Background: Management of acute appendicitis with antibiotics only, without surgery is currently evaluated. Non-operative management of uncomplicated acute diverticulitis and salpingitis has been well established but the non-operative management of acute appendicitis remains controversial. Growing evidence indicates that patients with acute uncomplicated appendicitis can be treated safely with an antibiotics- first approach.Methods: A tertiary care hospital based longitudinal study with duration of 26 month. Patients with clinical and radiological feature of acute appendicitis presenting within 48 hours of initiation of abdominal pain with Modified Alvarado Score ≥5 included. Various demographic, clinico-pathological, radiological factors were studied.Results: 71 patients evaluated, mean age of 30.45±9.71 years. Tenderness in RIF was the commonest finding followed by Fever and rebound tenderness. Leucocytosis seen in 74.65% Modified Alvarado score of 5-6 was present in 18.32% whereas 7-9 was present in 81.68% patients. USG was suggestive of appendicitis in 84.50% patients. Conservative treatment was successful in 74.65% patients with no treatment failure. 25.35% patients, conservative treatment failed. Overall recurrence was seen in 13.11% cases that were successfully managed during primary admission.Conclusions: Majority of cases of first attack of uncomplicated acute appendicitis can be treated successfully by conservative treatment. However, conservative treatment requires monitoring and repeated re-evaluation to identify failure which needs to be treated promptly by surgery. Treatment failure on primary admission as well as the short- term recurrence after conservative treatment is low and acceptable. The outcome of conservative treatment does not depend on Modified Alvarado Score.

Introduction: Central line associated blood stream infection (CLABSI) is a primary blood stream infection in a patient that had a central line within the 48-hour period before the development of bacteraemia and is not related to an infection at another site. It is often associated with serious infectious complications resulting in significant morbidity, increased duration of hospitalization and additional medical costs. Objective: We aimed to study the course of infection, microbiology of CLABSI, & to identify the degrees of severity of sepsis associated with CLABSI. Materials & Methods: Patients admitted in Intensive care units who fulfilled the inclusion criteria were enrolled. Various demographic, microbial and patients characteristics were noted along with outcome using a prestructured proforma. Results: We studied 58 patients in ICU in which males were common, Sepsis seen in 43% of patients, 37% had Staph. Aureus, and the mortality was 24.1%. Conclusion: CLABSI infection is best prevented rather than cured. It has mortality as high as 24.13%. It can manifest with varying degrees of severity of sepsis. Organ Dysfunction, multi organ involvement, TLC abnormalities, Oliguria, altered mental status, Hypotension are all markers of poor prognosis. More scientific data on the subject is required to formulate guidelines and protocols for prevention and treatment of CLABSI.

No abstract

Objective: The current investigation was aimed to compare the safety, efficacy, adverse effects, and outcome of air pyelogram versus contrast pyelogram for percutaneous nephrolithotomy. Materials and Methods: This was a cross-sectional study conducted from August 2018 to November 2020, which included 400 patients with a clinical diagnosis of renal calculus and randomly (1:1) assigned into Group I (air pyelogram) and Group II (contrast pyelogram). Air was injected in Group I and diatrizoate meglumine 76% was used in Group II for PCS identification. In the case of difficulty in visualization in either group, a mixture of contrast and air was used. The following parameters were assessed: duration of access, total duration of radiation exposure during access, total attempts needed to puncture the desired calyx, failure rate, complications, and outcomes. Results: Both the groups were comparable including renal calculus characteristics. The mean (standard deviation) duration of access was 3.08 (1.21) and 5.23 (1.02) min (P < 0.0001) in Groups I and II, respectively; in 85% and 57.5% of patients (P < 0.0001), respectively, the caliceal puncture was done in a single attempt. The duration of radiation exposure was more in Group II (P < 0.0001). The failure rate (22%) was higher and statistically significant in Group II. The stone clearance rate was not statistically significant between the groups (P = 0.380). No patient had hypoxia, cardiopulmonary complications, and air embolism in perioperative period. Conclusion: Air contrast is effective and safe, and it reduces the duration of caliceal puncture and radiation exposure with lower failure rate. If both air and contrast fail, a combination of both may be effective.

No abstract