ABSTRACT
Appendicitis is an acute inflammatory condition of appendix. Since it is a surgical emergency, needs early diagnosis and treatment strategies which include clinical examination, followed by Laboratory investigations and Imaging studies. The scoring systems like Alvarado score have been considered for better diagnosis. In most studies surgery has been reported as the best modality of treatment. Several studies clearly mentioned the impact of various surgical procedures which include Open appendectomy (OA), Conventional laparoscopic appendectomy (CLA) and Single incision laparoscopic appendectomy (SILA). Hence, the present study is carried in an aim to assess and compare the merits and demerits between the surgical procedures Like SILA and CLA. The patients were randomly selected from the surgical department (NMCH) who presented with acute pain abdomen and diagnosed as acute appendicitis. 50 patients were enrolled in the study after fulfilling the inclusion and exclusion criteria. The various demographic variables have been studied between the surgical procedures to demonstrate their impact, which include wound infection rate, pain scores at 24 and 48hrs, the amount of time period for surgery in minutes, patient satisfaction scores and post-operative stay tenure at the hospital in days. The laparoscopic hand instruments used in both techniques are similar, except covidien port which was reused in SILA, following gas sterilization to reduce the cost. Findings reveal that the pain score was significantly lower in SILA than CLA group. The procedure time is comparatively more in SILA than CLA group. Patients had significant satisfaction score in SILA measured at 6 weeks after appendectomy. However the post operative stay, wound infection rate was almost similar in both the groups. There was no conversion to open Appendectomy performed in either of these groups. Results also clearly suggest that the SILA procedure is the safe, alternative and effective technique for the better management of acute appendicitis and seems to be better choice.
ABSTRACT
Type-2 diabetes women are more prone for Urinary tract infections (UTI). Many UTIs are asymptomatic and whether the symptomatic UTI are preceded by asymptomatic bacteriuria (ASB) is not clear. Hence, the present study is conducted to understand the relationship between ASB and symptomatic UTI among Type-2 diabetic women along the sea coast.A hospital based study conducted in the Narayana Medical College & Hospital, which is situated within 10-15 km radius of the seacoast in Nellore district of Andhra Pradesh, India. 238 subjects were selected, out of these 164 diabetic subjects in the experimental and 56 in the control group. Findings indicate that the prevalence of ASB in type-2 diabetic women is high along the sea coast and significantly associated with nephropathy. The major risk factors include age, duration of diabetes, proteinuria, leucocyturia, glucosuria, nephropathy and rise in plasma glucose. Among the clinical isolates of ASB, gram negative isolates were more than gram positive. These isolates are highly resistant to antibiotics like Ciprofloxacin, Ofloxacin, Gentamicin and Cefotaxime while, sensitive to Amikacin and Cephaperazone ± sulbactam. Thus present study concludes that overall risk factors for ASB in type-2 diabetic women observed are proteinuria, leucocyturia, glucosuria, nephropathy and plasma glucose.
ABSTRACT
Tumors are either benign or malignant. The thyroid nodule, which is usually a clinical manifestation of most of the thyroid disorders, is one among them which has been the subject of controversies with divergent opinions and views. Clinical presentation of thyroid nodules varies widely ranging from solitary nodules to benign and malignant tumors. Thyroid nodules accounts up to 8% of the adult population having palpable nodules. However studies on its incidence in the population residing near seacoast are limited. Hence, the present study is carried in an aim to evaluate the clinico-pathological correlation of solitary thyroid nodule and the incidence of malignancy in the population residing at sea coast. The study is conducted in the Narayana Medical College & Hospital (NMCH), which is situated within 10-15 km radius of the seacoast in Nellore district of Andhra Pradesh, India. In this study, 73 subjects were selected who presented with thyroid swelling which was clinically confirmed as solitary thyroid nodule. Out of 73 cases, 12 cases (16.5%) were found to have malignant lesions with remaining 61 cases (83.5%) being benign lesions. The incidence of malignancy among solitary thyroid nodule subjects is up to 16.5% in the population residing near seacoast. Thus the present study warrants people to consult surgeons for early diagnosis and adequate treatment without being passive as most of these swellings are asymptomatic for long duration.
ABSTRACT
Acute appendicitis is a surgical emergency, which is associated with morbidity and mortality occasionally. If failed to diagnose early the situation may become more complicated. In acute appendicitis it is not possible to have definitive diagnosis by histopathology preoperatively, we would like a simple test like Alvarado scoring system which depends on the presence and absence of certain variable, which provides an accurate guide to whether or not the patient has the condition. Hence, accurate diagnosis and timely intervention is needed. Therefore, the present study was conducted to evaluate the Alvarado scoring system in diagnosing acute appendicitis and its co relation with histopathology. This prospective study was conducted in 100 consecutive patients admitted in the department of general surgery of Narayana Medical College, Nellore with the clinical diagnosis of acute appendicitis. The findings based on the Alvarado score indicate that 68% of the subjects had a score of more than 7 and 22% of the subjects had a score between 5 and 7. Only 10% of the subjects had a score between 1 and 4. Out of 83 eligible subjects 75 were found to have acute appendicitis by histopathological examination. Negative appendicectomy was very low representing up to 9.6% whereas the percentage of positive predictive value was high representing up to 90.4%. Although the diagnosis of acute appendicitis remains mainly clinical evaluation, the scoring system is easy, simple and cheap complementary aid for supporting the diagnosis of acute appendicitis.
ABSTRACT
Leptospirosis is a bacterial zoonosis, caused by pathogenic spirochete which belongs to the genus Leptospira. It exists in diverse ecological habitats and affects almost all the mammals including humans. Several online databases like NCBI etc will provide the complete genomic sequence data of various Leptospira species. However, the Phylogenetic and genetic diversity Analysis in Leptospira species based on 16S rRNA gene has not studied in detail. Therefore the present study was conducted. Sequences of various species related to genus Leptospira obtained from the NCBI database etc and aligned (CLUSTAL_X). Two Phylogenetic trees were constructed (MEGA-5) in which the first one is related to various serovars of L. interrogans and the other is related to various species of Leptospira. The Phylogenetic trees revealed the relationship and genetic diversity of various serovars of L. interrogans and the other Leptospira species, with their nearest phylogenetic relatives. In the first tree, two major clades were observed which were named as A and B, whereas in the second tree, three major clades were observed and named as A, B and C respectively. Aquifex pyrophilus strain has been used for out grouping in both the trees. The genetic distance between the species in the phylogenetic tree is presented by a bar which represents 0.5 nucleotide substitutions per alignment position in the 16S rRNA gene sequence among the various serovars of L. interrogans while 0.05 nucleotide substitutions in case of various species related to the genus Leptospira. Thus, the findings from the above study confirm that the genus Leptospira exhibits genetic diversity in the 16S rRNA gene.