Perforated appendicitis: accuracy of ct diagnosis and correlation of ct findings with the length of hospital stay

Objective: To determine the sensitivity and specificity of CT findings in the differentiation of perforated from nonperforated appendicitis and correlate CT diagnosis with the length of hospital stay.STUDY Design: An analytical study.PLACE AND DURATION OF STUDY: This study was conducted at Radiology Department of Aga Khan University Hospital, Karachi, from January 2004 to June 2005.PATIENTS AND Methods: The study included 70 patients who presented with right lower quadrant abdominal pain and underwent pre-operative CT scan followed by appendectomy. Patients were divided into two groups of having perforated and nonperforated appendicitis on the basis of CT scan findings. The surgical and pathological reports combined were considered the reference standard for the diagnosis of perforated appendicitis. Various CT scan findings and average duration of hospital stay in days was compared by t-test.Results: Twenty-six (37%) of 70 patients had perforated appendicitis. It was correctly identified on pre-operative CT scan in 18 patients. There were 18 true positive diagnoses, 43 true negative diagnoses, 1 false positive diagnosis and 8 false negative diagnoses which yielded a sensitivity of 69%, specificity of 97%, positive predictive value of 94% and negative predictive value of 84%. Mean length of hospital stay in perforated group was 6.3 days and 2.9 days in nonperforated group. Severe periappendiceal inflammation, periappendiceal and or abdominopelvic fluid and abscess were significantly associated with perforated appendicitis and with a significant longer hospital stay (p \u3c .001).CONCLUSION: CT scan is 69% sensitive and 97% specific for the diagnosis of perforated appendicitis and constellation of CT findings can be used to select patients with perforated appendicitis for initial non-operative management. Presence of CT signs of significant appendiceal inflammation is independent predictor of longer hospital stay

Synthesis, single crystal X-ray diffraction, Hirshfeld surface and biological activity of quinolone derivatives

Two new quinolone derivatives, 5-nitroquinolin-8-yl-3-bromobenzoate (1) and 5-nitroquinolin-8-yl-3-chlorobenzoate (2), were synthesized and their structures were elucidated using X-ray diffraction techniques. Both compounds crystallized in P21/n (monoclinic) space group having four independent molecules in asymmetric unit. The dihedral angle between benzene and planner quinoline rings in compounds 1 and 2 were found to be 117.7(2) and 117.4(2)ᵒ, respectively. No intermolecular hydrogen bonding was observed in compound 1. However, C-H···O intermolecular interaction was found to connect the molecules in crystal lattice of compound 2. Hirshfeld surfaces analysis was performed to evaluate the directions, and strength of interactions of molecules of compounds and 1 and 2 with neighbouring molecules, and the major contribution in the crystal packing was due to O-H (1, 24.6% and 2, 25.1%) interactions. The synthesized quinoline derivatives were found as potent anti-bacterial agents against E. coli reference (ATCC25922 and ATCC 35218) and multi-drug resistant strains (M2 and M3) with 91.42 to 94.72% inhibition. Both compounds 1 and 2 showed weak antileishmanial activity against L. Major promastigotes in vitro with IC50 values 73.2±3.1 and 72.2±2.3 mg/mL, respectively, and also found as cytotoxic in nature against 3T3 fibroblast cell line

EFFECT OF ETHANOLIC EXTRACT OF GLYCYRIZZA GLABRA AGAINST STEREPTOZOTOCIN AND HIGH FAT DIET INDUCED DIABETES AND HYPERLIPIDEMIA

Objective: To study the effect of ethanolic extract of Glycyrrhiza glabra against streptozotocin and high-fat-diet-induced diabetes and hyperlipidemia.Methods: The present study was conducted on a 14 d model in which Glycyrrhiza glabra extract was given to Streptozotocin (STZ; 50 mg/kg; i. p.) induced diabetic rats fed with high fat diet (HFD), and its protective effect has been studied. The antihyperlipidemic and antihyperglycemic effects have been evaluated on the basis of physical, biochemical as well as histomorphological parameters.Results: The Glycyrrhiza glabra extract pre-treated group showed a significant decrease in biochemical parameters like Total cholesterol (TC), Triglyceride (TG), High-density lipoprotein (HDL), Lactate dehydrogenase(LDH), Alanine transaminase (ALT) compared with D-HFD group (p<0.01). The pre-treated groups also showed significant protection in physical parameters as compared to D-HFD group (p<0.01) which was also confirmed by histopathological studies. All these results were compared and found to be similar with two standard drugs metformin (500 mg/kg) and atorvastatin (10 mg/Kg).Conclusion: This study concluded that alcoholic extract of Glycyrrhiza glabra (500 mg/kg) has significant antidiabetic and antihyperlipidemic potential against streptozotocin and high-fat diet induced diabetic hyperlipidemic rats comparable to the clinically used drugs.Keywords: Atherosclerosis, Diabetic hyperlipidemia, Diabetes mellitus, Hyperlipidemia, Lipid profile, Streptozotoci

α-Haloarylsulfonamides: Multiple Cyclization Pathways to Skeletally Diverse Benzofused Sultams

The development of new methods to skeletally diverse sultams based on a central α-halo benzene sulfonamide building block is reported. Several salient features of this building block are utilized in multiple reaction pathways, including the Heck reaction, C- and O-arylation, Sonogashira-Pauson-Khand, Sonogashira-intramolecular hydroamination, lithiative cyclization and domino aza-Michael Heck for the generation of 5-, 6- and 7-membered benzofused bicyclic and tricyclic sultams

What influences family planning in rural Pakistan: Franchised service provider and community health worker perspective

Background: Pakistan has a low modern contraceptive prevalence rate, 26%, leading family planning (FP) programmes to explore partnerships with local private providers to improve access to quality FP services. This study aims to understand the socio-cultural and organizational factors that influence delivery of quality family planning services. Methods: This qualitative study was conducted with private service providers and community health workers (CHW) in Marie Stopes Society\u27s (MSS) social franchise network. A total of 31 providers and 28 CHWs from Sindh, Punjab, and Khyber Pakhtunkhwa provinces of Pakistan were purposively selected for in-depth interviews. The study used thematic content analysis to understand providers\u27 and health workers\u27 perspectives of family planning service provision. Results: This study found that normative environment, propagation of myths and misconceptions, and health concerns remain major barriers to service provision in rural communities. Findings showed that CHWs were instrumental in increasing awareness and positive attitudes towards family planning in the catchment areas. Moreover, social franchising was effective in increasing access to high-quality, subsidised family planning services amongst economically marginalised and low-awareness communities. Providers and health workers expressed satisfaction with the franchising approach, and revealed that being part of this network substantially increased their client volume and ability to serve poorer segments of the population. Conclusion: The study found that franchising private service providers in rural areas enhances their ability to serve clients, and when coupled with demand-generation elements, such as vouchers and community health workers, it substantially increases their client volume. Albeit effective, the franchising approach currently lacks the element of long-term service provision at the current scale, and may require further strategizing by the franchisor. Moreover, alternate strategies should be explored to ensure continued provision of FP services without vouchers and CHWs

Synthesis and Evaluation of Anti-HIV Activity of Mono- and Di-Substituted Phosphonamidate Conjugates of Tenofovir

The activity of nucleoside and nucleotide analogs as antiviral agents requires phosphorylation by endogenous enzymes. Phosphate-substituted analogs have low bioavailability due to the presence of ionizable negatively-charged groups. To circumvent these limitations, several prodrug approaches have been proposed. Herein, we hypothesized that the conjugation or combination of the lipophilic amide bond with nucleotide-based tenofovir (TFV) (1) could improve the anti-HIV activity. During the current study, the hydroxyl group of phosphonates in TFV was conjugated with the amino group of L-alanine, L-leucine, L-valine, and glycine amino acids and other long fatty ester hydrocarbon chains to synthesize 43 derivatives. Several classes of derivatives were synthesized. The synthesized compounds were characterized by 1H NMR, IR, UV, and mass spectrometry. In addition, several of the synthesized compounds were evaluated as racemic mixtures for anti-HIV activity in vitro in a single round infection assay using TZM-bl cells at 100 ng/mL. TFV (1) was used as a positive control and inhibited HIV infection by 35%. Among all the evaluated compounds, the disubstituted heptanolyl ester alanine phosphonamidate with naphthol oleate (69), pentanolyl ester alanine phosphonamidate with phenol oleate (62), and butanolyl ester alanine phosphonamidate with naphthol oleate (87) ester conjugates of TFV were more potent than parent drug TFV with 79.0%, 76.5%, 71.5% inhibition, respectively, at 100 ng/mL. Furthermore, two fatty acyl amide conjugates of tenofovir alafenamide (TAF) were synthesized and evaluated for comparative studies with TAF and TFV conjugates. Tetradecanoyl TAF conjugate 95 inhibited HIV infection by 99.6% at 100 ng/mL and showed comparable activity to TAF (97–99% inhibition) at 10–100 ng/mL but was more potent than TAF when compared at molar concentration

Effects of coagulation on the two-phase peristaltic pumping of magnetized Prandtl biofluid through an endoscopic annular geometry containing a porous medium

In this article, motivated by more accurate simulation of electromagnetic blood flow in annular vessel geometries in intravascular thrombosis, a mathematical model is developed for elucidating the effects of coagulation (i.e. a blood clot) on peristaltically induced motion of an electrically-conducting (magnetized) Prandtl fluid physiological suspension through a non-uniform annulus containing a homogenous porous medium. Magnetohydrodynamics is included owing to the presence of iron in the hemoglobin molecule and also the presence of ions in real blood. Hall current which generates a secondary (cross) flow at stronger magnetic field is also considered in the present study. A small annular tube (endoscopic) with sinusoidal peristaltic waves traveling along the inner and outer walls at constant velocity with a clot present is analyzed. The governing conservation equations which comprise the continuity and momentum equations for the fluid phase and particle phase are simplified under lubrication approximations (long wavelength and creeping flow conditions). The moving boundary value problem is normalized and solved analytically (with appropriate wall conditions) for the fluid phase and particle phase using the homotopy perturbation method (HPM) with MATHEMATICA software. Validation is conducted with MAPLE numerical quadrature. A parametric study of the influence of clot height (δ), particle volume fraction (C), Prandtl fluid material parameters (α, β), Hartmann number (M), Hall parameter (m), permeability parameter (k), peristaltic wave amplitude (φ) and wave number (δ̅ ) on pressure difference and wall shear (friction forces) is included. Pressure rise is elevated with clot height, medium permeability and Prandtl rheological material parameters whereas it is reduced with increasing particle volume fraction and magnetic Hartmann number. Friction forces on the outer and inner tubes of the endoscope annulus are enhanced with clot height and particle volume fraction whereas they are decreased with Prandtl rheological material parameters, Hall parameter and permeability parameter. The simulations provide a good benchmark for more general computational fluid dynamics studies of magnetic endoscopic multi-phase peristaltic pumping