Non-Operative Management of Acute Uncomplicated Appendicitis in Children

Objective: To compare the efficacy of non-surgical conservative management with surgical management in cases of uncomplicated acute appendicitis in children. Study design: Prospective comparative study. Settings: Pediatric surgery Department, --removed for blind review---- Study duration: 1st February 2020 to 31st May 2021. Methodology: Ninety patients of either gender with age range from 5-12 years, diagnosed as uncomplicated acute appendicitis, were divided in two groups. Group C patients were managed conservatively with antibiotics (ceftriaxone 100 mg/kg/day, amikacin 10mg/kg/day and metronidazole 22.5 mg/kg/day) and maintenance fluids were started. Patients were observed for improvement or any signs of deterioration. Those who deteriorated within 24 hours were management with surgical management immediately. Follow ups were carried out after discharge at 7th day, 1 month and six months. Patients reporting with recurrence of symptoms were managed with appendicectomy. Group S patients were managed with appendicectomy with open technique. Patients were observed for post-operative complications. Results: Demographic data of both groups was comparable. In group C, 34 (75.56%) patients were successfully treated with conservative management, whereas in group S, 39 (86.67%) were successfully treated with surgical management. The difference was insignificant with a p-value of 0.114. In group C, 5 (11.11%) patients did not respond to conservative management and they were managed with appendicectomy and recurrence of symptoms was seen in 6 (13.33%) patients in group C, they were also managed with appendicectomy. In group S, 6 (13.33%) patients suffered post-operative complications. Mean length of stay in hospital was 4.31±1.20 and 4.09±1.12 days in group C and S respectively. This difference was statistically insignificant with a p-value of 0.368. Conclusion:     It is concluded in our study that uncomplicated acute appendicitis in children can be successfully managed with non-surgical conservative management. Keywords: Acute appendicitis, Appendicectomy, Conservative management, Non-surgical management, Pediatric surgery, Uncomplicated acute appendicitis

Non-Operative Management of Acute Uncomplicated Appendicitis in Children

Objective: To compare the efficacy of non-surgical conservative management with surgical management in cases of uncomplicated acute appendicitis in children. Study design: Prospective comparative study. Settings: Pediatric surgery Department, --removed for blind review---- Study duration: 1st February 2020 to 31st May 2021. Methodology: Ninety patients of either gender with age range from 5-12 years, diagnosed as uncomplicated acute appendicitis, were divided in two groups. Group C patients were managed conservatively with antibiotics (ceftriaxone 100 mg/kg/day, amikacin 10mg/kg/day and metronidazole 22.5 mg/kg/day) and maintenance fluids were started. Patients were observed for improvement or any signs of deterioration. Those who deteriorated within 24 hours were management with surgical management immediately. Follow ups were carried out after discharge at 7th day, 1 month and six months. Patients reporting with recurrence of symptoms were managed with appendicectomy. Group S patients were managed with appendicectomy with open technique. Patients were observed for post-operative complications. Results: Demographic data of both groups was comparable. In group C, 34 (75.56%) patients were successfully treated with conservative management, whereas in group S, 39 (86.67%) were successfully treated with surgical management. The difference was insignificant with a p-value of 0.114. In group C, 5 (11.11%) patients did not respond to conservative management and they were managed with appendicectomy and recurrence of symptoms was seen in 6 (13.33%) patients in group C, they were also managed with appendicectomy. In group S, 6 (13.33%) patients suffered post-operative complications. Mean length of stay in hospital was 4.31±1.20 and 4.09±1.12 days in group C and S respectively. This difference was statistically insignificant with a p-value of 0.368. Conclusion:     It is concluded in our study that uncomplicated acute appendicitis in children can be successfully managed with non-surgical conservative management. Keywords: Acute appendicitis, Appendicectomy, Conservative management, Non-surgical management, Pediatric surgery, Uncomplicated acute appendicitis

Impact of perception and attitude of the staff of the radiology department towards undergraduate medical imaging students on clinical training: students’ perspective

Behaviour of the clinical staff is one of the factors that can influence the students’ learning quality. The students’ contact with the radiology staff during the clinical practice can influence their process in learning new knowledge and skills. Hence, this research aims to determine the perception and attitude of radiology staff towards Medical Imaging students during clinical training from the students’ perspective. This study also ascertain the impact of the attitude of radiology staff towards practical performance and learning motivation of these students. A total of 43 students participated in this study using non-probability purposive sampling technique to calculate the sample size. The findings from this study revealed that radiology staff generally have positive attitude towards Medical Imaging students undergoing practicum. The majority of participants (55.8%) claimed that negative attitude of radiology staff can affect their learning ability and practical performance during clinical training. Also, 48.8% participants acknowledged that the attitude of radiology staff can affect their motivation and self-esteem. The major factors or element that the participants claimed to have a strong relation with an improvement in the quality of clinical training were willingness to teach student radiographers (95.3%), followed by portrayal of good patient care (76.7%) and effective communication among radiology staff and student radiographers (67.4%). The study revealed that there is a significant association between attitude of radiology staff and practical performance (p< 0.05). The findings of this study indicated that it is vital for radiology staff to portray a positive and professional attitude towards student radiographers as it can affect their practical performance, learning motivation and eventually the quality of clinical practice

Assessment of fasting gallbladder volume using ultrasound imaging in relation to weight and body mass index among female students for detection of asymptomatic gallstones

Gallstone disease is a common medical condition in Malaysia. Females are more prone to gallstones compared to males. Some studies have shown that weight and body mass index (BMI) impacts on the formation of gallstone. Thus, the purpose of this research was to assess the fasting gallbladder volume in relation with the weight and BMI using ultrasound imaging technique. Ultrasound imaging was selected as the modality of choice because it is the gold standard for detecting gallstones. The experimental research was conducted on undergraduate female students of International Islamic University Malaysia, Kuantan. There were a total of 45 female students involved in this research. Weight and BMI of subjects were recorded prior to the ultrasound examination. The gallbladder volume was calculated using the ellipsoid equation. Statistical analysis was done by using the Statistical Package for Social Sciences (SPSS) version 12.0.1. Normality tests, correlation tests and one sample T-test were conducted for the analysis of the data. Research findings show that, there is significant correlation of weight and average fasting gallbladder volume (p=0.00). Besides that, there is moderate significant correlation of BMI and average gallbladder volume (p=0.004). The result for reference value of average gallbladder volume in this study was found 32.98 ± 3.49 cm3. It is concluded that, in terms of gallstones prevalence, there is a possibility of one to have gallstones if the average gallbladder volume is greater than the reference value found in this study. Further research needs to be conducted in order to develop a guideline for asymptomatic gallstones patients in Malaysia

Neural minimization methods (NMM) for solving variable order fractional delay differential equations (FDDEs) with simulated annealing (SA).

To enrich any model and its dynamics introduction of delay is useful, that models a precise description of real-life phenomena. Differential equations in which current time derivatives count on the solution and its derivatives at a prior time are known as delay differential equations (DDEs). In this study, we are introducing new techniques for finding the numerical solution of fractional delay differential equations (FDDEs) based on the application of neural minimization (NM) by utilizing Chebyshev simulated annealing neural network (ChSANN) and Legendre simulated annealing neural network (LSANN). The main purpose of using Chebyshev and Legendre polynomials, along with simulated annealing (SA), is to reduce mean square error (MSE) that leads to more accurate numerical approximations. This study provides the application of ChSANN and LSANN for solving DDEs and FDDEs. Proposed schemes can be effortlessly executed by using Mathematica or MATLAB software to get explicit solutions. Computational outcomes are depicted, for various numerical experiments, numerically and graphically with error analysis to demonstrate the accuracy and efficiency of the methods

EVALUATION OF IMPACT OF HYPERGLYCEMIA AND HYPONATREMIA ON CLINICAL OUT-COME OF ACUTE STROKE

Hyponatremia and hyperglycemia are common metabolic disorders which could worsen the outcome after a cerebrovascular accident (stroke). This study aimed to evaluate the impact of hyponatremia and hyperglycemia on stroke and its clinical outcome, including morbidity and mortality. This prospective cohort study included 50 stroke patients admitted in tertiary care hospitals. Stroke severity, Glasgow coma scale (GCS), conscious level, gag reflex, clinical presentations, and outcomes were recorded. Following a stroke, patients were monitored for a period of six months, during which the patient's death was recorded on the event form. Linear logistic regression model was used to determine the stroke mortality. Hyponatremia and hyperglycaemia were associated with higher odds ratio of deaths, poor functional recovery, severe disability, low mean GCS score as compared to normonatremic and normoglycemic patients (odds ratio [OR] = 4.7; 95% CI= 0.929-43.782) and hyperglycaemia (OR= 2.74; 95% CI=0.577-13.03). Stroke patients admitted with hyperglycemia or hyponatremia were associated with greater morbidity and mortality and poor functional recovery