The utility of spectral Doppler evaluation of acute appendicitis.

PURPOSE: The use of spectral Doppler, peak systolic velocity (PSV), and resistive index (RI) imaging criteria to improve the accuracy of acute appendicitis diagnosis is hypothesized. METHODS: Graded compression ultrasound was performed for suspected patients. The spectral Doppler evaluation was conducted while observing the appendix. A total of 152 patients (82 males and 70 females, ages 4-63 years, mean age of 24.5 years) were examined using the spectral Doppler waveform between 2018 and 2019. RI and PSV values of patients with and without appendicitis were compared to histopathologic findings. SPSS 26 was used to analyze the data, including using descriptive statistics and measures of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS: Appendicitis was confirmed in 95 patients (62.5%) and rejected in 57 patients (37.5%). For the diagnosis of appendicitis, the area under the curve (AUC) of receiver operating characteristic (ROC) for RI (0.92 with 95% confidence interval (CI): 0.88, 0.97; P = 0.001) and PSV (0.96, with 95% CI: 0.93, 1.00; P = 0.001) was calculated. The discriminatory RI ≥ 0.49 demonstrated high sensitivity (90.5%) and low specificity (86%), and the discriminatory PSV ≥ 9.6 cm/s had high specificity (94.7%) and sensitivity (94.7%) for appendicitis. CONCLUSION: By incorporating spectral Doppler criteria into routine graded compression ultrasound, the diagnostic accuracy of acute appendicitis was increased. In comparison, high PSV and RI values of the appendix with a cut-off point of 9.6 cm/s and 0.49 differ significantly between positive and negative appendectomy patients.

Evaluation of weekly intramuscular methotrexate in the treatment of low risk gestational trophoblastic neoplasia.

BACKGROUND: The gestational trophoblastic neoplasms (GTNs) are rare and potentially life-threatening malignancies. AIMS: The aim of this study was to determine the rate of response to weekly intramuscular (IM) methotrexate (MTX) in patients with low-risk GTN (LR-GTN). SETTINGS AND DESIGN: The study was designed cross-sectional and prospectively. Patients followed for 1 year. MATERIALS AND METHODS: From 2006 to 2011, a total of 117 women with LR-GTN were studied. A weekly MTX regimen (50 mg/m² with dose escalation to 75 mg/m²) was administered to 87 of patients. A biweekly pulsed intravenous bolus of 1.25 mg/m² of actinomycin D was administered in patients resistant to MTX (n = 30) and combination therapy was performed in those who did not respond to aforesaid treatments (n = 8). STATISTICAL ANALYSIS: The data were analyzed using Statistical Package for Social Sciences (SPSS) 11.5 and Chi-square model was applied. Descriptive statistics and compare means (t-test) was used as well. P < 0.05 was statistically significant. RESULTS: All 117 patients with LR-GTN were cured. The primary remission rate was 74.3%, with primary dose of 50 mg/m² of MTX and escalation to 75 mg/m². Another patient achieved complete remission with actinomycin and combination chemotherapy. There were significant statistical correlation between remission and World Health Organization (WHO) scoring, International Federation of Gynecology and Obstetrics (FIGO) staging, pretreatment beta-human chorionic gonadotropin (ß-hCG) level, and antecedent pregnancy (P < 0.05). CONCLUSION: We suggest that cases with score ≥6 should be considered high risk. First-line combination chemotherapy is advised in GTN with score ≥6.

The effect of smoking by family members and friends on the incidence of smoking among high school students.

OBJECTIVE: Smoking is the most important preventable cause of death. According to the global youth tobacco survey (GYTS) presented by WHO, 25% of smokers smoked their first cigarette before the age of 10; hence, it is of great importance to investigate the effect of smoking of family members and friends on smoking incidence of adolescents. MATERIALS AND METHODS: This analytic cross-sectional study was conducted on the basis of GYTS questionnaire. The studied population consisted of 3000 high school students who were selected randomly. Data was collected by applying the questionnaires which were fulfilled by students anonymously without supervision of school authorities. The results were analyzed with SPSS 11.5 software employing chi-square test. RESULTS: The studied population included 1842 boys (61.4%) and 1158 girls (38.6%) with the mean age of 16.1 years. In terms of smoking habit, 827 students (27.6%) were occasional smokers, 122 students (4.2%) were regular smokers, 518 students (17.3%) used another type of tobacco, and 1533 students (51.1%) were non-smokers. In terms of gender, 77.6% of occasional smokers were males and 22.4% of them were females. At the same time, males and females made up 80.3% and 19.7% of regular smokers, respectively. Also, males and females made up 71.1% and 28.9% of students using another type of tobacco, respectively. In terms of smoker family members and friends, 1860 students (85.6%) of non-smoker students had no smoker in their families and only 313 (14.4%) had at least one smoker in family, while 61.5% of smoker students had at least one smoker family member (p <.001). Similarly, 50.3% of smoker students had a number of smoker friends, while only 13% of non-smoker students had smoker friends. In terms of economic status this study showed that 22.4% of smoker students and 20.7% of non-smoker ones had high pocket money. CONCLUSION: This study showed that the incidence of smoking among high school students significantly correlated with the incidence of smoking among their friendsandfamilymembers (p < 0.001). This study also showed that the economic status (based on the amount of pocket money) has little orno effect on the incidence of smoking among high school students (p value: 0.863).