Of the apparently healthy adult Indian central government employees, 15.04% and 13.12% were found to have early stages of CKD using the MDRD and CKD-EPI criteria for GFR, respectively.

Introduction: Chronic kidney disease (CKD) is associated with significant morhidity and mortality. Screening and detection of early stages of CKD can help institute interventions that may delay the progression of the disease. One aim was to study the prevalence of early stages of CKD in the Army. Methods: A cross-

Background: Appendicitis is the most commonly performed emergency abdominal surgery. An accurate and timely diagnosis of acute appendicitis remains a challenge. Objective: This study was performed to determine and correlate between the clinical patterns of acute appendicitis, laboratory and ultrasound findings and pathology found in appendicectomy specimens to help timely diagnosis and reduce negative appendicectomy rate. Methods: This is a cross sectional study, detailed history and clinical examination of the patient was carried out at the time of admission. Operative findings along with any complications as well as histopathological findings were recorded. Patients were followed up for one month for any complications. Results: A total of 125 patients were treated for appendicitis during this period with a male female ratio of 1:1.36. Most common age group was the 2 nd decade with mean age being 20 years, while most common symptom was abdominal pain. Ultrasonography showed evidence of acute appendicitis in 85.6% and leucocytosis in 66.4% cases. Although only 5.6% of appendices grossly appeared normal during surgery, histopathology showed 14.4% to be normal. Wound sepsis (24.8%) was the most common post-operative complication. Conclusion: Diagnosis of acute appendicitis in our setting is still based on high index of suspicion following clinical evaluation. Combining this with laboratory findings and ultrasound scan has yielded an acceptable negative appendicectomy rate. We advocate routine use of ultrasound along with clinical evaluation and laboratory tests for the timely diagnosis of acute appendicitis and an early surgical intervention to prevent complications.

Purpose: To compare the efficacy of eye-drop interferon (IFN) α-2b 1 millionIU/mL with eye-ointment tacrolimus 0.03% in refractory vernal keratoconjunctivitis (VKC). Materials and Methods: Fifty patients with VKC refractory to conventional treatment with topical corticosteroids and antihistamines after 4 weeks of regular use were selected retrospectively. Patients were divided into two groups depending on whether they received eye-ointment tacrolimus 0.03% three times a day or eye-drop IFN alpha-2b 1 millionIU/mL three times a day and were followed up for 24 months. The main outcome measures were total subjective symptom score (TSSS) and total objective ocular score (TOSS). Results: Mean baseline TSSS was 7.24±1.98 in Group A (tacrolimus group) and 7.84±1.82 in Group B (IFN group), and it reduced to 1.12±0.83 in Group A and 0.62±0.41 in Group B at 6 months, which was statistically significant compared to the baseline score (p<0.05) as well as between the two groups. Mean baseline TOSS was 6.72±2.07 in Group A and 6.56 ±2.04 in Group B, and it improved to 1 month onwards to 1.52±0.87 in Group A and 1.0 ±0.71 in Group B at 6 months, which was statistically significant compared to the baseline score (p<0.05) as well as between the two groups. Side effects like stinging and burning sensations were seen in the tacrolimus group only. Conclusion:Our study suggests that while both eye-drop IFN α-2b 1 millionIU/mL and eye-ointment tacrolimus eye ointment 0.03% are both safe and effective steroid-sparing agents in steroid-resistant VKC. IFN α-2b results in greater improvement in subjective symptoms and objective signs, has fewer side effects in long term and is better tolerated as compared to tacrolimus.

Necrotizing myositis is a rare and fatal disease of skeletal muscles caused by group A beta hemolytic streptococci (GABHS). Its early detection by advanced imaging forms the basis of current management strategy. Paucity of advanced imaging in field/rural hospitals necessitates adoption of management strategy excluding imaging as its basis. Such a protocol, based on our experience and literature, constitutes:i. Prompt recognition of the clinical triad: disproportionate pain; precipitous course; and early loss of power-in a swollen limb with/without preceding trauma.ii. Support of clinical suspicion by 2 ubiquitous laboratory tests: gram staining-of exudates from bullae/muscles to indicate GABHS infection; and CPK estimation-to indicate myonecrosis.iii. Replacement of empirical antibiotics with high intravenous doses of sodium penicillin and clindamycin iv. Exploratory fasciotomy: to confirm myonecrosis without suppuration-its hallmark v. Emergent radical debridement vi. Primary closure with viable flaps -unconventional, if need be.