Accuracy Evaluation of Pediatric Appendicitis Scoring (PAS) Method in Differentiating Nonspecific Abdominal Pain from Appendicitis

Background

This study aimed at evaluating the accuracy of the pediatric appendicitis scoring method in differentiating nonspecific abdominal pain (NSAP) from appendicitis.

Methods

This cross-sectional study was conducted on 391 children who were hospitalized in the emergency ward due to acute abdominal pain suspected of appendicitis . Pediatric Appendicitis Score (PAS), C-reactive protein (CRP), and appendicitis pathology results of patients undergoing surgery were recorded.

Results

The results showed that the no significant difference was found among patients in the three experimental groups (appendicitis, specific abdominal pain except appendicitis, and NSAP) with respect to temperature (p = 0.212), but the other variables were significantly different. Findings showed that high CRP frequency, pain migration to right lower quadrant (RLQ), tenderness in right iliac fossa (RIF), anorexia, leukocytosis, high neutrophil, and mean tenderness in RLQ in the appendicitis group were higher than those in the other two groups (p = 0.001). The PAS questionnaire can also be used as a reliable questionnaire with appropriate sensitivity (0.929) and specificity (0.993), and this questionnaire along with detailed clinical examinations could reduce the rate of negative appendectomy to less than 1%.

Conclusions

This study showed high accuracy of PAS in diagnosing children with appendicitis and differentiating appendicitis from cases of NSAP and specific abdominal pain other than appendicitis. The PAS system could also significantly reduce cases of negative appendicitis. Although high CRP had an excellent ability to diagnose appendicitis, its accuracy was lower than PAS.

Effect of heating bovine colostrum at 60°C for 90' on colostrum quality and, the health and growth characteristics of Holstein dairy calves

AIMS

The major objective of this study was to investigate the efficacy of heat-treating colostrum on the subsequent growth characteristics (weight gain, body size, dry matter intake and feed efficiency rate) and health of Holstein calves.

METHODS

A total of 1200 neonatal Holstein calves on one commercial dairy farm were enrolled. The calves were divided into heat-treated (60°C for 90 min) and unheated (raw) colostrum groups. Calf serum IgG and total protein concentrations were measured before and after colostrum consumption. Health characteristics and disease prevalence were recorded during the suckling period.

RESULTS

Consumption of heat-treated colostrum led to increased serum IgG (P < 0.0001) and total protein (P < 0.0001) concentrations, increased apparent efficacy of IgG absorption (P < 0.0001) and increased general health condition, weight gain (P < 0.0001) and clinical performance.

CONCLUSIONS AND CLINICAL RELEVANCE

Heat-treatment of colostrum is an effective method to improve health and increase growth characteristics (weight gain, body size, dry matter intake and feed efficiency rate) of neonatal dairy calves, most likely by decreasing microbial load and facilitating IgG absorption.

Conservative Management of Postpartum HELLP Syndrome and Intraparenchymal Liver Hematoma; A Case Report

The HELLP syndrome is an important variant of pre-eclampsia which is known by triad of hemolysis (H), elevated liver enzymes (EL) and low platelet count (LP). Intraparenchymal liver hematoma is a rare and important complication of HELLP syndrome which is a life threatening condition. The incidence of intraparenchymal hematoma of the liver has been reported to vary from 1 in each 40,000 to 250,000 deliveries worldwide. Herein we report a case of intraparenchymal liver hematoma following HELLP syndrome. An 18 year- old woman with moderate to severe preeclampsia after delivery, presented with Right upper quadrant (RUQ) pain and tachycardia and significant drop in hemoglobin level. Ultrasonography revealed intraparenchymal liver hematoma. This finding was also confirmed by computerized tomography (CT)-scan. Conservative treatment was applied and the patient improved without need of any surgical intervention. Spontaneous hepatic hematoma should always be considered as a life threatening and important complication of HELLP syndrome during pregnancy and it can be managed conservatively in a hemodynamically stable patient.

Effect of orally administered cisapride, bethanechol, and erythromycin on the apparent efficiency of colostral IgG absorption in neonatal Holstein-Friesian calves

Objective

To evaluate the effect of orally administered cisapride, bethanechol, and erythromycin on the absorption of colostral IgG in dairy calves.

Animals

Twenty‐four healthy neonatal Holstein‐Friesian calves.

Procedures

Calves were randomly assigned to one of the following treatments: 0.9% NaCl solution (2 mL, PO; negative control); erythromycin lactobionate (20 mg/kg BW, PO; anticipated to be a positive control); cisapride (0.5 mg/kg BW, PO); bethanechol chloride (0.5 mg/kg BW, PO). Calves were fed 3 L of pooled bovine colostrum containing acetaminophen (50 mg/kg) by suckling and oroesophageal intubation 30 minutes after each treatment was administered. Jugular venous blood samples were obtained periodically after the start of feeding and plasma total IgG, protein, acetaminophen, and glucose concentrations determined. Abomasal emptying rate was assessed by the time to maximal plasma acetaminophen concentration.

Results

Oral administration of cisapride facilitated the absorption of colostral IgG and protein. The effect of cisapride on abomasal emptying rate could not be evaluated because cisapride appeared to interfere with acetaminophen metabolism. Based on the total IgG and total protein concentration‐time relationships, the beneficial effects of cisapride appeared to occur early after oral administration and were transient.

Conclusions and Clinical Importance

Additional studies appear indicated to characterize the effect of cisapride dose on the magnitude and duration of its effect on facilitating the absorption of colostral IgG and protein. Identification of a nonantimicrobial method for increasing abomasal emptying rate, such as cisapride, will potentially provide a practical and effective method for facilitating transfer of passive immunity in colostrum‐fed dairy calves.

Molecular G typing of bovine rotaviruses in Iran

Fifty rotavirus-positive feacal samples, selected from 500 ELISA tested diarrheic specimens were used in this study. Viral RNA was extracted from each sample and reveres transcribed to cDNA. The cDNA was then amplified by oligonucleotide primers specific for RNA segment 9, coding for VP7. After the first amplification, PCR products were subjected to a multiplex semi-nested PCR to investigate the presence of bovine rotavirus serotypes: G6, G8 and G10. The results indicated prevalence of 48 and 26% for G6 and G10 serotypes, respectively. Twenty four percent of the samples showed a mix infection by G6 and G10 serotypes and no sample was found positive for the type G8. With the best of our knowledge this is the first report of molecular typing of bovine rotaviruses in Iran.

Reconstruction of bladder and urethra using ileocecal segment and appendix in patients with exstrophy-epispadias complex: the first report of a new surgical approach

OBJECTIVE

We aimed to describe our experience in administering an innovative surgical technique to treat pediatric cases of exstrophy-epispadias complex.

MATERIAL AND METHODS

Between 1995 and 2004, seven consecutive patients (six males) with exstrophy-epispadias complex were treated using ileocecal segment for bladder augmentation and appendix for urethral reconstruction. In a single-stage operation, the exstrophied bladder was dissected- and a segment of cecum, ascending colon, terminal ileum, and the corresponding appendix were isolated. Using the opened colon to augment the bladder, the ileal segment was fashioned to skin as temporary stoma, and the appendix was laid in the urethral lumen as the neourethra following urethral demucosation. This technique was used as a secondary surgery in one case and as a primary surgery in six neonates. Evaluation of the urinary tract status was performed by cystograms and ultrasonograms.

RESULTS

Renal function was saved in all cases and continence was achieved by clean intermittent catheterization every two hours either via the neourethra (n = 6) or through the temporary stoma (n = 1). The patients did not experience any metabolic complications in their follow-ups. Moreover, no one had vesicourethral reflux, dehiscence, or fistula.

CONCLUSIONS

The technique was deemed safe with acceptable outcomes even when secondary repair of previously failed operation was intended. Experiencing the technique in larger cohorts as well as longer follow-ups might be necessary to assess probable long-term complications.