scholarly journals A retrospective evaluation of Alvarado score in diagnosing acute appendicitis in a tertiary care hospital at Pondicherry

2021 ◽  
Vol 8 (4) ◽  
pp. 1089
Author(s):  
G. Ray ◽  
S. Selvakumaran
Keyword(s):  
Acute Appendicitis ◽  
Laboratory Finding ◽  
Tertiary Care ◽  
False Negative ◽  
Age Groups ◽  
False Negative Rate ◽  
Care Hospital ◽  
Alvarado Score ◽  
Diagnostic Skills ◽  
One Year

Background: Acute appendicitis is a common and sometimes confusing cause of acute abdomen in all age groups. Diagnosis of appendicitis can be difficult, occasionally taxing the diagnostic skills of even the most experienced surgeon. Despite the increased use of USG, CT, the rate of misdiagnosis of appendicitis has remained the same (15.3%). To evaluate the usefulness of the Alvarado score as a simple and reliable tool in preoperative diagnosis of acute appendicitis.Methods: This retrospective study conducted on 97 cases includes all patients who were admitted with a clinical diagnosis of acute appendicitis for a period of one year from February 2019 to January 2020 at IGMCRI Pondicherry with clinical suspicions of acute appendicitis were included in the study. The modified scoring system is based on 3 signs, 3 symptoms, and 1 laboratory finding. The patient was classified as males, females, and children (<12 years). These were further grouped based on the scores 7-9, 5-6, and <5.Results: A total of 80 patients with a score of 7-9 and 5-6 were operated on. Among males with a score of 7-9, 35 patients were operated and 34 were found to have an inflamed appendix. Females with scores 7-9, 16 were operated and 11 were found to have an inflamed appendix.Conclusions: Alvarado scores significantly reduce the number of negative laparotomies without increasing the overall rate of appendicular perforation. It is very effective in men and children but diagnostic laparoscopy or ultrasonography is advised to minimize the high false-negative rate in women.

scholarly journals Evaluation of a step-by-step approach to frozen section diagnosis in ovarian masses

2021 ◽  
Vol 12 (12) ◽  
pp. 133-139
Author(s):  
Ashumi Gupta ◽  
Neelam Jain
Keyword(s):  
Sensitivity And Specificity ◽  
Malignant Tumors ◽  
Frozen Section ◽  
Tertiary Care ◽  
False Negative ◽  
Significant Proportion ◽  
False Negative Rate ◽  
Accurate Diagnosis ◽  
Care Hospital ◽  
Ovarian Masses

Background: Ovarian cancer forms a significant proportion of cancer-related mortality in females. It is often detected late due to non-specific clinical presentation. Radiology and tumor markers may indicate an ovarian mass. However, exact diagnosis requires pathological evaluation, which may not be possible before surgery. Intraoperative frozen section (FS) is, therefore, an important modality for the diagnosis of ovarian masses. Aims and Objectives: This study was conducted to study step-by-step approach along with diagnostic utility and accuracy of intraoperative FS in diagnosis of ovarian masses. Materials and Methods: Retrospective comparative analysis was done to determine the diagnostic accuracy of FS as compared to routine histopathology in the pathology department of a tertiary care hospital. Diagnostic categorization was done into benign, borderline, and malignant. Overall accuracy, sensitivity, and specificity of FS technique were calculated. Results: Out of 51 cases, FS analysis yielded accurate diagnosis in 94.1% of ovarian masses. Intraoperative FS had a sensitivity of 94.7%, specificity of 96.9%, 3.1% false-positive rate, and 5.3% false-negative rate in malignant tumors. In benign lesions, FS had 91.7% sensitivity and 100% specificity. FS had 75% sensitivity and 96.4% specificity in cases of borderline tumors. Conclusion: FS is a fairly accurate technique for intraoperative evaluation of ovarian masses. It can help in deciding the extent of surgery. It distinguishes benign and malignant tumors in most cases with high sensitivity and specificity. A methodical approach is useful in determining accurate diagnosis on FS diagnosis.

scholarly journals Factors influencing perforated appendicitis in a tertiary care hospital

2017 ◽  
Vol 4 (6) ◽  
pp. 1918
Author(s):  
Palachandra A. ◽  
Shashank R. ◽  
Sreelatha C. Y.
Keyword(s):  
Acute Appendicitis ◽  
Tertiary Care ◽  
Age Groups ◽  
Delayed Diagnosis ◽  
Perforated Appendicitis ◽  
Life Time ◽  
High Morbidity ◽  
Care Hospital ◽  
Age Group ◽  
Cross Sectional

Background: Appendicitis is among the most common abdominal conditions requiring admission to emergency surgery departments. It has a life time risk of 6%. Untreated appendicitis may be complicated with development of gangrene or perforation, resulting in high morbidity and mortality rates in almost all age groups. The frequency of appendicitis may show variation by population, age, sex, socioeconomic status, and race. The objective of this study was to know the influence of some demographic factors on perforated appendicitis in a tertiary care hospital.Methods: A descriptive cross sectional was done in a teaching hospital which is a referral center. All the acute appendicitis cases admitted to the hospital between January 2015 to December 2016 were included in the study. A total of 532 acute appendicitis cases were diagnosed based on pathological features and were allocated to either the perforated or non-perforated appendicitis groups.Results: In our study total 532 cases were operated for appendicitis. Among that 294 (56%) were males and 238 (44%) were females with a ratio of 1.27:1.00. The mean age was 26.8±13.2 among non -perforated cases and 22.4±12.3 among perforated cases. In present study, maximum cases were in the age group 21-30 years and perforation was more among >50 years age group (23.3%).Conclusions: Perforation was higher among >50 years age group and in the patients from rural area which was found to be statistically significant. The reasons can be misdiagnosis, delayed diagnosis, financial and transportation problems.

EVALUATION OF MODIFIED ALVARADO SCORE IN DIAGNOSIS OF ACUTE APPENDICITIS AT TERTIARY CARE HOSPITAL IN WESTERN RAJASTHAN

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Anil Kumar Dadhich ◽  
Atul Kumar Sharma
Keyword(s):  
Acute Appendicitis ◽  
Acute Abdominal Pain ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Alvarado Score ◽  
Common Complaint ◽  
Emergency Department Patients ◽  
Modified Alvarado Score ◽  
High Degree

Background: Acute abdominal pain is a common complaint among emergency department patients. Methods:  A 100 consecutive patients suspected of acute appendicitis who were admitted in department of surgery. They were prospectively evaluated using the modified Alvarado scoring (MAS) to determine whether or not they had acute appendicitis. Result: In present study, out of total 100 patients 78(78%) were have MAS score 7-9, 20% were have 5-6 and 2% have MAS score 1-4. Conclusion: The study shows that use of MASS in patients suspected to have acute appendicitis provides a high degree of diagnostic accuracy. Keywords: Modified Alvarado Score (MAS), acute appendicitis, Patients.

scholarly journals Foreign Bodies in Ear, Nose and Throat: An Experience from a Tertiary Care Hospital in Central Nepal

2019 ◽  
Vol 21 (4) ◽  
pp. 276-282
Author(s):  
Apar Pokharel
Keyword(s):  
Foreign Bodies ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Age Groups ◽  
Care Hospital ◽  
Throat Region ◽  
Central Nepal ◽  
And Gender ◽  
One Year ◽  
Nose And Throat

Foreign bodies are frequently encountered otorhinolaryngology emergency. The objective of this research paper is to analyze different foreign bodies in terms of type, site, age, and gender distribution and methods of removal. A retrospective study was performed from March, 2018 to March, 2019 in a tertiary care hospital in the central part of Nepal. The information was obtained from hospital record books. A total of 315 patients visited the hospital with a foreign body in either of their ear, nose or throat. It comprised of approximately 12% of all the ENT emergencies in the hospital in the last one year of study. Foreign bodies in ear, nose and throat region were found in all age groups, although it was more prevalent among children of age group less than 10 years.

scholarly journals A comparative study between abdominal plain radiography and ultrasonography in non-traumatic acute abdominal emergencies in tertiary care hospital

2016 ◽  
Vol 5 (1) ◽  
pp. 113 ◽  
Author(s):  
Chiranjeev Kumar Gathwal ◽  
Monika B. Gathwal ◽  
Shreya Garg ◽  
Yogita Kumari ◽  
Kulvinder Singh
Keyword(s):  
Comparative Study ◽  
Acute Abdomen ◽  
Tertiary Care ◽  
False Negative ◽  
False Negative Rate ◽  
Plain Radiography ◽  
Radiographic Evaluation ◽  
Care Hospital ◽  
X Rays ◽  
Abdominal Emergencies

Background: Acute abdomen is a loose term frequently used to describe the acute abdominal pain in a subgroup of patients who are seriously ill developing suddenly, over a period of several hours or few days.Methods: It was a prospective comparative study between abdominal plain radiography and ultrasonography in non-traumatic acute abdominal emergencies in Tertiary Care Hospital.Results: All the included patients (140) were imaged with abdominal X-rays series (AAS) and Ultrasonography (US) by different blinded radiologists without conveying results to either. Final diagnosis was made on the basis of clinical findings / laboratory or biochemical findings /radiological evaluation /therapeutic response / operative findings / histopathological examination. The entire data was collected, recorded and statistically analyzed as per objectives. GIT system was most commonly involved, in 75/140 cases (53.57%). Most common diagnoses were acute appendicitis, KUB calculus disease and acute cholecystitis seen in 32/140 (22.86%), 24/140 (17.14%) and 21 (15%) cases respectively. US supersedes Provisional clinical diagnosis and Radiographic evaluation in diagnosing acute abdominal conditions with Sensitivity, Positive Predictive Value, False positive rate, False Negative rate and Diagnostic Accuracy as 90.71, 100, 0 ,9.28 and 90.71 percent respectively.Conclusions: We concluded that Plain X rays can be used as screening modality in the diagnosis of acute abdominal emergencies; however ultrasound examination is cheaper, non-invasive, quick, reliable and highly accurate modality in diagnosing the exact cause of pain and its origin in a patient presenting with an acute abdomen and thus helps the physician or surgeon to plan the timely management.

scholarly journals OUTCOMES OF COVID-19 INFECTIONS IN CHILDREN: A SINGLE-CENTER RETROSPECTIVE STUDY

2021 ◽  
Author(s):  
MUSTAFA GENÇELİ ◽  
Ozge Metin Akcan ◽  
Sevgi Pekcan ◽  
Fatih Akın ◽  
Mehmet Özdemir ◽  
...  
Keyword(s):  
Negative Impact ◽  
Severe Disease ◽  
Tertiary Care ◽  
Age Groups ◽  
Clinical Findings ◽  
First Year ◽  
Care Hospital ◽  
Mild Disease ◽  
Reactive Protein ◽  
One Year

Objective: The COVID-19 pandemic is an important cause of morbidity and mortality, which has had a negative impact worldwide. Our aim was to describe clinical findings and outcomes of SARS-CoV-2 viral infection and Covid-19 disease cared for at a large pediatric tertiary care hospital during the first year of the pandemic. Methods: Patients aged 1 month to 18 years who were diagnosed as having COVID-19 between March 2020 and April 2021 were included. The files of patients diagnosed with covid-19 were reviewed retrospectively. Results: 467 children were included in the study. There were 34 (7.3%) patients under one year of age, 111 (23.8%) between 1-5 years, 98 (30.4%) between 5-10 years, 142 (30.4%) between 11-15 years, and 82 (17.6%) age over 15 years. Fever (88.2%), vomiting (32.4%), and diarrhea (29.4%) in patients aged under 1 year, sore throat (36.6%) in patients aged 11-15 years, and dysgeusia (11%), anosmia (14.6%), headache (18.3%), malaise (40.8%), myalgia (28%), and dyspnea (17.1%) in those aged over 15 years of age were found significantly more common compared with the other age groups (p<0.05). Thirty-five (7.5%) patients were asymptomatic, 365 (78.1%) had mild disease, 35 (7.5%) were moderate, 27 (5.8%) were severe, and five (1.07%) were critical. Leukocyte count, erythrocyte sedimentation rate, ferritin, and C-reactive protein values were significantly higher in hospitalized patients. Four patients died during the study period (0.8%, 4/467). Conclusion: While SARS-CoV-2 infection may be asymptomatic and Covid-19 disease usually has a mild clinical course, some children have severe disease or mortality.

scholarly journals Comparison of acute inflammatory score and Alvarado score in diagnosis of acute appendicitis at a tertiary care hospital

2017 ◽  
Vol 4 (12) ◽  
pp. 4034
Author(s):  
Padmaja Rani Gopalam ◽  
M. V. Saila Suman Konidala
Keyword(s):  
Acute Appendicitis ◽  
Scoring System ◽  
Financial Burden ◽  
Tertiary Care ◽  
Area Under The Curve ◽  
High Specificity ◽  
Lower Sensitivity ◽  
Negative Appendectomy ◽  
Care Hospital ◽  
Alvarado Score

Background: Acute appendicitis remains as one of the most common surgical entity requiring early intervention. Hence there is always a need to develop a well-designed protocol for diagnosis and to reduce negative appendectomy. The most common and widely applied was Alvarado score and best performed in validating studies, but was observed with few drawbacks. A recently introduced appendicitis inflammatory response score (AIR) was designed to overcome the drawbacks associated with the implementation of Alvarado scoring system. The objective the present study was to evaluate the AIR score on cases of suspicious appendicitis and to compare it with Alvarado scorings system.Methods: A prospective study for a period of two years from March 2015 to February 2017 was conducted on consecutive patients who presented to emergency department and scoring was performed based on the necessary variables.Results: The present study was conducted on 300 cases suspicious of appendicitis. The results analysed showed the area under the ROC curve of the AIR score was 0.94 and better than the area under the curve of Alvarado score of 0.82. The AIR score also did well in difficult cases of women, children when compared to Alvarado score in diagnosis of appendicitis. In our study, in cases with >8 points, a lower sensitivity was observed in AIR scoring than Alvarado scoring (0.26 vs. 0.12), but was associated with higher specificity (1.00 vs. 0.95). In these cases, PPV turned out to be 1.00 for AIR scoring and 0.77 for Alvarado scoring.Conclusions: To conclude, AIR scoring performed well almost equally with Alvarado system with high specificity and high negative predictive value preventing unnecessary negative appendectomies. Follow up of these cases will help in deciding surgical intervention in unnecessary cases. This scoring system also prevents unnecessary and costly radiological investigations thereby reducing the financial burden to the patients.

scholarly journals Study of the prevalence of isolated vitamin B12 deficiency related dementia in patients presenting to a tertiary care hospital

2020 ◽  
Vol 7 (4) ◽  
pp. 694
Author(s):  
Patirla Devendra Reddy ◽  
Pranavendra Nath Seela ◽  
Pravin Gulab Rao Maske
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Age Groups ◽  
Vitamin B12 Deficiency ◽  
Peripheral Blood Smear ◽  
Vegetarian Diet ◽  
Care Hospital ◽  
History Of ◽  
B12 Deficiency ◽  
One Year

Background: Objective of the study was to determine the prevalence of Isolated B12deficient dementia in patients presenting to a tertiary care hospital. The MMSE was much lower in B12 deficiency compared to irreversible causes Thus, shorter duration, severe dementia, focal neurological signs, and a vegetarian diet were significantly associated with the development of B12 deficiency.Methods: Based on exclusion and inclusion criteria 100 patients were included in this study, a detailed history of the patient were taken with respect to duration of dementia and its symptoms, type and treatment. Study in terms of the correlation of the clinical features with investigations and diet. Estimation of the prevalence of dementia with reference to B12 deficiency. Mean MMSE analysis, assessment of the improvement in MMSE after treatment with B12 injections after a6-8 wks period.Results: In this study most of our patients were in the 60-69 age groups across all causes of dementia, 22out of 26, B12 deficient patients were vegetarians. This value was in keeping with the known fact that a vegetarian diet predisposes a person to develop B12 deficiency. The association between B12 deficiency, high MCV and megaloblastic blood picture in peripheral blood smear was significant. The MMSE scores were significantly lower 13.42 in patients with B12 deficiency as compared to those with Alzheimer's 14.3 means and those with multi-infarct state 17.3 means.Conclusions: The duration of the presentation in B12 deficiency was10-12months averagely. There was a significant improvement in MMSE after treatment in pureB12 deficient patients (by 9 points) if they presented within one year of symptoms. Except for myelopathy, there was an improvement in other neurological symptoms and signs. Early diagnosis and proper treatment can make improvements in a patient's memory and quality of life.

scholarly journals Outcome of Alvarado scoring system in the diagnosis of acute appendicitis at a tertiary care teaching hospital

2021 ◽  
Vol 15 (10) ◽  
pp. 2649-2651
Author(s):  
Afza Saleem ◽  
Zahra Ali ◽  
Wasif Majeed Chaudhry ◽  
Aruj Alam ◽  
Muhammad Shoaib ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Teaching Hospital ◽  
Clinical Judgment ◽  
Scoring System ◽  
Iliac Fossa ◽  
Tertiary Care ◽  
Accurate Diagnosis ◽  
Care Hospital ◽  
Alvarado Score ◽  
Surgical Residents

Background: Diagnosis of acute appendicitis is usually made on the basis of clinical judgment and experience of the surgeon. It may sometimes become a challenge due to variability in presentation. It is not unusual for surgical residents & consultants to miss the diagnosis. Aim: To evaluate the effectiveness of Alvarado score in making an accurate diagnosis of acute appendicitis and assessing its sensitivity at a tertiary care hospital, in Lahore, Pakistan. Methods: A Prospective observational study was conducted at the department of Surgery, Ghurki Trust Teaching Hospital (GTTH). The data was collected from 117 patients on a self-designed proforma over a one-year period i.e., from 1st January 2018 to 31st December 2018 with the suspected diagnosis of acute appendicitis and who underwent surgery. The variables were evaluated with Alvarado scoring system to assess its effectiveness and sensitivity. The data was analyzed using SPSS vr 23. Results: Demographic results showed 73(62.4%) males and 44(37.6%) female. The mean age was 23 years and most of the patient were in age group 11-20years 55(47%). Abdominal pain was the commonest feature found in all the patients followed by Nausea in 72% and migration of pain to Right Iliac fossa 60%. Complicated appendicitis was found as gangrenous (7.5%) and perforated (6%). 53% of the cases were performed by on-call team consisted of SRs and surgical residents. Conclusion: Alvarado score is an effective scoring system in making an accurate diagnosis of acute appendicitis. It can be very useful in the prompt management of patients with equivocal features and in extreme of ages. Keywords: Acute appendicitis, Clinical scoring, Alvarado score

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