Objective: To determine the impact of endemicity of ascariasis in the manifestation of acute appendicitis. Study Design: Prospective observational study. Place and Duration of Study: General Surgery Department, Combined Military Hospital Skardu, from May 2012 to Apr 2015. Methodology: Patients presenting with symptoms of acute appendicitis were included in the study. Patients were diagnosed after taking detailed history, clinical examination and blood chemistry. All the patients underwent open appendectomy under general anesthesia. Per-operatively presence of worms was assessed in terminal ileum and after that in the lumen of the appendix initially by palpation and then by opening its lumen after it was removed. Histopathologic diagnosis could not be confirmed due to its non-availability as the surgeries were performed in a remote and resource constraint area of the country. Results: A total of 224 patients were included in the study. Out of these, 143 (63.8%) were male and 81 (36.1%) female patients. The mean age of patients was 22 ± 6 years. Per-operatively, 21 (9.3%) patients had worms in both ileum and appendicular lumen while 22 (9.8%) patients had worms only in the terminal ileum and there were no worms seen in either ileum or appendix in 181 (80.8%) patients. Conclusion: There is a relation of parasitic infestation especially Ascaris lumbricoides in the manifestation of acute appendicitis in endemic areas.

Objective: To determine the diagnostic accuracy of extended focused assessment with sonography for trauma (E-FAST) for detecting thoraco-abdominal trauma, keeping contrast-enhanced CT chest and abdomen as the gold standard. Study Design: Cross-sectional study. Place and Duration of Study: Department of Radiology, Combined Military Hospital, Quetta, from Jan 2020 to Aug 2021. Methodology: A total of (n=196) patients, of age 18-60 years, of both genders, who sustained thoraco-abdominal injuries and were referred for contrast-enhanced Computed tomography of the chest and abdomen were enrolled in the study. Patients were subjected to the thorax and abdomen ultrasonographic examination first and then underwent a contrast-enhanced CT scan of the thorax and abdomen. The findings of both modalities were recorded and subjected to statistical analysis to confirm the accuracy of ultrasound, considering CT-scan as a gold standard procedure. Results: The mean age of the patients was 35 10.6. There were 164 (83.7%) males and 32 (16.3%) females. Blunt trauma was seen in 131 (66.8%) and penetrating trauma in 65 (32.2%) patients. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of E-FAST for chest trauma was 79.4%, 94.7%, 87.6%, 90.7% and 89.8% respectively, for abdominal trauma was 68.6%, 95.2%, 88.8%, 84.5% and 85.7% respectively and for combined chest and abdominal trauma was 77.1%, 95.9%, 85.9%, 92.8% and 91.3% respectively. Conclusion: E-FAST has good diagnostic accuracy for the chest, abdominal and both thoraco-abdominal trauma and can be incorporated into the routine assessment of patients presenting with trauma.

Objective: To analyze the commonest threats which lead to the failure of a permanent vascular haemodialysis access. Study Design: Prospective observational study. Place and Duration of Study: Department of Vascular Surgery, Combined Military Hospital Rawalpindi, from Nov 2018 to Nov 2019. Methodology: All patients who presented with arteriovenous fistula (AVF) or arteriovenous graft (AVG) related complications which can potentially fail an access were included. The frequency, with which these complications occurred, was noted. Results: A total of 158 patients were included, 73 (46.20%) were male and 85 (53.80%) were females. The complications observed in order of frequency were arteriovenous fistulathrombosis (anastomotic or draining vein) in 60 (38%), pseudo aneurysms in 39 (24.68%), stealing veins causing non-maturity of the access in 14 (8.86%), venous hypertension causing extremity edema in 14 (8.86%) (7 due to stealing veins and 7 due to central venous stenosis), AVF anastomotic or draining vein stenosis in 8 (5.06%), wound hematoma in 5 (3.16%), wound infection in 5 (3.16%), true aneurysm of the draining vein in 4 (2.56%), steal syndrome in 3 (1.9%), wound seroma in 3 (1.9%), post op arm edema(not related to central vein stenosis orstealing veins) in 2 (1.26%) and compression neuropathy in 1 (0.6%) of the patients. Conclusion: Complications of vascular access are the potential threats to the life of a permanent vascular access. Early diagnosis and timely intervention can help in fistula salvage.