Objectives: To compare the outcome of non-operative treatment (NOT) with antibiotics versus surgical management of uncomplicated appendicitis in children. Methods: This randomized clinical trial (NCT 04030741) was carried out in Pediatric Surgery Department, Mayo Hospital from September 2018 to September 2019. Total sample size was 180, and after informed consent patients were randomly allocated in two groups. All children between 5 and 15 years of age and having pediatric appendicitis score (PAS) ≥7 were included. Patients with previous abdominal surgery, peritonitis, appendicular mass, or intra-abdominal abscess were excluded. Children in NOT group (Group A) were given intravenous Meropenem and Metronidazole for 48 hours and after starting oral, antibiotics were continued orally for 7 days. In Group B, children underwent appendectomy. Failure of NOT was labeled if there was abscess formation or peri-appendiceal fluid collection on ultrasound, development of peritonitis or recurrence of appendicitis. Results: In Group A, mean age was 9.56±1.8 years and in Group B 10.11±1.8 years. There were 123 male and 57 female patients. Group B had 100% successful outcome. NOT (Group A) had successful outcome in 75 patients (83.3%) and failure was noted in 15 (16.7%). Five needed operation within 48 hours, all had appendicolith, and 10 patients presented within 6 months. Raised total leukocyte count (p value < 0.0001) and C reactive protein (p value < 0.04) levels were noted with failure of NOT. Conclusions: In this study, success of NOT was 84% so a trial of NOT in cases of uncomplicated appendicitis should be considered in children. doi: https://doi.org/10.12669/pjms.37.5.4016 How to cite this:Sajjad MN, Naumeri F, Hina S. Non-operative treatment versus appendectomy for acute uncomplicated appendicitis: A randomized controlled trial. Pak J Med Sci. 2021;37(5):---------. doi: https://doi.org/10.12669/pjms.37.5.4016 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.

We report a rare case of bronchopulmonary extralobar sequestration in a 9-year girl mimicking pulmonary tuberculosis. Patient had recurrent chest infections and two episodes of massive hemoptysis. Preoperative x-ray chest showed an opacity in left lower lobe and computed tomography-aortogram showed that the lesion had systemic arterial supply from celiac trunk. Diagnosis of pulmonary sequestration was made and left lateral muscle sparing thoracotomy was planned. Intraoperatively, extralobar sequestration was found with dual systemic blood supply. Histopathology confirmed it to be a hybrid lesion.

The main reason of conducting this research was to explore the influence of social surrounding, discount level and buying behavior on sales promotion. The research results found that there was no significant relationship of social surrounding, discount level with sales promotion. But on the other hand buying behavior, free sample, price reduction has a significant relationship with sales promotion. The results of this research paper will help the marketers to understand best promotional techniques to increase significantly in their sales as well as revenues. This research paper also plays a vital role in helping businessmen to develop their business planes more effectively so that they can get the competitive advantage over their competitors and make them able to maximize their profits.In total 180 Questionnaires were distributed by hand in different department of Islamia University of Bahawalpur. Data was feed in SPSS. This research was done on different sales promotional techniques.Findings shows that different sales promotional techniques have impact on consumer buying behavior and purchase intention for all type of products on the other hand there is no significant effect of discount level and social surrounding on sales promotion.

Background: Pain in right Iliac fossa is one of the most common presenting symptom in the surgical emergency in which acute appendicitis is the most probable amongst the differentials. Patients with equivocal signs and symptoms pose a significant diagnostic dilemma for which they are admitted for observation. Aim: To compare the efficacy of modified Alvarado scoring system with the routine clinical diagnosis. Study design: A randomized controlled trial was set up to compare clinical diagnosis (control group) with a diagnostic protocol using modified Alvarado scoring system (intervention group). Setting: This study was conducted in a government administered tertiary care referral center (Mayo Hospital Lahore), Pakistan, from Septembers 15, 2019 to September 14, 2020. Method: A total of 256 patients referred to surgical department with suspected appendicitis were included in the study. Patients above the age of 12 years were included in the study. Patients were randomly divided into two groups. Group A included 128 patients who were assessed on the basis of the Modified Alvarado score while the Group B also included 128 patients which were assessed on routine clinical evaluation. Histopathology was the Gold Standard which determined the Diagnostic Accuracy (DA) and Negative Appendectomy Rate (NAR), which were duly recorded. Results: The Diagnostic Accuracy (DA) of the Group A evaluated on the Modified Alvarado Scoring System was 88% in which 113 out of 128 patients were positive for acute appendicitis on histopathology while Negative Appendectomy Rate(NAR) was 12%.Only 15 out of 128 were negative on histopathology . However the Group B had a (DA) of 79% in which 101 patients out of 128 were proven positive through the histopathology while (NAR) was 21%. The mean age of the was found to be 25.34 years with a male to female preponderance ratio of 1.22:1 Conclusion: we have found the Alvarado scoring system to be an effective and a convenient scoring tool. We recommend its regular application in the emergency for the diagnosis of Acute Appendicitis. Keywords: Alvarado score, Acute appendicitis, Histopathology, Clinical diagnosis.