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Meckel's diverticulum is the most common gastrointestinal tract’s congenital abnormality. Spontaneous perforation of Meckel's diverticulum is very rare and can mimic acute appendicitis. Here we report the case of an 11-year-old male patient, who was presented to the Surgical A unit of Ayub Teaching Hospital, Abbottabad on 21st January, 2021 with one-day history of abdominal pain, predominantly in the periumbilical area and right iliac fossa, associated with nausea. On physical examination his abdomen was tense, tender with guarding and generalized rigidity. A provisional diagnosis of perforated appendix or enteric perforation of a hollow viscus was made. The patient had an emergency laparotomy, where a perforated Meckel's diverticulum was discovered. Resection of the portion of gut containing Meckel’s diverticulum was done along with primary anastomosis. Heterotopic gastric mucosa of diverticulitis, associated with perforation was confirmed on histopathology. The patient made an uneventful recovery during postoperative period. ---Continue

Dengue viral illness is endemic in many tropical countries with temperate climates. The haematological and cardiovascular sequelae of dengue are well known; however, respiratory manifestations are still an area of active medical research. We conducted a literature search on PubMed, Medline CINAHIL, EMBASE and found 64 articles on respiratory sequelae of dengue. All relevant original articles and case reports were included and the relevant information regarding the respiratory manifestations of dengue was retrieved from the relevant eligible articles. Respiratory manifestations of dengue range from mild pleural effusion to acute respiratory distress syndrome. The former was the most common complication, seen in 5.1% of patients, followed by acute respiratory distress syndrome (ARDS) in 1.7%, pneumonia in 0.5%, respiratory distress in 0.3%, pulmonary hemorrhage in 0.1%, and haemothorax in 0.01%. Involvement of the respiratory system indicates severe disease and is difficult to manage. Therefore its early detection is important.

Objectives: To determine the “frequency of ‘success’ of non-invasive ventilation (NIV) among patients with type II respiratory failure due to acute exacerbation of chronic obstructive pulmonary disease (COPD)”. Study Design: Cross sectional Study. Setting: Department of Pulmonology Nishtar Hospital Multan. Period: March 2016 August 2016. Material & Methods: A total of 101 study cases meeting inclusion and exclusion criteria of this study were registered using non probability consecutive sampling technique. Arterial samples for arterial blood gases (ABG) were sent. Base line pH and pcO2 were measured. All the patients were offered with NIV for 12 hours. After 12 hours, ABG was again measured to see any improvement in pH and pCO2. Success as labeled as ‘yes’ if pH > 7.35 and pCO2 is < 60 mm of Hg. The patients were discharged and follow up time was adjusted. Results: Out of these 101 study cases, 53 (52.5 %) were male and 48 (47.5 %) were female patients having mean age 61.50 ± 10.77 years. Mean duration of disease was 8.54 ± 5.26 years. Mean BMI levels of our study cases was 23.31 ± 2.18 Kg/m2. Mean baseline pH value was 7.32 ± 0.016. Mean baseline pCO2 value was calculated to be 67.56 ± 6.05 mmHg. Mean pH value at 12 hours after NIV was 7.37 ± 0.02. Mean pCO2 value at 12 hours after NIV was calculated to be 51.32 ± 6.30 mm Hg. Success was achieved in 98 (97%) of our study cases. Success was stratified with regards to gender, age, BMI and duration of disease and p values calculated were found to be p=1.00, p= 0.591, p=0.026 and p=0.606 respectively. Conclusion: Our study results indicate that Non-invasive ventilation (NIV) is effective, reliable, safe and very cost effective method among the patients with respiratory failure due to acute exacerbation of COPD.

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