Objective: To describe the technique and results of mucosectomy; A surgical technique that is easy to perform, and has a lower morbidity and complication rate as compared to standard appendectomy in cases of complicated appendicitis. Study Design: Quasi-experimental study. Place and Duration of Study: Surgical - A Unit, Ayub Teaching Hospital, in Abbottabad, from Mar 2017 to Mar 2019. Methodology: Patients included were those who presented with appendicular mass, phlegmon, recurrent appendicitis, appendicitis in uncommon locations, presence of adhesions, those cases of appendicular mass and phlegmon which was either not responding to medical treatment, or diagnosed per operatively being clinically not palpable or not seen on ultrasound. Per operative and post-operative variables were documented and analyzed. In mucosectomy, thesubserosal portion of the appendix i-emuscularis and mucosa of the appendix was dissected out from the serosa after ligation of the appendicular base, or ligation done after delivering the appendix out of the serosa. The serosa that was adherent to the surrounding gut, omentum or other viscera was left intact. Results: A total of 192 patients were included in this study, half of which underwent standard appendectomy and a mucosectomy was performed on the rest. The mean time of surgery was 30 ± 1.2min as compared to the standard appendectomy group (55min ± 3.6). More than half of the patients undergoing standard appendectomy required extension of the incision (56.2%), only 8% required so from those on whom mucosectomy was performed. Per operative hemorrhage was seen in 32.2%, however inmucosectomy group only 1%.

Pakistan has recently witnessed an epidemic of dengue infection and thereafter, certain various presentations of patients with dengue infection have been reported. The cardiac manifestation of dengue infection is primarily an inflammatory response to infection, however, dengue can rarely present as Takotsubo syndrome. Here, we report a the case of a 69-year-old male, who presented with fever and abdominal pain and was diagnosed with dengue fever on serological workup. Just prior to being discharged, the patient developed acute chest pain, and dyspnoea with ST-segment elevation in the anterolateral leads on electrocardiogram and raised cardiac biomarkers. An urgent coronary angiogram showed non-obstructive coronary artery disease with apical ballooning on ventriculography. On the basis of this, the patient was diagnosed as have TTS associated with dengue fever. The patient was medically treated with success and was later discharged. He remains currently asymptomatic and his left ventricular ejection fraction recovered to normal (60%) on repeat echo after 6 months. JRCD 2018; 3 (8): 278-280

Introduction: The severe acute respiratory syndrome coronavirus2 (SARS-CoV2) is a novel beta-coronaviridae family and its effects on the kidneys have been reported which included the increased requirement of renal replacement therapy during the Covid-19 pandemic. Our study is,thus, designed to determine the risk factors of AKI in critically ill patients with covid-19 and their outcomes Method and Material: It is a retrospective observational study of COVID-19 patients admitted in SIDH&RC(specialized facility center for COVID-19) from July 2020 to July 2021. The patients were divided into two groups; one with confirmed critical COVID-19 and had AKI during hospital stay and the other group who have confirmed critical COVID-19 and did not had AKI during hospital stay. Results: Total 232 patients included in this study who were critical at the time of admission in which 92(39.65%) of the patients had AKI during hospital stay. Most of the patients who had AKI were male 55(59.8%). We found that in this population mortality was not significant in critical COVID-19 patients with AKI. However, patients with AKI had worst survival distribution compared to non-AKI patients (p<0.05). Patients with AKI required mechanical ventilation compared to non-AKI patients (70.7% vs 50.7%, p<0.05) along with significant chances of occurrence of complications as superimposed bacterial infections (78.3% vs 52.9%, p<0.05), NSTEMI (33.7% vs 13.6%, p<0.05), septic shock (66.3% vs 38.6%, p<0.05) and progression to severe ARDS (78.3% vs 60.7%, p<0.05).  Conclusion: We found that patients with AKI had a worst survival distribution than non AKI in Critical COVID-19 patients

Objective: To compare the role of the cultural context in determining the use of patient safety by participants from private and public sector hospitals of Karachi, Pakistan. Study Design: Mix method study. Place and Duration of Study: In two tertiary care hospitals (one private and one public sector) of Karachi from Nov 2016 till Nov 2017. Methodology: A sample size of 153 was enrolled by consecutive convenient sampling technique. The role of the cultural context of both hospitals was compared by asking questions from the hospital's staff. Data were collected by the researcher using an open and closed-ended questionnaire. Results: Data of 153 successful and filled questionnaires were analyzed. Out of 153, 78 (51%) cases were for private hospitals and 75 (49%) cases were for public hospitals. The role of the cultural context in determining the use of the patient safety concept was not sufficiently understood by participants of both hospitals, and most of the participants gave vague answers. Conclusion: Cultural context is one of the key factors in patient safety as with collective mindfulness about safety issues, and health care can be delivered safely.