Role Of C-Reactive Protein in Diagnosis of Acute Appendicitis

Background: Appendicitis is a common surgical emergency and diagnostic dilemma. Making the correct diagnosis is often difficult as the clinical presentation varies according to the age of the patient and the position of appendix. The objective of this study was to identify clinical applicability of C- reactive protein, as a diagnostic test for appendicitis. Methods: This prospective study was carried out in Federal government Polyclinic hospital, Islamabad from January to July 2019, 114 patients underwent appendectomy for clinically diagnosed acute appendicitis. The decision to operate the patient was given by senior registrar. The blood samples for C-reactive protein were drawn before taking the patient to the operating theatre. Removed appendices were sent for histopathological confirmation of diagnosis. The C-reactive protein was then compared with the results of histopathology to determine its validity. The data was entered and analysed in SPSS 23. Results: The sensitivity, specificity, positive and negative predictive values of C-reactive protein in patients with clinical diagnosis of acute appendicitis were found to be 94%, 78%, 93% and 74 % respectively. Conclusion: CRP is helpful in making diagnosis of acute appendicitis. It is highly sensitive but has a relatively low specificity.

Torsion In A Complete Bicorporeal Gravid Uterus: A Case Report

PurposeBicorporeal uterus has a prevalence of 0.3% and can have significant implications in pregnancy. We encountered a patient in her third pregnancy with a bicorporeal uterus, having had two previous caesarean sections. This pregnancy was in the left hemi-uteri which was damaged during her previous delivery. We discuss the antenatal and intraoperative considerations undertaken. We also share her antenatal imaging and intraoperative photos of her pelvic anatomy.MethodsA comprehensive literature search was undertaken on PubMed revealing that uterine torsion in the context of a bicorporeal uterus in pregnancy is a rarely documented occurrence. We used the patient’s electronic obstetric notes for all her pregnancies as well as the computerised records of her imaging. Her caesarean section was electively planned and led by two experienced obstetric consultants and a senior registrar. Postnatally she was contacted for permission to publish the images from her scans and caesarean section. ResultsHer previous obstetric history was important and allowed a high index of suspicion for obstetric complications. Prediction of surgical complexities on antenatal screening and imaging was important in her case. Finally anticipation of possible intraoperative complications allowed for pre-operative planning. ConclusionThis case encompassing a series of learning points and surgical tips which has educational value as well as clinical interest. In the presence of a uterine abnormality, placental complications, extensions of incisions and vascular injury should be anticipated. A safe incision site must be identified before entering the uterine cavity. Therefore involvement of senior clinicians is essential.

PATIENTS’ SATISFACTION WITH THE QUALITY OF DERMATOLOGY CONSULTATION OF A TERTIARY CARE HOSPITAL OF PAKISTAN

Objective: To determine the satisfaction rate of dermatology patients, after purposefully improving the consultation skills of residents. Study Design: Mix-method study. Place and Duration of Study: Department of Dermatology, Combined Military Hospital Lahore, from Jan to Sep 2020, Methodology: Empathy informed curriculum was delivered by the consultants and senior registrar prior to the conduction of study as well as an ongoing process to the post-graduate trainees in the department. Patients’ satisfaction with the quality of dermatological consultation was assessed by consultation and relational empathy (CARE) measure. One hundred and seventy six patients were recruited during the study period. Descriptive statistics such as frequencies, means, standard deviations and percentages were determined from the data. Advanced level analysis was done by Pearson’s correlation coefficients to analyse relationships between variables. Results: The mean age of study participant was 39.01 ± SD 19.81 year, with a minimum of 3 years and maximum of 91 years. Ninety two (52.3%) patients were male and 84 (47.7%) were female. The mean consultation and relational empathy score was 40.34 ± SD 8.56 with 16 minimum score and 50 maximum. One hundred and sixty six (94.3%) patients were overall satisfied with the consultation whereas 10 (5.7%) were not. Conclusion: We found high satisfaction rate amongst patients attending dermatology outpatient department. Empathy informed curricula should be emphasized upon to provide holistic patient care.

Simple repair is sufficient for most injuries to the duodenum - a case series of 23 patients

Background: Duodenal injury is the most important hollow viscus injury in the abdomen. The study analysed the outcome of duodenal injuries at the unit. Patients & Methods: Prospectively collected data on a case series involving 23 patients over 3 years. It involved demographic details, part of duodenum injured, injury severity according to the AAST, injury-operation time lag, mode of repair, and the extent of significant associated injuries. Results: M:F ratio was 4.75:1. Mean age 33yrs. Patients with non-perforating injury were excluded. All were operated by a senior registrar or senior. 7/23 were blunt, 13/23 firearm & 3/23 stab injuries. D2 was involved in 87%. Injury severity was graded according to AAST (American Association for Surgery of Trauma). 17/23 were Grade II/III, 3 Grade IV & 3 Grade V injuries. Four had injury-operation lag of >18hrs. Two injuries were missed. All injuries up to Grade IV had simple repair. Two of them had T-tube duodenostomy. None had pyloric exclusion. Complex repairs wer e required for 3/23 patients. Five patients died, as a result of associated insults. One delayed repair developed duodenal fistula. Intra-abdominal abscess, septicaemia and wound dehiscence were seen in two patients each. Duodenum-related mortality was zero. Adverse prognostic factors towards morbidity were injury severity >GIII and injury-operation lag >18hrs. The mortality was related to associated injuries. Conclusion: Primary repair is sufficient for most non-resectional duodenal injuries.

The accuracy of after-hour registrar computed tomography (CT) reporting in a South African tertiary teaching hospital

Background: The Division of Radiodiagnosis at Tygerberg Academic Hospital, a 1384-bed tertiary training institution in Cape Town, South Africa provides a comprehensive 24-hour clinical radiology service, and has a duty registrar on-site at all times. The demand for computed tomography (CT) imaging is increasing and plays a pivotal role in patient management.Objectives: The purpose of this study was to determine the accuracy of after-hour registrar CT reporting, to identify possible factors that may affect the error rate, and to assess whether or not errors had any clinical impact.Method: A set of senior registrar reports (provisional reports) issued during a 28-day period was compared with the corresponding consultant reports (final reports). Discrepancies were identified and quantified, based on their impact on patient management.Results: The overall discrepancy rate was 8% (18 out of 225) and the overall accuracy rate was 92% (207 out of 225). The major error rate was 4% (9 out of 225) and the minor error rate was also 4% (9 out of 225).Conclusion: We observed that the accuracy of after-hour CT reporting by senior registrars at the Division of Radiodiagnosis at Tygerberg Hospital was on par with international standards. We investigated three factors which may have affected discrepancy rates, and only found one factor, namely the time of day, to be significant. Steps can be taken to create awareness of this fact amongst registrars, which hopefully would result in improved patient care and management.

The early development of diagnostic ultrasound in Denmark

The development of diagnostic ultrasound in medicine began in Denmark in November 1965 at the Surgical Department H at Gentofte County Hospital in Copenhagen, and a prosperous time for diagnostic ultrasound began. It was the young surgeon Hans Henrik Holm who took the initiative, strongly supported by the head of the department Professor P.A. Gammelgaard. Hans Henrik Holm had for years studied ultrasound and earlier in 1965 he had visited Helmuth Hertz in Lund in Sweden to discuss the prospects of ultrasound. A grant from a national scientific foundation of 60 000 Danish kroner (approximately $10 000) made it possible to buy the American Physionic A-mode ultrasound machine. It was installed in a spare room at the Surgical Department H at Gentofte County Hospital in Copenhagen. An ultrasound laboratory was hereby established, and it was increasingly involved in a variety of clinical ultrasound studies and in the development and testing of new ultrasound equipment. The expenses were met by both the hospital and the University of Copenhagen, and a great deal of the research was financed by foundations. Hans Henrik Holm became the day-to-day head of the laboratory and he kept this position for many years. The Surgical Department and the ultrasound laboratory, designated the Ultrasound Department, were relocated to the new Herlev County Hospital in 1976 where Hans Henrik Holm became consultant at the Urology Department and Professor in Ultrasound and Interventional Ultrasound affiliated with the Surgical Department. The Ultrasound Department at Herlev had an increasing number of rooms and staff members. A senior registrar (Jø rgen Kvist Kristensen) was associated to the department in 1975 and Søren Torp-Pedersen was appointed consultant at the department in 1989. In 1966, 250 patients were examined annually. Thirty years later the Ultrasound Department at Herlev Hospital examined 17 000 patients annually, and ultrasound departments had been established at other hospitals in the Copenhagen area. By 1966 two papers in Danish were published and two papers in English were published in 1967 and 1968 . The number of staff rapidly increased, and a group of enthusiastic doctors and technicians was formed, working with patients and on scientific projects.

National audit of higher training posts in child and adolescent psychiatry in Ireland

Aims and methodThe audit aimed to assess current senior registrar posts in child and adolescent psychiatry in Ireland in terms of working environment, conditions and training issues. The posts were compared with standards set down by the Child and Adolescent Psychiatry Specialist Advisory Committee of the Royal College of Psychiatrists and the National Higher Training Subcommittee of the Irish Psychiatric Training Committee.ResultsThe audit cycle was completed twice and a 100% response rate was achieved on both occasions.Clinical implicationsHigher training posts in child and adolescent psychiatry in Ireland compare favourably to standards for training and education, but poorly for working environment, case-load and educational supervision.