Acute appendicitis is one of the common causes of acute abdomen. The diagnosis of acute appendicitis is usually made on the basis of clinical features and confirmed by ultrasound examination and occasionally by Computerized tomography. This study was conducted to study the importance and diagnostic efficacy of Alvarado score in acute appendicitis and its effect on reducing negative appendectomies. Material and Methods: We conducted this prospective study comprising of 150 cases who were ill enough to warrant surgery for suspected appendicitis admitted to our institute scoring system described by Alvarado was adopted to reduce negative appendectomy. Patients were included in this study on the basis of a predefined inclusion and exclusion criteria Patients were either operated or managed conservatively on the basis of a combination of Alvarado score and clinical grounds. Surgery was done under general or spinal anesthesia. Data analysis was carried out using Minitab 17 version software. Results: Out of the 150 studied cases there were 90 (60%) males and 60 (40%) females with a M: F ratio of 1:0.66. Most common age group was found to be in between 21-30 yrs. Abdominal pain was predominant complaint which was present in all patients (100%) followed by anorexia (86%), nausea (84%) and constipation (16%). Most common site of pain was right iliac fossa (100%) and tenderness in RIF was present in 147 (98%) patients. Leukocytosis was seen in 85% cases. Modified Alvarado score was less than 5, 5-6 and more than 6 in 3, 21 and 126 patients respectively. Conclusion: The Modified Alvarado score is a useful diagnostic tool at a cutoff point of 7 for all patient groups. Modified Alvarado score (7 or more) has a high sensitivity and positive predictive value for the diagnosis of appendicitis and hence can be routinely used in all district general hospitals with basic lab facilities and particularly where facilities of USG Scan or CT scan are not available.

Bone is a dynamic tissue that is remodelled constantly throughout life. The arrangement of compact and cancellous bone provides strength and density suitable for both mobility and protection. Osteoporosis is defined as a reduction in the strength of bone that leads to an increased risk of fractures. The World Health Organisation operationally defined osteoporosis as a bone density also referred to as a T-score of <–2.5 and is associated with increased risk of fractures. Bone remodelling is regulated by multiple hormones, including oestrogens (in both genders), androgens, Vitamin D and parathyroid hormone (PTH), as well as locally produced growth factors, such as IGF-I, transforming growth factor β, PTH-related peptide (PTHrP), interleukins, prostaglandins and members of the tumour necrosis factor superfamily. The risk of fracture can be predicted by the Fracture Risk Assessment score. Several non-invasive techniques are available for estimating skeletal mass or bone mineral density including single energy X-ray absorptiometry, dual-energy X-ray absorptiometry, quantitative computed tomography and ultra-sound. Total daily calcium intakes <400 mg are detrimental to the skeleton. The recommended daily required intake of 1000–1200 mg for adults accommodates population heterogeneity in controlling calcium balance. For optimal skeletal health, serum 25(OH)D should be >75 nmol/L (30 ng/mL). Bisphosphonates have become the mainstay of osteoporosis treatment. Calcitonin preparations are approved by the FDA for osteoporosis in women >5 years past menopause. Denosumab was approved by the FDA in 2010. Parathormone analogues augment trabecular bone mineral density and reduce fracture occurrence. PTH (1–34) (teriparatide) produced substantial increments in bone mass. Abaloparatide is a synthetic analogue of human PTHrP, which has significant homology to PTH and also binds the PTH Type 1 receptor increasing the bone mass. Ageing is associated with progressive decline in overall muscle strength and bone loss. Resistance training increases bone strength and density, reducing the risk of fracture during a fall. Increased levels of endurance, strength and balance with exercises increase the threshold for disability and dependence as we age. Inactive and sedentary lifestyle should be discouraged. Treatment accessibility could be improved and treatment adherence should be encouraged.

Background: Colorectal cancers are one of the leading causes of cancer related deaths worldwide. Its a common knowledge that the colorectal cancers usually occur in older age groups. This has led to low index of suspicion of having this malignancy in young patients who are less than 40 years of age. We conducted this study of colorectal cancers in young patient to emphasise the importance of keeping in entity in mind while dealing with the patient presenting with complaints consistent with colorectal malignancy even if there age is less than forty year. the stage at which the diagnosis is made is of crucial importance in colorectal malignancy and a delayed diagnosis can have serious consequences for the patient. Objectives: (1) To determine incidence of colorectal malignancy in young patient.(2) To study the symptom complex (3) To determine sex and site distribution (4) To determine operability and respectability of tumour in young patients (5) To study the histopathological types and grading in young patients. Methods: This study was a prospective cohort study of 42 cases of colorectal malignancy of age 40 years and below conducted in patients admitted in department of surgery at a tertiary care institute. The duration of study was 2 years. Results: In this study of colorectal cancers in young patient maximum number of patients were found in the age group of 31-40 years (69.4%) followed by in the age group of 21-30 years (28.57%)and 11-20 years (2.38 %). Males were found to be affected more (54.76%) than females (45.23%). Most common site of involvement was found to be rectum(57.14%) followed by rectosigmoid (16.66%) , caecum and descending colon (11.90%).Most common sign was found to be bleeding per rectum (69.04%) and most common symptom was found to be altered bowel habits (50%) followed by pain abdomen (59.52%). Mucinous adenocarcinoma (52.38% ) was found to be most common histological type of colorectal malignancy followed by adenocarcinoma (42.85%). Most patients were diagnosed in Stage C (47.61%) of duke staging followed by stage B (23.80), stage D (19.04%) and stage A (9.52%). Metastasis were seen in 6 patients. 38 patients were operated. Most common surgical procedure done was abdominoperineal resection (11 patients) followed by Palliative sigmoid colostomy (10 patients ), Right hemicolectomy (5 patients), anterior resection (5 patients), while left colectomy and palliative transverse colectomy was done in 3 patients each. Only 1 patient underwent total proctocolectomy with ileostomy. 4 patients were not operated as they had advanced stages of the disease.Adjuvant chemotherapypy and radiotherapy was given in all patients except in 2 patients who had favourable histological stage and was under follow up. Total 9 patients died during follow up period. 2 refused treatment and 31 patients are still under follow up. Conclusion: Our study was aimed at analysing colorectal malignancy in young patients. It should promote high index of suspicion on the part of treating surgeons about this entity even in young pa...