ABSTRACT:Patients presenting with pain in the right iliac fossa is common for a surgeon. The causes differ based on the organ of origin. The common conditions include acute appendicitis, right ureteric calculus, mesenteric adenitis or ileocecal tuberculosis and right ovarian cyst. Other causes are appendicular abscess and ascending colon carcinoma. Rare conditions include Non-Hodgkin’s lymphoma, caecal carcinoma, amoeboma, lymph node mass, iliopsoas mass, retroperitoneal mass and Crohn’s disease. This makes it difficult to diagnose and manage these patients. Hence a prospective study on right iliac fossa masses was conducted. Out of a total of 50 patients, the most common cause was of appendicular origin, mainly appendicitis followed by right ureteric calculus. Pain, fever and leucocytosis were predominantly noted in inflammatory conditions whereas weight loss, anaemia and painless mass were noted in neoplastic causes. Appendicular mass patients were treated conservatively followed by interval appendectomy. Appendicular abscess was drained extraperitoneally. Right hemi-colectomy was done for carcinoma in the cecum and ascending colon. Tubercular patients with intestinal obstruction also underwent right hemi-colectomy. Intra-venous antibiotics were administered to all infective cases. Tubercular masses were started on anti-tubercular drugs. Carcinoma patients received adjuvant therapy. Crohn’s disease and non-specific lymphadenitis were treated medically. Hence our study shows that managing right iliac fossa mass patients can be challenging and requires vigilance.
Case Report Migrated Iucd Causing Unilateral Obstrutive Hydroureteronephrosis...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Case Report Migrated Iucd Causing Unilateral Obstrutive Hydroureteronephrosis...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
A 10 year old boy presented with fever, local swelling around the ankle with tenderness and antalgic gait, without any antecedent trauma or discharging sinus. He had no evidence of pulmonary tuberculosis. Laboratory tests revealed signs of inflammation with normal Mantoux test and chest X-ray. An irregular lytic lesion of the talus was seen on the x-ray of the affected part. Ziehl Nelson staining of the aspirated fluid revealed acid-fast bacilli. Material obtained after curettage and bone grafting confirmed the diagnosis of tuberculosis. He was treated conservatively with splintage and 4 drug anti-tubercular chemotherapy for 18 months, without any residual tenderness or foot deformity at the final follow-up. This case has been reported because of its rarity and atypical clinical presentation.
Abstract— Joint replacement operations which are applied to reduce the pain and increase the movement capacity are among the surgical procedures that are used mostly nowadays. Even though a dramatic recovery is seen in the life of the patient after total knee prosthesis, possible prosthesis infection increases cost and causes high morbidity. This study was conducted with the aim to determine rates of surgical site infection after performing primer total knee prothesis operation in our clinic. Furthermore, it has been intended to understand risk factors which may cause infection and then take precautions. This study was conducted from January 2008 to January 2013, 252 knees underwent primary total knee arthroplasty operations. Among these patients infection rates, relationship to risk factors and infection treatments were analysed. It was observed that iIn 252 knees, 10 (4%) superficial infections were found, debridement and antibiotics were applied to 3 knees out of 10 and only antibiotic treatment was applied to the rest 7 knees. Deep infection was detected in 4 knees (1,6%) out of 252. Acute deep infection in 1 knee and recovery was provided with debridement and intravenous antibiotics treatment. Late deep infection was not detected in any of patients. Delayed deep infection was detected in 3 (1,1%) of these knees though. Among all risk factors only increased body mass index showed increased superficial wound infection rate. It can be concluded that among the factors like rheumatoid arthritis, diabetes, age, gender, body mass index, just body mass index has an impact on superficial infection rate. Our infection rates were comparable to rates mentioned in universal literature for primary total knee replacement operations.
Brachial Plexus Injury in Abdominal and Breast Surgery_ Crimson PublishersCrimsonpublisherssmoaj
Brachial Plexus Injury in Abdominal and Breast Surgery by Eyüp Murat Yılmaz* and Ethem Bilgiç in Crimson Publishers: Annals of Medicine and Surgery
Brachial plexus injury is a picture of the upper extremity that leads to numbness, pain, and limitation of movement, usually seen in newborns and trauma cases. Iatrogenically, it is observed after thorax, orthopedics, breast, and abdominal surgeries nevertheless it is quite rare. Risk factors exist and treatment and management seem to be a challenging clinical condition.
https://crimsonpublishers.com/smoaj/fulltext/SMOAJ.000526.php
For more Open access journals in Crimson Publishers
Please click on: https://crimsonpublishers.com/
For more Articles on Annals of Medicine and Surgery
Please click on link: https://crimsonpublishers.com/smoaj/index.php
PERFORATIVE PERITONITIS: CONTINUING SURGICAL CHALLENGE.(PROSPECTIVE STUDY OF ...KETAN VAGHOLKAR
Background: Perforative peritonitis poses a significant diagnostic and therapeutic challenge to the attending
surgeon. Delay in diagnosis followed by sub-optimal treatment may lead to many complications, thereby increasing both
morbidity and mortality. This is by virtue of various factors which affect the prognosis. Hence the need arises to identify
these prognostic factors. Aims and Objectives: To study the various etiological factors of perforative peritonitis and to
identify prognostic factors and comorbid conditions which influence the outcome in perforative peritonitis. Materials
and Methods: 50 patients with an established diagnosis of perforative peritonitis due to various aetiologies confirmed
by clinical and radiological investigations were included in the study and studied prospectively. On admission to the
hospital, various haematological and radiological investigations were conducted to confirm the diagnosis. Patients
subsequently underwent surgical intervention. Postoperative recovery and outcomes assessed. Results were tabulated
and statistically analysed. Results: The mean age of patients in the study was 36.5 ±5 years. Patients who presented
in an advanced stage developed complications. The majority of patients were males. The interval between the onset
of symptoms and operative intervention was directly related to postoperative complications. Pneumoperitoneum was
the most common x-ray finding, followed by dilated bowel loops with free fluid in the peritoneal cavity as the most
common ultrasonography finding. Tachycardia and oliguria, which were markers of the severity of the disease process,
were associated with an increased rate of complications. Peptic ulcer perforation was the most common, followed by
perforations caused by infective aetiology. Perforations caused by infective aetiology had a higher rate of complication.
Primary closure of the perforation was the most commonly performed procedure. Significant abdominal contamination
found intraoperatively contributed to a negative outcome, as were comorbid conditions, which also increased the
complication rate significantly. Conclusion: Delayed intervention after the onset of symptoms, tachycardia, oliguria
and comorbidities are associated with a higher complication rate. Radiological investigations help in confirming the
diagnosis. Infective aetiology of the perforation and extensive peritoneal contamination was associated with higher
complication rates. Prompt and aggressive resuscitation on admission, optimum antibiotic administration, and early
meticulous surgical intervention can reduce morbidity and mortality to a bare minimum.
GastrointestinalAcute abdominal pain often represents a spectrum.docxgilbertkpeters11344
Gastrointestinal
Acute abdominal pain often represents a spectrums conditions or diseases ranging from self-limited and benign diseases to more serious surgical emergencies. When conducting an assessment on the patient’s abdominal pain, it is crucial to consider some important factors and information. The assessment or evaluation of the abdominal pain requires an approach that rely on the likelihood of a disease, of physical examination, laboratory tests, imaging studies, patient history (Mujagic et al., 2015). The location of the pain in the abdomen is an important starting point because it may guide on further evaluation process (Mujagic et al., 2015). For example, manifestation of right lower quadrant pain usually suggests appendicitis. Various elements of the physical examination and patient’s history are helpful, for example constipation and abdominal distension suggest bowel obstruction, while others have little value. For example, anorexia has insignificant predictive value for appendicitis. Imaging information are also important when conducting abdominal pain assessment.
Various professional organizations like the American Nursing Association and the American College of Radiology have recommended different imaging studies when assessing abdominal pain depending on the location of the pain (Mujagic et al., 2015). Ultrasonography is always recommended when assessing right upper quadrant pain while computed tomography (CT) scanning is recommended when assessing left and right lower quadrant pain (Mujagic et al., 2015). The other information to collect when conducting an assessment of the abdominal pain is considering special populations like women, especially those at a risk of genitourinary disease that can cause abdominal pain and the senior adults who may present with atypical symptoms of a disease
When conducting an assessment of the masses in the abdominal region, it is pivotal to identify their possible causes. As a registered nurse, I will conduct an examination of the supraclavicular and inguinal and nodes. In the examination process, I will inspect for the presence of scars, particularly in the umbilicus for the laparoscopy scars. The inspection will also involve identification of distension, pulsation, prominent veins, skin lesions, local swellings, asymmetrical movement, and visible peristalsis. In this case, it is recommended to exclude lesions that are located on the abdominal wall.
Auscultation of the abdomen is also performed to identify any abnormal or altered bowel sounds, rubs, or vascular bruits (Mujagic et al., 2015). Normal peristalsis usually creates bowel sounds that can be absent or altered in case of a disease.
Palpation is the last approach that can be utilized when assessing the masses in the abdomen. Warm hands should always be used in the palpation of the abdomen. It is important to check for any rebound tenderness, rigidity, and guarding in these abdominal masses.
Palpating a mass in the abdomen r.
Background: A 51-year-old woman had left lower abdomen pain for 18 hours with nausea and vomiting. Prior CT scans suggested pelvic neoplasms. Our hospital's emergency CT showed an enlarged uterus with cystic shadows, right adnexal cysts, and stomach fluid. Physical examination revealed left lower abdomen discomfort. A gynaecological examination revealed a painful, firm pelvic mass of 151210 cm. Further diagnosis is underway. Method: The patient underwent emergency exploratory laparotomy, discovering a twisted, swollen left ovary with a 540° rotation, classified as a benign cyst. It was found that the patient had congenital upper vaginal atresia and bilateral initial uteri. Pain was reduced after surgery, thanks to symptomatic treatment. An abnormal karyotype of 46, XX,1qh+ was found during genetic testing. Result: Fallopian tubes, uterus, and vagina develop from the embryonic accessory mesonephric duct. MRKH syndrome is caused by bilateral accessory mesonephric duct dysplasia and disappearance of the uterus or vagina. MRKH has three types, with Type 1 lacking uterus or vagina. Due to ovarian cyst torsion, this Type 1 MRKH with double initial uterus and upper vaginal atresia needed left adnexa resection. Genetic testing showed a typical female karyotype. MRKH's complex aetiology incorporates chromosomal abnormalities, emphasizing early cytogenetic evaluation for personalized treatment and fertility assistance. Conclusion: Early cytogenetic testing for MRKH syndrome patients is crucial for determining the underlying cause and guiding personalized treatment plans to restore reproductive function and improve quality of life.
Key-words: Double primordial uterus; MRKH syndrome; Upper vaginal atresia; Torsion of left ovarian cyst pedicle
A 10 year old boy presented with fever, local swelling around the ankle with tenderness and antalgic gait, without any antecedent trauma or discharging sinus. He had no evidence of pulmonary tuberculosis. Laboratory tests revealed signs of inflammation with normal Mantoux test and chest X-ray. An irregular lytic lesion of the talus was seen on the x-ray of the affected part. Ziehl Nelson staining of the aspirated fluid revealed acid-fast bacilli. Material obtained after curettage and bone grafting confirmed the diagnosis of tuberculosis. He was treated conservatively with splintage and 4 drug anti-tubercular chemotherapy for 18 months, without any residual tenderness or foot deformity at the final follow-up. This case has been reported because of its rarity and atypical clinical presentation.
Abstract— Joint replacement operations which are applied to reduce the pain and increase the movement capacity are among the surgical procedures that are used mostly nowadays. Even though a dramatic recovery is seen in the life of the patient after total knee prosthesis, possible prosthesis infection increases cost and causes high morbidity. This study was conducted with the aim to determine rates of surgical site infection after performing primer total knee prothesis operation in our clinic. Furthermore, it has been intended to understand risk factors which may cause infection and then take precautions. This study was conducted from January 2008 to January 2013, 252 knees underwent primary total knee arthroplasty operations. Among these patients infection rates, relationship to risk factors and infection treatments were analysed. It was observed that iIn 252 knees, 10 (4%) superficial infections were found, debridement and antibiotics were applied to 3 knees out of 10 and only antibiotic treatment was applied to the rest 7 knees. Deep infection was detected in 4 knees (1,6%) out of 252. Acute deep infection in 1 knee and recovery was provided with debridement and intravenous antibiotics treatment. Late deep infection was not detected in any of patients. Delayed deep infection was detected in 3 (1,1%) of these knees though. Among all risk factors only increased body mass index showed increased superficial wound infection rate. It can be concluded that among the factors like rheumatoid arthritis, diabetes, age, gender, body mass index, just body mass index has an impact on superficial infection rate. Our infection rates were comparable to rates mentioned in universal literature for primary total knee replacement operations.
Brachial Plexus Injury in Abdominal and Breast Surgery_ Crimson PublishersCrimsonpublisherssmoaj
Brachial Plexus Injury in Abdominal and Breast Surgery by Eyüp Murat Yılmaz* and Ethem Bilgiç in Crimson Publishers: Annals of Medicine and Surgery
Brachial plexus injury is a picture of the upper extremity that leads to numbness, pain, and limitation of movement, usually seen in newborns and trauma cases. Iatrogenically, it is observed after thorax, orthopedics, breast, and abdominal surgeries nevertheless it is quite rare. Risk factors exist and treatment and management seem to be a challenging clinical condition.
https://crimsonpublishers.com/smoaj/fulltext/SMOAJ.000526.php
For more Open access journals in Crimson Publishers
Please click on: https://crimsonpublishers.com/
For more Articles on Annals of Medicine and Surgery
Please click on link: https://crimsonpublishers.com/smoaj/index.php
PERFORATIVE PERITONITIS: CONTINUING SURGICAL CHALLENGE.(PROSPECTIVE STUDY OF ...KETAN VAGHOLKAR
Background: Perforative peritonitis poses a significant diagnostic and therapeutic challenge to the attending
surgeon. Delay in diagnosis followed by sub-optimal treatment may lead to many complications, thereby increasing both
morbidity and mortality. This is by virtue of various factors which affect the prognosis. Hence the need arises to identify
these prognostic factors. Aims and Objectives: To study the various etiological factors of perforative peritonitis and to
identify prognostic factors and comorbid conditions which influence the outcome in perforative peritonitis. Materials
and Methods: 50 patients with an established diagnosis of perforative peritonitis due to various aetiologies confirmed
by clinical and radiological investigations were included in the study and studied prospectively. On admission to the
hospital, various haematological and radiological investigations were conducted to confirm the diagnosis. Patients
subsequently underwent surgical intervention. Postoperative recovery and outcomes assessed. Results were tabulated
and statistically analysed. Results: The mean age of patients in the study was 36.5 ±5 years. Patients who presented
in an advanced stage developed complications. The majority of patients were males. The interval between the onset
of symptoms and operative intervention was directly related to postoperative complications. Pneumoperitoneum was
the most common x-ray finding, followed by dilated bowel loops with free fluid in the peritoneal cavity as the most
common ultrasonography finding. Tachycardia and oliguria, which were markers of the severity of the disease process,
were associated with an increased rate of complications. Peptic ulcer perforation was the most common, followed by
perforations caused by infective aetiology. Perforations caused by infective aetiology had a higher rate of complication.
Primary closure of the perforation was the most commonly performed procedure. Significant abdominal contamination
found intraoperatively contributed to a negative outcome, as were comorbid conditions, which also increased the
complication rate significantly. Conclusion: Delayed intervention after the onset of symptoms, tachycardia, oliguria
and comorbidities are associated with a higher complication rate. Radiological investigations help in confirming the
diagnosis. Infective aetiology of the perforation and extensive peritoneal contamination was associated with higher
complication rates. Prompt and aggressive resuscitation on admission, optimum antibiotic administration, and early
meticulous surgical intervention can reduce morbidity and mortality to a bare minimum.
GastrointestinalAcute abdominal pain often represents a spectrum.docxgilbertkpeters11344
Gastrointestinal
Acute abdominal pain often represents a spectrums conditions or diseases ranging from self-limited and benign diseases to more serious surgical emergencies. When conducting an assessment on the patient’s abdominal pain, it is crucial to consider some important factors and information. The assessment or evaluation of the abdominal pain requires an approach that rely on the likelihood of a disease, of physical examination, laboratory tests, imaging studies, patient history (Mujagic et al., 2015). The location of the pain in the abdomen is an important starting point because it may guide on further evaluation process (Mujagic et al., 2015). For example, manifestation of right lower quadrant pain usually suggests appendicitis. Various elements of the physical examination and patient’s history are helpful, for example constipation and abdominal distension suggest bowel obstruction, while others have little value. For example, anorexia has insignificant predictive value for appendicitis. Imaging information are also important when conducting abdominal pain assessment.
Various professional organizations like the American Nursing Association and the American College of Radiology have recommended different imaging studies when assessing abdominal pain depending on the location of the pain (Mujagic et al., 2015). Ultrasonography is always recommended when assessing right upper quadrant pain while computed tomography (CT) scanning is recommended when assessing left and right lower quadrant pain (Mujagic et al., 2015). The other information to collect when conducting an assessment of the abdominal pain is considering special populations like women, especially those at a risk of genitourinary disease that can cause abdominal pain and the senior adults who may present with atypical symptoms of a disease
When conducting an assessment of the masses in the abdominal region, it is pivotal to identify their possible causes. As a registered nurse, I will conduct an examination of the supraclavicular and inguinal and nodes. In the examination process, I will inspect for the presence of scars, particularly in the umbilicus for the laparoscopy scars. The inspection will also involve identification of distension, pulsation, prominent veins, skin lesions, local swellings, asymmetrical movement, and visible peristalsis. In this case, it is recommended to exclude lesions that are located on the abdominal wall.
Auscultation of the abdomen is also performed to identify any abnormal or altered bowel sounds, rubs, or vascular bruits (Mujagic et al., 2015). Normal peristalsis usually creates bowel sounds that can be absent or altered in case of a disease.
Palpation is the last approach that can be utilized when assessing the masses in the abdomen. Warm hands should always be used in the palpation of the abdomen. It is important to check for any rebound tenderness, rigidity, and guarding in these abdominal masses.
Palpating a mass in the abdomen r.
Background: A 51-year-old woman had left lower abdomen pain for 18 hours with nausea and vomiting. Prior CT scans suggested pelvic neoplasms. Our hospital's emergency CT showed an enlarged uterus with cystic shadows, right adnexal cysts, and stomach fluid. Physical examination revealed left lower abdomen discomfort. A gynaecological examination revealed a painful, firm pelvic mass of 151210 cm. Further diagnosis is underway. Method: The patient underwent emergency exploratory laparotomy, discovering a twisted, swollen left ovary with a 540° rotation, classified as a benign cyst. It was found that the patient had congenital upper vaginal atresia and bilateral initial uteri. Pain was reduced after surgery, thanks to symptomatic treatment. An abnormal karyotype of 46, XX,1qh+ was found during genetic testing. Result: Fallopian tubes, uterus, and vagina develop from the embryonic accessory mesonephric duct. MRKH syndrome is caused by bilateral accessory mesonephric duct dysplasia and disappearance of the uterus or vagina. MRKH has three types, with Type 1 lacking uterus or vagina. Due to ovarian cyst torsion, this Type 1 MRKH with double initial uterus and upper vaginal atresia needed left adnexa resection. Genetic testing showed a typical female karyotype. MRKH's complex aetiology incorporates chromosomal abnormalities, emphasizing early cytogenetic evaluation for personalized treatment and fertility assistance. Conclusion: Early cytogenetic testing for MRKH syndrome patients is crucial for determining the underlying cause and guiding personalized treatment plans to restore reproductive function and improve quality of life.
Key-words: Double primordial uterus; MRKH syndrome; Upper vaginal atresia; Torsion of left ovarian cyst pedicle
ABSTRACT- Background: Endometriosis is associated with chronic, benign, oestrogen-dependent inflammatory
disease that affects approximately 10% of reproductive age women and 35-50% of women with pelvic pain and
infertility. It can be a weakening disease with dysmenorrhoea, dyspareunia, and chronic pelvic pain symptoms.
Objective: To evaluate the role of serum marker (IL-6, IL-8, TNF-α) as non-invasive tool to diagnose endometriosis in
reproductive age group.
Methods: A case control study was conducted in Department of Obstetrics and Gynecology, KGMU, Lucknow for a
period of one year. Total numbers of women enrolled in study were 100. Out of 100 women, 75 women of reproductive
age group with clinical suspicion and USG findings were taken as cases. Out of 75 cases, 12 cases lost the follow up
and 26 cases kept on conservative management and they responded well. Finally 37 cases of endometriosis with strong
clinical suspicions (Dysmenorrhea, Heavy or irregular bleeding, Pelvic pain, Lower abdominal or back pain,
Dyspareunia, Dyschezia) and USG finding of endometriosis were recruited as cases and they underwent laparoscopy/
laparotomy. Control group comprises of 25 women undergoing for laparoscopic tubal ligation. After taking informed
consent, all the women were subjected to the detailed menstrual, gynaecological, medical history and general, systemic
and gynaecological examination. Patient was investigated for haemoglobin, ultrasound abdomen and pelvis and serum
markers (IL-6, IL-8, TNF-α). Blood sample (5ml of blood) was collected in vecutainer tube for serum analysis. The
blood was centrifuged to separate the serum and stored at -70ºC till examined. Finally 37 cases of endometriosis
underwent laparotomy/laparoscopy (gold standard to diagnose endometriosis) for proper diagnosis and treatment.
Results: Serum IL-8 cut-off at 0.78% pg/ml afforded a sensitivity of 70.3% and specificity of 80% in the diagnosis of
endometriosis and has good discriminant ability. TNF-α has average discriminant ability, 62.2% sensitivity and 56%
specificity for endometriosis diagnosis. So that serum IL-8 and TNF-α can differentiate cases with or without
endometriosis. By detecting these serum markers, we can diagnose endometriosis without undergoing laparoscopy or
laparotomy.
Conclusion: The serum markers (IL-8, TNF-α) can be used as a non-invasive tool for diagnosis of endometriosis.
Key-words- Endometriosis, Interleukins, Tumour necrosis factor, Laparoscopy
Abdominal Tuberculosis Revisited–A single institutional experience of 72 case...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Graded therapeutic approach to fissure in ano (study of 50 cases)KETAN VAGHOLKAR
Background: Fissure in ano is one of the commonest disease affecting all age groups. The condition is quite painful leading to interference in activities of daily living. A wide variety of modalities ranging from medical to surgical approaches have been proposed. However no single modality can be called the gold standard of treatment. Hence the need to develop an optimum graded approach to manage the condition. Methods: Fifty consecutive cases of fissure in ano presenting in an acute state were studied prospectively to develop a therapeutic algorithm for rational treatment of the painful condition. Results: Conservative treatment was commenced in all cases. Eighteen required anal dilatation while out of these eighteen patients, ten required sphincterotomy despite anal dilatation. Four patients had recurrence of symptoms despite all surgical treatments. Conclusions: Conservative treatment still has a significant and positive outcome in fissure in ano. Anal dilatation and sphincterotomy are the next options of treatment. Therefore a graded multimodal approach is therapeutic in treating fissure in ano.
Surgery for intra abdominal hydatid disease a single centre experienceKETAN VAGHOLKAR
Background: Hydatid cyst is one of the commonly encountered parasitic disease in agricultural countries. Man is an accidental host. However the parasite can cause cystic lesions in various organ systems of the body. Intra-abdominal hydatid cyst continues to be a challenging problem. Methods: Case records of patients diagnosed and surgically treated for intra-abdominal hydatid disease were studied. Demographic details, diagnostic modalities and surgical approach to each patient was studied. Results: Ten cases of intra-abdominal hydatid disease diagnosed and managed in a single surgical centre were studied. Eight patients had hepatic disease, one had splenic disease and one had disseminated disease which included both hepatic and peritoneal disease. All were treated surgically. Conclusions: Males involved in livestock industry are commonly affected. Liver is the commonest intra-abdominal site for hydatid disease. CT scan is diagnostic. Open surgery still continues to be the safest option for treating this condition.
Abstract—In Italy the hydatid disease is more prevalent and new cases are highlighted more frequently in Sicily, Sardinia, (Italy). Aim of this study is to put the indication in search of iaditea nature in both spleen swelling and muscle tendon.
Material and Method Patients observed during the period 2007-2009 at the Surgical Clinic III and Digestive Surgery, Policlinico G Rodolico were explored for Hydatid cyste at various sites. Diagnosis of cysts ecchinococcus occurred primarily for various four reasons either for compression of bodies involved or for eosinophilia or for instrumental investigation or for anaphylactic reaction to rupture of cysts. Biological diagnosis is based on serology rather than isolation of the parasite (indirect diagnosis);
Results Patients attended during the period 2007-2009 Hydatid cyst was found in 0.5% of all cases in liver along with 4 in the lung, 3 in splenic, 2 in the mammary and 2 in the chest wall No 2. The Surgical treatment with the complete removal of the cyst with a satisfactory postoperative course in the absence of cases of relapse of the disease and by following the therapeutic act, the assumption of mebendazole 50mg / kg / day for 3 weeks at a dose of 400mg for 4 months
Conclusions There is a need to define diagnostic methods with high specificity and sensitivity, which can provide a valid diagnostic aid for the cases clinically difficult to diagnose. And the final diagnosis must then also be based on the development of immunological methods that allow the determination of specific antibodies in the serum and their titration and / or the circulating antigen determination.
Hirschsprung’s disease in adults: Clinical and therapeutic featuresPremier Publishers
Hirschsprung’s disease (HD) is rare in adults and it is thus often undiagnosed or misdiagnosed. Through this series of 12 patients we try to study the clinical characteristics of this pathology, to define its diagnostic clues and to assess the different therapeutic approaches.
Definitive diagnosis is established on histology of specimens from the rectum and colon. The disease involved the rectum and the sigmoid colon in 2 patients and was confined to the rectum, in the 10 others.
Treatment was in all cases surgical consisting of recto-colic resection associated with coloanal anastomosis and a protective right lateral ileostomy.
We conclude that Hirschsprung’s disease is rare in adults but by no means exceptional. It should be considered in young adults with a history of chronic constipation. Diagnosis is first of all clinical. When barium enema appearances are pathognomonic we needn’t resort to histology to confirm the diagnosis. Anorectal manometry does not usually show RAIR. Current primary treatment of HD diagnosed in adults consists mainly of surgical resection.
ABSTRACT- A 76 years old male presented with complaints of fever, weight loss and anorexia for three months and increased frequency and urgency of urine for 20 days. Physical examination of abdomen showed a lump in right paraumblical region and extending up to inguinal and hypogastrium on right side. Postero-anterior view of chest radiograph was normal. Ultrasound and Computed tomography (CT) of abdomen revealed a giant exophytic right renal cortical cyst of 9.84x9.70 cm (volume 336 mL) size arising from lower pole. Ultrasound guided aspiration of the cystic lesion revealed yellowish coloured, purulent pus of about 280 mL. Ziehl-Neelsen staining and PCR tests of the pus was positive for Mycobacterium tuberculosis. Gram’s staining and pus culture was negative for other microorganisms. Patient responded to anti-tubercular treatment and finally considered as primary tubercular giant exophytic renal cortical cyst. To our knowledge, this common entity is an extremely rare manifestation.
Key-words- PCR, Giant cyst, Mycobacterium tuberculosis, Ultrasound and Computed tomography (CT)
Benefits of Mechanical Manipulation of the Sacroiliac Joint: A Transient Syno...CrimsonPublishersOPROJ
Benefits of Mechanical Manipulation of the Sacroiliac Joint: A Transient Synovitis Case Study by Brady Hauser* in Crimson Publishers: Orthopedic Research and Reviews Journal
Drs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: March CasesSean M. Fox
Drs. Breeanna Lorenzen and Travis Barlock are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
• Miliary tuberculosis
• Mediastinal mass
• Esophageal perforation
• Mucus plugging and left lung collapse
• Naloxone associated pulmonary edema
• Unilateral pulmonary edema in setting of severe Mitral Regurgitation
• ARDS and Ventilator-Acquired Pneumonia (VAP)
On the Use of the Causal Analysis in Small Type Fit Indices of Adult Mathemat...QUESTJOURNAL
ABSTRACT: Model evaluation is one of the most important aspects of Structural Equation Modeling (SEM). Many model fit indices have been developed. It is not an exaggeration to say that nearly every publication using the SEM methodology has reported at least one fit index. Fit is the ability of a model to reproduce the data in the variance-covariance matrix form. A good fitting model is one that is reasonably consistent with the data and doesn’t require respecification and also its measurement model is required before estimating paths in a covariance structure model. A baseline model of four constructs together with a combination of none, one, two, three or four additional constructs was constructed with latent variables: educational performance, socioeconomic label, self concept and parental authority using dichotomous digits 0 or 1 for each additional construct. 16 progressively nested models were considered starting with baseline model using the mathematics adult learners data from the modeling sample and employing some small fit indexes which are commonly used (AIC, CAIC, RMR, SRMR, RMSEA, 2 / DF among others) [1] to test the fitness of the model. The measures of model fit based on results from analysis of the covariance structure model are presented.
The Sov’reign Shrine of Veiled Melancholy- The Shadow of Consumption on La Be...QUESTJOURNAL
―Youth grows pale and spectre thin and dies‖ – John Keats, (Ode to Nightingale) Tuberculosis was one of the most misunderstood and misrepresented diseases of all times. Hailed as Consumption’s Poster Child, Keats' life, like Beethoven's, served as a pattern tor the Romantic artist. In acute distress and emotional turmoil, in 1819 masterpiece followed masterpiece. In Keats' poems we see a concreteness of description of the object he contemplates. All the senses - tactile gustatory, kinetic, organic, as well as visual and auditory combine to give the total apprehension of his experience. His experiences often accord closely with his personal, life and the disasters he had. Keats is austere in poetry and yet he keeps high colouring and variety of appeal to the senses and the mind. Tuberculosis remains with us today, especially in sub-Saharan Africa and Southeast Asia where more than a million people die of this disease each year. It is worth recalling its history and its association with literature with special reference to John Keats and his poetry- and specially La Belle Dame Sans Merci that shows a dominant forebrooding over man's mortality from it. La Belle becomes a representation of the disease in Keats’s La Belle Dame Sans Merci and reflects the poet’s struggle with tuberculosis.
Recruitment Practices And Staff Performance In Public Universities: A Case St...QUESTJOURNAL
ABSTRACT: Recruitment, as a human resource management function, is one of the activities that impact most critically on the performance of any organization irrespective of its size and location. Public Universities, known to train professionals that exhibit transformative leadership and successfully run blue-chip companies have equally suffered from rampart industrial unrest and human resource malpractices across Kenya. Could it be a unique trend of organizational deviance that could be reflecting absence of a well executed staff recruitment practice? While it is understood and accepted that poor recruitment decisions continue to affect organizational performance and limit goal achievement, knowledge about this aspect in Public Universities remains scanty. The aim of this study was to address this gap by evaluating how recruitment practices affect performance of administrative staff in Public Universities using Masinde Muliro University of Science and Technology, Kenya as a case reference. A cross-sectional survey design was employed while sampling strategy was a blend of multiphase, stratified and purposive sampling. A sample size of 124 out of 1150 comprised mainly of administrative staff was used and that a questionnaire was the principal tool of data collection. Results were analyzed using frequency tables, mean, standard deviation and simple linear regression. The study found that a recruitment policy existed at Masinde Muliro University of Science and Technology, Kenya and that both external and internal recruitment practices were used to recruit employees at the University. However, it was noted that most of the university employees are recruited through media advert, internal advertisement, through transfers and promotions. The results of the regression indicated that recruitment practices are a significant predictor of employee performance, which was explained by 32% of variance and a moderate relationship captured by beta weight value of 0.57. On effectiveness of the recruitment policy, only 30% rated it as effective while 62% were indifferent and 8% rated it ineffective. The study concluded that although a significant relationship between recruitment practices and employee performance existed, it’s effectiveness and therefore positive impact on employee performance depended on employees’ positive perception and rating. It’s recommended that the Universities should avoid biasness in the recruitment process as this will negatively impact on employee performance.
Pesse Na Siri’ Budgetary System: A Historiography Study of Luwu Kingdom in Is...QUESTJOURNAL
ABSTRACT: This study aimed to explore the budgetary system of pesse na siri’ at Luwu kingdom in the Islamic period of 1593 to 1945. Through the historiography method, it showed the base existence of the spiritual sense sensitivity, i.e., pesse (empathy) and siri’ (shame) and Islamic law in budgetary system. In the resources management, it was carried out in four stages, namely planning, implementation, reporting, and evaluation. Operationally, the pesse na siri’ budgetary system on the mobilization mechanism of resources or budget (balanca) through the top down system (i.e., known as balanca pole riwawo) and bottom up system (i.e., known as balanca pole riawa). The top down system was a mobilization resource form from agricultural products of the king’s land (i.e., known in Buginese language as Tanana datue) and the palace logistic. Meanwhile, the bottom up came from the resource offer–i.e., known as makkasiwiyang–mechanism, consisting of makkasiwiyang lili’ (the lower government level), makkasiwiyang ale (personal/individual), and makkasiwiyang reso (labor). One of the Islamic impacts in this system was to direct the budgetary system based on the Shari’a or Islamic law.
Fabrication of Complete Dentures for A Patient with Resorbed Mandibular Anter...QUESTJOURNAL
ABSTRACT: The loose and unstable lower complete denture is one of the most common problems faced by denture patients with highly resorbed ridge. The management of such highly resorbed ridges has always posed a difficulty to the prosthodontist.Obtaining consistent mandibular denture stability has longbeen a challenge for dental profession. The simplest approach often is to extend the denture base adequately for proper use of all available tisues.To achieve this goal impression of the resorbed mandibular ridge is very important. The objective is to develop a physiologic impression with maximum support of both hard and soft tissues.In such cases, an innovative technique of impressionmaking by using a close fitting tray and anelastomeric impression material tomake a proper impression to achieve maximum retentionand stability.This article describes an impression technique used for highly resorbed mandibular ridge using an all green impression technique, to gain maximum retention andstability
Steganographic Technique Using Instant Messaging Conversation DynamicsQUESTJOURNAL
ABSTRACT : Steganography is considered to be not only the science but also the art of hiding secret messages into other innocuous and non-secret media of different types. History of steganography started with the history of civilization and algorithms of data hiding have been constantly developed with the rise of mankind's knowledge. Some of steganographic algorithms are so close connected to the use of digital media, computers and information technology, that those algorithms do not have analogy in non-digital world. It is possible to see the use of hard disk drives (HDD), solid state discs (SSD) and file systems for the purpose of steganography, or steganography in TCP/IP networks as the example. In this paper we are concentrating on such algorithm and we are examining the possibility of the use of dynamics of conversation realized with the use of instant messaging services, which are very popular standalone services or are part of widely used social networks like Facebook. The paper discusses the possibility of hidden message encoding by the use of different parameters of conversation dynamics and introduces new algorithm and its program implementation. The last part of the paper summarizes results of its experimental use.
Simple Obfuscation Tool for Software ProtectionQUESTJOURNAL
ABSTRACT: This paper discusses the issue of source code obfuscation and also the creation of a tool for automatic obfuscation of source code written in C language. The result is a tool that performs both data flow and control flow obfuscation and allows the user to configure the applied transformation algorithm. For easier and better usability the tool provides a graphical user interface, which brings possibility to control and configure transformation process.
Block Hybrid Method for the Solution of General Second Order Ordinary Differe...QUESTJOURNAL
ABSTRACT: We consider the construction of block hybrid method for the solution of general second order ODEs. Derivation of the method was based on the use of hermite polynomial as basis function. The main method and its additional equations are obtained from the same continuous formulation via interpolation and collocation procedures. The method is then applied in block form as simultaneous numerical integrator, this approach eliminates requirement for starting values, and it also reduces computational effort. The stability properties of the method is discussed and the stability region shown. Two numerical experiments were given to illustrate the accuracy and efficiency of the new method.
Modeling – Based Instructional Strategy for Enhancing Problem Solving Ability...QUESTJOURNAL
ABSTRACT: The modeling-based instructional framework accommodates the physics modeling mechanism in which the learner apply the fundamental principles in physics and develop an idealized physics model of the real world situation by means of assumptions and approximations. The present study was intended to find out the effectiveness of Modeling-based instructional strategy for enhancing physics problem solving ability of students at secondary school level. The investigator adopted a quasi-experimental method with two group pretest post-test design for the study. The sample selected for the study consisted of 242 IX standard students from three different schools of Palakkad district. The tools used for collecting the data were the Problem Solving Ability Test in Physics, lesson designs based on Modeling-based instructional strategy and activity oriented method. The findings of the study concluded that the Modeling-based instructional strategy enhanced the problem solving ability of students of secondary school level. And also the strategy scaffolded the formation of mental models of problem representations with in the cognitive structure of the learner.
Exploring the Effectiveness of the Arabic LanguageTeaching Methods in Indones...QUESTJOURNAL
ABSTRACT: The aim of this research work is to identify the effectiveness of the Arabic language teaching methods in Indonesia(National University of Malang for Sample)in terms of making use of Arabic as a medium of communication among the students in the light of the modern approaches in teaching and learning of Arabic language. This research is methodologically characterized as a descriptive, analytical, evaluative and field research work. In order to arrive at the purpose of this study, a questionnaire has been designed and carried out on a specimen from the teachers of the concerned university. Eventually, the study has arrived into a finding that the method used in the university is the Eclectic Method (i.e. Selective Method), except that translation is utilized extensively with it, and it might influentially cause the depreciation of the communication skill of the students, and the major intermediary language for the Arabic language teaching is the Indonesian language. However, its uncontrolled over-usage in the Arabic language teaching procedure may negatively cause the weakness of the students in the listening and speaking skills, since they could not get enough opportunity to practice them during language learning, in addition to the fact that the teachers might be employed as Arabic language teachers on the basis of their high conversance with the grammatical rules of Arabic language and not on their skills in the Arabic language communication medium.
The Teller & The Tales: A Study of The Novels of Amitav GhoshQUESTJOURNAL
ABSTRACT: The paper re-visit the plot and setting of the novels of Amitav Ghosh. The paper has two parts – (i)The Teller & (ii) The Tales. In the first section the text tries to give a brief sketch of the life of Amitav Ghosh to chornicle the life of the visionary commentator of life and the social anthroplogist , the most prominent among the Indian writers of English. In the second part the theme and storyline of the novels were revisted along with characters and narrative technique. The first section has been introduced to give an overview of the prolificness of the author and the second part is the testimony of his logocentricism. The paper aims to present the plot and theme of all Ghosh’s novels
ABSTRACT: The purpose of Larkin as literary artist was to convey his ultimate message that man has to transcend the gross environment for the attainment for final goal. His poem opens with important question which prompt us to scrutinize ourselves. According to Philip Larkin “when you come to talk about once duty as writer then ones can say that his duty is to write for harmony”. In this paper there an urge in Larkin’s poem to attain transcendental knowledge by which everything is known. The meaningful change in environment through literature result from the development of qualities and attitude that foster constructive pattern of human interaction through literature. In an age of highly industrialized and mechanized structure of our society where we have 'given our hearts away a sordid boon' and where all spiritual values have been thrown overboard, the relevance of selecting this topic "Spiritual Quest in Philip Larkin" becomes important. In Larkin's poetry there is invariably, an element of spiritual crises, a note of subsequent struggle to step out of it. This inner conflict to proceed forward in the path of Divine realization lends magnificence to his poetic and spiritual personality.
The Influence of Religiosity on Marital Satisfaction and Stability AmongChris...QUESTJOURNAL
ABSTRACT: Various studies indicate that religious couples are more likely to enjoy stable and happy marriages. They are also less likely to experience conflict and violence, or to divorce perhaps because religion offers couples theologically grounded guidelines on how to handle marital conflicts when they arise. The present qualitative study was conducted using face to face interviews with nine participants in Kenya who had been identified as practicing Christians. The aim of the study was to explore how religiosity impacted the participant’s marital satisfaction. Results indicated that specific attributes related to religiosity like individual and partner prayer, reading the Bible, church attendance, impacted participants and their spouses lives positively and in turn their experiences in marriage. Engaging in religious practices was reported by the participants as eliciting qualities like perseverance, forgiveness and humility which in turn assisted them in keeping their marriages stable and thus resulting in marital satisfaction
The SA0 Group Reservoir ’S Compositive Evaluation In The Central Developing P...QUESTJOURNAL
ABSTRACT: Using the data from logging in a net of high density, the sand core from a airtight well, and the testing data for oil and gas , and then according to the experiment of exploitation, we studied the deposit visage in macroscopical way, the physical characteristics of the reservoir, and the partition of the oil and gas’s border. It is clear that the zero group of Sa’s oil floor is mainly deposit in the foreside of a delta under the background of lake incursion, and the ventro-delta express a character that there were some sandstones which was transited for two times. Make a certain that the oil and gas’s border of zero group in Sa is maybe 600m underground, and demarcated the maximal square is 26.8km2 about this reservoir, and tell us that it lies in the top of the anticline. Of course, this production can be used in the designing of the zero group of Sa’s exploitation
Down the Purgatory of Memories:The Pain of Remembering in M alayalam Naxal Ci...QUESTJOURNAL
ABSTRACT:Keralam, the southern most state in India is known for its cinema and politics. It is in Kerala that Communist Party came to power through Parliamentary election process for the first time in history. The political consciousness nurtured by the Communist movement found its reflections in Malayalam (language being spoken by the people of Keralam) Cinema as well. As a result films produced during the formative years of Malayalam Cinema were characterized by their political content. Having said this it should also be added that since those films are produced within the dominant production system with a view to garner profit they fail to politically stimulate the audience. But the situation had been changed after the Naxalite (radical left movement ideologically inclined to Maoism) uprising in 1969 during which both the feudal/bourgeois value orientations and the alleged degeneration of the Communist Party were challenged by the educated radical youths who fought for an immediate revolution. The state promptly intervened and contained Naxalite uprising with an iron fist. The repressive machinery of the state intervened whenever instances of resistance occurred. The Emergency declared in 1975 exposed the inhuman face of government that unleashed series of tortures against its citizens. The post -1980 political films, otherwise called as Naxalite films, try to recapture the tormenting experience of being political during the time of such mass oppression. Those movies resort to memory to expose the stark experience of the past.Remembering is a way of representing the past with all its nuances as it situates the remembering subject at close proximity with the past. At the same time Naxalite movies explored the possibility of forgetting also to unveil the subtle complexities of individual's relationship with the past. Here I consider two Malayalam films-AmmaAriyan(1986) directed by John Abraham and Margam (2003) directed by Rajeev Vijayaraghavan- to investigate how memory and oblivion are meticulously used by the filmic narratives to politicize a society already under the grip of political amnesia.
Professional Competences: An Integrative Approach for Defining The Training C...QUESTJOURNAL
ABSTRACT: This paper offers an integrative proposal for Business Administrationcurricular programs. For that purpose, we have carried out a survey with teachers from upper Business Administration courses so as to select a group of key competences for the contemporary Administrator, which has allowed us to elaborate an integrative proposal of curricular program for the Business Administration scholars in Brazil. As a qualitative research, it consists of a multiple case study with empirical approach and a triangular analysis based on Moraes (2014).Its main objective has been to analyze the curricular programs from five higher education institutions in the state of Rio Grande do Sul and two other foreign institutions in South America. At first, we have asked ourselves the following question: How to adapt the Business Administration curricular program to the contemporary needs as far as the vocational training competences of Administrators are concerned?In order to answer it, we have analyzed the National Curriculum Guidelines (DCN) and the Political-Educational Projects of Business Administration Courses (PPC/CSA). After that, we have compared the Curricular Components (CC) of the Higher Education Institutions (HEIs) under analysis. After performing the triangular textual analysis of the DCN, PPC/CSA and CC of all HEIs under study, we have carried out a survey with 35 teachers from Business Administration upper courses through a computerized online questionnaire.We have sent a Survey Monkey link for a total of 40 teachers, however, only 35 answered it (87.5%); we have considered 100% valid answers. Previously, based on the doctrine of competences and curriculum according to the most renowned authors – suchas Vygostsky, Freire, Sacristán, Piaget, Saviani, Bloom, Libâneo (curriculum); Fleury & Fleury, Zarifian, Perrenoud, Lisboa (competences), among others – wehave concluded that implementing the integrative proposal will providemore well-prepared graduates from the Business Administration course right to the competitive and globalized labor market.
Resisting Total Marginality: Understanding African-American College Students’...QUESTJOURNAL
ABSTRACT: This article explores collegiate Black identity development when African American students attend predominantly White institutions (PWIs) in the United States, considering the overall impact of total marginality. The term “total marginality” is used to describe the myriad, chronic, and often inescapable ways that African American college students attending PWIs are marginalized in a college setting. The focus of this paper is the impact of total marginality on Black identity development for those African American collegians who successfully complete their university studies at a PWI.
Alternative dispute resolution and civil litigation barriers to access to jus...QUESTJOURNAL
ABSTRACT: Civil law is the predominate system of law in the world. Civil law as a legal system is often compared with common law. The main difference that is usually drawn between the two system is that common law drawn abstract rules from specific cases, whereas civil law with abstract rules which judges must then apply to the various cases before them. Civil law has its roots in Roman law, Common law and the Enlightenment, alongside influence from other religious laws such as Islamic Law. The legal system in many civil law countries are based around one or several codes of law which set out the main principles that guide the law. On the other hand, Criminal Law as offences and prescribes punishment for them. It not only precludes or prevents crimes but also punish the offender. It is necessary for the maintenance of law, order and peace within state. In criminal cases, it is the state which initiates proceeding against the offender. Laws relating to the Civil Proceeding as the Code of Civil Procedure 1908; the Civil Courts Act 1887; the Suit Valuation Act 1887; the Limitation Act 1908; the Registration Act 1908; & the Specific Relief Act 1877.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
2. Study on Clinical observation in Patients Presenting With Right Iliac Fossa ….
*Corresponding Author**Dr. Mritunjay Sarawgi 64 | Page
Appendicitis
Hyperplastic ileocaecal tuberculosis
Crohn’s disease or regional ileitis
Amoebic typhilitis
Carcinoma of caecum
Actinomycosis of caecum and appendix
Impactions of roundworm’s in lower part of ileum
Lymph node enlargement
Retroperitoneal sarcoma
Iliac abscess
Ureteric calculi
Mesenteric adenitis
From neighbouring regions-
Unascended kidney
Tubo-ovarian mass
Pyosalpinx
Cyst and abscess of broad ligament
Fibroid of the uterus
Undescended testis developing malignancy
Extra abdominal causes
Right lower lobe pneumonia
Miscellaneous
In this work, we shall be focusing on the three other important causes of right iliac fossa pain besides
appendicitis; i.e ureteric calculi, mesenteric adenitis and ovarian cysts.
II. AIMS AND OBJECTIVES
To study the causes of right iliac fossa pain.
To compare between acute appendicitis and other causes of right iliac fossa pain.
III. MATERIAL AND METHODS
Source of data:
The patients with right iliac fossa pain who will present to the DEPARTMENT OF GENERAL SURGERY,
RIMS, RANCHI from NOVEMBER 2013 to OCTOBER 2015.
Method of collection of data:
The study is a clinical observational study. After obtaining a detailed history, complete general physical
examination and systemic examination, the patients will be subjected to the relevant investigations.
Inclusion criteria for the study:
All patients presenting with right iliac fossa pain.
Study Tools-
Detailed history
General examination
Per abdominal examination
Necessary investigations
Routine Investigations:
TLC DLC
Hemoglobin
Urine-routine examination
Random blood sugar
Blood urea, serum creatinine
Erythrocyte sedimentation rate
Serum electrolytes
X-ray erect abdomen
USG-abdomen
CT abdomen
Histopathological examination of the obtained tissue
3. Study on Clinical observation in Patients Presenting With Right Iliac Fossa ….
*Corresponding Author**Dr. Mritunjay Sarawgi 65 | Page
Treatment Modality and outcome.
IV. OBSERVATIONS
A Total of 100 patients were selected for the study.
Sex Frequency Percentage
Males 49 49
Females 51 51
Total 100 100
Age Frequency Percentage
10-19 35 35
20-29 38 38
30-39 19 19
40-49 5 5
50-59 3 3
Diagnosis Frequency Percentage
Acute Appendicitis 71 71
Right ureteric calculus 19 19
Mesenteric lymphadenitis 8 8
Right ovarian cyst 2 2
V. DISCUSSION
A Total of 100 patients were selected for this study of which females were 51 in number and males were 49
in number.
Out of 100 patients who presented to us with right iliac fossa pain 71 of them were diagnosed to be
suffering from acute appendicitis with female : male ratio being 1.21 : 1 (Females – 39, Males – 32) and 81
percentage of the patients were clustered in the age group of 10 -29 years.
Out of 100 patients with right iliac fossa pain 19 of them were diagnosed to have right ureteric calculus.
The male : female ratio was 1.7:1 (Males – 12, Females – 7) with 57 percentage of the patients were
between 30 – 50 years.
8 out of 100 patients with right iliac fossa pain were found to have mesenteric adenitis, the incidence of
which is more in the younger population. The incidence of the disease is slightly more common in males
with the male : female ratio being 1.5:1 (males- 5, Females – 3).
Acute appendicitis is the commonest diagnosis of the patients presenting with acute right iliac fossa pain.
But a number of intra–pelvic, retroperitoneal , extra–abdominal and other conditions can present as acute
right iliac fossa pain.
The ultimate goal of treating right iliac fossa pain should be to minimize the number of negative
explorations and its complications in the form of wound infections, adhesive small bowel obstruction,
incisional hernia.
VI. CONCLUSION
Acute appendicitis is by far the most common diagnosis made in patients presenting with right iliac
fossa pain.
Right ureteric calculus is the next most common entity encountered in these patients followed by mesenteric
adenitis and right ovarian cyst.
BIBLIOGRAPHY
[1]. Gray’s anatomy- 39th
edition. Burkhill GJC. Healy FC 2000 Anatomy of the retroperitoneum. Imaging 12 : 10 – 20. Newman. DL.
Gosling RG. Bowden R 1971.
[2]. A manual on clinical surgery- S. Das-8th
edition.
[3]. Sabiston text book of surgery-18th
edition. Vaglio. A salvarani C. Buzio C. lancet 367 : 241-251, 2006,
[4]. Junior sundresh. N, Narendran. S, Ramanathan. M; Journal of Biomedical Sciences and Research (JBSR), Volume 1, Issue
(October 2009).
[5]. Mohamed A kurer; journals of medical case reports. J med case reports. 2007; 1:132, Published online 2007 November 10.
[6]. Ata khan, Simon Rajendran, Chwanrow Baban 1, micheal Murphy, Deirdre O, Hanlon; BMJ Case Reports 2010, doi: 10.1136/bcr.
10.2009.2338 published – 15th
April 2010
[7]. Amit Goyal, Shruti Goyal, Rajinder Bagree, Somnath Sharma, D.K. jindel; Indian Journal of Surgery- Vol. 72 (suppl 1); july
2010-Pg 347-348.
[8]. Radka hazukova, Stanislav Rejchrt, Zdenuk Vacek, Marcela Kopaaova, Petr Dvofiak, Jan Bure; Folia Gastroenterol Hepatol 2005;
3 (3); 99-103.
[9]. Grossman EB Jr. Chronic Appendicitis, Surg Gynecol Obstet 1978. 146 596-598.
[10]. Hawes As, Whalen GF. Recurrent and chronic appendicitis the other inflammatory conditions of the appendix Am surg 1994, 60:
217-219.
4. Study on Clinical observation in Patients Presenting With Right Iliac Fossa ….
*Corresponding Author**Dr. Mritunjay Sarawgi 66 | Page
[11]. Chang SKY, Chan P. Recurrent appendicitis as a cause of recurrent right iliac fossa pain, Singapore Med j 2004. 45: 6-8.
[12]. Checkoff JL, Wechsler Rj, Nazarian LN. Chronic Inflammatory appendiceal conditions the mimic acute appendicitis on helical CT.
Am J Roentgenol 2002, 179:731-734.
[13]. Koudelka J, Preis j, Stefan H. Chronic appendicitis in children (in Czech). CeskPediatr 1990, 45:47-48.
[14]. Mattei P, Sola JE, Yeo CJ Chronic and recurrent appendicitis are uncommon entities often misdiagnosed J Am Coll Surg 1994,
178:385-389.
[15]. Meade RH An Introduction to the History of General Surgery, Philadelphia, PA, Saunders: 1968. Richardson RG. The Surgeon’s
Tale. New York. NY: Scribner’s 1958.
[16]. Williams RA, Myers P. Pathology of the Appendix London, England: Chapman & Hall: 1994.
[17]. Da Capri JB. Commentaria cum AmplissimusAdditionibus Super AnatomiaMundiniUna cum TextaEjusudem in
PristinumetVerumNitoremRedanto, 528 ff. Bolonial imp. Per H. Benedictus, 1521.
[18]. Vesalius A. DE humaniCorporisFabrica Liber V. Basel, Switzerland: JohanesOporinu; 1543.
[19]. Thomas CG. Classic Description of Disease. Springfield; 1932.
[20]. Amyand C. Of an Inguinal rupture, with a ppn in the appendix caeci, incrusted with stone, and some observations on wounds in the
guts. Philos Trans R SocLond. 1736;39:329-342.
[21]. Ellis H: Appendix in Schwartz Sl (ed) Maingot’s Abdominal operation, 8th
edition, Vol 2, Norwalk Conn Appleton- Century-
Crofts, 1985:p-1255.
[22]. Tait L. Surgical treatment of typhlitis. Birmingham Med Rev. 1890:27:26-34.
[23]. Fitz RH. Perforating inflammation of the vermiform appendix; with special reference to its early diagnosis and treatment. Am J
Med Sci, 1886;92:321-346.
[24]. Mc Burney CM. Experience with early operative interference in cases of disease of the vermiform appendix. N Y Med J.
1889;50:676-684.
[25]. Treves F. A series of cases of relapsing typhlitis treated by operation. BMJ. 1893;i:835-837.
[26]. Prystowsky JB, Pugh CM, Nagle AP: Current problems in surgery. Appendicitis. CurrProbl Surg 42:688-742,2005.
*Dr. Mritunjay Sarawgi. "Study on Clinical observation in Patients Presenting With Right Iliac
Fossa Pain - Acute Appendicitis V/S other Causes." Quest Journals Journal of Medical and
Dental Science Research 4.5 (2017): 63-66.
