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Journal of Clinical Medicine Aug 2023Acute appendicitis is a frequently encountered surgical emergency. Despite several scoring systems, the possibility of delayed diagnosis persists. In addition, a delayed... (Review)
Review
BACKGROUND
Acute appendicitis is a frequently encountered surgical emergency. Despite several scoring systems, the possibility of delayed diagnosis persists. In addition, a delayed diagnosis leads to an increased risk of complicated appendicitis. Hence, there is a need to identify biological markers to help clinicians rapidly and accurately diagnose and prognosticate acute appendicitis with a high sensitivity and specificity. Although several markers have been evaluated, the pressing concern is still the low specificity of these markers. One such marker is serum ischemia-modified albumin (IMA), which can be a novel biomarker for accurately diagnosing and prognosticating acute appendicitis.
METHODS
The authors conducted a systematic search of the PubMed, EMBASE, Web of Science, and Scopus databases through February 2023 as per the PRISMA guidelines. The difference in the levels of IMA between patients with acute appendicitis vs. healthy controls, and the difference in the levels of IMA between patients with complicated vs. non-complicated acute appendicitis were taken as the outcome measures. Statistical analysis was performed using a random effects model and mean difference (MD) was calculated. The methodological quality of the studies was assessed by utilizing the Newcastle-Ottawa scale.
RESULTS
A total of six prospective comparative studies were included in the meta-analysis. The analysis revealed that the mean level of serum IMA was significantly raised in the acute appendicitis group (MD 0.21, 95% CI 0.05 to 0.37, = 0.01). Similarly, the mean serum IMA levels were also raised in the complicated appendicitis group compared to the non-complicated appendicitis group (MD 0.05, 95% CI 0.01 to 0.10, = 0.02). Three of the studies included were, however, of poor methodological quality.
CONCLUSIONS
Serum IMA is a viable potential marker for diagnosing and prognosticating acute appendicitis. However, due to the limited methodological quality of available studies, further prospectively designed and adequately powered studies are needed.
PubMed: 37685553
DOI: 10.3390/jcm12175486 -
Health Science Reports Sep 2023Although appendicitis is rare in young infants, the reported mortality is high. Primary aim of this systematic review was to provide updated insights in the mortality...
BACKGROUND AND AIMS
Although appendicitis is rare in young infants, the reported mortality is high. Primary aim of this systematic review was to provide updated insights in the mortality and morbidity (postoperative complications, Clavien-Dindo grades I-IV) of appendicitis in infants ≤3 months of age. Secondary aims comprised the evaluation of patient characteristics, diagnostic work-up, treatment strategies, comorbidity, and factors associated with poor outcome.
METHODS
This systematic review was reported according to the PRISMA statement with a search performed in Pubmed, Embase and Web of Science (up to September 5th 2022). Original articles (published in English ≥1980) reporting on infants ≤3 months of age with appendicitis were included. Both patients with abdominal appendicitis and herniated appendicitis (such as Amyand's hernia) were considered. Data were provided descriptively.
RESULTS
In total, 131 articles were included encompassing 242 cases after identification of 4294 records. Overall, 184 (76%) of the 242 patients had abdominal and 58 (24%) had herniated appendicitis. Two-hundred (83%) of the patients were newborns (≤28 days) and 42 (17%) were infants between 29 days and ≤3 months of age. Either immediate, or after initial conservative treatment, 236 (98%) patients underwent surgical treatment. Some 168 (69%) patients had perforated appendicitis. Mortality was reported in 20 (8%) patients and morbidity in an additional 18 (8%). All fatal cases had abdominal appendicitis and fatal outcome was relatively more often reported in newborns, term patients, patients with relevant comorbidity, nonperforated appendicitis and those presented from home.
CONCLUSION
Mortality was reported in 20 (8%) infants ≤3 months of age and additional morbidity in 18 (8%). All patients with fatal outcome had abdominal appendicitis. Several patient characteristics were relatively more often reported in infants with poor outcome and adequate monitoring, early recognition and prompt treatment may favour the outcome.
PubMed: 37680208
DOI: 10.1002/hsr2.1435 -
Alternative Therapies in Health and... Nov 2023Acute appendicitis (AA) is a prevalent abdominal emergency in children, and there has been growing interest in the use of endoscopic retrograde appendicitis treatment... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Acute appendicitis (AA) is a prevalent abdominal emergency in children, and there has been growing interest in the use of endoscopic retrograde appendicitis treatment (ERAT) over the past two decades. A meta-analysis of published retrospective studies was conducted to investigate the clinical characteristics and therapeutic efficacy of ERAT for AA in children.
METHODS
A systematic review and meta-analysis of retrospective studies were carried out, encompassing data from PUBMED, MEDLINE, Cochrane, China National Knowledge Infrastructure (CNKI), WanFang, and VIP Database. The search was limited to studies published between January 1, 2012, and June 31, 2022, with the final search conducted on October 31, 2022. No restrictions were imposed regarding publication or study design filters. The registration number in PROSPERO was CRD42022377739.
RESULTS
Seven retrospective cohort studies with 423 patients were included. The majority of children who underwent ERAT were male (57.6%, 95% CI 52.8%-62.4%). The ERAT procedure had a high success rate (99.5%, 95% CI 98.2%-100.0%) and averaged around 49 minutes. ERAT's efficacy for treating acute appendicitis was high (99.0%, 95% CI 96.5%-100.0%), with a low recurrence rate (4.2%, 95% CI 2.2%-6.7%). Patients typically stayed in the hospital for about 4.3 days, and the rate of postoperative complications was around 3.9% (95% CI 2.0%-6.2%).
CONCLUSIONS
Despite the heterogeneity among studies, ERAT appears to be an effective treatment for acute uncomplicated appendicitis in children. It has a high success rate, a low recurrence rate, preserves the appendix's function, and causes minimal damage. ERAT could be considered a safe and effective treatment option for pediatric appendicitis.
Topics: Humans; Male; Child; Female; Appendicitis; Retrospective Studies; Treatment Outcome; Acute Disease; Postoperative Complications
PubMed: 37632960
DOI: No ID Found -
Journal of Clinical Medicine Jul 2023Today, the prevalence of obesity in the pediatric population has increased dramatically. Acute appendicitis (AA) is the most common surgical condition among pediatric... (Review)
Review
Today, the prevalence of obesity in the pediatric population has increased dramatically. Acute appendicitis (AA) is the most common surgical condition among pediatric patients. We aimed to investigate the impact of obesity on postoperative outcomes in terms of operative time (OT), length of stay (LOS), surgical site infection (SSI), overall complications, adverse events, and mortality in children undergoing appendectomy for acute appendicitis. An extensive search of the literature in PubMed and Google Scholar was conducted to evaluate the outcomes of normal weight (NW), overweight (OW), and obese (OB) children who underwent appendectomy. Although no statistically significant differences were noted in perioperative outcomes and overall postoperative complications between OW/OB and NW children in the majority of the included studies, prolonged OT and LOS and SSI were found in some studies. Moreover, no differences in terms of readmissions and ED visits were recorded. We conclude that the impact of obesity on postoperative outcomes for children undergoing appendectomy for AA is unclear, and, therefore, no safe conclusions can be drawn with the currently available data. Due to the lack of high-quality studies, further research is required to optimize the surgical approach and prevent unwarranted complications.
PubMed: 37510927
DOI: 10.3390/jcm12144811 -
BMC Surgery Jul 2023This meta-analysis aimed to compare the efficacy and safety of antibiotic treatment and appendectomy for acute uncomplicated appendicitis. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This meta-analysis aimed to compare the efficacy and safety of antibiotic treatment and appendectomy for acute uncomplicated appendicitis.
METHODS
We searched the randomized controlled studies (RCTs) comparing appendectomy with antibiotic treatment for uncomplicated acute appendicitis in the electronic database including Pubmed, Embase, Cochrane, Web of Science, CNKI, VIP, and WanFang. The primary outcomes included complication-free treatment success at 1 year, complications, surgical complications, and the complicated appendicitis rates. Secondary outcomes included negative appendicitis, length of hospital stay, the quality of life at 1 month, and the impact of an appendicolith on antibiotic therapy.
RESULTS
Twelve randomized controlled studies were included. Compared with surgery group, the antibiotic group decreased the complication-free treatment success at 1 year (RR 0.81; 95% CI 0.73-0.91; z = 3.65; p = 0.000). Statistically significance was existed between antibiotic group and surgical group with both surgical types(open and laparoscopic) (RR 0.43; 95% CI 0.31-0.58; z = 5.36; p = 0.000), while no between the antibiotic treatment and laparoscopic surgery (RR 0.72; 95% CI 0.41-1.24; z = 1.19; p = 0.236). There was no statistically significant differences between two groups of surgical complications (RR 1.38; 95% CI 0.70-2.73; z = 0.93; p = 0.353), the complicated appendicitis rate (RR 0.71; 95% CI 0.36-1.42; z = 0.96; p = 0.338), negative appendectomy rate (RR 1.11; 95% CI 0.69-1.79; z = 0.43; p = 0.670), duration of hospital stay (SMD 0.08; 95%CI -0.11-0.27; z = 0.80; p = 0.422), and quality of life at 1 month (SMD 0.09; 95%CI -0.03-0.20; z = 1.53; p = 0.127). However, in the antibiotic treatment group, appendicolith rates were statistically higher in those whose symptoms did not improve (RR 2.94; 95% CI 1.28-6.74; z = 2.55; p = 0.011).
CONCLUSIONS
Although the cure rate of antibiotics is lower than surgery, antibiotic treatment is still a reasonable option for patients with uncomplicated acute appendicitis who do not want surgery without having to worry about complications or complicating the original illness.
Topics: Humans; Appendectomy; Appendicitis; Anti-Bacterial Agents; Treatment Outcome; Acute Disease; Length of Stay
PubMed: 37488583
DOI: 10.1186/s12893-023-02108-1 -
Digestive Surgery 2023Diagnostic laparoscopy is often used when a patient is suspected of having acute appendicitis. The aim of this study was to assess the rate of other pathologies found... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Diagnostic laparoscopy is often used when a patient is suspected of having acute appendicitis. The aim of this study was to assess the rate of other pathologies found during diagnostic laparoscopy for suspected acute appendicitis.
METHODS
This systematic search included studies with ≥100 patients who received laparoscopy for suspected acute appendicitis and reported on the histopathologic and other intra-abdominal findings. We performed a meta-analysis estimating the rate of other pathologies, and a sensitivity analysis excluding smaller cohorts (≤500 patients). Age groups, sex, specific findings, and geographic regions were investigated. Certainty of evidence was assessed with GRADE.
RESULTS
A total of 27 studies were included covering 25,547 patients and of these 793 had an unexpected pathology. The findings were benign pathology in the appendix (34%), malignancy (30%), gynecologic pathology (5%), gastrointestinal pathology (4%), or unspecified (27%). Meta-analysis showed an overall rate of unexpected findings of 3.5% (95% CI 2.7-4.3; moderate certainty), and the sensitivity analysis showed similar results. Malignancy found in the appendix when treating suspected acute appendicitis was 1.0% (95% CI 0.8-1.3%; high certainty).
CONCLUSION
The rate of other histopathological findings in patients with suspected acute appendicitis was low and a malignancy in appendix was found in 1% of patients.
Topics: Humans; Female; Appendicitis; Appendectomy; Laparoscopy; Acute Disease
PubMed: 37463567
DOI: 10.1159/000531283 -
ANZ Journal of Surgery Sep 2023Paediatric appendicitis may be challenging to diagnose, and outcomes difficult to predict. While diagnostic and prognostic scores exist, artificial intelligence (AI) may... (Review)
Review
BACKGROUND
Paediatric appendicitis may be challenging to diagnose, and outcomes difficult to predict. While diagnostic and prognostic scores exist, artificial intelligence (AI) may be able to assist with these tasks.
METHOD
A systematic review was conducted aiming to evaluate the currently available evidence regarding the use of AI in the diagnosis and prognostication of paediatric appendicitis. In accordance with the PRISMA guidelines, the databases PubMed, EMBASE, and Cochrane Library were searched. This review was prospectively registered on PROSPERO.
RESULTS
Ten studies met inclusion criteria. All studies described the derivation and validation of AI models, and none described evaluation of the implementation of these models. Commonly used input parameters included varying combinations of demographic, clinical, laboratory, and imaging characteristics. While multiple studies used histopathological examination as the ground truth for a diagnosis of appendicitis, less robust techniques, such as the use of ICD10 codes, were also employed. Commonly used algorithms have included random forest models and artificial neural networks. High levels of model performance have been described for diagnosis of appendicitis and, to a lesser extent, subtypes of appendicitis (such as complicated versus uncomplicated appendicitis). Most studies did not provide all measures of model performance required to assess clinical usability.
CONCLUSIONS
The available evidence suggests the creation of prediction models for diagnosis and classification of appendicitis using AI techniques, is being increasingly explored. However, further implementation studies are required to demonstrate benefit in system or patient-centred outcomes with model deployment and to progress these models to the stage of clinical usability.
Topics: Humans; Child; Artificial Intelligence; Appendicitis; Algorithms; Acute Disease; Databases, Factual
PubMed: 37458222
DOI: 10.1111/ans.18610 -
Cureus Jun 2023Adults can accidentally swallow foreign bodies (FBs) with food. In rare occasions, these can lodge in the appendix lumen causing inflammation. This is known as foreign... (Review)
Review
Adults can accidentally swallow foreign bodies (FBs) with food. In rare occasions, these can lodge in the appendix lumen causing inflammation. This is known as foreign body appendicitis. We conducted this study to review different types and management of appendiceal FBs. A comprehensive search on PubMed, MEDLINE, Embase, Cochrane Library and Google Scholar was performed to detect appropriate case reports for this review. Case reports eligible for this review included patients above 18 years of age with all types of FB ingestion causing appendicitis. A total of 64 case reports were deemed to be eligible for inclusion in this systematic review. The patient mean age was 44.3 ± 16.7 years (range, 18-77). Twenty-four foreign bodies were identified in the adult appendix. They were mainly lead shot pellet, fishbone, dental crown or filling, toothpick, and others. Forty-two percent of the included patients presented with classic appendicitis pain, while 17% were asymptomatic. Moreover, the appendix was perforated in 11 patients. Regarding modalities used for diagnosis, computed tomography (CT) scans confirmed the presence of FBs in 59% of cases while X-ray only managed to detect 30%. Almost all of the cases (91%) were treated surgically with appendicectomy and only six were managed conservatively. Overall, lead shot pellets were the most common foreign body found. Fishbone and toothpick accounted for most of the perforated appendix cases. This study concludes that prophylactic appendicectomy is recommended for the management of foreign bodies detected in the appendix, even if the patient is asymptomatic.
PubMed: 37425596
DOI: 10.7759/cureus.40133 -
European Journal of Pediatrics Jul 2023
PubMed: 37266729
DOI: 10.1007/s00431-023-05043-8 -
Current Reviews in Clinical and... 2024A substantial number of research studies on metronidazole-related cutaneous symptoms have recently been published. Our objective was to identify and evaluate descriptive...
BACKGROUND
A substantial number of research studies on metronidazole-related cutaneous symptoms have recently been published. Our objective was to identify and evaluate descriptive studies that described metronidazole-related skin manifestations, therapeutic interventions, and consequences.
METHODS
A comprehensive literature search was carried out in the PubMed, Scopus, and grey literature databases from inception to April 2022 without any constraints, as well as a snowball search in Google and a search in Google Scholar. Descriptive articles describing metronidazole-related cutaneous manifestations were considered for the review. Two distinct reviewers carried out the research selection, data extraction, and quality assessment; any discrepancies were resolved by consensus with the third reviewer.
RESULTS
About 24 out of 4648 descriptive studies, including 26 patients (20 Female patients and 6 male patients), were included in this review. The included studies comprised a range of ages from 16 to 78 years old. Metronidazole was indicated for the treatment of bacterial vaginosis, trichomoniasis, sepsis, anti-infection therapy, perforated appendicitis, rosacea, vaginal discharge, dysentery, acne rosacea, trichomonal vaginitis, lichen planus, liver abscess, facial rosacea, intestinal amoebiasis, and gingivitis. Fixed drug eruption was the most common skin manifestation which was reported in 7 cases included in this review. Cutaneous manifestations were ameliorated by cessation of the offending drug and by apportioning antihistamines, topical steroids, parenteral corticosteroids, emollients, and topical moisturizers.
CONCLUSION
Clinicians and healthcare professionals should be cognizant of the potential cutaneous adverse drug reactions (CADRs) induced by metronidazole to mitigate fatal circumstances. The management of the CADRs appears to respond effectively with immediate drug discontinuation and supportive therapy.
Topics: Humans; Metronidazole; Drug Eruptions; Female; Male; Adult; Middle Aged; Young Adult; Aged; Adolescent
PubMed: 37264661
DOI: 10.2174/2772432819666230601155545