Acute Appendicitis In Patients Research Articles

Predictive values of indirect ultrasound signs for low risk of acute appendicitis in paediatric patients without visualisation of the appendix on ultrasound

Background and objectivesThe ability to rule appendicitis in or out using ultrasound is limited by studies where the appendix is not visualised. We determined whether the absence of indirect ultrasound...

Differences in the evolution and management of acute appendicitis in patients with COVID-19: a caseÓ?control study

Differences in the evolution and management of acute appendicitis in patients with COVID-19: a caseÓ?control study

Several genetic SNPs identified in acute appendicitis patients including the HLA-C known to be related to coeliac disease in a Genome-Wide Association Study

Acute Appendicitis (AA) is an inflammatory condition of the vermiform appendix in the caecum of the colon. Genetic polymorphisms have been suggested as risk factors predisposing to AA susceptibility but have remained relatively unknown, due to insufficient sample size in previous analyses. Therefore, the primary research aim was to identify genetic variants associated with AA. It was hypothesised that gene polymorphisms associated with AA will provide a connection to other diet-related inflammatory diseases. Genetic variants associated with AA were studied via a Genome-Wide Association Scan (GWAS) using the Global Biobank Meta-Analysis Initiative (GBMI). The GBMI is a collaborative consortium of 23 biobanks with a publicly released repository of de-identified genetic data linked with digital health records spanning 4 continents with a study population size of over 2.2 million consented individuals of multiple ancestral backgrounds1. A linear regression model was used to estimate the association between single nucleotide polymorphisms (SNPs), across the human genome, and AA by each contributing biobank. The results were then meta-analysed with a total of 32,706 cases and 1,075,763 controls. In the present study, the free open-source Complex Traits Genetic Virtual Lab (CTG-VL) platform was used to access, analyse, and visualise the GWAS summary statistics of AA2. Genome-wide significantly associated SNPs (p-value < 5 x 10-8) were further searched for their associations with health-related traits in publicly available GWAS summary statistics. Upon analysis, significantly associated SNPs for AA were identified within or nearby nine genes. HLX, NKX2-3, LTBR, and DLEU1 are genes involved in immune responses; IRF8 associated with maturation of myeloid cells; OSR-1 responsible for transmembrane ion transporter activity; NCALD a regulator of G protein-coupled signal transduction. In addition, based on the hypothesis, the SNP of key clinical importance was the HLA-C rs2524046 (p-value = 2.38 x 10-8), with the AA risk-increasing allele C being also strongly associated with a higher risk of coeliac disease (CD). The CD is an autoimmune condition where gluten, a protein present in grains such as barley, rye, and wheat, elicits an inflammatory response that results in damage to the small intestine lining. Considering how both AA and CD share the same SNP, it is possible to speculate whether gluten initiates a similar pathophysiological mechanism that exacerbates inflammation in the vermiform appendix in AA. In conclusion, the top AA associated SNPs suggests its development could be due to immunological responses influenced by dietary nutrient intake. The HLA-C SNP is common to AA and CD, suggesting that the gluten protein found in certain cereal grains possibly contributes to the pathophysiology of AA like CD. This warrants further investigations into whether dietary gluten could play a key role in AA development.

Is it possible to predict appendicitis caused by Enterobius vermicularis before surgery?

Objectives: This study aimed to develop statistical models based on hemogram data to predict the presence of the nematode parasite Enterobius vermicularis (EV) in the appendix before surgery. Patients and methods: The retrospective case-control study was generated from histopathological data of appendectomy 9,605 patients between January 1, 2007, and August 1, 2023. Enterobius vermicularis was detected in 32 patients (24 pediatric and 8 adult patients). Six patients were excluded due to missing hemograms, and 26 participants (pediatric patients: 10 males, 9 females; mean age: 11.1±4.4 years; range, 2 to 17 years & adult patients: 1 male, 6 females; mean age: 39.9±14.7 years; range, 22 to 68 years) were evaluated. The control (non-EV) group was composed of 99 randomly selected patients (42 males, 57 females; mean age: 18.3±13.5 years; range, 2 to 68 years) of nonparasitic acute appendicitis with available preoperative hemogram data. Univariate analysis was conducted on hemogram parameters to compare the groups, followed by predictive modeling using binomial logistic regression. Results: Enterobius vermicularis was present in 0.33% of all appendicitis patients and in 0.54% of pediatric patients. Histopathological diagnosis of appendicitis was present in 46.8% of EV patients, with a higher rate among pediatric patients (50%) compared to adult patients (37.5%). Patients with EV exhibited significantly lower counts of neutrophils and white blood cells in comparison to the non-EV group (p-values 0.031 and 0.046, respectively). The most effective EV prediction model (area under the curve: 0.685 [0.528-0.770]) ultimately included platelet distribution width and neutrophil count after evaluating all parameters (with corresponding p-values of 0.022 and 0.042, respectively). Conclusion: It is difficult to predict the presence of EV based on hemogram data prior to appendectomy. Studies that collect large amounts of data from multiple centers and different populations could provide better predictive models.

Comparison of miRNA profiles in the immune response of pediatric acute appendicitis and pediatric enterobiasis patients caused by Enterobius vermicularis.

The aim of this study was to determine and compare the miRNA profile in the immune response with the parasite in pediatric patients with acute appendicitis caused by Enterobius vermicularis and in pediatric patients with enterobiasis. A total of 30 tissue samples, which were operated with the diagnosis of pediatric acute appendicitis in the last 10 y and Enterobius vermicularis was detected by histopathological findings, were analyzed. In addition, blood samples were taken from 30 pediatric patients diagnosed with enterobiasis for this study. The miRNAs that activate T and B cells were evaluated by a quantitative real-time PCR, statistically calculated within ΔΔCt values, and fold changes were evaluated by Welch's T test, in which p<0.5 was considered to be significant. It was found that 48 out of 136 (35.3%) miRNAs differed between the pediatric patient and healthy control groups. It was determined that 22 (57.9%) of the different miRNAs were T cell activating miRNAs and 26 (68.4%) were B cell activating miRNAs. While there was a significant difference in miRNA values activating T cells in two patient groups (p<0.01), there was no significant difference in miRNA values activating B cells (p>0.01). In the study, although Enterobius vermicularis was the causative agent in both patient groups, it was revealed that the immune response of patients with acute appendicitis was more affected than enterobiasis patients.

Diagnostic value of abdominal ultrasound in patients with acute appendicitis and analysis of the expression of related inflammatory factors.

Appendicitis is an inflammation of the appendix that, if left un-treated, can be life-threatening. Abdominal ultrasound helps diagnose it and differentiate it from other causes of abdominal pain. This study aimed to evalu-ate the diagnostic value of abdominal ultrasound in acute appendicitis (AA) and assess inflammatory factor levels in different types of appendicitis. One hundred patients with AA were selected as the observation group, and 30 pa-tients with simple abdominal pain as the control group. Among the 100 AA patients, 37 (37%) cases had blurred appendiceal boundaries, 24 (24%) cases had fecal calculus in the appendix cavity, 13 (13%) cases had enhanced echo intensity of surrounding fat, 15 (15%) cases presented enlarged outer diameter of the appendix (&gt; 6mm), one (1%) case had peripheral lymphadenopathy, and one (1%) case had peripheral effusion. None of the cases (0%) presented a pe-ripheral mass. The levels of white blood cells (WBC) and inflammatory factors: C-reactive protein (CRP), interleukin-6 (IL -6), and tumor necrosis factor α(TNF-α)) patients with uncomplicated appendicitis were lower than those with suppurative appendicitis, gangrenous appendicitis, or peri-appendiceal abscess (p &lt;0.05). The blurred boundary of the appendix, fecal stones in the appendix cavity, an enlarged outer diameter of the appendix (&gt; 6mm), and an enhanced echogenicity of the surrounding fat are the most common ultrasonic signs of AA. Abdominal ultrasound has an excellent diagnostic value on pathological types of AA. The increase in the level of inflammatory factors can indicate the severity of the disease to a certain extent.

Characteristics of patients associated with antibiotic use among gastrointestinal surgery at the Academic Hospital, Universitas Gadjah Mada

Digestive surgery is a treatment for diseases of the parts of the body involved in digestion, which has a fairly high risk of infection. The study aimed to obtain a description of the types and specific characteristics of patients and the rationality of antibiotic use among digestive surgery patients. This study was conducted using observational analysis. Data on antibiotic use was collected prospectively from medical records of digestive surgery inpatients at the Academic Hospital Universitas Gadjah Mada (UGM) from January to March 2023. The Gyssens method was used to evaluate qualitatively the use of antibiotics. A total of 76 patients met the inclusion and exclusion criteria. No significant difference between the number of male and female patients was identified. The results showed that 24 (31.58%) acute appendicitis patients are the primary diagnosis most often encountered in patients undergoing digestive surgery. The most frequently used prophylactic antibiotics for digestive surgery patients were ceftriaxone (53.85%) and cefazolin (41.03%). Meanwhile, the most frequently used therapeutic antibiotics were ceftriaxone (41.94%) and levofloxacin (29.03%). The Gyssens analysis shows that large irrational use of antibiotics is still observed.

Conservative Versus Surgical Management of Acute Appendicitis: A Systematic Review.

Recent studies have discussed the role of antibiotic treatment in the conservative management of acute appendicitis and whether antibiotics are a safe option to replace appendicectomy, which has been the gold standard treatment of acute appendicitis for many years. The bibliographic databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, Embase, Medline, and PubMed comparing conservative versus surgical treatment of acute appendicitis were systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Twenty-one studies consisting of systematic reviews and meta-analyses involving 44,699 participants were identified. At least 17,865 participants were treated with antibiotics. Our studies compare antibiotic versus appendicectomy among acute appendicitis patients ranging from 7 to 94 years of age. In most studies, patients received parenteral antibiotics for a total of one to three days, and oral antibiotics such as oral cephalosporin plus metronidazole, oral amoxicillin/clavulanate, oral fluoroquinolones plus Tinidazole upon hospital discharge for a total of 7 to 10 days. The total course of antibiotics for both parenteral and oral regimes ranged from 2 to 16 days, with 10 days being the commonest duration. The recurrence rate following initial antibiotic treatment at one-year follow-up ranged from 13% to 38%, while the mean duration of recurrence ranged from three to eight months. The majority of the patients with recurrence underwent appendicectomy, while some patients were either given a repeat or different course of antibiotics due to the possible presence of antibiotic resistance; however, only 2.4% of the patients were successfully treated upon completion of the second course of antibiotics. Most of the studies concluded that appendicectomy remains the gold standard treatment for uncomplicated acute appendicitis, given its higher efficacy and lower complication rates. Although antibiotic treatment cannot be routinely recommended, it can be considered an appropriate alternative in selected patients with uncomplicated appendicitis who wish to avoid surgery and also acknowledge the risk of recurrence and the potential need for subsequent surgery at the same time.

The impact of the COVID-19 pandemic on acute appendicitis patients in a tertiary care center in Lebanon

IntroductionWith it becoming a global pandemic, the coronavirus disease of 2019 (COVID-19) imposed public health restraints that hampered patient’s presentation to hospitals. In Lebanon, little is known about the presentation patterns of acute appendicitis (AA) patients among different population groups during the COVID-19. Therefore, this study aims to assess the effects of the COVID-19 pandemic on the rates of cases seen during the pandemic period, the adopted management strategies, and evaluate the patient outcomes compared to presentations from previous years.MethodsThis is a retrospective, observational cohort study with no interventional procedures. All patients presented to our tertiary health care center were diagnosed with AA between February 2019 and February 2021 comprised the study analysis. We divided our patients into the pre-pandemic period cohort March 1st, 2019, till February 29th, 2020, and the pandemic period cohort March 1st 2020 till March 1st 2021.ResultsWe collected data retrospectively from 342 patients: 201 patients presented in the pre-pandemic period and 141 during the pandemic period. Male predominance was seen in both cohorts (51.7% and 58.9% respectively). A decrease in the number of AA cases was seen during the pandemic, however, the duration of symptoms before presentation was similar in both cohorts (p = 0.382) Additionally, the number of complicated appendicitis cases was not different between cohorts. The main imaging modality was CT in both groups with no statistically significant difference in the type of imaging between them (p = 0.398). Further, the predominant treatment modality remained surgery during the pandemic, with no difference between both periods (p = 0.200), and no statistically significant difference in the type of surgery performed as laparoscopic surgery remained the most common surgery type in the pandemic period (p = 0.43). Finally, no extra surgical and post-surgical complications were identified.ConclusionIn conclusion, our study is an example of how the COVID-19 pandemic did not significantly affect patients presenting for AA. Despite the COVID-19-related restrictions, Lebanese patients with worrying symptoms were presenting to the emergency department and the American University of Beirut Medical Center was providing them with the standards of care. Our study mirrors the Lebanese experience and gives an example of a population that focused more on their current symptoms than the fear of acquiring the COVID-19 virus. Further research is needed to assess whether this was the correct approach during these times.

The risks of failed nonoperative management of appendicitis in older adults

BackgroundThe consequences of failed nonoperative management of appendicitis in older patients have not been described. MethodsWe used the 2004–2017 National Inpatient Sample to identify acute appendicitis patients managed nonoperatively (<65 years old: 32,469; ≥65 years old: 11,265). Outcomes included morbidity, length of stay (LOS), inpatient costs, and discharge to skilled facilities. Differences were estimated using propensity scores. ResultsFor patients <65, nonoperative failure was associated with increased morbidity (7 ​% [95 ​% CI 6.9 ​%–8.1 ​%]), LOS (3 day [95 ​% CI 3–4]), costs ($9015 [95 ​% CI $8216- $9446]), and discharges to skilled facilities (1 ​% [95 ​% CI 0.9 ​%–1.6 ​%]) compared to successful nonoperative treatment. Patients ≥65 had differences in morbidity (14 ​% [95 ​% CI 13.6 ​%–16.2 ​%]), LOS (6 days [95 ​% CI 5–6]), costs ($15,964 [95 ​% CI $15,181- $17,708]), and discharges to skilled facilities (12 ​% [95 ​% CI: 10.0 ​%-13.3]) compared to nonoperative success. ConclusionsNonoperative management of appendicitis should be approached cautiously for older adults.

Evaluation of the Efficiency of Four Different Scoring Systems in the Diagnosis of Acute Appendicitis

Objective: The aim of this study was to investigate the effectiveness of four commonly used scoring systems (Alvarado, Lintula, RIPASA, Tzanakis) in the diagnosis of acute appendicitis in patients to be operated for acute appendicitis.&#x0D; Materials and Methods: We compared the results and efficacy of the scoring systems with the results of patients with an accurate histopathologic diagnosis of acute appendicitis.&#x0D; Results: A total number of 115 patients were included in the study (62 male and 53 female). For Alvarado, Lintula, RIPASA and Tzanakis scoring systems, sensitivity was 93.6%, 91.4%, 93.6%, 55.3%, specificity was 71.4%, 90.4%, 81%, 76%, Positive Predictive Value (PPV) was 93.6%, 97.7%, 95.7%, 91.2%, Negative Predictive Value (NPV) was 71.4%, 70.3%, 74%, 27.6%, respectively.&#x0D; Conclusion: Our findings show that among the four scoring systems, Alvarado, Lintula and RIPASA scoring systems are more effective scoring systems in diagnosing acute appendicitis whereas Tzanakis scoring system had a low diagnostic efficiency. Since ultrasonography findings have a high impact on Tzanakis scoring system, by working with an experienced radiology clinic, Tzanakis scoring system could be also a powerful scoring system at the diagnostic stage. None of the four scoring systems has 100% predictive accuracy in the diagnosis of acute appendicitis and all scoring systems have some shortcomings. Nevertheless, we believe that the most important criteria in the diagnostic process are the clinic where the patients are admitted, the examination findings and the experience of the clinician. Scoring systems seem to support the diagnosis and guide the clinician.

[Establishment and validation of nomogram prediction model for complicated acute appendicitis].

Objective: To establish and internally validate a nomogram model for predicting complicated acute appendicitis (CA). Methods: The clinical data from 663 acute appendicitis patients from the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from October 2015 to October 2022 were retrospectively analyzed. There were 411 males and 252 females, aged (M (IQR)) 41 (22) years (range: 18 to 84 years). There were 516 cases of CA and 147 cases of uncomplicated acute appendicitis. The minimum absolute contraction and selection operator regression model was used to screen the potential relative factors of CA, and the screened factors were included in the Logistic regression model for multivariate analysis. Software R was used to establish a preoperative CA nomogram prediction model, the receiver operating characteristic curve of the model was drawn, and the value of area under the curve (AUC) was compared to evaluate its identification ability, and the Bootstrap method was used for internal verification. Results: The elderly (age≥60 years) (OR=2.428, 95%CI: 1.295 to 4.549), abdominal pain time (every rise of 1 hour) (OR=1.089, 95%CI: 1.072 to 1.107), high fever (body temperature≥39 ℃) (OR=1.122, 95%CI: 1.078 to 1.168), total bilirubin (every rise of 1 μmol/L) (OR=2.629, 95%CI: 1.227 to 5.635) were independent relative factors of CA (all P<0.05). The AUC of this model was 0.935 (95%CI: 0.915 to 0.956). After internal verification using the Bootstrap method, the model still had a high discrimination ability (AUC=0.933), and the predicted CA curve was still in good agreement with the actual clinical CA curve. Conclusion: The clinical prediction model based on the elderly (age≥60 years), prolonged abdominal pain time, high fever (body temperature≥39 ℃), and increased total bilirubin can help clinicians effectively identify CA.

Profile of appendicitis patient: epidemiology, clinical, and laboratories evaluation in rural-urban area

Appendicitis is one of the most common abdominal inflammations in daily emergency cases. The diagnosis of appendicitis is often delayed because the symptoms resemble other abdominal emergencies. The present research aimed to describe the clinical and epidemiological profile of acute appendicitis patients. The research design is a cohort retrospective study employing appendicitis patients' medical record data at PKU Muhammadiyah Hospital from January 1, 2016, to December 31, 2020. The variables obtained through the patient records were age, gender, domicile location, vital signs, physical examination, blood laboratory, ultrasound, histopathology, postoperative diagnosis, the incidence of peritonitis, and length of stay. The median age value in patients with appendicitis was 27 years (0-95), and the largest group was young adults (19-44 years). Abdominal pain was found in almost all research subjects. The median of leukocytes was 10.1 (3.32-65.80)×10&lt;sup&gt;6&lt;/sup&gt;/ml and the neutrophil-lymphocyte ratio (NLR) was 3.52 (0.47-30.57)/μl. The median percentage of the neutrophil count was 70.7 (27.90-94.81). The final diagnosis of complicated appendicitis was more than uncomplicated appendicitis (51.2% vs. 48.8%). We conclude that several detailed parameters, such as the location of abdominal pain, leukocyte count, and NLR can help the physician diagnose appendicitis and guide surgeons in deciding the type of surgery.

Accuracy of Neutrophil-to-Lymphocyte Ratio in Predicting the Severity of Acute Appendicitis: A Single-Center Retrospective Study.

Investigate the potential use of the neutrophil-to-lymphocyte ratio (NLR) in the identification and differentiation of acute appendicitis patients, specifically between simple and complicated presentations. An observational retrospective cohort study was conducted in Aseer Central Hospital, Saudi Arabia. In total, 103 patients were included in this study, in which males (50.5%) weremore common than females (49.5%), and the most common age group was found to be 36-45 years (56.3%), followed by 18-25 years (23.3%). All patients (100%) had a diagnosis of acute appendicitis. The means of neutrophils, lymphocytes, and NLR were found to be68.970%, 22.067%, and 5.020, respectively. The majority (69%) had non-complicated appendicitis, while (31%) had complications. A significant association was seen between NLR and the occurrence of complications (p-value = 0.00001). This study can comprehensively support the evidence presented in the literature review. The use of the NLR demonstrates a notable level of accuracy in diagnosing acute appendicitis and differentiating between complex and uncomplicated cases.

Acute appendicitis during the fifth wave of the COVID‐19 pandemic in a local cluster: A retrospective cohort study

AbstractIntroductionAcute appendicitis is a common surgical emergency. This study aims to determine whether there are any delays in patients attending the emergency department, potentially leading to an increase in the rates of complicated appendicitis and post‐operative complications during the fifth wave of the coronavirus disease 2019 (COVID‐19) pandemic in a local cluster in Hong Kong.MethodsIn this retrospective cohort study, we analysed 138 patients diagnosed with acute appendicitis during the fifth wave of the COVID‐19 pandemic and pre‐COVID‐19 period. The main study parameters were the duration between the onset of symptoms and attendance to the accident and emergency department, severity of appendicitis, post‐operative complication(s), operation time and total hospital length of stay.ResultsThere was no delay in presentation between the two groups of patients. The rates of complicated appendicitis and post‐operative complications were comparable between the two groups. There was a significantly shorter length of stay for patients with acute appendicitis patients during the fifth wave of the pandemic.ConclusionThe perspective of the general public towards the COVID‐19 pandemic is changing. Increased understanding of the COVID‐19 infection and availability of antiviral medications against COVID‐19 could be useful to eliminate patient's anxiety when attending medical care in public hospitals.

Clinicopathological Profile of Appendicular Disease in Children: A Tertiary Health Care Center Study.

Background Acute appendicitis (AA) is the most common surgical emergency worldwide. Delay in diagnosis of disease often leads to serious complications such as perforation appendicitis (PA) and gangrenous appendicitis (GA). Aims and objectives The purpose of the study is to document clinicopathological outcomes in pediatric age group patients in a tertiary health care center. Material and method This study was a prospective observation study of 50 patients with pediatric appendicitis who had undergone emergency appendectomy from January 2022 to December 2022. All pediatric patients below 15 years of age with a diagnosis of AA were included. Institute ethical permission was granted before the study, and parent consent was taken for the surgery and also for inclusion in the study. After proper resuscitation, all patients underwent appendectomy, and necessary specimens were sent for histological examination. Based on histopathology reports, all patients were classified into four groups: AA, PA, GA, and normal appendix (NA). Results Out of 50 patients, 33 (66%) patients were males and 17 (34%) patients were females. The mean age of the patients was 10.22 ± 2.73 years. The mean age of AA, PA, GA, and NA patients were 10.25 ± 2.6 years, 9.78 ± 2.99 years, 10.00 ± 4.6 years, and 12.00 ± 2.8 years, respectively. The mean duration of symptoms at the time of hospital admission was 2.42 ± 0.97 days forhistopathologically proven AA patients, 4.67 ± 2.1 days for GA patients, 2.8 ± 0.83 for PA patients, and one day for NA patients. Overall clinical presentation was right iliac fossa (RIF) pain in 36 (72%) patients, migration of pain in 31 (62%) patients, anorexia in 37 (74%) patients, nausea and vomiting in 43 (86%) patients fever in 26 (52%) patients, RIF tenderness in 50 (100%) patients, rebound tenderness in 39 (78%) patients, guarding in 19 (38%) patients, Psoas's sign in nine (18% patients), and Rovsing's sign in 19 (38%) patients. On histopathological examination of the sent specimen, AA was found in 36 (72%) patients, PA was found in nine (18%) patients, GA was found in three (6%) patients, and NA was found in two (4%) patients. Wound infection was the most common complication and was found in five (10%) patients. The average duration of hospital stay for AA, PA, GA, and NA was 4.33 ± 1.04 days, 9.56 ± 4.2 days, 12.33 ± 8.5 days, and 3.50 ± 0.71 days, respectively. Conclusion The appendicular disease is common in teenage male children. Fever, dehydration, and rebound tenderness at the RIF are clinically significant findings. Duration of symptoms at the time of diagnosis, post-appendectomy complication, and duration of hospital stay significantly correlated with histopathological findings.

Development and Validation of a Deep Learning and Radiomics Combined Model for Differentiating Complicated From Uncomplicated Acute Appendicitis

This study aimed to develop and validate a deep learning and radiomics combined model for differentiating complicated from uncomplicated acute appendicitis (AA). This retrospective multicenter study included 1165 adult AA patients (training cohort, 700 patients; validation cohort, 465 patients) with available abdominal pelvic computed tomography (CT) images. The reference standard for complicated/uncomplicated AA was the surgery and pathology records. We developed our combined model with CatBoost based on the selected clinical characteristics, CT visual features, deep learning features, and radiomics features. We externally validated our combined model and compared its performance with that of the conventional combined model, the deep learning radiomics (DLR) model, and the radiologist's visual diagnosis using receiver operating characteristic (ROC) curve analysis. In the training cohort, the area under the ROC curve (AUC) of our combined model in distinguishing complicated from uncomplicated AA was 0.816 (95% confidence interval [CI]: 0.785-0.844). In the validation cohort, our combined model showed robust performance across the data from three centers, with AUCs of 0.836 (95% CI: 0.785-0.879), 0.793 (95% CI: 0.695-0.872), and 0.723 (95% CI: 0.632-0.802). In the total validation cohort, our combined model (AUC=0.799) performed better than the conventional combined model, DLR model, and radiologist's visual diagnosis (AUC=0.723, 0.755, and 0.679, respectively; all P<0.05). Decision curve analysis showed that our combined model provided greater net benefit in predicting complicated AA than the other three models. Our combined model allows the accurate differentiation of complicated and uncomplicated AA.

Impact of the COVID-19 Pandemic on the Severity and Early Postoperative Outcomes of Acute Appendicitis.

Background The coronavirus disease 2019 (COVID-19) pandemic caused changes in surgical practice. For acute appendicitis (AA), measures to control the pandemic might hinder patients from seeking medical care timely, resulting in increasing severity, postoperative complications, and mortality. This study aimed to investigate whether the COVID-19 pandemic had a negative impact on the severity and postoperative outcomes of patients with AA. Methodology We retrospectively reviewed medical records of AA patients treated operatively at Nhan Dan Gia Dinh Hospital hospital from June 1st to September 30th in three consecutive years: pre-pandemic (2019)/Group 1,minor waves (2020)/Group 2, and major wave (2021)/Group 3 (2021). Data were collected focusing on the duration of symptoms, severity of AA, time from admission to operation,postoperative complications, and mortality. Results There were 1,055 patients, including 452 patients in Group 1, 409 in Group 2, and 194 in Group 3. The overall number of patients decreased mainly in non-complicated AA. The percentages of hospital admission after 24 hours gradually increased (20.8%, 27.9%, and 43.8%, p < 0.05). The percentages of complicated AA in Group 2 and Group 3 were statistically higher than in Group 1 (39% and 55% vs. 31%, p < 0.05). Waiting time for operation increased to five hours during the major wave. Laparoscopic appendectomy was performed in 98-99% of AA patients during the pandemic, with an early postoperative complication rate of 5-9% and a mortality rate of 0.2-1%. Conclusions Although the percentages of hospital admission after 24 hours and complicated AA increased, laparoscopic appendectomy was still feasible and effective and should be maintained as the standard management for AA during the COVID-19 pandemic.

A comprehensive microbial analysis of pediatric patients with acute appendicitis.

Pathogenesis of pediatric acute appendicitis (AA) is yet to be elucidated. Therefore, we performed a comprehensive microbial analysis of saliva, feces, and appendiceal lumen of AA patients using 16S ribosomal RNA (rRNA) gene amplicon sequencing to elucidate the pathogenesis of pediatric AA. This study included 33 AA patients and 17 healthy controls (HCs) aged <15y. Among the AA patients, 18 had simple appendicitis, and 15 had complicated appendicitis. Salivary and fecal samples were obtained from both groups. The contents of the appendiceal lumen were collected from the AA group. All samples were analyzed using 16S rRNA gene amplicon sequencing. The relative abundance of Fusobacterium was significantly higher in the saliva of AA patients as compared to that in HCs (P=0.011). Bacteroides, Escherichia, Fusobacterium, Coprobacillus, and Flavonifractor were significantly increased in the feces of AA patients, as compared to that in HCs (P=0.020, 0.010, 0.029, 0.031, and 0.002, respectively). In the appendiceal lumen, Bacteroides, Parvimonas, Fusobacterium, and Alloprevotella were the top bacterial genera with an average relative abundance >5% (16.0%, 9.1%, 7.9%, and 6.0%, respectively). The relative abundance of Fusobacterium was high in the appendiceal lumen of pediatric AA patients. Moreover, the relative abundance of Fusobacterium was significantly higher in the saliva and feces of pediatric AA patients than in those of healthy children. These results suggest that ectopic colonization of oral Fusobacterium in the appendix might play an important role in the pathogenesis of pediatric AA.

Comparison of Post-Operative Pain Score Between Open Appendectomy and Laparoscopic Appendectomy on Acute Appendicitis Patient in Siloam Hospital Lippo Village

&lt;div class="WordSection1"&gt;&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Appendicitis is inflammation of vermiform appendix which can be caused by luminal obstruction. Appendicitis is one of the most common causes of emergency abdominal surgery, with 11 cases per 10.000 person per year. Until today, open appendectomy is still the gold standard for appendicitis treatment although laparoscopic appendectomy has significantly lower post-operative pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study uses cross-sectional study design with post-open appendectomy and laparoscopic appendectomy patients in Siloam Hospital Lippo Village as the sample population. The Visual Analogue Scale (VAS) is taken from patient’s medical record and processed using Mann-U-Whitney test.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Result:&lt;/strong&gt; From 70 acute appendicitis patients, 36 underwent open appendectomy and 34 underwent laparoscopic appendectomy. The result showed the median score of VAS 1 day post open appendectomy surgery (median = 3, min/max = 2/6 [95% CI = 2,55 – 3,14]) is higher than post laparoscopic appendectomy (median = 2,25, min/max = 0/4, [95% CI = 1,97 – 2,59]), with adjusted p value against age and surgery duration is 0,024. In pediatric patients, median score of VAS 1 day post open appendectomy surgery is the same with laparoscopic appendectomy (median = 3, p value = 0,863). Multivariate analysis showed that surgery duration affects VAS 1 day post appendectomy surgery in pediatric patients (p value = 0,042).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study shows that the median score of VAS 1 day post open appendectomy surgery is higher than laparoscopic appendectomy. This result is statistically significant. However, in pediatric patients the median score of VAS 1 day post open appendectomy surgery and laparoscopic appendectomy is the same. VAS 1 day post appendectomy surgery in pediatric patients is affected by surgery duration.&lt;/p&gt;&lt;/div&gt;