Efficacy of modified Alvarado score combined with ultrasound in the diagnosis of acute appendicitis: a prospective analytical study.

Background: Appendicitis is the most common surgical emergency encountered in the emergency department, and diagnosis is difficult at times. Imaging and various clinical scoring are present to aid in the diagnosis. Ultrasound is an easily accessible modality and can accomplish more than a computed tomography (CT) scan at times. Modified Alvarado score (MAS) includes parameters that do not pose an extra financial burden to the patient. Combining both the imaging and clinical scoring systems, the authors decided to evaluate the combined MAS for the diagnosis of acute appendicitis. Methods: This is a prospective analytical study conducted in a tertiary hospital for one and a half years. Fifty-five patients with right lower quadrant pain were enroled, and evaluated along with an ultrasound. MAS and combined MAS were obtained, and the results of the histopathological examination were compared. Results: Out of 55 clinically diagnosed cases who underwent an emergency appendectomy, 27 were males and 28 were females. Of these, 50 cases had acute appendicitis as per histopathological examination. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the MAS was 42%, 100%, 100%, 20.8%, 47.27%, respectively. The sensitivity, specificity, PPV, NPV and accuracy of the USG were 84%, 40%, 93.3%, 20%, and 80%, respectively. Combining both the scores, the Combined MAS had the sensitivity, specificity, PPV, NPV, and accuracy of 98.18%, 0%, 90.7%, 0%, and 89.09%, respectively. Conclusion: As the combination of USG has raised the sensitivity and diagnostic accuracy of the MAS, it can be an alternative to CT/MRI imaging for the diagnosis of acute appendicitis in resource-limited settings. This score requires further studies to validate with a larger sample size.

Obturator hernia: An uncommon cause of intestinal obstruction: A case report.

INTRODUCTION AND IMPORTANCE: An obturator hernia is a rare cause of bowel obstruction. Due to its narrow passage in the obturator canal, these are more susceptible to becoming incarcerated and subsequently strangulated. Due to its challenging detection, obturator hernia is often diagnosed late. CASE PRESENTATION: A 75-year-old thin-built female with COPD presented to the emergency room with symptoms of abdominal obstruction. Abdominal examination revealed distension, firmness, rigidity, and tenderness with no bowel sounds. An erect abdominal X-ray showed multiple air-fluid levels, indicating an acute abdomen due to intestinal obstruction. Emergency exploratory laparotomy revealed an obturator hernia with strangulated ileum and perforation, necessitating resection and double barrel ileostomy. Unfortunately, despite all medical interventions, the patient succumbed to hospital-acquired pneumonia following the surgery. DISCUSSION: Obturator hernia, known as 'the skinny old woman hernia,' is rarely externally visible or palpable, leading to frequent undiagnosed cases. It presents with bowel obstruction or perforation and carries the highest morbidity among abdominal hernias. Timely intervention is crucial to prevent complications like bowel strangulation. CONCLUSION: This case report highlights the challenges of diagnosing and managing obturator hernia, a rare condition with significant morbidity. Early detection through imaging or operative findings is crucial to prevent complications like bowel strangulation, especially in older women at higher risk.

Linking Copper-Associated Signal Transduction Systems with Their Environment in Marine Bacteria.

Copper is an essential trace element for living cells. However, copper can be potentially toxic for bacterial cells when it is present in excess amounts due to its redox potential. Due to its biocidal properties, copper is prevalent in marine systems due to its use in antifouling paints and as an algaecide. Thus, marine bacteria must possess means of sensing and responding to both high copper levels and those in which it is present at only typical trace metal levels. Bacteria harbor diverse regulatory mechanisms that respond to intracellular and extracellular copper and maintain copper homeostasis in cells. This review presents an overview of the copper-associated signal transduction systems in marine bacteria, including the copper efflux systems, detoxification, and chaperone mechanisms. We performed a comparative genomics study of the copper-regulatory signal transduction system on marine bacteria to examine the influence of the environment on the presence, abundance, and diversity of copper-associated signal transduction systems across representative phyla. Comparative analyses were performed among species isolated from sources, including seawater, sediment, biofilm, and marine pathogens. Overall, we observed many putative homologs of copper-associated signal transduction systems from various copper systems across marine bacteria. While the distribution of the regulatory components is mainly influenced by phylogeny, our analyses identified several intriguing trends: (1) Bacteria isolated from sediment and biofilm displayed an increased number of homolog hits to copper-associated signal transduction systems than those from seawater. (2) A large variability exists for hits to the putative alternate σ factor CorE hits across marine bacteria. (3) Species isolated from seawater and marine pathogens harbored fewer CorE homologs than those isolated from the sediment and biofilm.

Xanthogranulomatous Cholecystitis Mimicking Carcinoma Gallbladder.

Xanthogranulomatous cholecystitis (XGC) is a rare benign chronic inflammatory disease of the gallbladder that often presents as cholecystitis and can mimic gallbladder carcinoma. Distinguishing XGC from gallbladder cancer preoperatively is challenging. We present a case of a 62-year-old male who presented with features of carcinoma gallbladder in the CECT abdomen and MRCP. Intraoperatively, there was a mass in the gallbladder and extension into the adjacent structures with involvement of the hepatic artery, 1st part of the duodenum, portal vein, and hepatic flexure of the colon, and thus a palliative cholecystectomy was done. The histopathological report came out as XCG. The case aims to outline the clinical presentation of XGC and differentiate it from carcinoma gallbladder.

Development of a real-time quantitative PCR assay for detection and quantification of the marine bacterium Alteromonas macleodii from coastal environments.

Alteromonas macleodii is a ubiquitous marine bacterial species found in a variety of habitats that displays both planktonic and particle-associated lifestyles. Transcriptomic studies demonstrate that, even when present at low abundance, it can make significant contributions to biogeochemical cycles, and its specific association with key marine phytoplankton species indicates other ecological roles as well. It has also been shown to be one of the early colonizers of copper-treated marine vessels. There currently exist no rapid, reliable molecular assays for the detection and quantification of A. macleodii from its different environments. We developed a real-time PCR assay, specific to A. macleodii. This assay targets the DNA gyrase B subunit (gyrB) gene, which occurs as a single copy in the genome. The assay possesses an amplification efficiency of 94.3%, with a limit of detection of 2.5 gyrB copies per µL. Assay specificity was validated by melt curve analysis, followed by sequencing of the amplified product. The assay was specific to thirteen A. macleodii strains and did not amplify other marine bacteria, including Roseobacter denitrificans, Silicibacter sp. TM1040, Vibrio coralliilyticus, Vibrio harveyi, and Vibrio alginolyticus. It also did not amplify Alteromonas mediterranea, a close relative that can occur in the same environment as A. macleodii. This assay was used to determine the presence and abundance of A. macleodii from a range of coastal habitats. The assay was also used to monitor the A. macleodii growth in biofilm and planktonic cultures over time in the presence of elevated copper. This assay provides a rapid and reliable means to assess the presence and abundance of a ubiquitous marine bacterium that, even at low abundance, has been shown to make significant contributions to key marine processes.

Enhanced copper-resistance gene repertoire in Alteromonas macleodii strains isolated from copper-treated marine coatings.

Copper is prevalent in coastal ecosystems due to its use as an algaecide and as an anti-fouling agent on ship hulls. Alteromonas spp. have previously been shown to be some of the early colonizers of copper-based anti-fouling paint but little is known about the mechanisms they use to overcome this initial copper challenge. The main models of copper resistance include the Escherichia coli chromosome-based Cue and Cus systems; the plasmid-based E. coli Pco system; and the plasmid-based Pseudomonas syringae Cop system. These were all elucidated from strains isolated from copper-rich environments of agricultural and/or enteric origin. In this work, copper resistance assays demonstrated the ability of Alteromonas macleodii strains CUKW and KCC02 to grow at levels lethal to other marine bacterial species. A custom database of Hidden Markov Models was designed based on proteins from the Cue, Cus, and Cop/Pco systems and used to identify potential copper resistance genes in CUKW and KCC02. Comparative genomic analyses with marine bacterial species and bacterial species isolated from copper-rich environments demonstrated that CUKW and KCC02 possess genetic elements of all systems, oftentimes with multiple copies, distributed throughout the chromosome and mega-plasmids. In particular, two copies of copA (the key player in cytoplasmic detoxification), each with its own apparent MerR-like transcriptional regulator, occur on a mega-plasmid, along with multiple copies of Pco homologs. Genes from both systems were induced upon exposure to elevated copper levels (100 µM- 3 mM). Genomic analysis identified one of the merR-copA clusters occurs on a genomic island (GI) within the plasmid, and comparative genomic analysis found that either of the merR-copA clusters, which also includes genes coding for a cupredoxin domain-containing protein and an isoprenylcysteine methyltransferase, occurs on a GI across diverse bacterial species. These genomic findings combined with the ability of CUKW and KCC02 to grow in copper-challenged conditions are couched within the context of the genome flexibility of the Alteromonas genus.

Key Informant Methods: An Innovative Social Mobilization Strategy to enable Communitybased Diagnosis, Treatment and Rehabilitation for People with Disability.

Key informant method is an innovative technique for identifying people who are disabled in the community, by training local volunteers to act as key informants. Key informants are the local native people include teachers, village doctors, local health workers, religious leaders, community leaders, students, traditional healers, police, NGO staffs, health professionals, local journalists, village councils etc. For them, host organization organized a training to train the key informants to identify and refer the suspected disable people. The study proved key informant method as a valid method for identification of disabling children. Key informant method had a high sensitivity (average 98%) for case detection in all groups but specificity was lower (average 44%), particularly for hearing impairment. Key Informant Method can be used to collect data on types of disabilities, cause, the magnitude of impairments, severity, quantify a need for disabled people, and making access to services (including adoption, health check-up, vocational training, rehabilitation, and other facilitation training). Keywords: Bangladesh; disability; key Informant; key informant methods.