Objective: To assess pathological, biochemical and clinical parameters in HCC patients with low, normal and high AFP levels. Methodology: This comparative analytical study was conducted in Liver and Gastric Clinic, Holy Family Hospital, Rawalpindi from June 2019-June 2020.Sample size was calculated as 225 by WHO sample size calculator .  Non randomized convenient sampling was used. Patients were divided into three groups according to AFP values; <200 ng/ml, 200-400ng/ml and >400 ng/ml. Patients demographic details, medical history, clinical symptoms and signs, biochemical parameters and pathological findings on ultrasonography and CECT were assessed. Data was analyzed by SPSS version 21. Descriptive statistics were calculated for categorical   variable.  p Value less than 0.05 was considered significant. Results: Out of 256 patients, 161 (62.9%) were males and 95 (37.1%) were females.The mean age of patients was 60.5 years ±  10.5. 94.4% of patients with HCC had Hepatitis C. Anorexia, jaundice and abdominal distension, hepatomegaly and splenomegaly were more frequent in patients having high AFP level. Serum bilirubin, tumor size, number of lesions, BCLC staging and other pathological parameters associated with HCC worsens as AFP levels increase. Conclusion: Alpha-fetoprotein levels  are  significantly associated with clinical and pathological parameters of hepatocellular carcinoma thus can be used as a better diagnostic and prognostic tool.

Objective: The aim of this study is to report the clinic-pathological profile of children with TBM and their treatment outcome. Methodology: A retrospective observational study was conducted in the Pediatrics Department over 6 months period. Medical records of children admitted with TBM from November 2017 to May 2018 were reviewed for data collection. Data regarding clinical presentation, laboratory investigations were recorded. Patients were treated with a standard ATT regimen, and their outcome was noted. The study was approved by hospital ethics committee. Data was entered in SPSS for statistical analysis. Results: Females were predominant 39 (55.7%) and age ranged from 4 months to 13 years in this study. Only 28 (42.0%) children were fully vaccinated and had BCG scar presence. Most TBM cases were of stage II 24 (42.8%) or stage III 29 (42.8%). The frequent symptoms were fever 61 (87.1%), rigidity/irritability 35 (50.0%), and seizures 26 (37.1%). WBCs count in CSF was found below 500 in 64 (91.4%) children. There were 55 (78.5%) children with lymphocytosis and 14 (20.0%) with polymorph nuclear cells. A CT scan was suggestive of TBM in 51 (72.8%) children. Only 21 (30.0%) cases had a complete recovery whereas 17 (24.2%) recovered with sequelae and 10 (14.2%) deaths were noted. Conclusion: TBM presents with a poor clinical and pathological state in the advanced stage of the disease, and the therapy outcome is also non-satisfactory with high mortality and sequelae posing constant challenges.

Background: Acute appendicitis is a common surgical emergency and if complicated, manifesting as abscess, perforation, suppurative or gangrenous appendicitis, carries significant morbidity and mortality. Its early preoperative diagnosis can improve outcome in patients and reduce incidence of negative appendectomies. It, however, mandates identification of new diagnostic parameters for it. This retrospective study evaluates diagnostic accuracy of serum urea, creatinine, sodium and potassium for complicated appendicitis. Methods: 60 patients with suspected appendicitis were grouped into complicated and uncomplicated appendicitis based on histological reports. Preoperative laboratory results for serum urea, creatinine, sodium and potassium levels were obtained from hospital records. Diagnostic strength of these markers was calculated as specificity, sensitivity and area under curve. ROC curve analysis was used for their diagnostic accuracy. Results: The levels of serum urea, creatinine and K were not significantly different in uncomplicated and complicated appendicitis. However, sodium was significantly higher in complicated appendicitis. ROC curve analysis showed AUC values for all the studied variables to be greater than 0.5. However, none of the markers had good capability to differentiate complicated appendicitis from uncomplicated appendicitis. Conclusion: Serum urea, creatinine, sodium and potassium levels have shown a tendency to be predictive of complicated appendicitis but a strong association could not have been established. Hence, further investigation is warranted