Common Abdominal Emergency Research Articles

Acute Appendicitis at the Bougouni Reference Health Center

Introduction: Acute appendicitis is an acute inflammation of the vermicular appendix. The objective was to describe the epidemiological, clinical, anatomo-pathological, and therapeutic aspects of appendicitis. Methodology: We carried out a prospective study from January 2020 to December 2020. Results: We listed 60 cases of acute appendicitis which represented 34.4% of surgical emergencies. The average age was 30.9 years. There is a predominance of men with a sex ratio of 1.61. The average consultation time was 2 days. The clinical manifestation was pain in the right iliac fossa. Abdominal ultrasound revealed thickening of the appendicular wall in 55 (91.67%) of cases. The blood count showed hyperleukocytosis in 59 (98.3%). The Alvarado score was between 08 -10 in 57 (95%) of cases. The appendix was laterocecal in 36 (60%) of cases. Appendectomy with burial of the stump was performed in 40 (66.7%), appendectomy without burial in 20 (33.3%). The postoperative complication was parietal abscess 1 (1.66%). Mortality was 0%. Conclusion: Acute appendicitis is the most common abdominal surgical emergency in our department. Early treatment would help reduce complications.

ACUTE APPENDICITIS, PANORAMIC REVIEW

Introduction: appendicitis is distinguished by inflammation of the vermiform appendix and usually shows acutely within the first 24 hours. Acute appendicitis is the main source of abdominal surgery in children and the most common abdominal surgical emergency around the globe. Objective: to detail the current information related to acute appendicitis, etiology, epidemiology, pathophysiology, histopathology, anamnesis, physical examination, evaluation, treatment and complications of the disease. Methodology: a total of 37 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 25 bibliographies were used because the other articles were not relevant for this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: acute appendicitis, abdominal pain, appendix, abdominal surgery, acute abdominal treatment. Results: appendectomy by open laparotomy or laparoscopy is the standard treatment for acute appendicitis, however, intravenous antibiotics are exceptionally considered as first line therapy in individuals. The incidence of acute appendicitis varies from 100 to 223 new cases per 100,000 people per year. This disease can occur at any age, however it is most commonly seen in the age range of 5 to 45 years. The lifetime incidence of acute appendicitis is 8.6% in men and 6.7% in women. The risk of appendiceal rupture may vary with 2% of cases being frequently perforated 36 hours after the onset of symptoms. Conclusions: It is of vital importance to recognize the etiology, epidemiology, pathophysiology, clinical picture and tests that support the diagnostic decision in any case of acute abdomen, especially in cases of acute appendicitis, because an accurate diagnosis will lead us to a rapid intervention, adequate treatment, reducing the risk of mortality and the risk of potential complications in the affected individual. Diagnostic tests and scales play an important role in the diagnosis. The efficacy of antibiotics as primary treatment for uncomplicated acute appendicitis has been extensively investigated, with conflicting and mixed results and conclusions. Comparing the results between individuals who underwent laparoscopic appendectomy and those who underwent open appendectomy, the former group showed a lower incidence of wound infection, a lower level of postoperative analgesic requirement and shorter postoperative hospital stays in the former group, with the main disadvantage being the longer operative time. KEY WORDS: appendicitis, pain, appendix, surgery.

Pathogenic Bacteria Associated With Acute Appendicitis: A Review Article

Acute appendicitis is one of the most common abdominal emergencies, yet the cause is still not clearly understood. The most accepted theory is based on luminal obstruction, but obstructive fecaliths are found in only a portion of the patients. In fact, the bacterial etiology of appendicitis may be more common than fecal-foreign body. Literature was searched for studies that isolated bacteria from the appendix using either culturing techniques or molecular techniques and were case-control in nature. The main scope of this review is to provide an overview of the studies conducted regarding the role of bacteria in the causation of appendicitis, as well as to review recent molecular studies.

The Role of Vascular Cell Adhesion Molecule-1 (VCAM-1) in Predicting Complicated Appendicitis in Children.

Acute appendicitis is a common abdominal emergency observed in emergency departments (ED). Distinguishing between uncomplicated and complicated appendicitis is important in determining a treatment strategy. Serum soluble vascular cell adhesion molecule-1 (VCAM-1) is an inflammatory biomarker. We aimed to determine the role of VCAM-1 in predicting complicated appendicitis in children. Pediatric patients with suspected appendicitis admitted to the ED were enrolled in this prospective study. Pre-surgical serum VCAM-1 was tested in children with acute appendicitis within 72 h of symptoms (from day 1 to day 3). Serum VCAM-1 levels were further analyzed and compared between patients with and without complicated appendicitis. Among the 226 pediatric appendicitis patients, 70 had uncomplicated appendicitis, 138 had complicated appendicitis, and 18 had normal appendices. The mean serum VCAM-1 levels in patients with perforated appendicitis were higher than in those with simple appendicitis (p < 0.001). On day 1 to day 3, the mean VCAM-1 levels in patients with complicated appendicitis were all significantly higher than in those with uncomplicated appendicitis (all p < 0.001). Serum VCAM-1 levels may be helpful in differentiating uncomplicated and complicated appendicitis in children and could predict appendiceal perforation.

Two intussusceptions in a single infant

Acute intestinal intussusception (AII) is the telescoping of one segment of the intestine and its mesentery into the lumen of the adjacent intestine. It is the most common abdominal emergency in young children between 3 months and 3 years old but can occur at any age. We report the case of a 4-month-old infant.

Compilation of Evidence Supporting the Role of a T Helper 2 Reaction in the Pathogenesis of Acute Appendicitis.

Despite being the most common abdominal surgical emergency, the cause of acute appendicitis (AA) remains unclear, since in recent decades little progress has been made regarding its etiology. Obstruction of the appendicular lumen has been traditionally presented as the initial event of AA; however, this is often the exception rather than the rule, as experimental data suggest that obstruction is not an important causal factor in AA, despite possibly occurring as a consequence of the inflammatory process. Type I hypersensitivity reaction has been extensively studied, involving Th2 lymphocytes, and cytokines such as IL-4, IL-5, IL-9 and IL-13, which have well-defined functions, such as a positive-feedback effect on Th0 for differentiating into Th2 cells, recruitment of eosinophils and the release of eosinophilic proteins and the production of IgE with the activation of mast cells, with the release of proteins from their granules. Cytotoxic activity and tissue damage will be responsible for the clinical manifestation of the allergy. AA histological features are similar to those found in allergic reactions like asthma. The intestine has all the components for an allergic immune response. It has contact with hundreds of antigens daily, most of them harmless, but some can potentially induce an allergic response. In recent years, researchers have been trying to assess if allergy is a component of AA, with their latest advances in the understanding of AA as a Th2 reaction shown by the authors of this article.

Is there a link between appendicitis and the risk of diverticular disease?: a large German cohort study

PurposeAppendicitis, characterized by inflammation of the vermiform appendix, is a common abdominal emergency necessitating appendectomy. Recent evidence suggests a potential link between appendicitis and subsequent diverticular disease, yet population-based studies investigating this association are limited.MethodsUtilizing the Disease Analyzer database encompassing data from over 1000 primary care practices in Germany, we conducted a retrospective cohort study. We included 25,379 adults diagnosed with appendicitis and an equal number of matched controls without appendicitis. The incidence of diverticular disease over a 10-year follow-up period was compared between the two cohorts. Cox regression analysis was performed to assess the association between appendicitis and diverticular disease, adjusting for potential confounders.ResultsOur findings revealed a significant association between appendicitis and subsequent diverticular disease (HR: 1.76; 95% CI: 1.57–1.97), with an increased risk observed across all age groups. Notably, this association was stronger in men (HR: 2.00; 95% CI: 1.68–2.37) than in women (HR: 1.58; 95% CI: 1.36–1.84). The cumulative 10-year incidence of diverticular disease was higher in patients with appendicitis (6.5%) compared to those without (3.6%). Additionally, we observed a clear age-dependent increase in the incidence of diverticular disease.ConclusionThis large-scale population-based study provides valuable insights into the interaction between appendicitis and diverticular disease. The study underscores the need for further research elucidating the underlying mechanisms linking appendicitis to diverticular disease. Probiotics emerge as a potential therapeutic avenue warranting exploration in the management of both conditions. These findings have important implications for clinical practice, highlighting the importance of considering appendicitis as a potential risk factor for diverticular disease, particularly in men. Further investigation is warranted to validate these findings and explore potential therapeutic interventions targeting the shared pathophysiological pathways underlying both conditions.

Effect of in-hospital delay on acute appendicitis severity: does time really matter?

Appendicitis is one of the most common abdominal emergencies. Evidence is controversial in determining if the in-hospital time delay to surgery can worsen the clinical presentation of appendicitis. This study aimed to clarify if in-hospital surgical delay significantly affected the proportion of complicated appendicitis in a large prospective cohort of patients treated with appendectomy for acute appendicitis. Patients were grouped into low, medium, and high preoperative risk for acute appendicitis based on the Alvarado scoring system. Appendicitis was defined as complicated in cases of perforation, abscess, or diffuse peritonitis. The primary outcome was correlation of in-hospital delay with the proportion of complicated appendicitis. The study includes 804 patients: 278 (30.4%) had complicated appendicitis and median time delay to surgery in low-, medium-, and high-risk group was 23.15h (13.51-31.48), 18.47h (10.44-29.42), and 13.04 (8.13-24.10)h, respectively. In-hospital delay was not associated with the severity of appendicitis or with the presence of postoperative complications. It appears reasonably safe to delay appendicectomy for acute appendicitis up to 24h from hospital admission. Duration of symptoms was a predictor of complicated appendicitis and morbidity. Timing for appendicectomy in acute appendicitis should be calculated from symptoms onset rather than hospital presentation.

Retrospective analysis of acute appendicitis in COVID-19 pandemic – A clinical study of 100 cases

Acute appendicitis is a very common abdominal emergency condition. The incidence varies from 5.7 to57 patient /lakh population per year in the world wide survey. It is frequent in both sexes, But highest in children &amp; adolescences. Presentation of this condition is some time so confusing that it should be distinguished from other acute abdominal conditions in proper time and appropriate measures should be taken to treat the patients to avoid unwanted complications, this complication is probably more complicated in COVID-19 pandemic period. This study is designed to compare acute appendicitis cases in relation to clinical features, gradation of disease &amp; post operative complications before COVID-19 (June 2019-March 2020) and during COVID-19 pandemic period (April 2020-October 2021). METHOD-Cases of the study were divided into 2-groups.Group-A (65 cases) in pre- pandemic period and Group-B (35 cases) in pandemic period. The study is based on the clinico-radiological features, laboratories investigations and gradation of disease. Gradation: Grade-I (probably appendicitis), Grade-II (definite appendicitis), Grade-III (perforation of appendices), Grade-IV (appendicular abscess), Grade-V (complicated appendicitis/ appendicular lump). Out of 100 enrolled cases 65 belongs to pre pandemic and 35 in pandemic period. It was found that increase in post-operative complications, were more in higher grade groups during pandemic periods. The COVID-19 pandemic has great impact on diagnosis, treatment and increased complications in post operative period of acute appendicitis, probably due to late presentation in emergency department. Pandemic directly or indirectly affect the outcome of a disease process and management.

Appendicular ‘Googlies’ – Googlies bowled at us by the human vermiform appendix and mimickers of it’s acute inflammation ! – A Case series with Review of literature

Objective: Acute appendicitis is one of the common abdominal emergencies encountered in surgical practice. However there are a host of other medical and surgical conditions that closely mimic it, clinically. The objective of this paper is to present a study and analysis of our burden of incidental encounters with such mimicking surgical conditions that were erroneously diagnosed as acute appendicitis, prior to surgery. Methods: Data was retrieved from the hospital’s electronic medical records about all patients operated for acute appendicitis, by a single surgeon, over a 14 year period. Results: A total of 450 patients were operated for acute appendicitis from 2008 to 2022. Out of these, we identified 20 patients who had a normal appendix with some other mimicking surgical condition (Incidence 4.44%). Conclusion: Acute appendicitis has many differential diagnoses, both common and rare. At times, some of these are confirmed ‘on table’; as seen in this case series. A sound, reliable and fool proof palpatory assessment of the abdomen is crucial in diagnosing it’s surgical conditions. It is interesting to note that although the initial diagnosis of acute appendicitis made for all the subjects of this case series was erroneous, all still turned out to have alternate conditions which merited surgery.

Acute Appendicitis Incidence, Diagnostic Markers, and Sequelae; Dallah Hospital-Based Study in Riyadh, Saudi Arabia.

Acute appendicitis is currently considered one of the most common acute surgical diseases of the abdomen and requires emergency surgery. It is also one of the most common abdominal emergencies in both developed and developing countries. The current study is aimed at assessing the specificity and sensitivity of Ultrasound and Computed Tomography in the diagnosis of appendicitis as well as the prevalence of its complications. The association of appendicitis with several laboratory findings will also be evaluated. A retrospective study was conducted at Dallah-Namar Hospital, Riyadh City, Saudi Arabia. 720 patients were differentially diagnosed with appendicitis in the study area. Of these, 618 patients had US abdomen/pelvis, with 15 (2.4%) showing positive findings. Amongst the 203 patients noted to have undergone abdominal CT,8 (4.0%) was found to have positive findings. The sensitivity of the US was determined to be relatively low. Also, serum creatinine was found to be elevated among all patients diagnosed with appendicitis. Further research with a larger sample size is needed to be conducted to further support the current findings.

Robotic Appendicectomy

Acute appendicitis is one of the most common abdominal emergencies. There has been an increasing news of robotic abdominal surgery. However, it remains underutilised in emergency settings. This study aimed to systematically review robotic appendicectomy (RA) feasibility. A 20-year systematic review was performed, along with quality assessment. The research protocol was registered with PROSPERO. The search yielded 1,242 citations, including 9 articles. The mean quality score was 10.72 ± 2.56. The endpoints across the studies were rate of conversion to open surgery, length of hospital stay, blood loss and operative time. RA is a safe, feasible technique that can be performed in elective and emergency settings with minimal blood loss. The operative time and hospital stay were within acceptable limits. Robotic surgery’s major drawback is its high cost and limited availability. Future studies evaluating RA with a focus on its application during emergencies and its cost-effectiveness are recommended. Keywords: Robot Surgery; Robotic-Assisted Surgery; Robot Enhanced Surgery; Robotic Surgical Procedure; Appendectomy; Appendicectomy; Gastrointestinal Surgical Procedure.

EGS P36 Scan every clinical appendicitis before operation. Can we prevent unnecessary operations in this era of CT?

Abstract Background Acute appendicitis is the most common abdominal surgical emergency in the world, with around 50,000 acute appendectomies performed annually in the UK. However, appendectomy has been associated with negative appendectomy rates (NARs) of 15%-39% in large series. On the other hand, CT scan is associated with radiations increasing the risk of cancer and considerable cost to the trust. Methods Notes of 25 patients admitted with suspicion of acute appendicitis were reviewed retrospectively by the auditors from their admission to the discharge from hospital and CT scan reports were evaluated. Results All of the patients seen by the surgical team had a CT scan to confirm the diagnosis of acute appendicitis before surgery. 15/25 patients had a diagnosis of acute appendicitis and all of the histology reports in these patients after the surgery confirmed the diagnosis. 10/25 patients had other diagnosis on CT despite clinical features suggestive of acute appendicitis. Colitis was the second most common cause of abdominal pain after acute appendicitis. 0% negative appendectomy rate was achieved when CT scan was done before the surgery. Conclusions This audit concludes that all the patients who present with the clinical suspicion of acute appendicitis should have a CT scan before the surgery to avoid the unnecessary operations however, an audit of 1 year or more would be more beneficial in formulating a clear picture and the development of guidelines.

Elevated total and direct bilirubin are associated with acute complicated appendicitis: a single-center based study in Saudi Arabia

BackgroundAppendicitis is the most common abdominal surgical emergency and up to our knowledge no previous studies have been conducted in Saudi Arabia particularly at Qassim region and this study aimed to determine a total and direct bilirubin as a predictor of acute complicated appendicitis.MethodsObservational retrospective study that included patients admitted under the general surgery department with a diagnosis of acute appendicitis at King Saud Hospital, Unaizah, Saudi Arabia. Data on age, gender, BMI, diabetes mellitus, total and direct bilirubin, AST, ALT, sodium, and WBCs levels were obtained.ResultAmong the overall study population of 158 patients, the age median [IQR] was 24.5 [19–31], males were 99 (62.7%), and complicated appendicitis was 33 (20.9%). The multivariable analysis revealed that both elevated total and direct bilirubin are associated with complicated appendicitis (aOR = 3.79, 95% CI: 1.67–8.48, P = 0.001) and (aOR = 4.74, 95% CI: 2.07–10.86, P < 0.001) respectively. A receiver operating characteristic curve showed the best cutoff value of total and direct bilirubin as ≥ 15 µmol/L and ≥ 5 µmol/L respectively, with a sensitivity of 57.6%, and specificity of 73.6% for elevated total bilirubin, and a sensitivity of 54.6%, and specificity of 80% for elevated direct bilirubin.ConclusionElevated total and direct bilirubin are associated with acute complicated appendicitis in this setting. However, it should be supportive factor for acute complicated appendicitis and not considered as standalone diagnostic test.

A Rare Case of Cecostomy Tube in Complicated Acute Appendicitis Leading to Fecal Peritonitis

The most common abdominal surgical emergency in the world in acute appendicitis. Most common age group involved is between first to second decades but patients at extreme age have higher mortality rate due to late presentation. We are presenting a case of appendicitis which was complicated as long history at time of first surgery which led to caecal injury which was managed with ceacostomy. 62 years gentleman was referred from private hospital with fecal discharge from the open appendectomy wound and cecostomy tube insitu. Patient was diagnosed as phlegmon sequelae of acute appendicitis. Patient underwent emergency laparotomy, peritoneal lavage, removal of cecostomy tube, primary repair of caecal perforation and diversion loop ileostomy. Patient recuperated well. This case report highlights the challenges faced and complexities associated with failure of cecostomy in managing caecal perforation following laparoscopic appendectomy. The conversion from a laparoscopic approach to an emergency open appendectomy followed with cecostomy proved to be a vital decision in the face of phlegmon sequelae of acute appendicitis. The phlegmonous nature of acute appendicitis should be managed conservatively otherwise leading to a more aggressive surgical intervention. Keywords: Acute appendicitis, cecostomy, ileostomy, fecal discharge, phlegmon, complicated appendicitis.

Diagnosis, risk factors, and treatment of pediatric benign pneumoperitoneum: A single‐center retrospective study

AbstractPneumoperitoneum is one of the common acute abdominal emergencies that leads to surgical exploration in children, but not all pneumoperitoneum require emergency surgery. This study evaluated the diagnostic methods, predisposing risk factors, and therapeutic options in children with benign pneumoperitoneum for accurate diagnosis and reducing the risk of adverse surgical consequences. A total of 63 cases of pneumoperitoneum diagnosed by the radiographs were involved in this study and were divided into the surgical pneumoperitoneum and benign pneumoperitoneum groups, respectively, from 2009 to 2021. The general information, abdominal signs, laboratory examination, therapies and outcomes, total hospitalization time, and comorbidities were analyzed. Logistic regression analysis assessed the risk factors and protective factors of benign pneumoperitoneum. Promising biomarkers underwent receiver operating characteristic curve analysis. Children with surgical pneumoperitoneum were younger than those with nonsurgical pneumoperitoneum in the study. The C‐reactive protein (CRP) level in the surgical pneumoperitoneum group was higher than that in the other group, albumin (ALB) was lower than that in the benign pneumoperitoneum group, and the ratio of ALB to CRP can be used as an effective indicator to predict whether the pneumoperitoneum is benign or whether surgery is needed. Pulmonary injury, pneumonia, and blunt abdominal injury are the major causes in patients with benign pneumoperitoneum. The establishment and management of clinical criteria for the diagnosis of benign pneumoperitoneum in children will be important for the treatment and recovery of children diagnosed with pneumoperitoneum.

A Study of Misconceptions About Appendicitis Among the Resident Population of the Aseer Region.

Appendicitis is a common abdominal emergency requiring swift medical intervention. Misconceptions about this condition can lead to delayed diagnosis and potentially life-threatening complications. In the Aseer region of Saudi Arabia, where healthcare accessibility and awareness levels vary, addressing such misconceptions is of paramount importance. The aim of this study is to investigate and identify the prevalent misconceptions regarding appendicitis among the resident population of the Aseer region. Understanding the prevalent misconceptions and knowledge gaps is essential to develop targeted educational interventions and enhance public awareness. This study utilized a cross-sectional study design to investigate misconceptions about appendicitis among residents in the Aseer region. Over a period of three months, 329 Aseer region resident population were interviewed.The symptoms, causes, diagnosis, treatment, and preventive measures of appendicitis were all covered in a questionnaire that was created to gather information on people's knowledge of appendicitis.Data were collected using an online questionnaire. Descriptive analysis was performed using frequencies and percentages, while inferential analysis employed appropriate statistical tests such as chi-square. The study's 329 participants were made up of 56% men and 44% women. 40%of the sample size was between the ages of 18 and 30, 26% were between the ages of 31 and 40, 15% were between the ages of 41 and 50, and 10% were above 50 years, with those under the age of 18 years accounting for the smallest proportion (9%). The majority of the respondents (37%) were college graduates, 25% were college students, 23% were in high school and 15% were in middle school. Chi-square tests were conducted to examine the associations between background knowledge and pain area, as well as between background knowledge and source of information. For the association between background knowledge and pain area, the Chi-square test yielded a significant result (X² = 9.104, p = 0.028); the Chi-square test also revealed a significant result (X² = 8.078, p = 0.044) between background knowledge and the source of information about appendicitis. The analysis suggests a notable knowledge gap among the participants, with a significant portion displaying limited understanding or responding with "I don't know" when queried about appendicitis. It is important to note that this observation includes middle school students, who may be too young to be expected to possess knowledge about medical conditions. Additionally, there appears to be gender-related variation in opinions, misconceptions, and understanding regarding appendicitis.

Comparison of Pediatric Acute Appendicitis Before and During the COVID-19 Pandemic in New York City.

Background: Acute appendicitis (AA) is the most common abdominal surgical emergency in children and adolescents. In the year immediately following the declaration of the coronavirus disease 2019 (COVID-19) pandemic by the World Health Organization (WHO), there was a precipitous decline in emergency department (ED) visits especially for surgical conditions and infectious diseases. Fear of exposure to severe acute respiratory coronavirus 2 infection resulted in delay in presentation and time to surgery, and a shift toward more conservative management. Objective: Our goal was to compare the incidence and severity of AA before and during the COVID-19 pandemic. Methods: Patients aged 2-18years admitted with the diagnosis of AA to Flushing Hospital Medical Center or Jamaica Hospital Medical Center in Queens, New York, were selected for chart review. Data extracted from electronic health records included demographics, clinical findings, imaging studies, and operative and pathological findings. We calculated the Alvarado score (AS) for incidence and the American Association for the Surgery of Trauma (AAST) grade for severity. We compared patients admitted between March 1, 2018-February 29, 2020 (pre-pandemic) to patients admitted between March 1, 2020-February 28, 2021 (pandemic). We then compared pre-pandemic and pandemic groups to determine differences in pediatric AA incidence and severity. Results: Of 239 patients diagnosed with AA, 184 (77%) were in the pre-pandemic group and 55 (23%) in the pandemic group. Incidence (number per year) of AA declined by 40%. The pandemic group had significantly greater overall AS of ≥7, indicating increased likelihood to require surgery, (P = 0.04) and higher AAST grade demonstrating increased severity (P = 0.02). Conclusion: There was a decline in the number of AA cases seen in our pediatric EDs and admitted during the first year of the pandemic. Clinicians need to be aware of increased severity of AA at time of presentation during public health emergencies such as a pandemic, possibly due to modified patient behavior.

Tumor Necrosis Factor Alpha Preconditioned Umbilical Cord Mesenchymal Stem Cell-Derived Extracellular Vesicles Enhance the Inhibition of Necroptosis of Acinar cells in Severe Acute Pancreatitis.

Severe acute pancreatitis (SAP) is a common abdominal emergency with a high mortality rate and a lack of effective therapeutic options. Although mesenchymal stem cell (MSC) transplantation is a potential treatment for SAP, the mechanism remains unclear. It has been suggested that MSCs may act mainly through paracrine effects; therefore, we aimed to demonstrate the therapeutic efficacy of extracellular vesicles (EVs) derived from human umbilical cord mesenchymal stem cells (UCMSCs) for SAP. Na-taurocholate was used to induce a rat SAP model through retrograde injection into the common biliopancreatic duct. After 72 h of EVs transplantation, pancreatic pathological damage was alleviated, along with a decrease in serum amylase activity and pro-inflammatory cytokine levels. Interestingly, when UCMSCs were preconditioned with 10 ng/mL tumor necrosis factor alpha (TNF-α) for 48 h, the obtained EVs (named TNF-α-EVs) performed an enhanced efficacy. Furthermore, both animal and cellular experiments showed that TNF-α-EVs alleviated the necroptosis of acinar cells of SAP through RIPK3/MLKL axis. In conclusion, our study demonstrated that TNF-α-EVs were able to enhance the therapeutic effect on SAP by inhibiting necroptosis compared to normal EVs. This study heralds that TNF-α-EVs may be a promising therapeutic approach for SAP in the future.

CLINICAL STUDY ON ACUTE APPENDICITIS INCORPORATING MODIFIED ALVARADO SCORE AND ABDOMINAL ULTRASOUND

Acute appendicitis is one of the most common acute abdominal surgical emergencies the diagnosis of which is often challenging. If there is a delay in the diagnosis and prompt action is not taken, it may lead to perforation and other complication. Many scoring systems have been devised for the diagnosis of appendicitis, among which Modified Alvarado score is being used widely. Ultrasound also has gained importance in recent years. Our study aims in combining the use of Modified Alvarado score and USG in the diagnosis to bring down the rate of negative appendicectomies. Aimof The Study 1. To evaluate the sensitivity of the use of modified Alvarado scoring system and ultrasound in the diagnosis of acute appendicitis 2. To reduce the rate of negative appendicectomy. Materials &amp; Methods: This study was done in 100 patients admitted in Navodaya Medical College Hospital from November 2019 to May 2021. All patients chosen on purposive sampling basis who present with right lower quadrant pain. Preoperatively, modified Alvarado score and abdominal ultrasound are assigned to those included in the study. Intraoperative findings and histo-pathological reports are followed up and the results are compared with modified Alvarado score and abdominal ultrasound. Results 1. In our study, the sensitivity of Modified Alvarado score in diagnosing Acute Appendicitis in the score range of 1-4 is 60%, so 6 out of 10 patients were confirmed with Acute Appendicitis. 2. In the score range of 5-7, out of 26 patients, 24 patients were confirmed with Acute Appendicitis using HPE having 92.3% sensitivity. 3. In the score &gt;7, out of 64 patients , 63 patients had Acute Appendicitis confirmed with HPE and the sensitivity of HPE was the highest among this score range and its found to be 98.43%.The remaining 7 patients had normal appendix. 4. In our study, the sensitivity of USG Abdomen in diagnosing Acute Appendicitis was 95.83% in the score range of 5-7, 71.42% in score range of &gt;7 and 66.6% in score range of 1-4.Out of 100 patients, USG abdomen showed positive result for Acute Appendicitis in only 72 patients when compared to HPE which showed 93 patients with Acute Appendicitis. Interpretation &amp; Conclusion: Modified Alvarado scoring system is the better indicator for confirmation of diagnosis of Acute Appendicitis in the clinical setting rather than relying on USG abdomen imaging modality of investigation for diagnosing and treating the patient with Acute Appendicitis. When we incorporate both Modified Alvarado Scoring system and USG abdomen then we can diagnose Acute Appendicitis with accuracy close to HPE diagnosis of Acute Appendictis.