Validation of various scoring systems in diagnosis of acute appendicitis

NEED OF THE STUDY: Acute appendicitis is a commonly presenting acute condition in emergency department. It needs prompt diagnosis without any delay to avoid complications such as mass, abscess, perforartion and peritonitis which may lead to increase in morbidity and mortality. Incorrect diagnosis may miss the underlying other pathology and also cause unnecessary morbidity. There are various scores available to diagnose acute appendicitis such as: 1) Alvarado score -1986, 2) Samuel score- 2002 (child 4-15 yrs), 3) Tzanaki score (tzanaki et al 2005), 4) Appendicitis inflammatory response score( Anderson & Anderson 2008), 5) Ohmann score (ohmann et al 1995), 6) Lintula score (lintula et al 2005), 7) Fenyo lindberg scoring system (fenyo et al 1997). Many of these scoring systems require radiological and laboratory investigations which are not feasible in all institution, so im chosing modified Alvarado scoring, Ohmann scoring, Eskelinen scoring, which can be done in all institutions with clinical parameters and basic investigations. OBJECTIVES OF THE STUDY: 1. To do observational study of the various diagnostic scoring systems in the diagnosis of acute appendicitis. 2. To compare the sensitivity, specifity of Modified Alvarado scoring, Ohmann scoring, Eskielinen score. 3. To analyse the accuracy of this scoring with HPE report or intra-operative findings. MATERIALS AND METHODS: 1. SOURCE OF DATA: Cases admitted in M.G.M.G.H with suspicion of appendicitis. Patient was monitored and scored by the various diagnostic scoring systems. 2. STUDY DESIGN AND SAMPLING: On a average of fifty cases with provisional diagnosis of acute appendicitis between Sep 2012- Oct 2014. The decision of appendicectomy was taken by the senior surgeon irrespective of the score. INCLUSION CRITERIA: 1) All patients who present at the emergency department with clinical suspicion of acute appendicitis. 2. Age group > 10 yrs - < 70 yrs. 3. Both sexes. 4. Hemodynamically stable patients without concurrent illness. EXCLUSION CRITERIA: 1. Patients with other known causes of pain. 2. Patients undergone previous appendicectomy. 3. Age < 10 yrs. 4. Age > 70 yrs. 5. Hemodynamicallly unstable patients. CONCLUSION: In our study, the better scoring system in the diagnosis of appendicitis based on clinical parameters and simple lab investigation, which is comparable to study conducted by *H.Sitter, S.Hoffmann, J.Hassan, A.Zielkl Et Al Study Langenbeck‘S Archives of Surgery at June 2004, Vol 389.among these scoring system Modified Alvardo had better sensitivity. But its variable in other subgroups according to age and sex variation. The parameters of these three scoring systems are mostly same, but the idea of improving the diagnostic accuracy simply by assigning numeric values to defined signs and symptoms has been a goal. It is well known that sex and age play an important role in the presentation of acute appendicitis. These scoring systems, do not take into consideration different diagnostic weights of each parameter in different subpopulation. No single score may be used alone to dictate or decline surgey, different cut-off points may also be considered for different subpopulation

Image Analysis as a Tool for Estimation of Red Peppers’ Color

Red pepper is an excellent source of natural red color. The estimation of color is of great importance, as it is being used for grading red peppers to suit various applications in the food industry. A novel method for quick and easy determination of the color of red peppers by analyzing the color images obtained from a flatbed scanner was developed and validated. ImageJ software was used for measuring the RGB values of the images and the RGB values thus obtained were converted into the industrially accepted American Spice Trade Association (ASTA) color values in red peppers by using an empirical formula. The results were compared with color values obtained through ASTA chemical analytical method. The developed image analysis method was used for the analysis of red peppers with color values ranging from 15 to 154 ASTA units. The image analysis method showed good agreement with the chemical method for color values ranging from 40 to 140 ASTA units. The new method is also fast and easy to adopt and is deemed useful in the field, of processing and storage facilities, where access to sophisticated instrumentation for color estimation and color stability studies is limited.</p

The role of lateral and medial posterior tibial slope in anterior cruciate ligament injuries: a case-control study

Background: The anterior cruciate ligament (ACL) is one of the major stabilisers of the knee   and is the most frequently involved ligament in knee injuries and related functional instability. The objective of the study was to compare the lateral posterior tibial slope (LPTS) and medial posterior tibial slope (MPTS) among those with ACL injury and those with the intact ligament.Methods: MRI of 65 (male-43, female-22) ACL injured and 65 (male-58, female-7) ACL intact knees were studied. Using RadiAnt DICOM viewer software, the slopes of both medial and LPTS s were measured. The statistical analysis was performed by IBM SPSS 25. Associations between various factors were assessed using the Chi square test for categorical variables and independent t test were done for quantitative variables. P&lt;0.05 had been considered statistically significant.Results: Among cases the mean LPTS was 10.230±3.930 and mean MPTS was 6.610±3.490. Among controls, mean LPTS was 8.460±3.630, mean MPTS was 5.510±2.910. Case had a statistically significant (p=0.009) steeper LPTS than control population. MPTS of cases were steeper than the control population with no statistical significance (p=0.055).Conclusions: In this study, the LPTS was significantly increased among patients with ACL injury as compared with ligament-intact controls. LPTS measurements should be considered as a significant independent modifiable risk factor for ACL injury

Eaton’s reagent catalysed alacritous synthesis of 3-benzazepinones

An expeditious method for the synthesis of 3-benzazepinones has been developed by using a mixture of phosphorus pentoxide-methane sulfonic acid (Eaton’s reagent) at room temperature under solvent and metal catalyst free condition. Wide functional group tolerance, mild reaction conditions, simple procedure, ease of work-up and high yields is the citable features of this protocol

Antibacterial properties of fucoidan from thirteen Indian brown seaweeds against various pathogenic bacteria

The present study aimed to evaluate the antibacterial properties of hot water extracted fucoidan from thirteen Indian brown seaweeds against various pathogenic bacteria. The agar-well diffusion method was used to assess the antibacterial test of different fucoidan. The results revealed that S. vulgare fucoidan had higher antibacterial activity against many pathogenic bacteria, while fucoidan from other brown seaweeds had the least or no antibacterial activity in comparison to S. vulgare fucoidan. Therefore, we evaluated the minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), and brine shrimp toxicity assay in S. vulgare fucoidan. The MIC and MBC values were found to be 1.25 mg/mL and 10 mg/mL in S. vulgare fucoidan against pathogenic bacteria. S. vulgare fucoidan were found to be nontoxic as no mortality (Artemia) was found at different fucoidan concentrations. In addition, characterizations such as ultraviolet-visible spectroscopy, fourier-transform infrared spectroscopy, thermogravimetric analysis, differential scanning calorimetry, and scanning electron microscopy were studied in Sargassum vulgare fucoidan and revealed the properties of fucoidan. This study revealed that hot water extracted fucoidan may have other biological activities but not antibacterial action. Furthermore, studies may reveal the mode of action in fucoidan

Isolation and characterization of a novel agarolytic bacterium vibrio SP.B4-6A from coral reef ecosystem off Tutiocorin

Isolation and characterization of a novel agarolytic bacterium vibrio SP.B4-6A from coral reef ecosystem off Tutiocori

5′′-(4-Chloro­benzyl­idene)-1′,1′′-dimethyl-3′-phenyl­acenaphthene-1-spiro-2′-pyrrolidine-3′-spiro-3′′-pyridine-2,4′′-dione

In the title compound, C34H28Cl2N2O2, the five-membered pyrrolidine ring adopts an envelope conformation and the six-membered piperidinone ring is in a distorted half-chair conformation. The mol­ecular structure shows three intra­molecular C—H⋯O inter­actions and the crystal packing is stabilized through inter­molecular C—H⋯O and C—H⋯π inter­actions

Frictional behaviour of AA7050/7.5B4Cp/Gr hybrid composites fabricated through stir casting

In this research, AA7050 aluminium alloy strengthened with Boron carbide (B4Cp) and Graphite (Gr) was manufactured by stir casting. The impact of the reinforcing particles on various process parameters on the friction coefficient were thoroughly examined utilizing pin-on-disc apparatus with experiments centred on design of experiments. The outcomes exposed that the coefficient of friction decreases with upsurge in percentage reinforcement and increases with applied load, and sliding distance. With respect to the sliding velocity it decreases until a saddle point, there after it starts to increase. Utilising the response surface methodology, a mathematical model for the friction coefficient was established

1′-Methyl-4′-(1-naphth­yl)-3′′-(1-naphthyl­methyl­ene)acenaphthene-1-spiro-2′-pyrrolidine-3′-spiro-1′′-cyclo­hexane-2,2′′-dione

In the title compound, C42H33NO2, the six-membered cyclo­hexa­none ring adopts a slightly distorted chair conformation and the five-membered pyrrolidine ring is in an envelope conformation. The mol­ecular structure features four intra­molecular C—H⋯O inter­actions and an intra­molecular C—H⋯π inter­action. Furthermore, the crystal packing is stabilized by an inter­molecular C—H⋯O and three inter­molecular C—H⋯π inter­actions