An unusual foreign body ricocheting into the pericardium after a penetrating thoracic injury: A case report.

INTRODUCTION AND IMPORTANCE: Injuries to the thorax are common in trauma patients, among whom cardiac injuries are most lethal, particularly in the setting of penetrating trauma. CASE PRESENTATION: In this case report, the foreign body was visualized to be lodged in between the left atrium and ventricle. After that, an emergency open heart surgery was performed. Post-intervention, the patient was shifted to the intensive care unit without ionotropic support and with stable haemodynamics. CLINICAL DISCUSSION: Cardiac foreign bodies are rarely seen because most patients with penetrating cardiac injuries die from hemorrhagic shock or cardiac tamponade. CONCLUSION: We report a case of a penetrating injury into the thorax with the foreign body being lodged into the pericardium and then managed surgically. The patient was discharged subsequently and followed up after a few days with progressive recovery.

Role of serum C-reactive protein (CRP)/Albumin ratio in predicting the severity of acute pancreatitis: A retrospective cohort.

Acute pancreatitis is a disease with a wide spectrum of severity, complications, and outcome with severe life-threatening complications develop in patients leading to high mortality in severe acute pancreatitis. The rationale of this study is to diagnose the severity of acute pancreatitis using a single test ratio, i.e., CRP/albumin ratio which is a combination of markers for systemic inflammation and nutritional status. All those patients with age group 16-80 years who were diagnosed with acute pancreatitis and admitted subsequently to ICU were included. Severe pancreatitis was determined as CT severity score above 7. About 41% patients out of total 225 had severe pancreatitis. CRP/albumin ratio >4.35 had a sensitivity of 87% and accuracy of 76% to predict acute severe pancreatitis. Elevated CRP/albumin ratio was also associated with complications like multi-organ failure OR: 2.31 [1.3-4.2], duodenal thickening OR: 2.25 [1.2-4.2], and ascites OR: 2.90 [1.5-5.6]. Although, the severity of this elevation varied with different age groups, such non-invasive and readily available parameters should be relied upon admission to risk stratify the patients suffering from pancreatitis. CRP/albumin ratio has higher sensitivity and negative predictive value to predict severe pancreatitis than CRP alone and hence give additional advantage as a prognostic marker, although Delong's test to compare AUROC was indifferent (P-value: 0.22).

Role of inflammatory and hematological markers in predicting the complicated and perforated acute appendicitis in pediatric population: A cohort study.

Introduction: It is important to promptly assess the severity of appendicitis since late diagnosis can proceed towards perforation, peritonitis and sepsis. The main objective of this study is to decipher the ability of CRP, TLC and neutrophils in acute appendicitis to predict complications and perforation in pediatric age group. Methods: This cohort study was conducted in the Pediatric Surgery Department of Liaquat National Hospital, Karachi. It included all the patients diagnosed and operated on for acute appendicitis within the pediatric age group. Results: The median (IQR) age of study population was 9 (7-11) years, the majority of which fell into 6-12 years of age group with 70% males. Histopathology came out positive in 127 individuals. Out of those 127 patients, 45.9% (n = 62) had simple appendicitis and 48.1% (n = 65) had complicated appendicitis (n = 65), while 37 (27.4%) had shown perforation. The majority of individuals had suppurative appendicitis on histopathology (35.6%). On receiver operating characteristic (ROC) analysis, CRP has the highest specificity for complicated appendicitis and the highest positive likelihood ratio for both complicated and perforated appendicitis. Conclusion: CRP was observed in our study to be an independent marker of severity in acute appendicitis.

Outcome of heat stroke patients referred to a tertiary hospital in Pakistan: a retrospective study.

BACKGROUND: Climate change has heightened the threat of heat stroke in previously temperate zones. AIMS: This study aimed to assess the outcome of patients in relation to mortality and the role of effect modifiers among heatstroke patients presenting to a tertiary care hospital in Karachi during June 2015. METHODS: A retrospective observational study was conducted on heatstroke patients 20-27 June 2015 at the Emergency Room(ER) of a private hospital in Karachi, Pakistan. Patients' demographic data, disease severity, presentation and outcomes were determined. Statistical data was reported as numbers, percentages and mean ± SD. RESULTS: In total, 315 patients reported to ER; 76.6% patients survived, 23% expired. Males were 55% and 60% patients were fully mobile. Hypertension was the most frequent concurrent disorder. Fever documented in 79.4% and CNS derangement in 73.3% patients were the top most presenting features. Fever and disease severity were found to exert significant impact on disease outcome. Mortality rate dropped from 26 June onwards from 24.35% to 15.9% by using evaporative cooling technique combined with air conduction and maintaining room temperature at 22-24°C. CONCLUSIONS: Poor outcome during heatstroke can be minimized by advance planning and timely intervention in lowand middle-income countries.

High sustained response to daily dosing of interferon with ribavirin in chronic hepatitis C patients naïve to therapy.

BACKGROUND: : Viral kinetics suggests that daily administration of alpha-interferon (IFN) will clear hepatitis C virus (HCV) RNA earlier and more frequently compared with standard t.i.w. To reduce the likelihood of viral replication, mutation and subsequent development of resistance, daily dosing with IFN may be appropriate. To determine the safety and efficacy of daily IFN with ribavirin in chronic HCV infection we performed a prospective study. METHODS: : Thirty-five naïve adult HCV-positive patients (25 male/10 female) were treated with IFN-alpha2b; 5 MU daily for 2 weeks followed by 3 MU daily for 22 weeks and ribavirin 800-1200 mg/day depending on weight. Liver biopsy, performed in 25 patients, showed mild to moderate activity in 19 patients (76%) and severe activity in six patients (24%). Two patients showed staged IV fibrosis. Serotyping was performed in 29 patients by an enzyme immunoassay-based Murex assay. Type 3 was the predominant serotype, present in 14 cases. Hepatitis C virus RNA was measured by the Chiron bDNA assay. RESULTS: : Mean baseline HCV-RNA level was 14.2 +/- 18.7 MEq/mL (median 6.09; range 0.2-92.5), which became undetectable in all but three patients at week 4. Normalization of alanine aminotransferase (ALT) at week 4 was seen in 27 patients. Three patients withdrew due to non-compliance. Thirty-two patients completed 24 weeks of therapy as per the protocol. At the end of treatment, the HCV-RNA level was negative in 29 of 32 patients (90.6%) and ALT was normal in 31 of 32 patients (97%). Sustained viral response at 6 months follow up was seen in 28 of 32 patients (88%). The ALT level was normal in 28 of 32 patients (88%). CONCLUSION: : Daily administration of IFN with ribavirin is well tolerated in the majority of patients. There is rapid elimination of virus with normalization of ALT and a significantly high sustained viral response.