The Introduction Of Clinical Practice Guideline For The Management Of Suspected Appendicitis In Female Patients May Influence Computed Tomography Usage

Introduction-Concerns about the radiation exposure have led to decrease in use of computed tomography (CT) in appendicitis, with increased reliance on the ultrasound. Females with appendicitis should be risk stratied using the combination of the clinical signs and symptoms, white blood cell count (WBCs), and ultrasound in order to show further evaluation and management.Material and Methods-We prospectively evaluated the clinical guideline in female patients with suspected . Patients were risk-appendicitisstratied based on the history, physical examination ndings, and laboratory results. Imaging was ordered selectively based on the risk category, with ultrasound as initial imaging modality. Computed tomography was ordered if US was indeterminate or negative.Results-One hundred and twenty patients were involved in the study with 49 patients having had appendicectomies for appendicitis while 71 were not diagnosed with apendicititis. CTusage was less in the post guideline implementation. There was not much difference between the sensitivity and the specicity of Ct and USG ndings.Conclusion-We concluded that hospitals with the high CTusage rates for appendicitis may reduce their CTusage to be reliable with national average & clinical practice guidelines.

Focused Abdominal Sonography In Trauma (FAST) In Patients With Blunt Trauma Abdomen In Rural Area- A Prospective Study

Background: Unrecognized blunt abdominal injuries are often causing of the preventable death. Clinical examination is frequently inaccurate and therefore, the reliable, accurate and repeatable bed-side diagnostic test should be chosen such as Sonography. This study was under-taken to assess Focused Assessment Sonography in Trauma (FAST) examination for in rural area in the patients with Blunt Abdominal Trauma.Material and Methods:This was the prospective study including all the trauma team cases in a 24 months period between March 2016 to February 2018 in emergency department of a Uttarpradesh University of Medical Sciences& hospital,Saifai. The results of the FASTscans were analyzed and when the FASTwas positive or followed by the period of the clinical observation when FASTwas negative. Descriptive statistics & sensitivity, specicity, & predictive values were calculated.Results: Total of 100 patients were included in our study and the majority of them were males and the commonest cause of injury was a Road Trafc Accident. The sensitivity & specicity of FASTwere 92.68% and 98.31%, respectively, with an accuracy of 96.0%.Conclusion:Our study found that FASTis the highly sensitive, specic, accurate initial bedside and reliable investigation in the patients with blunt abdominal trauma, which may be done rapidly even in the haemodynamically unstable patients, making it a useful tool.

Lichen Planus in Four Clinical Forms.

Lichen planus is an autoimmune disorder which comes under lichenoid reactions. It is T-cell mediated cytotoxic reaction directed against antigen expressed by basal cell layer of the oral mucosa. Autoreactive T-lymphocytes may be of primary importance for the development of oral lichen planus. Lichen planus presentations in the oral cavity are in 6 forms: Reticular, papular, plaque, bullous, erythematous and ulcerative. We present a case report of 4 forms in a patient.

Efficacy of Ferric Carboxymaltose in Anaemia of Malignancy - A Pilot Study.

Anaemia is an important problem in malignancy. It may be due to chronic causes like malnutrition, marrow infiltration, associated renal or endocrine disorders and it may be complicated with blood loss. Measures like blood transfusion, erythropoietin injections often pose a logistical problem. Parenteral iron injections have proved to be useful in fighting anaemia in some chronic conditions e.g. patients on hemodialysis. Aims and Objectives: Primarily to see the observable change in hemoglobin (Hb) level with ferric carboxymaltose (FCM) in treating patients of malignancy on anti-cancer treatment. Materials and Methods: Twenty seven patients were enrolled for this study who were suffering from various malignancies. The baseline Hb level was estimated and FCM injection was administered as per the schedule of 500 mg intravenously (IV) weekly once. The overall results of increase in Hb level was noted during the middle of the treatment (chemotherapy or radiotherapy) and later 3-4 weeks after treatment completion. The results were analysed using SPSS and the mean values of initial Hb and after treatment were analysed. Level of significance (p value) was noted using t test. Results: In 27 patients the mean initial Hb level was 8.09 g/dl before treatment which increased to 10.28 g/dl after FCM treatment (p <0.0001). Conclusion: Treatment with FCM definitely led to a significant increase in Hb level in patients of malignancy undergoing treatment. However, further detailed study is needed to establish its definite role in improving the body iron parameters.

Comparative analysis of fecal microflora of healthy full-term Indian infants born with different methods of delivery (vaginal vs cesarean): Acinetobacter sp. prevalence in vaginally born infants.

In this study fecal microflora of human infants born through vaginal delivery (VB) and through cesarean section (CB) were investigated using culture-independent 16S rDNA cloning and sequencing approach. The results obtained clearly revealed that fecal microbiota of VB infants distinctly differ from those in their counterpart CB infants. The intestinal microbiota of infants delivered by cesarean section appears to be more diverse, in terms of bacteria species, than the microbiota of vaginally delivered infants. The most abundant bacterial species present in VB infants were Acinetobacter sp., Bifidobacterium sp. and Staphylococcus sp. However, CB infant’s fecal microbiota was dominated with Citrobacter sp., Escherichia coli and Clostridium difficile. The intestinal microbiota of cesarean section delivered infants in this study was also characterized by an absence of Bifidobacteria species. An interesting finding of our study was recovery of large number of Acinetobacter sp. consisting of Acinetobacter pittii (former Acinetobacter genomic species 3), Acinetobacter junii and Acinetobacter baumannii in the VB infants clone library. Among these, Acinetobacter baumannii is a known nosocomial pathogen and Acinetobacter pittii (genomic species 3) is recently recognized as clinically important taxa within the Acinetobacter calcoaceticus–Acinetobacter baumannii (ACB) complex. Although none of the infants had shown any sign of clinical symptoms of disease, this observation warrants a closer look.

Molecular typing of fecal eukaryotic microbiota of human infants and their respective mothers.

The micro-eukaryotic diversity from the human gut was investigated using universal primers directed towards 18S rRNA gene, fecal samples being the source of DNA. The subjects in this study included two breast-fed and two formula-milk-fed infants and their mothers. The study revealed that the infants did not seem to harbour any microeukaryotes in their gut. In contrast, there were distinct eukaryotic microbiota present in the mothers. The investigation is the first of its kind in the comparative study of the human feces to reveal the presence of micro-eukaryotic diversity variance in infants and adults from the Indian subcontinent. The micro-eukaryotes encountered during the investigation include known gut colonizers like Blastocystis and some fungi species. Some of these micro-eukaryotes have been speculated to be involved in clinical manifestations of various diseases. The study is an attempt to highlight the importance of micro-eukaryotes in the human gut.