Diagnostic accuracy of alvarado scoring for diagnosis of acute Appendicitis in children

Objective: To determine the diagnostic accuracy of Alvarado scoring for diagnosis of acute appendicitis in children

Study Design: This was a cross sectional validation study

Place of Study: Department of Pediatric Surgery, Services Hospital. Lahore

Duration: July 2017 to December 2017

Methodology: In this study the cases of both gender with age range 2 to 12 years were included. The diagnosis of acute appendicitis was made on the basis of fever, vomiting and right sided abdominal pain with raised total leucocyte count. True positive was labelled when there were inflammatory cells found on histopathology. The detailed Alvarado scoring was used and to label the cut off value of 6 was used

Results: In the present study there were total 386 cases with mean age of 7.45+/-2.45 years. There were 208 males and 178 females. Alvarado score in cases who underwent appendectomy was 5 and maximum 8 with mean of 6.92 +/- 0.898. The mean Alvarado score was 5.76+/-2.77. Alvarado score 6 or above was seen in 286 cases while 280 cases were confirmed as acute appendicitis on histopathology. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of Alvarado score 6 or more was seen in 89.29 percent, 66.04 percent, 87.41 percent, 70 percent and 82.90 percent respectively with a significant p value of 0.001

Conclusion: Acute appendicitis is an acute emergency and Alvarado score 6 or above has shown significant better diagnostic accuracy in such cases

Effect of Heavy Metals on Liver, Kidney, Gills and Muscles of Cyprinus carpio and Wallago attu inhabited in the Indus

ABSTRACT: The present study was aimed to evaluate the effect of heavy metals on an important tissue of two fish species Cyprinus carpio and Wallago attu, sampled from the Indus river, Mianwali District, Pakistan. The concentration of selected heavy metals Fe, Cr, Cu, and in gills, muscles, kidney and liver was compared with an International standard of food fish. The overall metal concentrations among different weight categories in C. carpio were in the order of Fe > Cu > Cr >. In W. attu the overall accumulation of these metals were, in order of Fe > Cu > Cr > Pb The order of accumulation of metals in gills and muscle of C. carpio was Fe > Cr > Pb > Cu; kidney and muscles of W. attu was Fe > Cr > Cu > Pb; liver Fe > Cu > Cr > Pb. An increasing trend of concentration of iron, copper, chromium and lead occurred with an increase in weight of C. carpio and W. attu. There was a significant difference in the accumulation of heavy metals in different organs of both species (p<0.01). All studied heavy metals except Cr were within permissible limits described by various international agencies like WHO, FAO and FEPA in edible tissues of C. carpio and W. attu.