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Objective: To determine the accurate ability to diagnose the pleural fluid GeneXpert MTB/RIF assessment in the suspected pleural tuberculosis patients considered as gold standard the pleural biopsy. Materials & Methods: This study was a validation cross-sectional survey and it was conducted in the pulmonology department of Pakistan Institute of Medical Sciences, Islamabad from 1st July to 31st December 2018 after approval of IRB. Participants with suspected pathology ≥ 18 years with exudative pleural effusion were included in the study. By implementing the process of the standard technique, closed needle pleural biopsy was executed by means of ABRAM'S needle. The collected samples of patients were sent to the pathology department of the Pakistan Institute of Medical Sciences for histopathology. Pleural fluid was referred to the National Institute of Health Islamabad for GeneXpert MTB/RIF assessment on the alike day and reports were assembled. All findings were entered in a structured Proforma. Data was entered in SPSS version 20 and analyzed. Results: A total of 180 patients were included; 65.6% of patients were male. When the sensitivity of pleural fluid GeneXpert MTB/RIF examination was calculated it was 10.4% whereas, the calculated specificity was 72.8%. While +ve predictive value of GeneXpert was 22.2% and the -ve predictive value was 52.1%. The likelihood ratio was 8.25 and the ROC curve also showed similar values. Conclusion: The sensitivity of pleural fluid GeneXpert MTB/RIF assay is very low and specificity is moderate for diagnosis of pleural tuberculosis when compared with pleural biopsy. [ABSTRACT FROM AUTHOR]

Background: To compare proportion of the patients with attainment of sensory level T4, at 5 and 10 min supine, and after 10 min prone amongst patients receiving 22.5 mg bupivacaine with those receiving 30 mg. Methods: In this randomized clinical trial patients (n=60), undergoing percutaneous nephrolithotomy, were included. It was done to compare the achievement of sensory level T4 during PCNL after spinal anaesthesia with two doses of bupivacaine before and after positioning patients in prone position. Patients were grouped into: Group A (22.5 mg hyperbaric Bupivacaine 0.75%) versus Group B (30 mg hyperbaric Bupivacaine 0.75%) consisting 30 patients each. Spinal anaesthesia was performed while sitting. Sensory level was checked using icecube in mid-axillary line while patients were positioned supine and prone. Results: Number of patients with T4 level at 5 min and 10 min supine in Group B was much higher than in Group A (p<0.001). In comparison of attainment of T4 level in supine and after 10 min of prone position, more number of patients achieved the level after 10 minutes of prone position in contrast to Group A and it was statistically significant (p<0.001). Conclusion: Positioning in prone extends the sensory level of spinal anaesthesia to higher level (T4) when 22.5 mg of hyperbaric bupivacaine is used and hence reduced dose can be given efficiently and safely for the procedure. [ABSTRACT FROM AUTHOR]

Background: To compare the hemodynamic changes during induction of anesthesia with propofol and sevoflurane in children undergoing forearm orthopedic surgeries. Methods: In this descriptive study 60 pediatric patients, scheduled for forearm orthopedic surgical procedure under general anesthesia requiring LMA insertion were included. The selected patients were allocated into two groups; A (Propofol) and B (Sevoflurane) of 30 each. Group A was induced with IV Propofol 2mg/kg while Group B was induced by sevoflurane 6-8%. Anesthetic induction was supposedly achieved after loss of eyelash reflex. Results: Compared with base line, both groups showed a statistically significant decline in mean arterial pressure after induction. Propofol group (A) showed a larger transient decrease in MAP compared to sevoflurane group (B) (p<0.001). There was a statistical significant overall greater decline in MAP and heart rate after induction with propofol when compared with sevoflurane. Conclusion: Sevoflurane provides slightly better hemodynamic stability compared to propofol during anesthetic induction. [ABSTRACT FROM AUTHOR]

Background: To compare variation in haemodynamics during percutaneous nephrolithotomy in spinal anaesthesia with two doses of hyperbaric bupivacaine (0.75%). Methods: In this randomized comparative study 60 patients, undergoing percutaneous nephrolithotomy, were included. It was done to compare the variation in haemodynamic parameters after spinal anaesthesia using two different doses of local anaesthetic before and after keeping patients in prone position. Patients were divided into two groups: Group A(n=30) (22.5 mg hyperbaric Bupivacaine 0.75%) and Group B (n=30)(30 mg hyperbaric Bupivacaine 0.75%). Spinal block was performed in sitting position. Hemodynamic measurements were carried out at different time points while patients were in supine and prone position. Results: Decrease in heart rate was significant in Group B than in Group A after 10 minutes of spinal block while in supine position (p<0.001) and the drop in heart rate was significant statistically in Group B when patients were turned to prone position (p<0.001). Systolic and diastolic blood pressures decreased in Group B at 5 and 10 minutes in supine position which further decreased following prone positioning and the decrease was highly significant statistically(p=<0.001). Conclusion: 22.5 mg of injection hyperbaric Bupivacaine is haemodynamically safer as compared to 30 mg of the same drug during spinal anaesthesia in percutaneous nephrolithotomy. [ABSTRACT FROM AUTHOR]

Background : To compare low dose peri-operative lidocaine infusion and placebo for post-operative mean pain score and mean analgesic requirement in open cholecystectomy. Methods: In this prospective randomized comparative study 120 patients, undergoing open cholecystectomy in general anaesthesia, were included. Patients were randomly allocated to either lidocaine infusion (L) or saline group (S) using systematic randomized sampling with 60 patients in each group. Patients in the lidocaine infusion group were given bolus injection of lidocaine 30 minutes before the skin incision followed by a continuous intraveonous via infusion pump whereas the patients in the saline group received 0.9% normal saline in equal volume and in the same manner. The infusion was continued throughout the surgery and was terminated 60 min after the skin closure. Results: Out of the 120 patients 34 (28.3%) were male while 86 (71.7%) were female. Mean age was 41.32±11.512 years. Both mean VAS pain score and mean analgesic requirement were found to be significantly lower in the lidocaine Group (p-values 0.04 and 0.29 respectively), as compared to controls. Conclusion: Peri-operative low dose systemic lidocaine appears to reduce pain in the immediate post-operative period. [ABSTRACT FROM AUTHOR]

Background: Serum ferritin levels are usually raised in dengue virus infection. This study was conducted to see the association of raised serum ferritin levels on the day of admission with the disease severity. Methods: In this cross sectional observational study, patients admitted with the diagnosis of dengue fever were included. Serum ferritin levels of all the patients were measured by ELISA on the day of admission. Patients were divided into two groups on the basis of ferritin levels. Group A comprised those with normal ferritin level; those having raised level were included in group B. Patients were followed up during their hospital stay for development of severe dengue. Chi-square test was used as test of significance. Results: out of 104 patients 63.5% (n=66) patients were male and 36.5% (n=38) were female. Mean patient age was 30.7 ± 13.8 years. Mean duration of hospital stay was 3.7 ± 1.02 days. In 70% serum ferritin level was found >100 μg/dl, whereas 30% had ferritin level ≤ 100μg/dl. Out of 31 with normal ferritin level only 2 (6.45%) developed severe dengue, whereas 35 (47.94%) out of 73 developed severe dengue with ferritin level >100 μg/dl( p Value <0.005). Conclusion: Serum ferritin levels on the day of admission may serve as biomarker for an early prediction of disease severity in dengue virus infection. [ABSTRACT FROM AUTHOR]

Abdominal pain has vast differentials and routine etiologies are diagnosed easily. The difficulty arises with an uncommon presentation. This is a case of 28 years old lady presenting to the emergency department of Holy Family Hospital, Rawalpindi with worsening abdominal pain, vomiting, and loose stools over 2 weeks. Abdominal examination and baseline laboratory workup (CBC, electrolytes, septic, renal, and liver profile) were inconclusive. Ultrasound of abdomen revealed matted gut loops with enlarged lymph nodes. CECT abdomen confirmed a non-differentiating tissue collection in the right iliac fossa. Later diagnosis of complicated gossybioma (retained gauze surrounded by fibrotic tissue with entero-enteric fistula and fecolith in appendix) was confirmed by laparoscopy that was surgically removed. Conclusion: Gossybioma is an infrequent but avoidable complication that needs to be considered by the surgeon meticulously especially by swab counting, avoiding staff change over during procedure, and considering in a follow-up visit. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 52-year-old male patient, who developed dyspnea with intermittent cough and diagnosed with pulmonary alveolar microlithiasis (PAM). His chest x-ray showed bilateral distribution of sand-like calcifications throughout the lungs. The rare lung disease has no established effective treatment that leaves lung transplantation as the only effective therapy.

The article presents a case of a 19-year-old healthy woman admitted with complaints of 8-month exertional dyspnea, low grade fever, and sleeping in squatting position. Based on chest X-ray (CXR), she has massive left sided pleural effusion. She was eventually diagnosed with sclerosing mediastinitis, which is also known as fibrosing mediastinitis.

Background: To find out misconceptions about insulin among diabetics presenting in outpatient department of a tertiary care hospital. Methods: in this cross-sectional observational study, diabetic patients either male or female, more than 15 year of age, irrespective of their diabetes typing were included. Patient less than 15 year of age, having dementia, having other mental or psychiatric illness were not included. The sampling technique was non probability random sampling . The study tool was a predesigned questionnaire, containing close-ended questions. . Results: Out of 250 respondents,50% were male. About 69% responded that insulin commencement means serious stage of diabetes and 68% considered as an expensive modality . According to 32% insulin usage restricts daily life activities. Conclusion: Diabetic patients of this area had many misconceptions about the insulin therapy. [ABSTRACT FROM AUTHOR]