Accurate Diagnosis Of Acute Appendicitis Research Articles

Reactive Protein can be use as a Diagnostic Tool for Acute Appendicitis

Background: Diagnosing and treating appendicitis is a common surgical emergency.Based on a thorough history, physical examination, test results, and imaging studies, an accurate diagnosis of acute appendicitis can be made. Correct diagnosis is frequently challenging since the patient's age and the location of the appendix might affect the clinical presentation. This study aimed to determine the C- reactive protein's clinical usefulness as an appendicitis diagnostic test.Materials and Methods: An eight (08) months cross-sectional study was performed done between March and October, 2021. The study was conducted at the tertiary care hospital. In this study, 116 patients were included. Clinical details, examination, and history were noted. All patients having negative HBsAg, and Anti-HCV, required emergency surgery irrespective of age and gender were included in the study. All collected data were entered and analyzed through Microsoft Excel 2016.Results: A total of 116 appendicitis patients were studied in which majority patients were in age range from 18-30 years with 62.1% and 37.9% were observed in age between 31 to 45 years. Male patients were found frequently with 56.9%. CRP was positive in majoritypatients with 84.4% acute appendicitis.Conclusion: Acute appendicitis is not likely to be recognized in preoperative instances with increased CRP values. When a patient is suspected of having acute appendicitis, a standard laboratory test assessing CRP should be implemented. Acute appendicitis can bediagnosed with this test and utilized as a surgical indication marker.

Open appendectomy for left sided acute appendicitis in a young patient with situs inversus totalis.

Primary appendicitis presenting in left side is uncommon. Diagnosis is dependent on index of suspicion which is high. We present to you a case of left-sided appendicitis. Appendix was visualized as a long, tubular, edematous, inflamed structure in left lower quadrant with the whole of the colon present in the same region. Commuted tomography is useful in providing accurate diagnosis of acute appendicitis and in detecting rotational abnormalities.

Values of White Blood Cell Count and C-Reactive Protein in Diagnosis of Acute Appendicitis

Background and objectives. Acute appendicitis is one of the most common surgical emergencies. Accurate diagnosis of acute appendicitis is based on careful history, physical examination, and laboratory investigation. The purpose of this study is to investigate the value of white blood cells (WBC) and C-reactive protein (CRP) in the diagnosis of acute appendicitis. Methods. A retrospective analysis of 350 files of patients who underwent appendectomy was conducted. Selected files were those patients who were admitted to ALmasara clinic Tripoli Libya between Aug 2011 to July 2023, ages of patients ranged from 18 to 80 years. Statistical analysis was performed using SPSS version 26 software. A statistical procedure was implemented to compare the hematologic parameters in two groups (Males and Females) to determine if there was any significant difference between them. Means of WBC, Neutrophil, Lymphocyte and CRP were compared between two groups by an independent one-way analysis of variance (ANOVA). Results. This study consisted of 350 participants who were diagnosed with appendicitis. The results showed that about (69.4%) of appendicitis patients exhibited a high white blood cell count (leukocytosis). Slightly over half (52.6%) of the participants had an elevated neutrophil percentage (neutrophilia). Approximately (64.3%) of the appendicitis patients had decreased lymphocyte percentage (lymphopenia). In relation to CRP values, the study showed that most participants (76.5%) had positive CRP results. Conclusion. Individuals with appendicitis have higher levels of leukocytes, neutrophils, and C-reactive protein, and decreased lymphocyte counts. Elevated WBC and CRP values together provide a better specificity and positive predictive value than individual markers.

Development and evaluation of a clinical decision support system for early diagnosis of acute appendicitis

The most frequent reason for individuals experiencing abdominal discomfort to be referred to emergency departments of hospitals is acute appendicitis, and the most frequent emergency surgery performed is an appendectomy. The purpose of this study was to design and develop an intelligent clinical decision support system for the timely and accurate diagnosis of acute appendicitis. The number of participants which is equal to 181 was chosen as the sample size for developing and evaluating neural networks. The information was gathered from the medical files of patients who underwent appendicectomies at Shahid Modarres Hospital as well as from the findings of their appendix samples' pathological tests. The diagnostic outcomes were then ascertained by the development and comparison of a Multilayer Perceptron network (MLP) and a Support Vector Machine (SVM) system in the MATLAB environment. The SVM algorithm functioned as the central processing unit in the Clinical Decision Support System (CDSS) that was built. The intelligent appendicitis diagnostic system was subsequently developed utilizing the Java programming language. Technical evaluation and system usability testing were both done as part of the software evaluation process. Comparing the output of the optimized artificial neural network of the SVM with the pathology result showed that the network's sensitivity, specificity, and accuracy were 91.7%, 96.2%, and 95%, respectively, in diagnosing acute appendicitis. Based on the existing standards and the opinions of general surgeons, and also comparing the results with the diagnostic accuracy of general surgeons, findings indicated the proper functioning of the network for the diagnosis of acute appendicitis. The use of this system in medical centers is useful for purposes such as timely diagnosis and prevention of negative appendectomy, reducing patient hospital stays and treatment costs, and improving the patient referral system.

Using MRI appendicitis scale and DWI for the diagnosis of acute appendicitis in pregnant women.

To assess the performance of MRI scale for the diagnosis of acute appendicitis in pregnant women and to determine the added diagnostic value of diffusion-weighted imaging (DWI). From January 2018 to December 2020, 80 patients were included. All MRI were performed with a 1.5-Tesla scanner with anterior array body coil. This analysis included (1) T2-weighted imaging (T2WI), (2) fat-saturated T2WI, and (3) DWI. Two radiologists blinded to the diagnosis recorded their assessment of four findings: appendiceal diameter, appendiceal wall thickness, luminal mucus, and periappendiceal inflammation. The MRI scale of acute appendicitis which ranged from 0 to 4 was determined from these factors. An additional one point was added to the MRI appendicitis scale in those patients with evidence of appendiceal restricted diffusion on DWI. The diagnostic values and predictive factors were computed. Multivariate analysis demonstrated that the calculated MRI appendicitis scale was a significant independent predictor of acute appendicitis with a sensitivity of 96.6%, specificity of 90.2%, and PPV of 84.8%. The odds ratio of appendicitis is increased by 22.3 times for every increase in one point on the MRI appendicitis scale. Therefore, the addition of one point for restricted diffusion in the appendix on DWI imaging can add substantial value, both positive and negative predictive value, towards making an accurate diagnosis of acute appendicitis. MRI appendicitis scale is an objective and significant independent predictive factor for acute appendicitis in pregnant women. Incorporation of diffusion weighted imaging to MRI can improve diagnosis of acute appendicitis. MRI appendicitis scale is an objective and significant independent predictor of acute appendicitis in pregnant women. Incorporation of DWI/ADC map to MRI examinations can improve diagnosis of acute appendicitis in pregnant women. • MRI appendicitis scale is an objective and significant independent predictive factor for acute appendicitis in pregnant women. • The odds ratio of appendicitis can be increased by 22.3 times for every increase of one unit in MRI scale. • Incorporation of diffusion-weighted imaging to MRI examinations can add value to the scale (4.2 ± 0.7 vs. 0.7 ± 1.1; p < 0.001) among pregnant women with appendicitis versus pregnant women without appendicitis.

Diagnostic Utility of Serum Leucine-Rich α-2-Glycoprotein 1 for Acute Appendicitis in Children.

The aim of this study is to assess the diagnostic utility of serum leucine-rich α-2-glycoprotein 1 (LRG1) in pediatric patients with acute abdominal pain, admitted to the emergency surgical unit, in order to make a prompt and accurate diagnosis of acute appendicitis. Pediatric patients older than 5 years of age who presented to the emergency department from 15 October 2021 to 30 June 2022 with acute abdominal pain and suspected acute appendicitis were prospectively recruited in the study. Demographic and clinical data, as well as operative and postoperative data, were recorded. A total of 92 patients were equally distributed into two groups: children with acute appendicitis who underwent laparoscopic appendectomy and non-appendicitis patients, presenting with non-specific abdominal pain. LRG1 levels were determined using a commercially available LRG1 enzyme-linked immunosorbent assay (ELISA) kit. Serum LRG1 levels, as well as other inflammatory markers (white blood cell count (WBC), C-reactive protein (CRP) and absolute neutrophil count) were compared between groups. The median level of LRG1 in serum was significantly higher in the group of children with pathohistologically confirmed acute appendicitis than in the control group, at 350.3 µg/mL (interquartile range (IQR) 165.2-560.3) and 25.7 µg/mL (IQR 14.7-36.8) (p < 0.001), respectively. Receiver operating characteristic area under the curve for LRG1 from serum was 1.0 (95% CI 0.96-1.00; p < 0.001) and the value of >69.1 µg/mL was found to perfectly separate acute appendicitis cases from controls. Additionally, as expected, each of the examined laboratory inflammatory markers provided a significantly higher values in the acute appendicitis group compared to the control group: WBC 14.6 × 109/L (IQR 12.7, 18.7) vs. 7.0 × 109/L (IQR 5.4, 9.0) (p < 0.001), CRP 16.3 mg/dL (IQR 6.9, 50.4) vs. 2.2 mg/dL (IQR 2, 2) (p < 0.001) and absolute neutrophil count 84.6% (IQR 79.5, 89.0) vs. 59.5% (IQR 51.5, 68.6) (p < 0.001). LRG1 in the serum was found to be a promising novel biomarker, with excellent differentiation of acute appendicitis from non-appendicitis cases in children presenting with non-specific abdominal pain.

TZANAKIS SCORE AS A TOOL TO DIAGNOSE ACUTE APPENDICITIS.

Background:Appendicitis presents with pain in the right lower quadrant of the abdomen which radiates to other parts which varies with degree of inammation.1 It is one of the most common emergencies in surgery. The accurate diagnosis of acute appendicitis is approximately 70 to 87% and misdiagnosis are common which may result in occurrence of perforation 20% and negative appendectomy 2% to 30%.2 For diagnosis of acute appendicitis it depends on clinical history, presentation, examination and laboratory investigations along with early appendectomy can avoid complications arising from perforation, mass formation, peritonitis. Along with this Ultra sonogram is also tagged with the clinical examination in this condition3. Appendectomy is one of the most commonly performed surgical emergency operations which can mimic other acute conditions of the abdomen in the right iliac fossa pain mainly among the young, the elderly and females. Appendicitis is a common surgical condition in department of surgery, its diagnosis always doubtful and is mainly diagnosed with clinical presentation and laboratory investigation such as total leukocyte count, CRPetc. USG and CTAbdomen and Pelvis also have high sensitivity and specicity but is not cost effective hence results in delay of treatment leading to complication. To reduce such circumstances and to reduce the cost many scorings systems are introduced based on blood investigations, clinical presentation and radiological ndings are performed to diagnose this condition4. Raja IsteriPengiranAnakSaleha Appendicitis (RIPASA) 5, Alvarado6, Tzanakis 1 are most commonly used scoring systems to diagnose acute appendicitis. The aim of this study is to determine the accuracy of three scores in accurate diagnose of acute appendicitis by correlating them with the gold standard of histopathological conrmed appendicitis. Objectives: The objective was to compare the TZANAKIS,Raja IsteriPengiranAnakSaleha Appendicitis (RIPASA), Alvarado, scores in patients with right iliac fossa pain to diagnose acute appendicitis and obtain best scoring system out of these in RL jalappa hospital in cost effective way. Materials And Methods: A.Retrospective descriptive B.Total number of study subjects-135 All patients treated at the RLJalappa Hospital for acute appendicitis between January 2021 and April 2022 were identied through a computer-generated search through the Medical Records Department. Data were extracted retrospectively from hospital records. All patients were evaluated and graded using TZANAKIS, Raja IsteriPengiranAnakSaleha Appendicitis (RIPASA), Alvarado score. Conclusion TZANAKIS score was better in predicting appendicitis in RL Jalappa Hospital compared to other RIPASA and ALVARADO scoring system. It had better sensitivity and specicity than the other two scoring system. It overall reduced negative appendectomy rate and is cost effective with limited characteristics.

Histopathological examination of cases with acute appendicitis, A retrospective study at King Abdulaziz University Hospital, Jeddah, Saudi Arabia

IntroductionAppendicitis is one of the most prevalent abdominal emergencies globally. Despite the fact that acute appendicitis is a clinical diagnosis, preoperative imaging investigations are often conducted. Other disorders that might mimic acute appendicitis can occur in the appendix. The aim of this paper is to describe the histopathological findings of all appendectomy specimens. MethodsA retrospective study of 940 cases of appendectomy that were performed between 2010 and 2017 at King Abdulaziz University Hospital, Jeddah, Saudi Arabia were reviewed. The main outcome measured in this study is to describe the histopathological findings of all appendectomy specimens. The secondary outcomes measured in this study were the disease incidence in relation to age, and gender. Moreover, the accuracy of imaging diagnostic tools were also evaluated. ResultsThis study included 940 participants who underwent an appendectomy procedure. The patients' mean age was 23.4 years (±12.2), with a 3:2 male to female proportion. The incidence in males and females were 59.4% and 40.6%, respectively. Being male (p < 0.001), undergoing preoperative ultrasound (p < 0.001), having elevated white blood cells count (p < 0.001) was significantly associated with accurate diagnosis of acute appendicitis confirmed by histopathology. In this study, the negative cases of appendectomy that account for 14.4% were reported primarily as normal appendix with no inflammatory changes (7.44%) followed by other unexpected findings in the appendectomy specimen (3.93%) that included faecolith, granulomas, mucocele, endometriosis, food/fecal impaction, and schistosomiasis. Our study showed CT sensitivity as a diagnostic tool of acute appendicitis is 90.2%, and its accuracy is 89.4%, while US sensitivity is 46% and its accuracy is 52.4%. ConclusionHistopathological evaluation after common procedures, such as appendectomy, is essential to avoid missing other pathologies in the appendix. Surgeons should be aware of the uncommon histopathology findings as some disorders call for additional management beyond appendectomy. The clinical details, radiological investigations including CT scan and histopathological diagnoses are required for better management in cases of appendicular lesions.

Robust Automatic Segmentation of Inflamed Appendix from Ultrasonography with Double-Layered Outlier Rejection Fuzzy C-Means Clustering

Accurate diagnosis of acute appendicitis from abdominal ultrasound is a challenging task, since traditional sonographic diagnostic criteria for appendicitis, such as diameter, compressibility, and wall thickness, rely on complete identification or visualization of the appendix and the diagnosis is frequently operator subjective. In this paper, we propose a robust automatic segmentation method for inflamed appendix identification to mitigate abovementioned difficulties. We use outlier rejection fuzzy c-means clustering (FCM) algorithm within a double-layered learning structure to extract the target inflamed appendix area. The proposed method extracts the target appendix in 98 cases out of 100 test images, which is far better than traditional FCM, standard outlier FCM, and double-layered learning with FCM in correct extraction rate. Furthermore, we investigate the outlier rejection effect and double layered learning effect by comparing our proposed method with standard double-layered FCM and the standard outlier-rejection FCM. In this comparison, the proposed method exhibits robust segmentation results in accuracy, precision, and recall by 2.5~5.6% over two standard methods in quality with human pathologists’ marking as the ground truth.

A diagnostic testing for people with appendicitis using machine learning techniques

Appendicitis is a common disease that occurs particularly often in childhood and adolescence. The accurate diagnosis of acute appendicitis is the most significant precaution to avoid severe unnecessary surgery. In this paper, the author presents a machine learning (ML) technique to predict appendix illness whether it is acute or subacute, especially between 10 and 30 years and whether it requires an operation or just taking medication for treatment. The dataset has been collected from public hospital-based citizens between 2016 and 2019. The predictive results of the models achieved by different ML techniques (Logistic Regression, Naïve Bayes, Generalized Linear, Decision Tree, Support Vector Machine, Gradient Boosted Tree, Random Forest) are compared. The covered dataset are 625 specimens and the total of the medical records that are applied in this paper include 371 males (60.22%) and 254 females (40.12%). According to the dataset, the records consist of 318 (50.88%) operated and 307 (49.12%) unoperated patients. It is observed that the random forest algorithm obtains the optimal result with an accurately predicted result of 83.75%, precision of 84.11%, sensitivity of 81.08%, and the specificity of 81.01%. Moreover, an estimation method based on ML techniques is improved and enhanced to detect individuals with acute appendicitis.

C-Reactive Protein and Serum Lactate Dehydrogenase as Diagnostic Parameters in Acute Appendicitis

Background Acute appendicitis is the most common disease requiring urgent surgical attention. Accurate diagnosis of acute appendicitis is based on careful history physical examination laboratory and imaging investigation. Hence this study was done to determine the laboratory values of C-reactive protein CRP and serum lactate dehydrogenase LDH in clinically diagnosed acute appendicitis.Methodology This cross-sectional study was done in the Department of Surgery for a duration of 18 months from December 2019 to June 2021. All the patients with acute appendicitis attending the OPD of Department of Surgery were included. Demographic data such as age gender residence occupation date of admission history of present illness were noted. The diagnosis of acute appendicitis was made based on clinical signs and symptoms. Patients were subjected to routine investigations such as CBC RBS blood grouping CRP levels and serum LDH levels USG of abdomen and pelvis.Results Hundred and ten patients with acute appendicitis were included. Age distribution was from 12 years to 52 years. Majority were noted among 12 ndash 22 years constituting 61.82 of the sample with a mean age years plusmn SD of 23.87plusmn6.79 years. MaleFemale ratio was 1.71. The sensitivity and specificity of C-reactive protein was 99.07 and 50 with negative and positive predictive values of 50 and 99.07 respectively. The sensitivity and specificity of serum LDH was 98.04 and 100 with negative and positive predictive values of 80 and 98.18 respectively.Conclusion CRP can lead to precise prediction of severity of acute appendicitis for the treatment. The inflammatory markers i.e. CRP and LDH can be helpful in the diagnosis when measured together as this increases their specificity and positive predictive value.

Diagnostic Performance of Magnetic Resonance Imaging for Detection of Acute Appendicitis in Pregnant Women; a Systematic Review and Meta-Analysis.

The diagnosis of acute appendicitis (AA) in pregnant women is commonly challenging owing to the normal results of laboratory tests, organ displacement, and normal physiological inflammatory alterations. This meta-analysis aimed to investigate the accuracy of magnetic resonance imaging (MRI) in diagnosis of AA in pregnant women. Two investigators independently performed a comprehensive systematic literature search of electronic databases including MEDLINE, Cochrane Central, EMBASE, Web of Science, Scopus, and Google Scholar to identify studies that reported accuracy of MRI for diagnosis of AA in pregnant women from inception to April 1, 2022. Our systematic search identified a total of 525 published papers. Finally, a total of 26 papers were included in the meta-analysis. The pooled sensitivity and specificity of MRI in diagnosis of AA in pregnant women were 0.92 (95% CI: 0.88-0.95) and 0.98 (95% CI 0.97-0.98), respectively. The pooled positive likelihood ratio and negative likelihood ratio were 29.52 (95% CI: 21.90-39.81) and 0.10 (95% CI: 0.04-0.25), respectively. The area under hierarchical summary receiver operating characteristic (HSROC) curve indicated that the accuracy of MRI for diagnosis of AA in pregnant women is 99%. This meta-analysis showed that MRI has high sensitivity, specificity, and accuracy for diagnosis of AA in pregnant women and can be used as a first-line imaging modality for suspected cases of AA during pregnancy. Furthermore, it should be noted that when the result of ultrasonography is inconclusive, the use of MRI can reduce unnecessary appendectomy in pregnant patients.

Outcome of Alvarado scoring system in the diagnosis of acute appendicitis at a tertiary care teaching hospital

Background: Diagnosis of acute appendicitis is usually made on the basis of clinical judgment and experience of the surgeon. It may sometimes become a challenge due to variability in presentation. It is not unusual for surgical residents &amp; consultants to miss the diagnosis. Aim: To evaluate the effectiveness of Alvarado score in making an accurate diagnosis of acute appendicitis and assessing its sensitivity at a tertiary care hospital, in Lahore, Pakistan. Methods: A Prospective observational study was conducted at the department of Surgery, Ghurki Trust Teaching Hospital (GTTH). The data was collected from 117 patients on a self-designed proforma over a one-year period i.e., from 1st January 2018 to 31st December 2018 with the suspected diagnosis of acute appendicitis and who underwent surgery. The variables were evaluated with Alvarado scoring system to assess its effectiveness and sensitivity. The data was analyzed using SPSS vr 23. Results: Demographic results showed 73(62.4%) males and 44(37.6%) female. The mean age was 23 years and most of the patient were in age group 11-20years 55(47%). Abdominal pain was the commonest feature found in all the patients followed by Nausea in 72% and migration of pain to Right Iliac fossa 60%. Complicated appendicitis was found as gangrenous (7.5%) and perforated (6%). 53% of the cases were performed by on-call team consisted of SRs and surgical residents. Conclusion: Alvarado score is an effective scoring system in making an accurate diagnosis of acute appendicitis. It can be very useful in the prompt management of patients with equivocal features and in extreme of ages. Keywords: Acute appendicitis, Clinical scoring, Alvarado score

Can Diffusion-Weighted Imaging be a Gold Standard Method for Acute Appendicitis? A Comparative Study

Background: Diagnosis of an inflamed appendix is commonly based on clinical, laboratory, and diagnostic imaging data. Ultrasonography (US) is the leading diagnostic modality for these patients. However, an inconclusive US examination suggests the application of non-enhanced computed tomography (NECT). Objectives: This study aimed to compare US, NECT, and diffusion-weighted magnetic resonance imaging (DW-MRI) examinations for an accurate diagnosis of acute appendicitis with the rate of proven appendicitis by surgery. Patients and Methods: This retrospective study was performed on 70 patients, diagnosed with acute appendicitis between February 2018 and January 2020. The diagnostic accuracy of US, CT, and DW-MRI for acute appendicitis was examined in relation to the demographic and clinical variables. Results: Age and gender were not significantly associated with surgically proven appendicitis. However, the appendix diameter had a significant association with surgically proven appendicitis. All DW-MRI–positive patients with acute abdominal symptoms were surgically diagnosed with acute/subacute appendicitis (even those with &lt; 6 mm in diameter). Based on the ROC curve analysis, the sensitivity and specificity of DW-MRI in predicting acute appendicitis was 100% and 90.90%, respectively. Conclusion: The appendix diameter was an important factor in diagnosing acute appendicitis. However, DW-MRI is an advanced technique that may exclude the need for the appendix diameter measurements.

The role of thiol-disulfide and ischemia-modified albumin levels in the diagnosis of childhood appendicitis

Aim: The accurate diagnosis of acute appendicitis can be achieved by a combination of evaluation of clinical symptoms, physical examination findings and history taking, but is still challenging for the clinician. Some biochemical markers have been evaluated for the purpose of increasing the diagnostic accuracy rate for appendicitis. In this study, our aim is to evaluate the diagnostic value of thiol-disulfide levels and IMA, in pediatric patients with suspected acute appendicitis. &#x0D; Materials And Methods:&#x0D; The children (1-17 years age) who were admitted to our clinic for suspected acute appendicitis between March 2017 and September 2017 were evaluated. A total of 238 children are enrolled in the study; 119 were operated for suspected acute appendicitis and the 119 children who did not have appendicitis constituted the control group. Serum levels of native thiol (-SH), total thiol (SH + SS), dynamic disulfide (SS), dynamic disulfide (SS)/total thiol (SH + SS) ratio, albumin, ischemic modified albumin (IMA) and WBC levels were obtained and compared within groups. &#x0D; Results: &#x0D; The mean age of the patients was 10.9 years (±3.7, 3-17 years) and 9.1 years (±3.7, 1-17 years) in the operation and the control groups, respectively. The SH, SH+SS, SS and albumin levels and SS/SH+SS ratio were significantly lower and IMA levels were significantly higher in the operation group than the control group. Among the operated patients, IMA and dynamic disulfide levels were significantly higher and WBC levels were significantly lower in patients with non-perforated appendicitis than patients with perforated appendicitis. A significant decrease in serum levels of IMA was observed in the postoperative 1st day when compared with the preoperative values.&#x0D; Conclusion:&#x0D; Measuring the IMA levels with thiol/disulfide homeostasis may increase the diagnostic accuracy rate when evaluating the patients with suspected appendicitis. However, it appears that these evaluations fail to distinguish the patients with perforated and non-perforated appendicitis, thus further studies are necessary.

Importance of clinical, laboratory and imaging parameters in evaluating acute appendicitis

Background: Appendicitis is a frequent cause of abdominal pain, caused by acute inflammation of the appendix, and occurs in approximately 8 to 10% of the population (over a lifetime). Appendicitis has its highest incidence between the ages of 10 and 30 years. The ratio of incidence in men and women is 3:2 through the mid-20s and then equalizes after age 30. Appendicitis is the most common abdominal surgical emergency and a challenge for the world.Aims and Objectives: To assess the Importance of clinical, laboratory and imaging parameters in evaluating acute appendicitis. Materials and Methods: A prospective study of 162 patients who were admitted, Department of Surgery in Mahavir Institute Of Medical Sciences, Vikarabad, during Jan 2020 to July 2021; and underwent appendectomy at first presentation. Age of presentation was between 5 years to 35 years. Data collected for each patient included demographics (age and sex), clinical information (duration of symptoms, physical signs at examination on admission to the department of surgery), laboratory tests (WBC and neutrophil counts), results of imaging tests, and pathology results. We compared the pathology reports of 162patients with the preoperative assessment of acute appendicitis. Results: In One and half year period, 162 children were admitted and underwent appendectomy at first presentation in Department of Surgery for suspected acute appendicitis. The study population included 162 patients 90 males (55.55%) and 72 females (44.44%) who underwent surgery for suspected acute appendicitis. The age at presentation was between 5 years to 35 years. The study population was divided into 2 groups according to the pathology results. Group I consisted of 150 patients (92.6%) diagnosed with acute appendicitis. Group II included 12 (7.4%) patients who had a normal appendix based on pathological examination. No differences were found between acute and normal appendices with regard to clinical complaints. However, laboratory and imaging results showed differences between groups. Fever on admission to hospital was higher in patients with acute appendicitis (37.5 °C ± 0.8 vs. 36.8 °C ± 0.7) as were WBC values (14.5 ± 4.9×10 3/ mL vs. 10.2 ± 3.6 × 10 3 / mL) and neutrophils (75% ± 10.1 vs. 60.0% ± 12.9). Ultra sonogram (USG) was performed in all patients. The appendicular diameter was significantly smaller in patients with a normal appendix compared to those with acute appendicitis (0.7 ± 0.08cm vs. 0.9 ±0.2cm, respectively). Conclusion: USG may be a useful tool for evaluating cases with suspected appendicitis, regardless of age or gender, and should be the first choice of imaging modalities. The results of laboratory tests (WBC, Neutrophils) and Imaging (USG) contributed far more than clinical parameters to the accurate diagnosis of acute appendicitis. When these 3 parameters were positive, the probability of normal appendix was less than 1%. The contribution of USG was particularly high as its results matched the final diagnosis.

Serum and Urine Biomarker Leucine-Rich Alpha-2 Glycoprotein 1 Differentiates Pediatric Acute Complicated and Uncomplicated Appendicitis.

Purpose: This prospective, single-center cohort study analyzes the potential of inflammatory protein mediator leucine-rich alpha-2 glycoprotein 1 (LRG1) for the early and accurate diagnosis of acute appendicitis (AA), and differentiation of acute complicated (AcA) from uncomplicated appendicitis (AuA). Methods: Participants were divided into the AcA, AuA, and control groups, and their serum (s-LRG1) and urine LRG1 (u-LRG1) levels were assayed preoperatively on the second and fifth postoperative days. Results: 153 patients participated, 97 had AA. Preoperative u-LRG1 with a cut-off value of 0.18 μg/mL generated an area under the receiver operated characteristic (AUC) curve of 0.70 (95% CI 0.62–0.79) for AA versus control (p < 0.001), while the results for AcA versus AuA were not significant (AUC 0.60, 95% CI 0.49–0.71, p = 0.089). The s-LRG1 levels of AA versus the control with a cut-off value of 51.69 μg/mL generated an AUC of 0.94 (95% CI 0.91–0.99, p < 0.001). The cut-off value of s-LRG1 was 84.06 μg/mL for diagnosis of AcA from AuA, and therefore, significant (AUC 0.69, 95% CI 0.59–0.80, p = 0.001). Conclusions: LRG1 exhibited excellent diagnostic performance as an inexpensive, non-invasive, rapid, and accurate biomarker able to reflect the pathogenesis of AA. LRG1 has the potential to replace advanced imaging to diagnose clinically ambiguous AA cases.

Predictive Value of Alvarado Score and Ultrasound in the Diagnosis of Acute Appendicitis (A prospective study

Background: Acute appendicitis is the commonest non traumatic cause of acute abdominal pain that needs surgical management .Alvarado score and ultrasonographies are the most cost effective, easy and available aids for diagnosis. The aim of the study was determining the reliability of Alvarado score and ultrasound in the diagnosis of acute appendicitis.&#x0D; Results: The study was applied with 100 cases with different types of abdominal pain at presentation with 51 males and 49 females .The sensitivity was97.3% ,specificity 90%, and accuracy 89 of combined usage of Alvarado score and U/S findings preoperatively.&#x0D; Patients and method: A prospective non-interventional study including patients admitted with suggestive history with signs and symptoms of acute appendicitis to the surgical emergency ward of Baghdad teaching hospital from July 1st 2017 to Feb 10th 2018, Alvarado score calculated and ultrasonography done for each patient enrolled in this study, then to be followed for intraoperative findings.&#x0D; Conclusions: Combined application of Alvarado score and U/S has sensitivity 94.1% ,specificity 90% and accuracy 89% . In our medical facility and emergency ward, acute appendicitis remains as one of the top acute abdominal emergencies needing surgery in patients presenting with atypical clinical finding. So diagnosis becomes difficult. So Alvarado score along with ultrasound findings are useful for increasing the reliability in emergency department for accurate diagnosis of acute appendicitis therefore there should be training for the use of U/S by emergency physician and general surgeon in the diagnosis of acute appendicitis in order to decrease the rate of negative appendectomies .

Comparison Between Alvarado Score and Paediatric Appendicitis Score in Diagnosing Acute Appendicitis in Children

Introduction: Acute appendicitis is the most common atraumatic surgical emergency in childhood. The accurate diagnosis of acute appendicitis is not always easy. Alvarado score (AS) and paediatric appendicitis score (PAS) are commonly used tools to assist diagnosis. This study compares the diagnostic accuracy between AS and PAS. &#x0D; Methods: A prospective study was conducted from September 2016 to September 2017 in Paediatric Surgery Unit of Tribhuvan University Teaching Hospital. All eligible patients (children up to 16 years) who were operated for acute appendicitis were included. AS and PAS were calculated for all patients preoperatively. Final diagnosis of acute appendicitis was based on histopathological examination and labeled as ‘appendicitis’ or ‘no appendicitis’. A cut off score of 7 for AS and 6 for PAS was compared with ‘appendicitis’ or ‘no appendicitis’ group. &#x0D; Results: A total of 70 patients were included in the study. Sixty five (93%) were histologically proven acute appendicitis and five (7%) were no appendicitis. The sensitivity, specificity, PPV, NPV and accuracy of AS were 89%, 40%, 95%, 22% and 85% respectively. For PAS, sensitivity, specificity, PPV, NPV and accuracy was 97%, 40%, 95.5%, 50% and 92% respectively. On Receiver Operating Characteristic curve, ‘area under curve’ of AS was 0.64 and that of PAS was 0.84. It was not statistically significant (p = 0.152). &#x0D; Conclusions: There was no statistical significant difference between AS and PAS for diagnosing acute appendicitis.

A Combination of Clinical Examination with Specific Biomarkers and Judicious Use of Imaging Modality can Reduce the Rates of Negative Appendicectomy.

Background: Acute appendicitis is one of the most common surgical emergencies. Accurate diagnosis ofacute appendicitis is based on careful history, physical examination and laboratory and imaging findings.Objective: The primary aim is the correlation between clinical, biochemical and radiological assessment inpatients of appendicitis and also to reduce the rates of negative appendicectomy.Method: The study was carried out in Department of General Surgery, Sir Sunderlal Hospital, IMS and BHUfrom September 2015 to July 2017. Total 61 patients of age group 16-65 years and either sex were evaluatedon the basis of predetermined proforma, which included a detailed history, clinical examination, laboratoryinvestigations and high resolution sonography or CT and histopathology. Sensitivities, specificities, positiveand negative predictive values of TLC, neutrophil percentage, Modified Alvarado Score, CRP, D-dimer,USG and CT scan were calculated in respect to histopathology finding as a gold standard.Results: Modified Alvarado scoring (MAS 7-9:Appendicitis definitive) was present in 24 (39.3%) patients.Raised leucocyte count was present in 49 (80.32%) patients, while neutrophil count above 75% waspresent in 47 (77%) patients. Raised CRP was present in 55 (90.16%) patients with cut-off of &gt;3 mg/l(normal range 1-3 mg/l) while D-dimer was elevated in 44 (72.13%) patients with cut-off of &gt;5 mg/l. Onultrasonography,(77%) patients were diagnosed as acute appendicitis whereas (83.3%) had diagnosis ofacute appendicitis in CECT abdomen. Histopathological examination was positive in 60 (98.4%) patients.Conclusion: We concluded that combination of thorough clinical evaluation along with certain routinebiochemical &amp; specific markers and ultrasonography as the primary imaging modality is sufficient inestablishing a diagnosis of acute appendicitis in more than 90% cases.