Background: Acute appendicitis is one of the challenging surgical conditions presented in the emergency departments. Clinical scoring systems were developed to reduce the negative appendectomy rate and also to avoid unnecessary diagnostic evaluation. Objectives: The primary aim was to compare the clinical adequacy of the Alvarado, Acute Inflammatory Response, and the Raja Isteri Pengiran Anak Saleha Appendicitis scores in patients with right lower quadrant pain for the diagnosis of acute appendicitis. Methods: This was a prospective and observational study. All patients over the age of 18 years who presented with a complaint of right lower quadrant pain were enrolled. The Alvarado, Acute Inflammatory Response, and Raja Isteri Pengiran Anak Saleha Appendicitis scoring systems were compared. The patients were either admitted or followed-up as out-patient. Face-to-face or telephone follow-up visits were arranged for the patients who did not have surgery and who were not admitted. Results: 232 patients were included and 14 patients were excluded from the study. Of the 218 patients, 114 patients underwent surgery. Of the 114 patients, 107 patients were pathologically diagnosed with acute appendicitis. It was determined that Raja Isteri Pengiran Anak Saleha Appendicitis score was the most valuable score with 0.88 accuracy, followed by Acute Inflammatory Response (area under the curve = 0.79) and Alvarado (area under the curve = 0.71) scores. Conclusion: The accuracy of Raja Isteri Pengiran Anak Saleha Appendicitis scoring system was higher for the diagnosis of acute appendicitis than the other scores. The cut-off of the Raja Isteri Pengiran Anak Saleha Appendicitis score from a 7.5-point threshold provides a practical, non-invasive, rapid diagnostic method that increases acute appendicitis discriminative power in patients presenting with right lower quadrant pain.

Background: Acute myocardial infarction is one of the most common causes of mortality in developed countries, and high-sensitive troponin test usually becomes positive within 3 h from the onset of symptoms. Myocardial perfusion index (Tei index) is a parameter measured during the echocardiographic examination. Objectives: The aim of this study is to investigate the diagnostic value of the Tei index for early diagnosis of acute myocardial infarction in the emergency department and to evaluate the correlation between the Tei index and Hs-Troponin value. Materials and Methods: A total of 129 cases were evaluated, and patients were divided into two groups according to their final diagnosis as “acute myocardial infarction (non-ST segment elevation myocardial infarction)” and “non-acute myocardial infarction” groups. Baseline and third-hour Hs-Troponin levels and Tei index values were determined, and their correlation was analyzed. Results: A total of 84 cases were diagnosed with acute myocardial infarction (non-ST segment elevation myocardial infarction), 84.5% had positive Tei index results at the time of admission while the remaining 45 patients were diagnosed as non-acute myocardial infarction and only 48.9% of them had positive Tei index. The diagnostic value of the Tei index and Hs-troponin were calculated as 79.8% and 60%; 67.9% and 60%, respectively. Also, we found that a 0.02 or more increase in the Tei index value has a 97.6 sensitivity and 97.5 specificity for the diagnosis of non-ST segment elevation myocardial infarction. A weak correlation was found between the Tei index and Hs-Troponin values in the acute myocardial infarction group (r = 0.425) and a negative correlation in non-acute myocardial infarction patients at presentation. Conclusion: It is suggested that the use of Tei index might be used as a supportive measure for the early diagnosis of acute myocardial infarction, and the deterioration of Tei index seems to be more significant than Hs-Troponin especially in ruling out acute myocardial infarction.