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Risk assessment for pulmonary embolism (PE) currently relies on physician judgment, clinical decision rules (CDR), and D-dimer testing. There is still controversy regarding the role of D-dimer testing in low or intermediate risk patients. The objective of the study was to define the role of clinical decision rules and D-dimer testing in patients suspected of having a PE. Records of 894 patients referred for computed tomography pulmonary angiography (CTPA) at a University medical center were analyzed. The clinical decision rules overall had an ROC of approximately 0.70, while signs of DVT had the highest ROC (0.80). A low probability CDR coupled with a negative age-adjusted D-dimer largely excluded PE. The negative predictive value (NPV) of an intermediate CDR was 86–89%, while the addition of a negative D-dimer resulted in NPVs of 94%. Thus, in patients suspected of having a PE, a low or intermediate CDR does not exclude PE; however, in patients with an intermediate CDR, a normal age-adjusted D-dimer increases the NPV.

Background: Published studies have reported that acute kidney injury (AKI) and other kidney related manifestations are associated with COVID-19 and linked with poor outcome. This study aimed to determine the incidence, risk factors and outcomes of AKI in hospitalized COVID-19 patients. Methods: This retrospective study of 154 patients involved retrieving data from hospital records confirm COVID-19 infection admitted to the Northwest General Hospital & Research Center, Peshawar from 1st April to 31st July 2020. AKI was defined using Kidney disease. Improving Global Outcomes (KDIGO)” guidelines. Results: Incidence of AKI was 37.01%. Age, gender, intensive care (ICU) requirement, number of co-morbid, diabetes mellitus, coronary artery disease, chronic kidney disease, chronic obstructive airway disease (COAD), arrhythmias among comorbid and fever and shortness of breath among symptoms were found to be significantly differed between AKI and non-AKI patients. Numerous differences of laboratory results such as serum sodium, potassium, total leukocyte count, absolute lymphocyte count and platelets between both groups were observed (p<0.05). Inflammatory markers including lactate dehydrogenase (LDH), ferritin, d-dimer and C-reactive protein (CRP) were significantly raised in AKI group. Overall mortality was observed to be 38 (24.7%). Moreover, age, ICU requirement; COAD, creatinine, serum sodium, inflammatory markers (LDH, ferritin, d-dimers and CRP), total leukocyte count, absolute lymphocyte count, platelets and support requirement were significantly differed between survivors and non-survivors.  Mortality was significantly higher among AKI group, i.e., 52.6% compared to 8.2% in non-AKI group (p<0.001). Conclusion: AKI is common among hospitalized COVID-19 patients and is associated with mortality. In all, AKI patients less than half of the patients survived.

IntroductionAcute appendicitis is a leading cause of abdominal conditions in emergency departments. Evidence from research studies has indicated the efficacies of surgical procedures involving appendectomies. However, in Pakistan, there is a paucity of information regarding the epidemiology, clinical presentations, and surgical management of acute appendicitis. ObjectiveThis paper aims to report the epidemiologic data and findings of surgical management of acute appendicitis in Lahore General Hospital (LGH). The data was based on our two-year experiences of appendectomies in the hospital.

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