Factors Associated with Perforated Appendicitis in Elderly Patients in a Tertiary Care Hospital

Background. The incidence of perforated appendicitis in elderly patients is high and carries increased morbidity and mortality rates. The aim of this study was to identify risk factors of perforation in elderly patients who presented with clinical of acute appendicitis.Methods. This was a retrospective study, reviewing medical records of patients over the age of 60 years who had a confirmed diagnosis of acute appendicitis. Patients were classified into two groups: those with perforated appendicitis and those with nonperforated appendicitis. Demographic data, clinical presentations, and laboratory analysis were compared.Results. Of the 206 acute appendicitis patients over the age of 60 years, perforated appendicitis was found in 106 (50%) patients. The four factors which predicted appendiceal rupture were as follows: male; duration of pain in preadmission period; fever (>38°C); and anorexia. The overall complication rate was 34% in the perforation group and 12.6% in the nonperforation group.Conclusions. The incidence of perforated appendicitis in elderly patients was higher in males and those who had certain clinical features such as fever and anorexia. Duration of pain in the preadmission period was also an important factor in appendiceal rupture. Early diagnosis may decrease the incidence of perforated appendicitis in elderly patients.

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TO DETERMINE THE ROLE OF CA125 IN THE DIAGNOSIS OF ACUTE APPENDICITIS

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i7.1276 ◽

2020 ◽

Vol 4 (7) ◽

Author(s):

Vinod Kumar ◽

Bhupen Songra ◽

Richa Jain ◽

Deeksha Mehta

Keyword(s):

Acute Appendicitis ◽

Clinical Diagnosis ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Ca 125 ◽

Care Hospital ◽

Serum Samples ◽

Roc Curve Analysis ◽

Surgery Department

Background: the present study was under taken to determine the role of CA-125 in the diagnosis of acute appendicitis (AA), to prevent its complications and also in preventing negative appendicectomies in tertiary care hospital. Methods: The study was conducted at a tertiary care and research center between 01/03/2018 to 30/06/2019. Patients admitted to the surgery department with diagnosis of AA were considered for the study. After informed consent, a, standardized history was obtained as a case Performa. Serum samples from all the cases with clinical diagnosis of AA were obtained and stored. Only the cases with histopathologically approved AA were included in the study. Cases operated for clinical diagnosis of AA, but not histopathologically proven AA was not included in the study. CA125 levels in cases with definitive diagnosis of AA were measured. Results: In present study, ROC curve analysis revealed the sensitivity of 87.27 % and specificity of 90.91 % when the CA 125 cut-off value of > 16.8 was taken to diagnose acute appendicitis. AUC was 0.911 with a standard error of 0.0292. Conclusion: In this study we have observed that CA125 showed a positive correlation with acute appendicitis, that was statistically not significant (P>0.05). We didn’t evaluate the correlation with the disease severity. We consider that CA125 can be used as a marker in acute appendicitis cases although further research is still needed. Keywords: CA125, Acute Appendicitis, Surgery.

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A Study on Clinical Presentations of Oral Cancer at Tertiary Care Hospital, Bellary, Karnataka

International Journal of Scientific Research ◽

10.15373/22778179/july2014/168 ◽

2012 ◽

Vol 3 (7) ◽

pp. 1-3

Author(s):

Dr Govindaraja Dr Govindaraja ◽

◽

Dr Jashvanth Dr Jashvanth ◽

Dr Murali Krishna ◽

Dr Kasa Somasekhar ◽

...

Keyword(s):

Oral Cancer ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Clinical Presentations

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EP.FRI.479 Clinical accuracy of u/sound combined with inflammatory markers in Acute Appendicitis

British Journal of Surgery ◽

10.1093/bjs/znab312.080 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Nadia Gulnaz ◽

Sadia Tasleem ◽

Farooq Abdullah

Keyword(s):

Acute Appendicitis ◽

Clinical Diagnosis ◽

Inflammatory Markers ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Negative Appendectomy ◽

Care Hospital ◽

Clinical Accuracy ◽

Negative Appendicectomy ◽

Sensitivity Specificity

Abstract Traditionally acute appendicitis has been a clinical diagnosis based on patients' history and physical examination, but the accuracy of clinical diagnosis ranges from 70-95%. Pre-operative diagnosis of acute appendicitis still remains an enigmatic challenge, because no single test alone can reduce the rate of negative appendectomy. Hence some authors have recommended a combination of two or more investigations to increase accuracy and therefore the use of imaging is gaining support. The objective of the study was to determine the clinical accuracy of ultrasound, combined with inflammatory markers such as CRP, WBC, and neutrophilia keeping histopathology as the gold standard. Methods The study was conducted in a Tertiary care hospital in Peshawar from September 2014 to March 2015 on 250 patients who were clinically diagnosed with acute appendicitis. All these patients underwent u/sound scanning in addition to blood tests. Findings In this study, WBC had the highest sensitivity (77.68%) followed by neutrophil% (69.96%), CRP(67.10%), and U/Sound (62.96%) respectively. While U/Sound had the highest specificity (70.59%) followed by CRP and TLC (64.71% each) and neutrophil% (58.82%) respectively. When all the four tests were combined the sensitivity, specificity, (99.17% and 98.45%) increased significantly. When all four tests were negative, appendicitis could be safely ruled out. Conclusion Acute appendicitis is very unlikely and surgery can be safely deferred in these patients when all tests are negative thereby reducing the negative appendicectomy rates.

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A Study on Polypharmacy and Potential Drug-Drug Interactions among Elderly Patients Admitted in Department of Medicine of a Tertiary Care Hospital in Puducherry

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2016/16284.7273 ◽

2016 ◽

Cited By ~ 4

Author(s):

Kartik Janardan Salwe

Keyword(s):

Elderly Patients ◽

Drug Interactions ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Potential Drug

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Solitary thyroid nodule: an overview of one year study at a tertiary care hospital

International Surgery Journal ◽

10.18203/2349-2902.isj20193648 ◽

2019 ◽

Vol 6 (9) ◽

pp. 3117

Author(s):

Shyam Sundar Tandri ◽

Ayathu V. S. Sai Mahesh

Keyword(s):

Thyroid Nodule ◽

Tertiary Care Hospital ◽

Demographic Data ◽

Tertiary Care ◽

Common Finding ◽

Clinical Approach ◽

Care Hospital ◽

Cross Sectional ◽

Solitary Thyroid Nodule ◽

One Year

Background: Thyroid nodules are a common finding in general practice. These nodules are either solitary or multinodular. In the present study thorough evaluation of all the cases presenting with a solitary thyroid nodule (STN) is done. The clear overview of prevalence of STN, associated risk factors, its distribution and its percentage of malignancy, clinic-pathological correlation and findings on ultra-sonogram.Methods: A one year cross sectional study at a tertiary care hospital was done after ethical committee approval. All cases of thyroid with solitary thyroid nodule were included and socio demographic data, clinical examination and USG data was noted. Thyroid hormone profile, FNAC and HPE was performed for every case enrolled and data was noted. The data was analyzed using SPSS version 22.Results: 350 cases were enrolled with 44.42% prevalence and 61.43% were females. Maximum age group was 31-40 years with swelling as the most common sign. 81.14% were euthyroid, 6.3% of cases had lymph node involvement. Micro calcification in 69.7% of nodules and 78.65 were solid. 40.3% of the STN were of colloid on FNAC and 6% were malignant. Malignancy on HPE was 14.6% and papillary carcinoma was the most commonest and follicular least.Conclusions: All cases of STN require a thorough clinical approach supported by ultra-sonogram, FNAC and detailed HPE after surgery for evaluation of benign and malignant lesions. Fine needle aspiration cytology has become an invaluable, minimally invasive and reliable tool in the preoperative assessment of patients with suspicion of malignancy.

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Prevalence of Carbapenem Resistant Enterobacteriaceae in a Tertiary Care Hospital of Gujarat, India

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/47332.14627 ◽

2021 ◽

Author(s):

Chirag Manojkumar Modi ◽

Suman Praveen Singh ◽

Yagnesh Gajanand Pandya ◽

Chirag Premjibhai Patel ◽

Rupal Minesh Patel

Keyword(s):

Tertiary Care Hospital ◽

Demographic Data ◽

Treatment Options ◽

Tertiary Care ◽

Carbapenem Resistance ◽

Defined Daily Dose ◽

Sample Type ◽

Care Hospital ◽

Carbapenem Resistant ◽

Carbapenem Resistant Enterobacteriaceae

Introduction: Carbapenem Resistant Enterobacteriaceae (CRE) are major cause of community as well as healthcare associated infections and have limited treatment options. Measuring the magnitude of the problem of CRE, it is important for making strategies to lower its spread. Aim: To assess the incidence and prevalence rate of CRE in a tertiary care hospital of Gujarat, India. Materials and Methods: Retrospective data was collected for a period from 2014 to 2018 using Laboratory Information System (LIS). Prevalence of CRE was determined as number of CRE isolated per 100 Enterobacteriaceae isolated during the study period whereas incidence rate was determined as number of CRE cases per 1000 patient-days. Consumption of Carbapenems was calculated as Defined Daily Dose (DDD) per 1000 patient-days. Demographic data including age, gender, location in the hospital and sample type from which CRE was isolated was also analysed using Microsoft Excel. Results: The incidence of CRE cases per 1000 patient-days in 2014 to 2018 was 1.66, 2.11, 1.90, 2.26 and 1.91, respectively with an overall incidence of 1.99 per 1000 patient-days. The overall prevalence of CRE over a period of five years was found to be 29.07%. Klebsiellasp. was the most common CRE and had the highest percentage of Carbapenem resistance among all Enterobacteriaceae. Conclusion: The rate of CRE in present study was high and worrisome. Screening of the patient for CRE, source isolation and stringent implementation of infection control practices is required to confine the spread of CRE in this institute.

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Brucellosis, Unravelling an Enigma: Eight Years of Experience from a Tertiary Care Hospital in Central Kerala, India

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/46011.14270 ◽

2020 ◽

Author(s):

M Ardra ◽

Chithra Valsan ◽

KA Sathiavathy

Keyword(s):

Tertiary Care Hospital ◽

Demographic Data ◽

Tertiary Care ◽

Clinical Signs ◽

Unknown Origin ◽

Personal Contact ◽

Human Brucellosis ◽

Care Hospital ◽

Laboratory Findings ◽

Middle East Countries

Introduction: Various emerging and re-emerging infectious diseases have made the existence of mankind in this world a great challenge. In the midst of these havocs, some important diseases has undermined in the dark. Brucellosis is an endemic zoonotic disease in most of the developing world and it has far-reaching and deleterious effects on humans and animals alike. In humans, brucellosis shows a variety of non-specific clinical signs. To recognise and diagnose this neglected but debilitating disease, the awareness and alertness of medical personnel has to be enhanced. Aim: To determine the prevalence of brucellosis in Tertiary Care Hospital. Materials and Methods: A retrospective study was conducted from June 2011 to May 2019, all culture proven cases of human brucellosis admitted in a Tertiary Care Hospital in central Kerala, India were reviewed. Demographic data, clinical presentations, laboratory parameters, treatment and outcomes of the same were analysed in Microsoft excel sheets as percentages. Results: Of the 12 culture proven Brucella cases, 11 presented as Pyrexia of Unknown Origin (PUO) cases and one was a soft tissue infection. Eleven patients had history of either consumption of unpasteurised milk products or had contact with animals before the symptoms developed. A 75% cases were imported cases from middle-east countries. In one case the route of entry was by close personal contact probably sexual transmission. All the patients complained of fever and malaise (100%), while low backache and arthralgia was noted in 83%. Most common clinical and laboratory findings associated with brucellosis were hepatosplenomegaly (41.7%) and anaemia (66.6%). Oral doxycycline for six weeks combined with either aminoglycoside or rifampicin was used for treatment. There was no death or relapses noted. Conclusion: This study emphasises the close collaboration of an alert clinician and an experienced microbiologist to correctly diagnose and treat an infection with multiple presentations as brucellosis, in endemic areas also.

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