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Background: Appendicitis is a surgical emergency and surgery is crucial for patients diagnosed with having acute appendicitis as any delay in surgery leads to perforation of the organ Methods: 50 Patients with provisional diagnosis of acute appendicitis were included in the study. Preoperative blood sample was analysed for neutrophil percentage. The patients were divided into two groups, each comprising of 25 patients on the basis of neutrophil percentage i.e. group A having neutrophils ≥ 75% and group B having neutrophils ≤ 75%. Patients were then followed-up and peroperative findings and histopathology reports were noted for differentiating between perforated and inflamed appendices. SPSS version 22.0 was used for analysis and Pearson's Chi square test was applied at 5% level of significance. Relative risks along with 95% confidence intervals were also calculated. Results: 15/25 (60%) patients in Group A developed perforation of appendix when compared to only 1/25 (4%) patient in Group B, who later developed perforation (Relative risk = 15.0, 95% confidence interval=2.1408 to 105.10, P value=0.00). No statistically significant association was observed between age and gender with perforation of appendix. Conclusion: There is a highly significant statistical association of shift to the left of neutrophils with perforation of appendix. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic Cholecystectomy (LC) is considered to be the gold standard treatment option for cholelithiasis. Various studies have shown that LC causes elevation in serum levels of certain hepatic enzymes. Objective:The objective of this study was to compare the mean pre-operative levels of serum Alanine Transaminase (ALT) with mean postoperative levels of serum Alanine Transaminase after Laparoscopic Cholecystectomy in tertiary care hospital of Rawalpindi. Materials & methods: This single group experimental study was conducted from January 2017 to March 2017 at Surgical Unit 1 of Holy Family Hospital, Rawalpindi. 44 patients with confirmed diagnosis of cholelithiasis undergoing LC were included. Their pre-op serum ALT levels were investigated. Immediately after LC, serum ALT levels were repeated to determine post-op serum ALT levels. Data was analyzed with SPSS v22 and in addition to descriptive statistics; Wilcoxon Signed Ranks test for paired data was applied at 5% level of significance. Results: After LC, serum ALT levels increased in 82%, decreased in 14% while remained same in 4% of the patients. Post-op Derangement of serum ALT levels (>43u/l) was observed in 50% of the patients, with normal baselines, undergoing LC. Mean Pre-op ALTs observed were 28±10 u/l while mean post-op ALTs were 42±15 u/l. Mean change observed between Pre op and Post op ALTs of patients after LC was 14±12 u/l. There was highly significant difference in mean pre-op and mean post-op serum ALT levels with P value 0.00. Results were statistically extremely significant. No relation between elevation of serum ALT levels and gender could be established (P value 0.103) while derangement of ALT levels (>43u/l) was observed more in male than in female patients. Mean change in ALT levels after LC increased proportionally with age. Conclusion: Significant change was observed in serum levels of ALT which suggests that pneumoperitoneum created during LC causes hepatocellular ischemia leading to cellular injury which might be the cause of elevation in serum ALT level. [ABSTRACT FROM AUTHOR]

Background: This study was designed to determine the relationship between vitamin D deficiency and asthma in paediatric age group as compared to controls. Asthma is among one the major causes of morbidity in children and it is suggested that vitamin D deficiency plays a role in asthma severity since it has immunomodulatory effects. Methods: This case-control study was performed at Benazir Bhutto Hospital Rawalpindi in paediatric department from January 2015 to May 2015. Cases and controls were recruited from the same hospital through consecutive sampling. Cases were patients with asthma and controls were patients with a minor illness other than asthma presenting in the outpatient department. The patients who had rickets, known vitamin D deficiency, renal disease, liver disease and other respiratory problems (tuberculosis, pneumonia cystic fibrosis) as assessed on medical records or history and examination were excluded both for cases and controls. Vitamin D levels were checked in all patients. The data was recorded and analysis was done through SPSS 14. Results: The two groups were comparable for age and gender. The mean age of patients in cases was7.66+2.92 while among controls it was 7.23± 2.65 years. Among 30 patients with asthma, vitamin D deficiency was found in 19 (63.33%) while in controls it was found in 8 patients (26.67%). P-value was 0.004 which was statistically significant. The odds ratio was 4.75, 95 % confidence interval for odds ration showing a significant difference between the two groups. Conclusion: Vitamin D deficiency was remarkably higher in asthmatics in comparison to non-asthmatic children. [ABSTRACT FROM AUTHOR]

Introduction: Hepatitis C virus is an RNA virus that is affecting almost 170 million people worldwide. Hepatitis C is also associated with increased incidence of chronic liver diseases, liver cirrhosis and hepatocellular carcinoma. Therefore serum levels of ALT are considered to be the more specific indicator of hepatocellular damage than serum levels of AST. Serum ALT levels vary according to age and gender. Materials And Methods:This is a descriptive cross sectional study that was conducted from September 2016 to April 2017 at Centre of Liver Diseases of Holy Family Hospital, Rawalpindi after approval from Institutional Research Forum of Rawalpindi Medical University. Consecutive nonprobability sampling technique was used. The findings of serum ALT levels were classified into 5 groups: <40u/l, 41-60u/l, 61-80u/l,81-100u/l and >100u/l. Normal value of serum ALT levels was <40u/l. Patients were divided into 5 age groups: 10-25 years, 25-40 years, 40-55 years, 55-70 years and >70 years. The data was analyzed using SPSS v22. Frequency and Percentages were calculated for gender, age and serum ALT levels. Results:405 (198 male and 207 female) patients were included in this research. Mean ALT levels in male patients were 89.5u/l while in female patients were 70.4u/l. The difference between their mean values was significant (P=0.016). Serum ALT levels of 24.2% (98) patients were within normal range (<40u/l) while they were deranged (>40u/l) in 75.8% (307) patients. Serum ALT levels were higher in female patients in all age groups Conclusion: It was concluded that serum ALT levels vary significantly with age and gender. Elevation of serum ALT is seen more frequently in male than in female patients although mean ALTlevels are higher in female patients in all age groups than in male patients. [ABSTRACT FROM AUTHOR]

Introduction: Urinary tract infection (UTI) is a common infection in children. It has high morbidity and long-term sequelae. Objective: To determine the frequency of bacteriological organism of Pediatric UTI and its drug sensitivity and resistance pattern and to improve the treatment of UTI according to culture sensitivity, hence minimizing the resistance pattern and disease burden. Materials and Methods: It was a descriptive cross-sectional study conducted in 2018 over a period of 6 months. A total of 225 children with UTIs were enrolled. Urine culture and sensitivity reports were evaluated and an isolated microorganism along with their sensitivities to the mentioned drugs was entered through designed Performa. Results: The average age of the children was 7±.18 years. Common bacteriological agents leading to UTI were E.Coli (59.1%), followed by Pseudomonas aeruginosa (14.2%), Klebsiella (13.8%), staphylococcus aureus (8.9%), and enterococcus (4%). The most common organism isolated was E.coli (133 cultures). It was fully resistant to amoxicillin-clavulanate and ofloxacin (100%), while the resistance pattern with other antibiotics was ceftriaxone (88.7%), imipenem (88.7%), and ciprofloxacin (75.9%). The most effective antibiotic for E.coli was amikacin (81.2%). Pseudomonas aeruginosa was the second most common isolate (32 cultures). Its drug resistance pattern was amikacin (84.4%), amoxicillin & clavulanate (90.6%), imipenem (100%), and ofloxacin (100%). Conclusion: A most common organism that causes UTI was E.coli followed by Pseudomonas Aeroginosa and Klebsiella. These isolates were highly resistant to commonly used antibiotics. Therefore new antibiotics policy should be adopted to treat these infections. [ABSTRACT FROM AUTHOR]

Introduction: Asthma is a common chronic inflammatory disease of the airways characterized by reversible airflow obstruction, and bronchospasm. The first line of treatment in the management of acute asthma is inhaled beta 2 agonists (salbutamol). This study is designed to determine the effectiveness of intravenous dexamethasone compared to oral prednisolone in asthmatic children in preventing exacerbation and relapse. It may be more helpful in improving the quality of life of asthmatic children being a better convenient treatment modality. Aim: To compare the frequency of relapse of asthma with dexamethasone and prednisolone in the treatment of asthma exacerbations in children. Subject and Methods: This is a randomized controlled study that was conducted at the ICU of the Paediatric Department, Holy Family Hospital from 16th March 2016 to 15th September 2016. 468 patients with asthma exacerbation were selected in this study. Patients were randomly allocated into two groups. A total of 234 patients in group A were treated with single IV dose Dexamethasone and 234 in group B were treated with oral prednisolone. Baseline characteristics of children were recorded in the structured proforma along with signs and symptoms assessed through history, physical examination and PRAM (Paediatric Respiratory Assessment Measurement) Scoring. After treatment and assessment, the patients were discharged on day 5 and they were called back by the end of 2 weeks for the final follow up visit. In case of any relapse, they were clearly instructed to immediately return to the hospital which was recorded. Results: The average age of the children 3.31±0.97 years. There were 173(37%) females and 295(63%) males. The rate of relapse was significantly low in group A as compared to group B (9.8% vs. 17.9% p=0.011). Conclusion: it is concluded that dexamethasone is an effective alternative to prednisone in the treatment of moderate acute asthma exacerbations in children, with the added benefits of improved compliance and cost. [ABSTRACT FROM AUTHOR]