Objective: Our study aimed at identifying the characteristics and etiology of various causes of acute undifferentiated fever in patients presenting to the emergency department of a tertiary care hospital. Methods: This was a retrospective study conducted at the department of emergency medicine, Aga Khan University Hospital from January to June 2016. Adult patients presenting to Emergency department with acute undifferentiated fever were enrolled. Descriptive statistics were calculated in terms of mean±SD for continuous variables like age of the patients and duration of fever, whereas frequency and percentage were computed for categorical variables like gender and causes of fever. Results: A total of one hundred and fifty five patients were included. Out of these 97 (62.6%) were males and 58 (37.4%) were females. Most patients (25.2%, n= 39) were diagnosed as malaria followed closely by dengue fever (n=33, 21.3%) and then enteric fever (n= 10, 6.5%). while 41.9% (n=65) were diagnosed as suspected viral fever based on clinical judgment and inconclusive laboratory results. Conclusion: Malaria was found to be the most common confirmed cause of acute undifferentiated fever followed by dengue and enteric fever. The provision of accurate epidemiological data will enable resources to be directed towards key areas and will be of practical importance to clinicians. doi: https://doi.org/10.12669/pjms.36.6.2334 How to cite this:Ali N, Khan NU, Waheed S, Mustahsan S. Etiology of acute undifferentiated fever in patients presenting to the emergency department of a tertiary care center in Karachi, Pakistan. Pak J Med Sci. 2020;36(6):---------. doi: https://doi.org/10.12669/pjms.36.6.2334 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 is one of the most frequent causes of lower abdominal pain and requires immediate surgical intervention. The diagnosis often poses a lot of challenge even to experienced surgeon. Those patients with equivocal symptoms may require different imaging modalities like radiography, contrast examination and ultrasound with limited utility. Multidetector computed tomography (MDCT) used in suspected acute appendicitis has, however, resulted in improved diagnostic accuracy and also reduction of negative surgeries.ObjectiveWe intend to determine the diagnostic efficiency of MDCT in clinically equivocal cases of acute appendicitis correlating it with surgical/histopathological findings.Materials and methodsA group of 116 patients was included in this study. Spiral MDCT was performed in all these cases after administration of oral and intravenous contrast. All these patients underwent surgery and the CT findings were correlated with histopathology. Out of these 116 patients, 60 patients were male and 56 female. The age range was from three to seventy years and mean age was 28+1 years.ResultsThe results proved that MDCT had a sensitivity of 97.5%, specificity of 97.0%, and accuracy of 97.4% for the diagnosis of appendicitis with one false positive and two false negative cases. The study showed 100% accuracy in diagnosing acute appendicitis in children. In 33 patients, an alternate cause was identified with CT. The alternate diagnosis made on CT findings was consistent with the final diagnosis in 27 (81.8%) of 33 patients in whom there was no evidence of acute appendicitis. The clinical diagnosis disagreed with the CT diagnosis in six patients (18.18%).ConclusionOur study verifies that MDCT plays an important role in evaluation and consequent management of equivocal cases of acute appendicitis. MDCT is also able to diagnose appendicitis or detect alternative diagnosis in pediatric population.

A cross-sectional study was conducted to determine the prevalence, causes and outcome of head injury in children at Neurosurgery Department of Jinnah Postgraduate Medical Centre from 1st December, 2013 to 1st February, 2014. A total of 37 patients under the age of 12 years, presented with head injuries to the emergency department, were included in the study. A self-designed questionnaire was filled for these children after getting the oral consent from their parents. The questionnaire comprised a complete detail on the causes of head injury, clinical presentation on reaching the hospital, X-rays and Computed Tomography (CT) scans of the children and their reports. SPSS version 20 was utilized as an analytical tool. The mean age of patients was 6.93 years ± 3.02. Out of these 37 patients, 54.1% were males and 45.9% were females. Road traffic accidents accounted for most of cases (48.6%) with marked peak observed in boys as compared to the girls. Majority had a good Glasgow Coma Scale (GCS) score (43.2%) whereas a depressed fracture was found to be the dominant feature (21.6%) on X-rays. Additionally, 29.7% of children had intracranial hemorrhage while 32.4% also acquired other injuries. In total 29.7% were offered surgical intervention with majority (83.8%) landing in neurosurgical ward. As head injury in childhood is an important issue, keeping in view the lack of research in this field we need to properly highlight the burden of such injuries in childhood so that all the concerned governing authorities should take every possible step in preventing as well as managing this devastating health concern.

Objective: This study aimed to find out the existing differences in anxiety and depression among patient’s family care providers in public and private health sectors of Karachi. Background: For family care givers, care-giving is extremely rewarding it makes a bond between patient and a care-giver. It makes a union which is indispensable for patient welfare. The wellness of caregiver depends on patient’s condition and level of satisfaction with the circumstances associated with care-giving, undeniably care-giving constitute myriad of stresses, like depression, anxiety, frustration which if not addressed can have serious impact on caregivers health and can even make them resentful of their role as well. The present study was conducted to investigate the major mood changes among patients’ family care givers in public and private health sectors. Method: A cross-sectional study was carried at Jinnah Postgraduate Medical Centre (Public Health Sector) and Liaquat National Hospital (Private Sector) from 1st March till 1st August, 2013. The study was conducted on the family care givers of the patients residing with them at the hospitals. Hospital Anxiety and Depression Scale (HADS) was completed by 288 participants out of 290 caregivers who enrolled in the study. The HADS was used to evaluate the factors and symptoms of mood disorder (anxiety and depression) in the caregivers of patients. Results: Out of 288 participants who completed the HADS, 223 showed a high rate of psychological disturbed state which was more prevalent in the females (79.8%) than males (75.1%). The HADS was equally filled by the caregivers at public health sector (n = 145) and private health sector (n = 145). The total cases of mood disorder is relatively high in the caregiver population and most of the cases were found in public health sector (n = 134) as compared with private health sector (n = 89). Conclusion: Anxiety and depression among the patients family care providers was very appreciable especially in Public Health Sector as compared to Private Health Sector perhaps due to economic burden, doctor-family caregiver relationship and negligence of concerned authorities. We strongly suggest and request concerned authorities to reduce stress and enhance the quality of life of family care-provider.