Comparison of Tzanakis and Alvarado scoring system in diagnosis of acute appendicitis, with Histopathology as gold standard

Objective: To determine the diagnostic accuracy of Tzanakis and Alvarado score for the diagnosis of acute appendicitis taking histopathology as the gold standard. Materials and Methods: It was a Cross-sectional validation study The study was carried out at the emergency department of RMC allied hospital Rawalpindi. The study was completed in eighteen months from 1st May 2016 till 30th Nov 2017. After approval from the ethical committee total of 420 patients fulfilling inclusion criteria from the emergency department of District head Quarter hospital, Rawalpindi was taken. Informed consent was taken from patients or their attendants, and their demographic information like name, age, sex, and address was obtained. Alvarado score and Tzanakis score were calculated (as per operational definition) at the time of admission of the patients. After surgery, the specimen appendix was sent for histopathology in the hospital lab.  The diagnosis of the acute appendix was based on a positive histological report which was verified by a pathologist. All the data was entered by a researcher who will collect the data by himself. Results: The mean age of patients in this study was 20.15±7.13 years with 218 (51.9%) males and 202 (48.1%) females. The mean Alvardo score was recorded as 7.22±1.58 with the mean Tzanakis score being 9.64±3.13. The histopathology for diagnosing appendicitis showed positive for 367 (87.4%) patients and negative for 53 (12.6%) patients. The sensitivity of Alvarado score for diagnosing appendicitis, keeping histopathology as the gold standard was 86.92%, specificity was 92.45%, Positive Predictive Value was 98.76%, and Negative Predictive Value was 50.52% and overall diagnostic accuracy was 87.62%. The sensitivity of the Tzanakis score for diagnosing appendicitis, keeping histopathology as the gold standard was 88.83%, specificity was 88.6%, Positive Predictive Value was 98.19%, Negative Predictive Value was 53.41% and overall diagnostic accuracy was 88.81%. Conclusion: The sensitivity of the Tzanakis score was high when compared to the Alvarado score. And specificity was high in the Alvarado score when compared to the Tzanakis score. Moreover, the overall diagnostic accuracy of the Tzanakis score was high when compared to the Alvarado score. SoTzanakis score can be utilized to predict appendix and in the future, we can avoid negative appendectomies

Comparison of Tzanakis and Alvarado scoring system in diagnosis of acute appendicitis, with Histopathology as gold standard

Objective: To determine the diagnostic accuracy of Tzanakis and Alvarado score for the diagnosis of acute appendicitis taking histopathology as the gold standard. Materials and Methods: It was a Cross-sectional validation study The study was carried out at the emergency department of RMC allied hospital Rawalpindi. The study was completed in eighteen months from 1st May 2016 till 30th Nov 2017. After approval from the ethical committee total of 420 patients fulfilling inclusion criteria from the emergency department of District head Quarter hospital, Rawalpindi was taken. Informed consent was taken from patients or their attendants, and their demographic information like name, age, sex, and address was obtained. Alvarado score and Tzanakis score were calculated (as per operational definition) at the time of admission of the patients. After surgery, the specimen appendix was sent for histopathology in the hospital lab.  The diagnosis of the acute appendix was based on a positive histological report which was verified by a pathologist. All the data was entered by a researcher who will collect the data by himself. Results: The mean age of patients in this study was 20.15±7.13 years with 218 (51.9%) males and 202 (48.1%) females. The mean Alvardo score was recorded as 7.22±1.58 with the mean Tzanakis score being 9.64±3.13. The histopathology for diagnosing appendicitis showed positive for 367 (87.4%) patients and negative for 53 (12.6%) patients. The sensitivity of Alvarado score for diagnosing appendicitis, keeping histopathology as the gold standard was 86.92%, specificity was 92.45%, Positive Predictive Value was 98.76%, and Negative Predictive Value was 50.52% and overall diagnostic accuracy was 87.62%. The sensitivity of the Tzanakis score for diagnosing appendicitis, keeping histopathology as the gold standard was 88.83%, specificity was 88.6%, Positive Predictive Value was 98.19%, Negative Predictive Value was 53.41% and overall diagnostic accuracy was 88.81%. Conclusion: The sensitivity of the Tzanakis score was high when compared to the Alvarado score. And specificity was high in the Alvarado score when compared to the Tzanakis score. Moreover, the overall diagnostic accuracy of the Tzanakis score was high when compared to the Alvarado score. SoTzanakis score can be utilized to predict appendix and in the future, we can avoid negative appendectomies

Emergency Peripartum Hystrectomy and Postnatal Depression

Objective: to investigate postnatal depression after emergency peripartum hysterectomy versus controls.  Material and methods: This case control study was conducted at District headquarters teaching hospital Rawalpindi between July 2020 and June 2021.We compared postnatal depression among patients who underwent emergency peripartum hysterectomy (EPH)versus control group where surgical procedures other than hysterectomy (B-Lynch, uterine artery ligation or internal iliac artery ligation) were performed.  Results: A total of 88 patients were included, 44 in hysterectomy group and 44 in non hystrectomized/control group. The scores on Edinburgh post-natal depression scale were high in hysterectomy group (11.61±2.48) , compared to non hysterectomy group(6.79±2.13) which was statistically significant. ( p=0.001).Uterine atony, Placental abruption, placenta previa and accrete, were identified as main reasons for surgical intervention in both groups. Emergency peripartum hysterectomy is a  traumatic birth event with serious physical, emotional and psychological consequences. It is empirical to not only screen the women in immediate postpartum period, but a long term follow up in community is required.  

Emergency Surgery during Lockdown: Experience at a tertiary care hospital

Introduction: COVID-19 has halted the economic and social progression of the human race. This pandemic has exposed the vulnerabilities of all walks of life. But, most of all, this crisis has jolted the health care systems around the globe. A decrease in emergency surgical interventions was observed at District headquarters Hospital, Rawalpindi. The purpose of this study was to evaluate the impact of a pandemic on acute surgical emergency presentation and referral to a tertiary care hospital. Material and Methods: It is a retrospective cohort study. We compared emergency surgical interventions requiring spinal or general anaesthesia followed by admission in a ward at DHQ hospital, Rawalpindi during a control period (15th March 2019–15th June 2019) and during the pandemic lockdown period (15th  March 2020- 15th June 2020). Results: A total of 228 cases were included in the study including both groups. About 73% (167 ) cases were performed in an emergency during Pre COVID-19 period i.e. from March 15th- June 15th, 2019.  A total of 41 exploratory laparotomies were performed in a total of which 28 (68%) were done in the control period while 13 (32%) were done during the lockdown period. Out of 13 laparotomies due to road traffic accidents, only 3 were done during the lockdown period. Civilian Violence causing penetrating trauma resulted in 21 laparotomies in total out of which 11 were before the COVID-19 crisis and 10 during the lockdown. A total of 107 appendectomies were performed. Out of which 75 (70%) were performed in the Pre COVID-19 pandemic. Less than half the number (32) of appendectomies were done during the lockdown.  A marked decrease in emergency hernia surgeries was observed. In the Pre COVID-19 time period, 13 emergency hernia surgeries were done, while only 03 surgeries were done during the lockdown. Regarding Hepatobiliary emergency surgeries, none was done during lockdown while 08 were done during three months of the Pre COVID-19 period. Conclusion: Firstly, Keeping these figures under consideration, surgical units should expect more complicated cases in the coming days and a high influx of patients should be expected once the lockdown is over. Secondly, the question that remains unanswered is that Are we doing unnecessary surgeries other than trauma in an emergency? Thirdly, there is room to consider that all appendicitis and cholecystitis don’t always need surgery. Fourthly, the private sector has the potential to share the burden on public hospitals

A Novel Hybrid GWO-LS Estimator for Harmonic Estimation Problem in Time Varying Noisy Environment

The power quality of the Electrical Power System (EPS) is greatly affected by electrical harmonics. Hence, accurate and proper estimation of electrical harmonics is essential to design appropriate filters for mitigation of harmonics and their associated effects on the power quality of EPS. This paper presents a novel statistical (Least Square) and meta-heuristic (Grey wolf optimizer) based hybrid technique for accurate detection and estimation of electrical harmonics with minimum computational time. The non-linear part (phase and frequency) of harmonics is estimated using GWO, while the linear part (amplitude) is estimated using the LS method. Furthermore, harmonics having transients are also estimated using proposed harmonic estimators. The effectiveness of the proposed harmonic estimator is evaluated using various case studies. Comparing the proposed approach with other harmonic estimation techniques demonstrates that it has a minimum mean square error with less complexity and better computational efficiency

Infective agents in diabetic foot ulcers and their sensitivity patterns

Background: Diabetic-foot syndrome is a difficult & debilitating complication of inadequately regulated Diabetes Mellitus. Attributed to neural & vascular pathology, the condition is further potentiated by glycemic healing impairment.  A wide array of microorganisms have been implicated & sensitivity-guided antibiotics are essential to save both limb as well as to minimize rampant microbial resistance. Present study aims to determine the culture & sensitivity pattern of bacteria in stated cohort of patients at a Surgical Unit. Materials & Methods: This prospective cohort study was conducted over a period of 1 year-duration at a tertiary-care-Hospital. All patients presenting with diabetic-foot who had not been subjected to empiric antibiotic-therapy were enrolled. Demographic & lesion-based variables were studied and the Culture & Sensitivity pattern was evaluated and statistically analyzed. Results:100 patients were included in the study,of which 80 were male (mean-age 60.8±12.7 years) & rest female (mean-age 58.4±11.3-years).35% cultures yielded no growth. Remaining cases showed following pathogens in descending order of incidence. Maximal sensitivity was also reported as mentioned. 1) Staphylococcus-aureus & Klebseilla-Pneumoenae– Piperacillin/Tazobactam,2) Pseudomonas-Aerugionas-Cefotaxime,3)E-coli–Amikacin& Sulbactam,4) Proteus -Gentamicin, 5) Streptococci– Amikacin and 6) Bacteroides – Cefoperazone & Aztreonam. Of 71 cases, 70  had aerobic-organisms isolates & only 1 had anaerobic-isolate.   Conclusions: Six pathogens were identified in present study of which Staphylococcus-Aureus was the most prevalent as well as the most resistant. Streptococci & Gram-negative Organisms were observed in remaining cases. While formulation of an adequate antibiotic regime is rendered difficult by resistance & mixed infections, targeted antibiotic administration is decisively crucial to achieve optimal & timely outcome in diabetic foot. &nbsp