Correlation of USG findings and Clinical presentation of Appendix in Appendicitis: A Hospital-Based Study

Background: We have been knowing from our past that appendix is a vestigial organ, useless to man, with no known important function, but sometimes it can cause problems, when it may become the seat of infection. The diagnosis of appendicitis is not very easy, requiring the skills of the most experienced clinician. The objective of this study was to find out and compare accuracy of USG findings with that of per-operative findings of location & status of appendix. Methods: The present prospective study was carried out in surgery department at Chandulal Chandrakar Memorial Medical College, Kurud Rd, Kachandur, durg, Chhattisgarh. A total of 75 cases were selected on the basis of inclusion and exclusion criteria and subjected to ultrasound examination by a qualified radiologist to exclude any other associated pathology and also to confirm the diagnosis. Results: Out of 30 cases, a total of 14 cases presented with clinical features suggestive of retrocaecal appendicitis, out of which 11 had typical presentation & 3 had atypical presentation with overall sensitivity of 73.25%, followed by pelvic position which had a sensitivity of 16.29% in which 3  patients had typical presentation & 2 had atypical presentation. Conclusions: A total of five modalities that were used for the diagnosis of position of appendix & appendicitis, i.e. clinical features, lab Ix, ultrasound, intraoperative findings & histopathology, only 47% of cases all the modalities were positive.

Etiology, age and sex distribution, investigations and treatment of gallstone pancreatitis

Background: Acute pancreatitis occurs in only 3-7% of patients with gallstones. But gallstones were implicated in about 27% cases of acute pancreatitis reported in a decade prior to 1980. The relative risk of developing acute pancreatitis varies from country to country, and within a given country it is influenced by socio-economic, ethnic, and cultural factors. The present study evaluated the incidence of the disease, age-sex distribution, clinical manifestations methods, and management of gallstone pancreatitis. Aim and objectives: To diagnose a case of gallstone pancreatitis by various investigations like blood investigations, USG or by CT scan, age-sex distribution, to observe the varied clinical presentations of biliary pancreatitis with regards to symptoms and signs, to study the management protocol of gallstone pancreatitis. Material and methods: 50 cases of gallstone pancreatitis were studied during the period from May 2012 to July 2014, from all surgical units at our institute. Inclusion criteria: All patients admitted in surgical wards in a given particular unit who have diagnosed as having gallstone pancreatitis. Exclusion criteria: Patients having pancreatitis other than biliary cause. This study included all the age groups and both the sex. Results: In our study, most (34%) of male patients at the age group of 50-70 years, biliary pancreatitis was more predominant. Most (34%) of female patients at the age group of 40-60 years had biliary pancreatitis. In our study, most (92%) of the patient’s serum amylase was 3 fold above normal value,alkaline phosphatase was raised in 88% of patients, 68% of them had increased AST, and 22% of them had had elevated serum bilirubin levels. Normal value of serum amylase ranges from 40 to 140 Naik N, Patel G, Parmar H. Etiology, age and sex distribution, investigations and treatment of gallstone pancreatitis. IAIM, 2016; 3(1): 46-50. Page 47 U/L, Alkaline phosphatase from 45 to 115 U/L and AST from 8 to 48 U/L. In our study, out of 50 patients, 28 patients underwent laparoscopic cholecystectomy and 8 patients underwent open cholecystectomy during same admission. In 9 patients endoscopic retrograde cholangiopancreatography (ERCP) plus endoscopic sphincterotomy (ES) was done and remaining patients managed conservatively. Conclusion: Gallstone pancreatitis represents the most severe form of disease. The diagnosis is based in history and physical examination, an elevation of serum amylase 3 fold above the normal level, and ultrasound and CT scans. Endoscopic retrograde cholangiopancreatography is one of the tools in less certain cases of the absence of an agent that can abort progression of the disease; therapy should consist of adequate resuscitation, nutritional support, and careful monitoring to detect early complications.

Outbreaks, Pathogen Containment and Laboratory Investigations of Lassa fever in Nigeria: How Prepared Are We.

Lassa is a highly contagious and devastating re-emerging vector-borne disease transmitted primarily by Mastomys natalensis. Lassa fever virus (LFV) and its vector are largely conserved to West African communities hence they experience frequent sporadic outbreaks. Lassa are usually associated with high mortality rates partly because cases are usually presented late to healthcare centers and its high virulence. The transmission rate of LFV is usually very high in affected areas in Nigeria due to poor pathogen containment, a necessity in medical care of infected individuals and inadequate and/or delayed laboratory confirmation of cases, consequently placing immediate communities and healthcare providers at higher risk of contracting LFV. Laboratory diagnose for Lassa are crucial because of similarities of clinical features it presents with other more frequent fever-causing infections such as severe malaria, typhoid and fulminant hepatitis. Understanding its basic virology, ecology, transmission pattern and immunology are crucial in embarking on appropriate infection control strategies and diagnostic protocols. In view of these, we sought to present this mini-review to summarize the pertinent literatures for healthcare providers especially in endemic locations, suggest the need to use the information from epidemiologic and laboratory findings to incorporate international best practices into community health and clinical practice in Nigeria.

A comparative study of different anatomical position, clinical presentation and USG findings with operative findings in patients of appendicitis.

Background: The objective was to find out and compare accuracy of USG findings with that of per-operative findings of location & status of appendix, to compare , evaluate & study the signs and symptoms in different varieties of appendicitis, to compare & study pre, per & post op follow up of patients with such different location of appendix undergoing appendicectomy and to study the type of appendicitis responsible for inflammation/infection by histopathological examination of different locations of appendix. Methods: The present study was prospective, observational and longitudinal. Protocol of the procedure was formed along with Performa, Patient Information Sheet and Informed Consent Form. The present study was carried out in surgery department of C.U. Shah medical college, Surendranagar; Gujarat state. The study was carried out from 1st October 2010 till 31st September 2012. A total of 100 cases were subjected to clinical assessment using signs, symptoms and laboratory criteria, histopathology and also the position of the appendix, which were recorded in the proforma. All patients were subjected to ultrasound examination by a qualified radiologist to exclude any other associated pathology and also to confirm the diagnosis. At surgery the Position of the appendix was first identified before disturbing the structures and the position of the appendix. After completion of the appendectomy the specimen was subjected to histopathological examination by the qualified pathologist only those cases, which were proved as, appendicitis by the histopathology were included in the study. Results: Out of 100 cases, a total of 62 cases presented with clinical features suggestive of retrocaecal appendicitis, out of which 51 had typical presentation & 11 had atypical presentation with overall sensitivity of 72.9%, followed by pelvic position which had a sensitivity of 15.29% in which 8 patients had typical presentation & 5 had atypical presentation. All modalities (clinical presentation + lab investigations + USG + intra operative + histopathology) patients were 47; with clinical presentation + lab investigations + USG + intra operative patients were 51; with clinical presentation + lab investigations + USG patients were 57; with clinical presentation + lab investigations patients were 69 and with only clinical presentation patients were 85. Conclusions: A total of five modalities that were used for the diagnosis of position of appendix & appendicitis, i.e. clinical features, lab Ix, ultrasound, intraoperative findings & histopathology, only 47% of cases all the modalities were positive. So the diagnosis of position of appendix & appendicitis is a combination of all the modalities and not just dependent on one basis.