Acute appendicitis is perhaps the most common surgically correctable cause ofacute abdominal pain and its diagnosis remains difficult in many instances. Some ofthe signs and symptoms can be subtle to both the clinician and the patient and may notbe present in all the instances. Arriving at the correct diagnosis and decreasing therate of negative appendicectomy is essential. However a delay in diagnosis may allowprogression to perforation and significantly increase the morbidity and mortality.This study was a prospective study and comprised 60 patients admitted with suspected acute appendicitis and planned for Appendicectomy. The patients selected were older than 15 years, of either sex. The preoperative modified Alvarado score (MAS) was determined and C-reactive protein levels (CRP) were estimated. The results of the MAS and preoperative CRP levels were compared with the histopathology of the removed appendix.Among all the patients studied, 6, 29 and 25 patients had preoperative MAS of <5, 5-6, and 7-9 respectively. 42 patients had CRP level raised. 41 patients were histopathologically positive for appendicitis. 55% and 88% of patients with a MAS of 5-6 and 7-9 had appendicitis on histopathology respectively. We found 82.9% sensitivity and 57.9% specificity of CRP for the diagnosis of acute appendicitis. When combined with CRP, the sensitivity and specificity of MAS in patients with score of 5-6 was raised significantly from 55% to 75% and 45% to 61.5%. CRP was raised in all patients with MAS score of 7-9.Our study concluded that MAS in combination with the CRP levels is very helpful in the diagnosis of acute appendicitis especially in patients with modified Alvarado scores in the middle range, who are categorized as "equivocal" for appendicitis by the Alvarado score.
Objective: The use of drug coated balloon (DCB) for angioplasty has shown superior efficacy against plain balloons for treating complex infrainguinal arterial disease. We report and compare the clinical outcomes following application of DCB(Paclitaxel) and plain angioplasty (POBA) in our tertiary care centre. Methods: A retrospective, single centre analysis of 301 patients with chronic limb-threatening ischemia involving the infrainguinal segment was conducted between September 2014 and September 2018, after approval from the Institutional review board. We analyzed clinical outcomes by measuring postoperative ABI improvement, restenosis requiring reintervention procedure, minor and major amputations at the end of 18 months. . To find the association between the group variables (POBA and DCB) and other risk variables, Chi-square test/Fisher’s exact test was used. Multivariable logistic regression analysis was used. Results: Patients who underwent treatment with plain balloon (POBA) and DCB(Paclitaxel) angioplasty were 246(81.7%) and 55(18.3%) respectively. Our study group was predominantly male (Male: Female = 6.7:1), most patients were more than 50 years of age (n = 251, 83.4%). Smoking (n = 199, 66.1%) and diabetes (n = 210, 69.8%) were the most common atherosclerotic risk factors. Postoperative Ankle Brachial Pressure Index (ABI) improvement were similar in both groups (POBA = 57.7%; DCB = 69.8%; p = 0.103). Minor and major amputations following POBA were 26% and 22%; and DCB were 12.7% and 16.4% respectively. Re-stenosis requiring a re-interventional procedure within 18 months was 15%, (n = 37) following POBA; and 12.7% (n = 7) following DCB (p = 0.661). Conclusions: This retrospective study shows similar clinical limb related outcomes following POBA and DCB at 18 months. However, our comparative analysis between the POBA and DCB groups was totally unadjusted and not adjusted for common confounders such as age and sex. Hence, for one to draw definitive conclusions leading to changes in clinical practice; a randomized, prospective study with a larger patient cohort is needed.
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