BackgroundThe diagnosis of abdominal tuberculosis is a major health challenge. Limited data are available to support the use of GeneXpert MTB/RIF in the diagnosis of abdominal tuberculosis. The current study is an analysis of the sensitivity and specificity of GeneXpert MTB/RIF for the diagnosis of abdominal tuberculosis, keeping histopathology as the gold standard.Materials and methodsA prospective study was conducted in Surgery Unit-I of Holy Family hospital in the year 2017. Data of 21 patients presenting with abdominal tuberculosis were collected. The samples collected were ascitic fluid for GeneXpert and acid-fast bacilli (AFB) and a tissue sample for histopathology, which included either the enlarged lymph nodes or the involved gut segment.ResultsOut of a total of 21 patients, 10 were male and 11 were female. The predominant age group was less than 30 years with 76.2% cases. Of the 21 samples analyzed, all were positive for tuberculosis (TB) by histopathology. GeneXpert was positive in six and negative in 15 patients. The sensitivity of GeneXpert was 28.57% and specificity was 0%. The positive predictive value was 100%. The diagnostic accuracy was found to be 28.57%.ConclusionIn our study, GeneXpert has shown poor sensitivity and specificity for the detection of abdominal TB from ascitic fluid samples. On the basis of this data, we lay stress on finding new tests and biomarkers for the rapid diagnosis of abdominal TB.

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Objectives: To compare open hemorrhoidectomy with internal sphincterotomy versus open hemorrhoidectomy alone in terms of frequency of the postoperative pain. Study Design: Randomized Controlled Trial. Setting: Surgical Unit - I, Holy family Hospital, Rawalpindi. Period: For one year  i.e. from January 2016 to December 2016. Material & Methods: 250 patients were divided in two equal groups by lottery method. The surgical procedure was performed using standard protocols after obtaining written informed consent. Anal dilatation was done  after open hemorrhoidectomy in patients of control group (Group A). In the study group (Group B), the patients were subjected to lateral internal sphincterotomy after completion of classical open hemorrhoidectomy. Postoperative pain score was recorded by using visual analog scale. Difference between both groups for pain was analyzed using chi-square test. Results: There were 68 males and 57 females in Group-A and 61 males and 64 females in Group-B. The mean age of patients in Group-A was 33.10±8.77years and in Group-B was 32.52±9.4years. The mean pain score of patients in Goup-A and Group-B was 2.82±2.51 and 1.59±1.58 respectively (P<0.05). In Group-A, 94 (75.2%) cases had no pain while in Group-B, 116 (92.8%) cases were pain free following the procedure. The difference between both groups was significant i.e. P < 0.05. Conclusion: Open hemorrhoidectomy with internal sphincterotomy is effective in reducing postoperative pain.

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Tuberculosis is one of the leading causes of morbidity and mortality, responsible for annual 7-10 million new cases and 6 per cent of deaths in developing countries. It can involve any part of abdomen but most common is intestinal tract in which it can present with wide variety of symptoms. Early diagnosis and appropriate management is challenging for clinicians. Objectives: To determine the modes of presentation of abdominal tuberculosis and effectiveness of surgical procedures in our setup. Study Design: A retrospective study. Setting: Surgical unit-I of Holy Family Hospital, Rawalpindi. Period: January 2014 to December 2014. Materials and Methods: 50 patients with abdominal tuberculosis were included in the study. Histopathology confirmed the diagnosis of abdominal tuberculosis. Age, gender, mode of presentation, evidence of co-existing tuberculosis, family history, drug history of antituberculous treatment, laboratory and radiological investigations, treatment modalities and duration of hospital stay were recorded. Results: There were 28 female (56%) and 22 male (44%) patients with a mean age of 29± 10.23 years. 56% patients presented with subacute intestinal obstruction, 16% with acute intestinal obstruction and 14% with peritonitis. All 50 patients underwent laparotomy. Ileocecal mass with perforation (40%) was seen as the most common per-operative finding. Limited right hemicolectomy with ileocolostomy (44%) was performed in most of the cases. Mean length of hospital stay was 10 ± 4.67 days. Conclusion: Abdominal tuberculosis is a common cause of acute abdomen especially intestinal obstruction in our setup, with a variable mode of presentation. Early diagnosis with appropriate surgical management and chemotherapy can prevent significant morbidity and mortality.