Predicting Complicated Appendicitis Based on Neutrophil to Lymphocyte Ratio, A Study in University Hospital of Nepal.

Background Acute appendicitis is one of the most common causes of acute abdomen requiring surgical treatment. Accurately diagnosing appendicitis and identifying complicated appendicitis can be difficult at times. Objective To evaluate the ability of the neutrophil-to-lymphocyte ratio (NLR) to differentiate between uncomplicated and complicated appendicitis. Method This was a prospective hospital-based observational study conducted at the Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital from July 2021 to December 2022. Patients with the clinical diagnosis of acute appendicitis who had undergone emergency appendectomy were included in the study. Informed consent was taken from each patient and data collection was done by filling the proforma. Result A total of 218 patients were included in the study. Male: female ratio was 1.18:1. Mean age of patients was 28.58 ± 16.65 (3-78) years. A significant correlation was found between increasing neutrophil count and neutrophil-to-lymphocyte ratio with complicated appendicitis. However, no significant correlation was found between White Blood Cell counts and complicated appendicitis. Neutrophil-to-lymphocyte ratio > 12.6 was found to be associated with complicated appendicitis. Conclusion A simple, cost-effective, and yet perfect test is not available for identifying complicated appendicitis. Increased Neutrophil count and neutrophil-to-lymphocyte ratio can indicate complicated appendicitis. Elevated WBC counts alone has no role in differentiating complicated appendicitis. According to the results of our study, an neutrophil-to-lymphocyte ratio of 12.6 can help to differentiate complicated from uncomplicated appendicitis.

Comparative Study between the Use of Pigtail Catheters and Traditional Chest Tube Drain in Cases with Pneumothorax.

Background Pneumothorax is a condition in which air or other gas is present in the pleural cavity. Mainstay of management of pneumothorax is to remove the air from the pleural space usually done by chest tube insertion. There is still uncertainty whether minimal invasive management with pigtail catheter is sufficient for the management of pneumothorax. Objective To find the effectiveness, safety, tolerability, efficacy of pigtail catheters and large bore chest tubes. Method Prospective comparative study was done in Dhulikhel Hospital between August 2019 till August 2021. Chest tube insertion used to be the only available treatment modality till December 2020 (15 months). Following January 2021 after obtaining ethical clearance for use of pigtail insertion for pneumothorax, this treatment modality was done (8 months). Result Among 76 patients, 52(68.4%) underwent a large bore chest tube and 24 (34.6%) pigtail catheter patients. Mean age of the patients was 48 years (SD 18.01). Duration of hospital stay and length of hospital stay was more in large bore catheters and less in pigtail catheters. Eight hours post tube placement of the expansion of the lungs was present in pigtail and was statistically significant. Pain killer used in pigtail catheters was limited to Non-steroidal anti-inflammatory drugs, for large bore catheter opioids were added and were statistically significant. Conclusion Pigtail catheter is nearly effective as compared to traditional wide bore catheters.