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Objective: To validate ‘stress only’ protocol against ‘rest stress protocol in normal and essentially normal cases undergoing Tc99m MIBI gated myocardial perfusion Single Photon Emission Computed Tomography imaging. Study Design: A retrospective observational study. Place and Duration of Study: Department of Nuclear Cardiology, Armed Forces Institute of Cardiology/National Institute of Heart Disease, Rawalpindi, Pakistan, from Jul to Sep 2019. Methodology: 136 cases were included. Patients underwent Tc-99m gated Single Photon Emission Computed Tomography MPI using a single day, rest/stress protocol. The rest study was performed first with 8-10 mCi Tc-99m MIBI followed by stress study, 3 hours later with 3 times the rest dose. The most common stress technique was pharmacological stress and bicycle ergometer exercise with 0.14 mg/kg/min adenosine infusion. Few patients underwent physical stress using Bruce protocol, achieving a minimum of 85% of the target heart rate. Mages–stress followed by rest–were evaluated by two experienced nuclear cardiologists (blinded to the MPI reports) and interpreted as ‘normal’ or ‘essentially normal’. Results: Evaluation of stress-only and rest-stress Single Photon Emission Computed Tomography myocardial images yielded a concordance rate of 84.56% with Cohen’s kappa coefficient of 0.69. Conclusion: Substantial agreement and good concordance were found in normal and essentially normal ‘stress only’ and ‘rest stress protocols. [ABSTRACT FROM AUTHOR]

Objective: To compare the mean hospital stay, mean operative time and frequency of port site infections in patients with early-perforated appendix managed laparoscopically versus open approach. Study type, settings & duration: The randomized control trial was conducted at surgical unit-2, Holy Family Hospital, Rawalpindi, Pakistan from May 2015 to April 2016. Methodology: All patients diagnosed on CT as perforated appendix presenting to emergency department were included and randomized by lottery method to open and laparoscopic appendectomy group. Open approach was by lower midline laparotomy. Abdomen was closed however skin was left open. Laparoscopic appendectomy was done by creating pnuemo-peritoneum by 3-port technique. Appendectomy and peritoneal lavage with normal saline was done in both groups. Appendix was retrieved through an endobag in laparoscopic group. Results: Of the total 130 patients, Mean operative time was 46.98±2.99 minutes in laparoscopic surgery and 53.02±2.88 minutes in open surgery group with p value of 0.0001(showing a statistically significant difference), length of hospital stay was 4.38±1.09 day in laparoscopic surgery and 4.18±0.77 days in open surgery group (p value = 0.23, showing insignificant difference). Surgical site infection (port site infection and laparotomy access wound) was seven (10.77%) in Laparoscopic group and eighteen (27.69%) in open surgery group (p value = 0.01, showing significant difference). Conclusion: Frequency of surgical site infection, mean hospital stay and mean operative time in the patients with perforated appendix managed laparoscopically are significantly lower when compared with open approach. However mean hospital stay in both groups was same showing non significant difference. [ABSTRACT FROM AUTHOR]