Migration of Abdominal Pain - An Effective Tool to Identify Appendicitis and the Only Parameter to Screen.

Acute appendicitis is a common disease. It may be tough to identify even with radiological and laboratory investigations. Migratory pain in the abdomen is a helpful key symptom, provided the patient presents within 24 hours of onset of appendicitis. METHODSPatients clinically presenting as acute appendicitis and operated for appendicectomy were recruited in the study. The presence and absence of migratory pain in the abdomen were evaluated and compared with the histopathology of the appendix. Parameters of diagnostic accuracy were measured. RESULTSThe sensitivity and specificity of migration of abdominal pain was found to be 97 percent and 100 percent respectively. The positive predictive value and the negative predictive value was 100 percent and 94 percent respectively. Overall diagnostic accuracy was 98%. CONCLUSIONSMigratory pain in the abdomen is a significant symptom to identify as well to rule out acute appendicitis.

Reliability of Leukocytosis in Diagnosing Acute Appendicitis.

Acute appendicitis is a frequently encountered surgical disease. Detection is difficult even with imaging and blood investigations. Total leukocyte count is a promising investigation. Its role in the confirmation of acute appendicitis is investigated and analysed in the present study. MethodsPatients having acute appendicitis treated by surgical intervention (appendicectomy) were included in the study. The leukocyte count measured before surgery was compared with histopathology findings of the appendix. Parameters of diagnostic accuracy of leukocytosis were measured by standard formulae. ResultsThe sensitivity and specificity of leucocytosis were found to be 76 percent and 12.5 percent respectively. The positive predictive value and negative predictive value of leucocytosis was 65 percent and 20 percent respectively. Overall diagnostic accuracy was 56 percent. The results were compared with histopathology of acute appendicitis. ConclusionsLeukocytosis is a helpful investigation to support the diagnosis of acute appendicitis.

Drug utilization pattern of antimicrobials use in upper respiratory tract infection in paediatric patient of rural tertiary care hospital

Background: Antimicrobial agents (AMAs) are most commonly prescribed drugs for lower respiratory tract infection (LRTI). This study was conducted to evaluate pattern of prescription and AMAs use in paediatric patient for LRTI in wards of rural tertiary care teaching hospital.Methods: This is prospective, observational study undertaken in paediatric patient in tertiary care hospital. Prescriptions of 60 patient of age group 1-12years diagnosed with LRTI admitted in paediatric ward of rural tertiary care teaching hospital were studied. Positive blood sample were studied for common microorganisms, their sensitivity and resistance to AMAs.Results: Out of 60 patients admitted in paediatric ward of LRTI, 12 patients were of mild to moderate pneumonia, three patients were of bronchiolitis, ten patients were of croups, three patients were of bronchitis and 37 patients were of severe pneumonia. The most frequently prescribed AMAs were combination of cephalosporin and aminoglycosides. The most common organism isolated was streptococcus pneumoniae sensitive to vancomycin in 92.3% and meropenem in 84.6%, resistant to ampicillin, amoxicillin and cloxacillin in 92.3% of cases.Conclusions: The study shows utilisation pattern of AMAs in LRTI, prescribing on which future intervention studies may be based to promote rational drug use.

Anesthetic potential of lidocaine/prilocaine cream versus placebo before venepuncture

Background: Pain associated with venepuncture has long been accepted as an unavoidable consequence. Many studies show reducing pain during venepuncture after application of prilocaine/lignocaine, but there are few studies that has depicted, the depth of anesthesia produced by prilocaine/lignocaine tends to be too superficial for the reducing the pain during venepuncture. These two scenarios were debatable. Therefore, authors planned a study to assess anesthetic potential of lidocaine /prilocaine cream versus placebo before venepuncture with help of VAS in an adult patient who were drawn blood sample for investigation purposes.Methods: Prospective interventional study. All adult patient for blood sampling from surgery OPD to central laboratory were included in study. Site of venepuncture selected in both control and study group was left cubital fossa. 30 patients selected in study group received lignocaine/prilocaine locally, 30min prior to venepuncture which was later covered with occlusive tape, whereas 30 control group patient received normal saline locally as placebo. The extent of pain was assessed by patient on 10cm visual analogue scale (VAS) with end points of 0 cm rated as no pain and the points of 10cm as intolerable pain.Results: A total of 60 patient were randomly selected who were referred from surgery OPD for blood sampling. Other 30 patient were applied normal saline as placebo and 30 patient with lignocaine and prilocaine cream. In the control group there were 30 patients (5 female and 25 male). In the study group there were 30 patients (8 females and 22 males). The level of pain among study group is as follows: mild 22, moderate 7, worst 1 and in control group: no pain 0, mild 5, moderate 14 and worst pain 1. Statistical analysis between outcome of two groups done by calculating chi-square test. Chi- square test was 20.0263. P value is 0.000168. Hence the result is significant at p <0.05.Conclusions: The present study shows that prilocaine-lidocaine cream reduces the pain of needle puncture in adults and facilitates the procedure of venous blood sampling.