ObjectivesTo evaluate the functional outcome, morbidity, and viability of foot salvage in diabetic patients.Materials and methodsThis prospective case series was conducted from March 2007 to December 2012 at the department of surgery Pakistan Ordnance Factories Hospital, Wah Cantt, Pakistan. 123 males and 26 female patients were included in the study. All the patients were treated after getting admitted in the hospital and wounds were managed with daily dressings, nursing care and debridement of necrotic tissue with adequate antibiotic coverage.ResultsIn total, 149 patients (mean age: 56±7.52 years) with 171 amputations were included in the study. The mean duration of diabetes mellitus (DM) was 9±4.43 years. Ninety-seven percent of the patients were diagnosed with type 2 DM. Wound debridement was performed under general anesthesia in 48 (33.2%) patients, whereas local anesthesia was used for the rest of the patients after having good glycemic control and improvement in general health. The most common pathogen isolated from the infected wounds was Staphylococcus aureus in approximately 46% cases. Regarding the types of amputation, partial toe amputation was performed in 21 (12.2%) cases, second-toe amputation in 60 (35%) cases, hallux amputation in 41 (24%) cases, multiple toe amputations in 29 (17%) cases, bilateral feet involvement was observed in 16 (9.3%) cases, and transmetatarsal amputation was performed in 4 (2.3%) cases. The wounds healed well except in 19 cases where amputation had to be revised to a more proximal level. Thirty-nine patients died during the study period: 3 died of wound-related complications and 36 died of systemic complications.ConclusionWith the ever-increasing epidemic of DM, the number of patients with diabetic foot ulcers has also significantly risen. Early surgical management with good glycemic control and foot care with close monitoring can decrease amputations and thus foot salvage can be successfully achieved.

It is very rare to have a big foreign body in the lungs without any complications or symptoms for 2 years. A 14-year-old male with episodes of minor hemoptysis for 4 weeks had a history of inhalation of a bullet 2 years earlier. He had asymptomatic for lung complications for 2 years. The bullet was removed by right thoracotomy and non-anatomical wedge stapled resection, and he followed an uneventful recovery. An aspirated foreign body although big can remain asymptomatic for a long time, especially if it has migrated to the periphery.

Objective: To evaluate clinical presentation and surgical outcome in children with enteric perforation. Methods: A descriptive retrospective study was conducted in Department of Paediatric Surgery at National Institute of Child Health, Karachi from August 2016 and September 2019, in children 12 years of age and under with diagnosis of enteric perforation. Data about age, gender, duration of illness, hemodynamic status and baseline investigation on admission was reviewed. Details about patients operated early and those who required prolong resuscitation and were operated after 24 hours of admission, need for tube laparostomy, operative findings, type of surgical procedure performed and post-operative outcome were reviewed. Data was analyzed using SPSS version 22. Results: Ninety-seven patients, 60(61.85%) males and 37(38.14%) females were managed during the study period with age ranged from 3-12 years (mean 7.82, ± 2.94 years).and duration of symptoms ranged from 7-30 days (mean 15.56, ± 9.39days). High grade fever and abdominal pain were seen in all patients (100%). Pneumoperitoneum was noted in 71(73.19%) cases on X-ray abdomen. Fifty-one (52.57%) children were anemic and required blood transfusion before surgery. Seventy-one (73.19) patients were optimized and operated within 24 hours while 28(28.86%) cases required more resuscitation so tube laparostomy was done initially and operated after 24 hours. Seventy nine (81.44%) cases had single perforation, 14(14.43%) cases had multiple and four had sealed perforation. Primary repair of perforation was done in 37(38.14%) cases, while ileostomy in 65(76.01%) cases. Postoperatively wound infection was seen in 71(73.19%) cases, intra-abdominal collections in 31(31.95%) and burst abdomen in nine (9.27%) cases. Overall mortality was 12.37%. Till date in 47 patients (72.30%) reversal of stoma has been done. Conclusions: Enteric perforation in children presents usually with hemodynamic instability and sepsis due to prolong period of illness. Therefore, regardless of surgical procedure performed it is associated with high morbidity and mortality. doi: https://doi.org/10.12669/pjms.36.5.2270 How to cite this:Azhar M, Zamir N, Shaikh M, Inayat ullah4. Enteric Fever Complicated by Intestinal Perforation in Children: A Persistent Health Problem Requiring Surgical Management. Pak J Med Sci. 2020;36(5):---------. doi: https://doi.org/10.12669/pjms.36.5.2270 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Acute appendicitis, though one of the commonest emergencies in surgical practice. Failure of an early diagnosis could lead to the increased risk in its morbidity and mortality. However a negative appendectomy rate of about 25% is described in the surgical literature. This study was performed to evaluate the usefulness of commonly used laboratory tests like leucocyte count, Creactive protein and use of diagnostic scores like Alvorado score along with radiological imaging modalities to diagnose acute appendicitis and decrease negative appendectomies rates. Misdiagnosis and delay in surgery can lead to complications like perforation and finally peritonitis. METHODS: This study was done in Shadan Teaching Hospital with 200 patients of acute right iliac fossa pain including both genders and all ages. Out of 200 patients, 40 patients were managed conservatively and 160 patients were operated. Clinical evaluation done using Alvorado scores and radiological imaging like ultrasound and plain X-ray of abdomen before operation. Subsequently, histopathological findings of appendix specimen were compared with preoperative tools and results were noted. STATISTICAL ANALYSIS: The data were entered and analyzed using Statistical Package for Social Science (SPSS) version 14.0. The p value was taken as significant when less than 0.05. RESULTS: In proven acute appendicitis, both WBC count & serum CRP levels were raised. WBC count showed 80% sensitivity & 67% specificity in diagnosis. Alvorado score proved helpful to diagnose complicated appendicitis with significant high scores. Ultrasonography of Abdomen had accuracy of only 58.2% in diagnosis. CONCLUSIONS: Alvorado scoring method proved helpful in decision making for operative intervention in acute appendicitis.