Hepatitis C--a risk factor for gallstone disease.

BACKGROUND: There is increasing evidence that chronic liver disease is one of the risk factors for gallstone disease. A few published studies have documented the link between Hepatitis C Virus (HCV) related chronic liver disease and increased incidence of gallstones but these studies did not exclude subjects with other risk factors like cirrhosis. This study aimed to establish an association between HCV infection and gallstones by excluding subjects with all other risk factors for gallstones. METHODS: This cross sectional study was carried out at four hospitals of Rawalpindi, Pakistan, over a period of 18 months. It included all cases referred for ultrasound scan of abdomen. A total of 2000 cases, were included in the study by consecutive, non-probability sampling. Anti-HCV antibody test was carried out in all subjects by ELISA and sonography was done to determine presence or absence of gallstones. RESULTS: Patients suffering from HCV had a significantly high percentage of gallstones as compared to seronegative subjects (p = 0.001). In seropositive group, more males had gallstones (p = < 0.001) and prevalence of gallstones was significantly high in younger population with age at or below 40 years (p = < 0.001). CONCLUSION: Risk of gallstone disease is increased in patients suffering from HCV infection. This association is more pronounced in males.

Pulmonary Artery Pseudoaneurysm: A Post-Covid Complication.

We present a case report of a potentially lethal post-COVID complication. A 65-year-old male presented with shortness of breath and fever with chills. He had recently recovered from COVID pneumonia. Contrast enhanced CT scan chest gave the suspicion of pulmonary pseudoaneurysm. CT aortogram revealed a well-defined rounded mass in the right lung mainly occupying the lower lobe of the right lung. Angiography through the right common femoral vein was performed and it confirmed a huge pseudoaneurysm arising from the posteromedial branch of the right descending interlobar artery. As the artery was not found suitable for endovascular embolization, the patient was referred to a thoracic surgeon.

Outcomes of Conservative Management of Acute Appendicitis during COVID-19 Pandemic.

OBJECTIVE: To measure the outcomes of conservative treatment of acute appendicitis. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Fauji Foundation Hospital, Rawalpindi from April to July 2020. METHODOLOGY: All 58 patients (n=58) presenting with acute appendicitis (AA) were included. Assessment was done with Alvarado score (AS) and ultrasound. Treatment was initiated according to the algorithm corresponding with AS. Those with AS score of 4 or less were started on outpatient oral antibiotics. Patients with AS score of 5 or more were admitted for IV antibiotics. If the symptoms and signs resolved, they were sent home on oral antibiotics to complete a course of 5 days. If their condition did not improve in 72 hours or deteriorated at any time, appendectomy was done. Outcomes were recorded and analysed on SPSS. RESULTS: Out of 58 patients, 16 were treated with oral, while 42 with IV antibiotics. This yielded a statistically significant difference on the course of disease (p=0.028). Resolution of symptoms was seen in 27.6% (n=16) with conservative management; whereas, 72.4% (n=42) patients needed a subsequent appendectomy. The difference in operative findings between patients, who had been given oral or IV antibiotics was statistically insignificant (p=0.536). Diagnostic value of leukocyte count (TLC), ultrasound and AS was not found to be significant. CONCLUSION: Non-operative management is successful in about a quarter of the patients of AA. There is very limited value of sonography, laboratory parameters, or AS in confirming the diagnosis of AA. Key Words: Appendicitis, Conservative treatmen, COVID-19.

Outcomes of Conservative Management of Acute Appendicitis during COVID-19 Pandemic.

OBJECTIVE: To measure the outcomes of conservative treatment of acute appendicitis. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Fauji Foundation Hospital, Rawalpindi from April to July 2020.  Methodology: All 58 patients (n=58) presenting with acute appendicitis (AA) were included. Assessment was done with Alvarado score (AS) and ultrasound. Treatment was initiated according to the algorithm corresponding with AS. Those with AS score of 4 or less were started on outpatient oral antibiotics. Patients with AS score of 5 or more were admitted for IV antibiotics. If the symptoms and signs resolved, they were sent home on oral antibiotics to complete a course of 5 days. If their condition did not improve in 72 hours or deteriorated at any time, appendectomy was done. Outcomes were recorded and analysed on SPSS. RESULTS: Out of 58 patients, 16 were treated with oral, while 42 with IV antibiotics. This yielded a statistically significant difference on the course of disease (p=0.028). Resolution of symptoms was seen in 27.6% (n=16) with conservative management; whereas, 72.4% (n=42) patients needed a subsequent appendectomy. The difference in operative findings between patients, who had been given oral or IV antibiotics was statistically insignificant (p=0.536). Diagnostic value of leukocyte count (TLC), ultrasound and AS was not found to be significant. CONCLUSION: Non-operative management is successful in about a quarter of the patients of AA. There is very limited value of sonography, laboratory parameters, or AS in confirming the diagnosis of AA. Key Words: Appendicitis, Conservative treatmen, COVID-19.

HRCT Features Of COVID-19 In Relation To Duration Of Disease.

BACKGROUND: Despite the fact that much has been written on various aspects of COVID-19, literature lacks a detailed and accurate description of HRCT findings in relation to the duration of the disease. The aim of this study was to investigate the difference in HRCT scan findings depending on the time after onset of the disease. The objective of the study is to identify and compare findings of HRCT scan at different time points after onset of the disease. METHODS: A total of 224 patients, scanned over a period of 2 months, were placed in one of the four groups at the time of their scan depending on the days lapsed after their symptoms appeared. All scans were carried out on the same machine. Findings in each group were recorded and compared. A finding showing significant difference between groups indicates its importance in describing the course of the disease. Analysis was done on SPSS 23. RESULTS: Ground glass opacities in posterior segments of one or more lobes was the most common feature and had a significant association with first 5 days of the disease (p=.027). Interlobular thickening and subpleural reticulation, are found between 3-5 days or later in the course of the disease (p=.000). CONCLUSION: Ground glass opacities located in posterior segments are the predominant feature in patients who are scanned up to 5 days after their symptoms appear. This feature is the most common in scans done in asymptomatic cases too. Interlobular septal thickening and subpleural reticulation start appearing at 3 days of disease process.

Inter-Rater Reliability Of Objective Structured Long Examination Record.

BACKGROUND: Objective Structured Long Examination Record (OSLER) scale was introduced in 1997 by Gleeson to improve the long case examination. There is no psychometric evidence to support reliability of OSLER. This study was done to analyse inter-rater reliability of OSLER. METHODS: Two groups of examiners assessed 105 students in long case examination of their final professional examination, using OSLER scale. Group 1 was composed of actual examiners while Group 2 was mock examiners. Kappa statistic and intraclass correlation coefficient (ICC) were used on SPSS 23 to calculate reliability. RESULTS: Mean score awarded by actual examiners was 55.36 (SD=11.2) whereas mean score by mock examiners was 57.74 (SD=14.1). Cronbach's alpha was 0.586, Kappa was 0.019 whereas inter-rater reliability on ICC was 0.413. CONCLUSIONS: Although OSLER is a practical modification of long case examination with good validity, the scale needs to be more structured to improve its reliability.

Effectiveness Of Horizontal Peer-Assisted Learning In Physical Examination Performance.

BACKGROUND: All students cannot be individually trained in physical examination skills due to faculty and time limitations. Peer-assisted learning (PAL) can solve this dilemma if it is used in undergraduate curriculum. Empirical effectiveness of horizontal peer-assisted learning model has not been reported previously. The objective of this study was to compare horizontal peer-assisted learning (PAL) with expert-assisted learning (EAL) in teaching of physical examination skills. METHODS: This is a randomized controlled study (Solomon four group design) carried out at a medical school. A total of 120 undergraduate year 5 students were randomized into two groups to undergo training in four areas of physical examination. Stratified random sampling technique was used. Group 1 was trained by EAL while Group 2 by PAL. Half students from both groups were given a pre-test to assess the testing effect. Both groups were given a post-test in the form of an OSCE. Independent samples t-test and paired sample t-test were used as tests of significance. RESULTS: Group 2 scored significantly higher than Group 1. There was significant difference (p=.000) in mean post-test scores of Group-1 (69.98±5.6) and Group-2 (85.27±5.6). Difference in mean scores was not significant (p=.977) between students who had taken the pre-test and those who had not. CONCLUSIONS: This study has implications in curriculum development as it provides quantitative evidence indicating that horizontal PAL as a learning strategy can actually replace, rather than augment, expert-assisted learning in teaching clinical skills to undergraduate students.