Modified Alvarado score versus Tzanaki’s Score in diagnosing acute appendicitis: An observational study

Background: Appendix is a blind muscular tube derived from the midgut. During the embryogenic development, in the 6th week appendix and cecum appear as out pouching from midguts caudal limb. Acute appendicitis is one the most common diagnosis made whenever patient presents with right illac fossa pain and mostly encountered in young and middle-aged individuals. The diagnosis and management of acute appendicitis depend on clinical presentation, that is, clinical signs and symptoms. The most common presentations in these cases have abdominal pain along with fever, anorexia, nausea, and vomiting. Various Scoring systems are developed to diagnose acute appendicitis based mainly on the presenting signs and symptoms, but widely none of them are used as an uniform scoring system. Aims and Objectives: The purpose of this study was to assess effectiveness and comparison of modified Alvarado score and Tzanaki’s Score in the early diagnosis of acute appendicitis. Materials and Methods: A prospective observational study was done in department of General Surgery JLN Medical College Hospital, Ajmer which included 200 patients presenting with the signs and symptoms of acute appendicitis, clinically. During admission the patients were evaluated by Modified Alvarado score and Tzanaki’s Score and final surgical decision was taken by the treating surgeon. Finally, the scores were compared with the histopathological examination of the surgically operated specimen. Results: The sensitivity and specificity of Modified Alvarado Score was 84.26% and 72.7%, respectively, with a positive predictive value of 96.15% and negative predictive value of 36.3%. The sensitivity and specificity of Tzanaki’s score was 88.2% and 72.7%, respectively, with a positive predictive value of 96.31% and negative predictive value of 43.24%. The diagnostic accuracy of Alvarado score was 83% and that of Tzanaki’s score was 86.5%. Conclusions: Our study showed that Modified Alvarado scoring system is a simple tool with limited features for bedside diagnosis of acute appendicitis, but its effectiveness is not as good as that of Tzanaki’s scoring system.

Intestinal obstruction – A retrospective study of 150 cases

Mechanical bowel obstruction presenting acutely is a common surgical emergency and a frequently encountered problem in department of surgery. Intestinal obstruction continues to remain a challenge to surgeons despite advances in field of medicine, pathophysiology, surgical technique and conservative management. This retrospective study in patients operated for acute mechanical bowel obstruction in our department, was intended to highlight the common causes of intestinal obstruction in this geographical location of the study which had suggested measures for prevention and treatment of the condition. 150 patients who underwent exploratory laparotomy for intestinal obstruction were compared in terms of age, sex, symptoms, etiology of intestinal obstruction, site of obstruction, operative procedure performed

Quorum sensing (QS) as etiological phenomenon: the bacterial paradigm.

Signaling mechanisms that govern physiological and morphological responses to change the cell density are common in bacteria. Quorum sensing is signal transduction processes which involves the production and release of and response to hormone-like molecules (auto-inducers) that accumulate in the external environment as the cell population grows. Quorum sensing is found in a wide variety of bacteria, both Gram-positive and Gram-negative and the spectrum of physiological functions that can be regulated is impressive. Variation in the nature of the extra-cellular signal in the signal detection machinery and in the mechanisms of signal transmission demonstrates the evolutionary adaptability of quorum sensing systems for multiple uses.

Antifertility effects of leaf extracts of some plants in male rats.

Ethanolic leaf extracts of different local folklore plants (Azadirachta indica, Beaumontia grandiflora, Chordia dichotoma, Casiarea tomentosa, Diospyros embryopteris, Milletia auriculata and Melia azedarach) were investigated for antifertility effects on male rats in oral doses of 100 mg/kg daily for 21 days. Though, none of these extracts interfered with spermatogenesis, anti-implantational and abortifacient effects were observed in females mated by the males fed with leaf extracts of A. indica and C. dichotoma. Leaf extract of B. grandiflora besides having anti-implantational and abortifacient effects, had luteolytic effects. Abolition of libido in 100% males by leaf extracts of D. embryopteris and M. azedarach and in 60% of males by extract of C. tomentosa preclude these plants for antifertility use.