COMPARISON OF ALVARADO SCORE AND RIPASA SCORE IN THE ACCURATE DIAGNOSIS OF ACUTE APPENDICITIS IN COMBINED MILITARY HOSPITAL RAWALPINDI

Objective: To determine the diagnostic accuracy of Alvarado score and the RIPASA score for acute appendicitis using histopathology as a gold standard. Study Design: Cross sectional validation study. Place and Duration of Study: Department of General Surgery, Combined Military Hospital, Rawalpindi Pakistan, from Mar to Sep 2018. Methodology: A total number of 270 patients were included in the study presenting with pain right iliac fossa to the Accident and Emergency department. Surgeons and Seniors Residents in Surgery on call in the Accident and Emergency Department. Combined Military Hospital, Rawalpindi, scored the patients with suspicion of acute appendicitis with Alvarado Score and RIPASA score simultaneously. After appendectomy of these patients, the removed appendix was sent for histopathology to confirm whether it was normal or inflamed. A 2x2 table was used for calculating sensitivity, specificity and diagnostic accuracy of the RIPASA score and Alvarado Score. The two scoring systems were then compared for diagnostic accuracy. Results: In our study, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of RIPASA score and Alvarado score for diagnosing acute appendicitis were 92.1%, 62.1%, 95.2%, 48.6%, 88.9% and 72.6%, 68.9%, 95.1%, 23.2%, 72.2% respectively. Conclusion: The diagnostic accuracy of RIPASA score was more than that of Alvarado score in diagnosing acute appendicitis.

Study of Age and Gender Predilections amongst the Victims of Burns of Domestic Violence

Background: Human life from conception till death needs some sources of energy or heating mechanism to advance from a day to another in the process of livelihood. From innocent infants falling victims to fires, toddlers to scalds, youth to vitriolage and elders to enmity of a variety of sources or to their own debilitation bring them close to the fire source let them fell a prey to burns. Aim: To observe the age and gender predilections amongst the victims of burns Methods: The study was carried out among 250 victims of burns presented from December 2017 to August 2018 and reported in the Accident and Emergency Department of Mayo Hospital Lahore and filtered in Medicolegal Clinic of King Edward Medical University Lahore. Results: The study revealed maximum involvement of pediatric and geriatric age groups falling victim to burn incidents. In an analysis as a whole almost 84% victims were belonging to these two extremes of ages. Gender disparity showed a slight difference of just 10% showing female preponderance being exposed to burns. Keywords: Burns, Age, Gender, Variation, Disparity

Sphenoid sinusitis: a rare cause of ischaemic stroke

We present the case of a 61-year-old woman who presented to the accident and emergency department with an ischaemic stroke, on a background of receiving intravenous and oral antibiotics to treat chronic left sphenoid sinusitis. Initially presenting with right-sided weakness and aphasia, a diagnosis of acute ischaemic stroke was made. Antibiotics had been commenced 1 month prior to the ischaemic stroke. Imaging at that time showed changes in keeping with chronic sphenoid sinusitis along with a small dehiscence in the lateral wall of the left sphenoid sinus and thrombosis of the left superior ophthalmic vein. During that admission blood cultures grew Streptococcus constellatus, a member of the Streptococcus milleri group. We discuss the unusual aetiology of this stroke, the emerging evidence associating chronic rhinosinusitis with stroke and the complex multidisciplinary approach required for management in this case.

Study of Seasonal Varaiations In Presentation Of Medicolgegal Cases Of Burns In A Tertiary Care Hosptial

Background: The burns resulting from heating mechanisms or hot sources are inevitable as such a scheme is an integral part of human’s life. It though benefits on one hand but unfortunately it harms as well especially if due care is not rendered in this regard. Aim: To assess the seasonal effects on presentation of victims of burns. Methods: An analytical cross-sectional study was conducted on the medicolegal cases of burns filtered at medicolegal clinic of Mayo Hospital Lahore, Accident and Emergency Department from December 2017 to August 2018. A total of 250 cases were studied presenting in the above setting. Result: The study revealed the seasonality as a quiet common and impressive factor in reporting of victims of burns in the medicolegal clinic of Mayo Hospital/King Edward Medical University Lahore. The winter months of December, January and February were the most common reporting months of study showing maximum peaks. Keywords: Burns, Season, Variation, Factors

Obstructed right Duari hernia

The caecum and appendix are uncommon contents of femoral hernia (Duari hernia). Diagnosis is usually intraoperative. We report a rare case of obstructed right femoral hernia in a 65-year-old woman. She was admitted into the accident and emergency department because of sudden irreducibility of a previously reducible right groin swelling of 5 years duration. She had obstructive symptoms with an irreducible right groin mass clinically diagnosed as obstructed right femoral hernia. A combination of infra-inguinal transverse incision and a lower midline laparotomy incision was used. The intraoperative findings included the herniation of the caecum and appendix into the right femoral canal. Patient had an uneventful recovery. Duari hernia is uncommon. A high index of suspicion and an experiencedsurgeon, who can handle uncommon findings should be involved in the management of obstructed femoral hernias.

Copper-induced Haemolytic Anaemia

Acute copper toxicity is uncommon in Western countries and is often the result of accidental consumption or a suicide attempt. We report the case of a 65-year-old man presenting to the accident and emergency department after a suicide attempt with ingestion of Bordeaux mixture, ibuprofen, acetaminophen and bleach. Primary evaluation showed caustic oesophagitis, toxic hepatitis and acute renal injury, which were treated with supportive care. During admission, he developed a non-immune haemolytic anaemia associated with high levels of copper in urine and blood. Chelation treatment with penicillamine was started and evolution was favourable after 1 month of treatment. Copper poisoning can be lethal. Prompt diagnosis and treatment are key for a favourable prognosis.