Dear Sir,

We have read the original article “Combined use of modified Alvarado score and USG in decreasing negative appendicectomy rate” by Nautiyal H, Ahmad S, Keshwani NK, and Awasthi DN in the January–February issue, 2010 [1]. We find it obligatory to report some inconsistencies in the article. The authors have not organized the data in a format fit for publication but have submitted 13 tables as is usually done in the case of a postgraduate thesis. The article has not included a “Result” section. Few references are not in accordance with journal style (reference numbers 21, 24, and 27). The number of patients who underwent surgical exploration/appendicectomy is not mentioned. Fifteen of the 50 patients are shown to have other pathologies; it is not mentioned (1) whether these patients were operated upon or not, appendicectomy was performed or not, and (2) how and when the diagnosis of these pathologies, including abdominal tuberculosis, terminal ileitis, Meckel's diverticulitis, was made. The data presented in 13 tables are not consistent and do not inspire confidence. In table 4a and 4b, 37 patients are shown to have undergone appendicectomy including five who underwent interval appendicectomy. It is not mentioned why these five patients, who were required to undergo appendicectomy according to the treatment plan, were treated conservatively, breaching the protocol. It has not been mentioned why these five patients undergoing interval appendicectomy later have been included in the study and how these patients were treated while analyzing the data. Table 13 which deals with pathological types of acute appendicitis does not include tubercular appendicitis as shown in figure 4.

Clarifications from the authors will be highly appreciated concerning these issues. We hope further inputs from the authors explaining these deficiencies will help readers of this esteemed journal in understanding this valuable work further.