Background: Acute appendicitis remains as one of the most common surgical entity requiring early intervention. Delay in management results in complications and misdiagnosis results in negative appendectomy. Hence there is always a need to develop a well-designed protocol for diagnosis and to reduce negative appendectomy. Alvarado score for diagnosis of acute appendicitis is an easy, affordable and diagnostic which has been evaluated early with variable reports. In cases with equivocal score, additional tools like sonography may provide a reliable result in accurate diagnosis of acute appendicitis. Objective of the study was to determine the diagnostic accuracy of Alvarado score and ultrasonography in diagnosis of acute appendicitis. To determine the sensitivity, specificity and predictive values of ultrasonography in cases operated with histopathological correlation.Methods: A prospective observational study was conducted at our hospital by department of general surgery for a period of six months. All suspected cases of appendicitis were scored by Alvarado score and cases with>5 were performed additional USG for further evaluation. All the cases of appendicitis that underwent surgery were further confirmed by histopathological correlation with USG and clinical Alvarado score.Results: A total of 200 cases were enrolled with male predominance (57.5%) and mean age of study group was 34.26±8.64 years and male to female ratio of 1.3:1.69% of cases presented with Alvarado score of 7 and above, while 21% of cases with 5-6. Migratory pain in RIF was the commonest symptom and tenderness RIF was the most common sign.160 cases (80%) were operated totally with 75% cases lap appendectomy and 25% cases by open appendectomy. USG was performed on 160 cases and 146 were positive and 14 were negative whereas histopathologically 142 cases were confirmed as Acute appendicitis. The sensitivity, specificity, PPV and NPV of USG is 97.18%, 55.56%, 94.52% and 71.43%. The accuracy of USG is 92.5.Conclusions: Acute appendicitis is first and foremost a clinical diagnosis with scoring systems and imaging being necessary adjuncts in equivocal cases. USG is an easily available tool in diagnosis of acute appendicitis. Application of USG as adjunct tool to Alvarado scoring improves the diagnostic accuracy.

INTRODUCTIONAmong the Health care associated infections (HAI), surgical site infections (SSI) previously termed as postoperative wound infections are one of the most common HAI in low and middle income countries. The prevalence of these infections varies widely ranging from 5-16%. In India, based upon the various studies prevalence of SSI varies between 5% and 24%.1 SSI are defined as an infection occurring within 30 days after a surgical operation (or within 1 year if an implant is left in place after procedure) and affecting either incision or deep tissues at the operation site.2 Despite advances in SSI control practices, like improved operating room ventilation, sterilization methods, use of barriers, surgical technique there has been an alarming rise in low and middle income countries. Increase in SSI is associated with increased morbidity, as well as mortality due to emergence of antimicrobial resistant pathogens. Factors related to development of SSI include patient related factors like smoking, diabetes etc. and also operation ABSTRACT Background: Among the Health care associated infections (HAI), surgical site infections (SSI) previously termed as post-operative wound infections are one of the most common HAI in low and middle income countries. Increase in SSI is associated with increased morbidity, as well as mortality due to emergence of antimicrobial resistant pathogens. Understanding the pathogens implicated in causing the SSIs and their antimicrobial sensitivity place a good role in reducing the mortality and morbidity. Methods: A prospective study was conducted at a tertiary care hospital to all the patients admitted in Department of surgery, Orthopedics and Gynecology and Obstetrics for six months from January 2016 to June 2016. The demographic data, inclusion criteria and exclusion criteria, risk factors, clinical history, laboratory data with gram stain, culture results and antibiotic sensitivity of the isolates were collected. Results: Two hundred patients were recruited in the study and the prevalence of SSI in the study was 3.83%. Patients who underwent emergency operations and diabetics were at higher risk of acquiring SSI. The most commonly isolated pathogens in the study were Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa. Pseudomonas aeruginosa was most common isolate from orthopedic cases of SSI, Escherichia coli was most common isolate from intestinal surgeries and Staphylococcus aureus from LSCS. Increased rate of isolation of MRSA and ESBL strains were observed in the study. Conclusions: Study clearly explains the various causes and risk factors associated in development of SSI. The study guides in the type of the organism isolated and possible antibiotic of choice in treatment and management of SSI. The prevalence of SSI was 3.83%, which is comparable with some of the studies and lower than many of the studies.