Combination of Blue Laser Exposure with UV-LED to Improve Antimicrobial Effects on Staphylococcus aureus Biofilm

@#Introduction: Staphylococcus aureus biofilm is a major mediator of infection. The light based therapy is still not adequate to eradicate biofilm caused by Extracellular Polymeric Substances (EPS). The Ultra Violet (UV) irradiation has high energy and sufficient to penetrate a tissue. This study aims to investigate the effect of combination of UV LED irradiation and blue laser on the biofilm. Methods: The pure culture of Staphylococcus aureus ATCC 25923 approximated 108 CFU/mL or 1.0 McFarland Standard was used for this study. The biofilm sample was placed onto micro plate for 48 hours. The treatment group was divided into 3 groups, which were blue laser group, UV LED group and UV-Blue laser group. Results: The results showed that the highest biofilm reduction (80.57 ± 0.77) % was treated by blue laser irradiation for 4 minutes and UV irradiation for 20 s. Conclusion: Thus, the combination UV LED and Blue laser is the best choice to eradicate more biofilm.

Validity of modified alvarado scoring system [mass] in the diagnosis of acute appendicitis

Objective: To determine the validity of Modified Alvarado Scoring System [MASS] in the diagnosis of acute appendicitis. Study Design: Cross sectional validation study. Place and Duration of Study: Department of Surgery Combined Military Hospital [CMH] Kohat Pakistan, from Nov 2013 to Oct 2014

Material and Methods: A total of 248 patients fulfilling the inclusion criteria were enrolled in the study after getting the informed written consent. Modified Alvarado Score of all patients was calculated on a proforma which included migratory right iliac fossa pain, anorexia, nausea/vomiting, tenderness in right iliac fossa, rebound tenderness, elevated temperature and leucocytosis [>10 x 109/L]. Surgeries were performed by residents and consultant surgeons. Decision to operate upon was not only on the MASS of the patients rather it was on overall clinical condition of the patients using different scoring systems. Where required aid of different laboratory investigations, ultrasonography, CT scan and laparoscopy was also taken. After surgery histopathological examination of resected specimens was performed. Pre operative modified alvarado score and post operative histopathological results were endorsed on a proforma. A two by two table was used to determine the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of MASS

Results: Out of total 248 patients, 183 [73.8%] patients were males and 65 [26.2%] were females. Male to female ratio was 2.8:1. Sensitivity of MASS in this study was 89.39%, Specificity 84.06%, positive predictive value 93.57%, negative predictive value 75.32% and diagnostic accuracy was 87.90%

Conclusion: Modified alvarado score is a highly sensitive test with fair degree of specificity for the early diagnosis of acute appendicitis especially in the adults. It is particularly helpful for young doctors and in the peripheral hospitals where more sophisticated investigations are not available

Spectrum of diseases in acute intestinal obstruction

To determine the etiological spectrum of acute intestinal obstruction in our clinical setup Military Hospital Rawalpindi. Descriptive study. Surgical department of Military Hospital, Rawalpindi from Jul 2012 to Jul 2013, over a period of about 1 year. A total of 120 patients with acute mechanical intestinal obstruction who underwent laparotomy were included in our study while those with non-mechanical intestinal obstruction like history of trauma and paralytic ileus were excluded from the study. All the patients were selected by non-probability purposive sampling technique. Emergency laparotomy was done and operative findings were recorded. A total of 120 patients with mechanical intestinal obstruction were included in this study out of which 93 [69.17%] were female and remaining 27 [30.83%] were males. Male to female ratio was 1:2.24. Age range of patients was 22-85 years. Out of 120 patients operated for acute intestinal obstruction post-op adhesions were found in 37 [30.83%] patients followed by intestinal tuberculosis in 23 [19.17%] patients, obstructed inguinal hernias in 13 [10.83%], gut malignancies in 15 [12.5%], Meckel's diverticulum with bands in 7 [5.83%], volvulus in 7 [5.83%], perforated appendix in 6 [5%], intussusception in 2 [1.7%], inflammatory bands in 5 [4.17%], trichobezoar and faecal impaction in 2 [1.7%] while in 3 [2.5%] patients no definite cause was found. Post-op adhesions are the commonest cause of mechanical intestinal obstruction in our setup followed by intestinal tuberculosis as second most common clinical pattern of presentation