training for paraplegics using a telemedicine training center in a curriculum that would support connectivity and offer new skills for career applications in the rehabilitation phase and beyond. This was a hospital-based, cross-sectional study. The study was conducted from October 10, 2005 to May 10, 2006 in the hospitals of Rawalpindi Medical College and the Melody Rehabilitation Center, Rawalpindi, Pakistan. These centers provided care for casualties of the October 2005 earthquake in Pakistan. One hundred and ninety four (194) paraplegics were admitted to Rawalpindi Medical College allied hospitals after injuries in the rural mountains near the epicenter. Surveys assessed the education level of the patients, and a sample of 12 patients was enrolled in computer training classes. Of the 194 patients, 144 were female and 50 were male. The majority, 78% (151) were 16-39 years of age. Although only 60% were literate, the overall literacy rate of Pakistan is just 48.7%. Telephone service at home was available after discharge for 40% of patients. Only 8% of patients had basic computer skills. All patients participated in the survey and sought to take the course. All the enrolled patients demonstrated full competency in the skills taught. The social disruption of disaster plus the new challenge of a neurological deficit in paraplegia did not deter a remarkable number of patients from a rural area from engaging in computer and telemedicine training. This study demonstrated the feasibility of educating rural paraplegics in computer skills for telemedicine. The telemedicine training center was used for this task without special equipment or personnel, thereby increasing the utilization of the facility.

The impact of curriculum on a national telehealth program.

Pakistan developed a curriculum for training in telemedicine based upon international experience and regional needs. The curriculum was offered to selected specialists across the spectrum of medicine, policymakers, and engineer experts. The curriculum was experience based and hands-on. Each participant at the end was asked to develop a telemedicine application based upon their area of practice or expertise. Most of the first 30 graduates are currently involved in telemedicine applications in varied and unanticipated areas of contribution. The first graduates also were instrumental in the national and regional response to the earthquake disaster of 2005 in the Rawalpindi region. The curriculum is being expanded under government sponsorship to become a national telemedicine initiative.