Correlation Between Systemic Inflammatory Physiology and Severity of Appendicitis in Patients Undergoing Appendectomy

A regression model based on computed tomographic (CT) findings alone can accurately predict the histologic severity of acute appendicitis in patients who have a high disease likelihood. Retrospective study. Mayo Clinic in Scottsdale, Ariz. Consecutive sample of 105 patients (50 women and 55 men, aged 15-89 years) undergoing nonincidental appendectomy within 3 days of nonfocused abdominal CT. Computed tomographic scans and histologic features were retrospectively reinterpreted. Each patient's histologic and CT findings were scored by standardized criteria. An ordinal logistic regression model was constructed with a subset of CT findings that statistically correlated best with the final histologic features. Predicted severity values were then generated from the model. Agreement between predicted and actual histologic severity, using weighted kappa measurement. Computed tomography variables used in the model were fat stranding, appendix diameter, dependent fluid, appendolithiasis, extraluminal air, and the radiologist's overall confidence score. The weighted kappa measurement of agreement between predicted and actual histologic severity was 0.75, with a 95% confidence interval between the values of 0.59 and 0.90. Computed tomographic findings, when used with the regression model developed from this pilot study, can accurately predict the histologic severity of acute appendicitis in patients initially seen with a high clinical suspicion of the disease. These findings provide a platform from which to prospectively test the model.

Perforated appendicitis is a leading cause of morbidity and mortality in all appendicitis cases, both for adults and children. Delay in preoperative diagnosis is the main reason for perforation. In previous studies, it was revealed that diagnostic modalities such as radiological examination and the current scoring system have not been able to predict the onset of perforated appendicitis. Serological biomarkers of lactic acid are associated with intestinal obstruction and ischemia. The increase in the serological value of lactic acid in perforated appendicitis compared to acute one was shown to increase significantly by 0.25 mmol/L (p<0.05) according to a previous study. This study aimed to determine the correlation between lactic acid level and the severity of appendicitis in patients visiting Dr. Hasan Sadikin General Hospital. This was a cross-sectional prospective analytic observational study on adult patients diagnosed with appendicitis who were admitted to the emergency room of Dr. Hasan Sadikin General Hospital from January 1, 2021 to June 1, 2021. Data analysis was performed using bivariate analysis and correlation tests of difference. This study involved 54 subjects with a mean lactic acid level of 2,5093 mmol/L (0.9 mmol/L - 11.8 mmol/L). In the complicated appendicitis group, 20 subjects (37%) was found to experience an increase in lactic acid (OR 1.07; 95% CI: -0.03-0.22; p=0.14). The correlation analysis showed the direction of negative correlation. Thus, it is concluded that there is no significant correlation between lactic acid level and the severity of appendicitis in patients with appendicitis.

Background: Coronary artery disease (CAD) is a major cause of morbidity and mortality worldwide. Chronic inflammation is a known risk factor for atherosclerosis, plaque formation, disease progression, and plaque instability. Novel inflammatory biomarkers have been recently linked to excess risk of adverse cardiovascular events, including incident myocardial infarction. Elevated inflammatory biomarkers may help identify patients at higher risk for severe CAD. Aim: This study aimed to evaluate the use of novel systemic inflammatory markers in predicting the pretest probability of severe CAD in patients referred to diagnostic coronary angiography in a single tertiary care center. Methods: This was a prospective observational cohort study enrolling consecutive patients referred to diagnostic coronary angiography in a tertiary care center. Preprocedural laboratory results were obtained from medical charts, including complete blood counts with differentials. Three novel systemic inflammatory markers were computed using existing mathematical formulas: systemic immune-inflammation index (SII = neutrophil count*platelet/lymphocyte); systemic inflammation response index (SIRI = neutrophil*monocyte/lymphocyte); and systemic immune inflammatory response index (SIIRI = neutrophil*monocyte*platelet/lymphocyte). The primary study outcome was severe CAD defined as the presence of ≥70% stenosis in one of three main coronary arteries requiring percutaneous coronary intervention). The outcome was adjudicated by an independent reviewers blinded to computations of biomarkers. Result: The sample included 264 patients (age 59.3±10.8, 47% Females). Overall, 84 patients (32%) met the primary study outcomes. In univariate analysis, those with severe CAD had significantly higher SIRI (2.9±0.7 vs. 2.6±0.6, p = 0.001) and SIIRI (8.4±0.8 vs. 8.1±0.7, p = 0.015) compared to their counterparts. In multivariate analysis adjusted for age and sex, only SIRI was an independent predictor of severe CAD. Using SIRI > 20.8 (upper quartile) was associated with nearly three-fold excess risk of severe CAD (OR = 2.72, 95% CI 1.45-5.09). Conclusion: Elevated SIRI, a marker of ongoing systemic inflammatory response, could be indicative of severe CAD. As an inexpensive biomarker based exclusively on complete blood count, SIRI can be used to prioritize patients referred for diagnostic angiography and potentially expedite treatments in those at higher risk for coronary events.

IntroductionAcute 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.

Introduction: This study was aimed to determine the association between PSA levels and biomarkers of subclinical systemic inflammation based on data from 119 middle-aged healthy men from the general population. Materials and Methods: Serum levels of PSA and biomarkers of systemic inflammation (CRP and fibrinogen) were measured. Demographic data were also collected. Subjects were divided into two groups according to PSA levels; < 2 ng/ml and ≥ 2 ng/ml. Results: The mean (SD) age of men was 55 ± 4.0 years. We found a positive significant correlation between PSA and fibrinogen levels (r = 0.20, p = 0.04), and between CRP and fibrinogen levels (r = 0.60, p = 0.01). On the other hand, no significant correlation between PSA and CRP levels was found. Men with PSA values ≥ 2 ng/ml had significantly higher levels of fibrinogen as compared to those with PSA < 2 ng/ml (2.9 ng/ml vs. 2.4 ng/ml, p = 0.01). In a multivariate regression analysis model adjusted for the age of subjects, BMI, marital status, smoking, snuff, and alcohol intake with serum levels of PSA as a dependent variable, serum level of fibrinogen predicted higher PSA-values (odds ratio = 3.30, 95% CI = 1.05-10.20, p = 0.042). Conclusions: The present results indicate that serum fibrinogen is a biomarker of subclinical systemic inflammation associated with PSA elevation among middle-aged healthy men from the general population.

Introduction: Acute appendicitis is one of the most common surgical emergencies in children, where early diagnosis is crucial to reducing morbidity and mortality.This study aimed to identify predictive factors for appendicitis and evaluate the diagnostic value of serum sodium and blood and urine ketone levels.Methods: This prospective study included patients under 18 years of age who presented with acute abdominal pain and were clinically suspected of having appendicitis.Patients were divided into two groups: appendicitis and non-appendicitis.The appendicitis group was further categorized into acute and complicated cases.Demographic data, clinical symptoms, physical examination findings, symptom duration, preoperative laboratory values, blood and urine ketone levels, and pathology results were recorded.Results: A total of 153 patients were included [100 with appendicitis (51 complicated) and 53 non-appendicitis].In the appendicitis group, leukocyte count, neutrophil count, C-reactive protein (CRP), blood ketones [area under the curve (AUC)=0.618],and urine ketones (AUC=0.627)were significantly higher (p<0.001,p<0.001, p=0.001, p=0.03, and p=0.04, respectively).Among patients presenting within 24 hours of symptom onset, leukocyte count (p=0.013),neutrophil count (p=0.014), and blood ketones (p=0.035) were significantly higher in the appendicitis group.For patients with symptom duration longer than 24 hours, leukocyte count (p=0.005),neutrophil count (p=0.001), and CRP levels (p=0.001) were significantly elevated, while serum sodium levels were significantly lower (p=0.046) in appendicitis cases. zGiri: Akut apandisit, ocuklarda en sk grlen cerrahi acil durumlardan biridir.Morbidite ve mortaliteyi azaltmak iin erken tan kritik neme sahiptir.Bu almann amac, apandisit iin ngrc faktrleri belirlemek ve serum sodyum ile kan ve idrar keton dzeylerinin tan deerini deerlendirmektir

Background: Acute appendicitis is the most common surgical emergency that affect about 7% of the population. Obstruction of the lumen by faecoliths is the usual cause of acute appendicitis. The histopathologic stages of appendicitis are important to regarding prognosis. Study of diagnostic accuracy and pathological correlation aiming to reduce not only late complications but also the rate of negative appendicectomies had been studied worldwide. Application of quantitative microscopic techniques for assessing the diagnosis of inflammatory condition of appendix is quite useful since it imparts objectivity and reliability to the diagnosis. This is the first study we carried out for analysis of severity of acute appendicitis by morphometric measurement of diameter of blood vessels in relation to degree of eosinophil and basophil (mast cells) infiltration. Materials and Methods: A retrospective review of archives of the department of pathology, for the period of three years from 2010 to 2012, we identified 100, clinically and histopathologically diagnosed cases of acute appendicitis. Slides and blocks were selected for the study. Blood vessel morphometric analysis was performed on H and E stained sections. Diameter of one largest measuring blood vessel in each layer (Mucosa, Muscularis propria, Submucosa and serosa) of the appendix, is measured by using ProGres Capture Pro software. Mean and SD of the diameters of the blood vessels in each layer of appendix in 100 specimens were calculated. Number of eosinophils infiltration/10 hpf on H & E stained sections and number of mast cells infiltration/10 hpf on Toluidine blue stained sections in each layer of appendix in 100 specimens were counted by using light microscopy. Results: All 100 patients, who underwent operative procedure, came with chief complaint of pain in the periumbilical region migrating to the right iliac fossa. The mean age of presentation was 25.10 years. This study found that as there is increase in the number of eosinophils (counted as number of eosinophils/10 hpf) in each layer of appendix, there is decrease in the diameter of blood vessel in corresponding layer of the same appendicectomy specimen and as there is increase in the number of mast cells (counted as number of mast cells/10 hpf) in each layer of appendix, there is also increase in the diameter of the blood vessel in corresponding layer of the same appendicectomy specimen in acute appendicitis. Conclusion: The study establishes the statistical correlation between morphometry and degree of cellular inflammatory infiltrate (eosinophils and mast cells counted by using light microscopy) which helps to assess severity of inflammation of the appendix. Keywords: Acute Appendicitis, Morphometry

Peripheral blood analysis is a non-invasive and low-cost technique of prognostic value for several diseases, including oral cancer. Considering the role of inducible nitric oxide synthase in tumor-associated inflammation, this study purposed to evaluate the influence of this enzyme on peripheral blood parameters and systemic inflammatory biomarkers during murine oral carcinogenesis. A 50 μg/mL solution of 4-nitroquinoleine-N-oxide was provided to 15 C57BL/6J (Nos2+/+ ) and 16 B6.129P2-Nos2tm1Lau /J (Nos2-/- ) for 16 weeks. Animals were followed for 8 weeks after treatment. Blood samples and tongues were collected for hematological and histopathological analyses. Red blood cells, white blood cells, and platelet cell parameters were analyzed. The neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and the systemic immune-inflammation index were also calculated. The depth of invasion of all carcinomas was measured. Differences were found in several blood parameters. The depth of invasion in Nos2-/- was lower than in Nos2+/+ (p = 0.009), and strong correlations were found between depth of invasion and neutrophil count (ρ = -0.68, p = 0.017), lymphocyte count (ρ = 0.72, p = 0.011), neutrophil-to-lymphocyte ratio (ρ = -0.65, p = 0.025), platelet-to-lymphocyte ratio (ρ = -0.73, p = 0.013), and systemic immune-inflammation index (ρ = -0.67, p = 0.037) in Nos2-/- mice. Inducible nitric oxide synthase seems to have an important role in OSCC invasion and progression, which might be associated to alterations in immune-inflammatory cell dynamics evidenced by peripheral blood and systemic inflammatory biomarkers.

Background: One of the most common surgical emergencies that happens in the abdomen is the acute appendicitis. According to the research, liver function tests (LFT) may be utilized to predict the severity of appendicitis and serve as a marker for acute appendicitis. Methods: From January to June 2024, 100 cases of acute appendicitis were observed in the emergency room of “Azadi Teaching Hospital,” located in Duhok City, Kurdistan region, Iraq, as part of a single-center, observational, prospective study. The Research Ethics Committee granted ethical permission (Ref. No. 29112023-10-8). Every patient had blood testing, including liver function tests as well as abdominal ultrasonography. Reports on histopathological findings were also examined. Patients with uncomplicated and complicated appendicitis (perforated, gangrenous) were split into two groups. Microsoft Excel 2020 was used to collect and statistically evaluate the data. Results: Among the 100 patients, 54% were male, while 46% were female. Negative appendectomies were found in 2% of cases. Elevated total bilirubin levels were found in 71% of patients with an uncomplicated appendicitis and 89% of those with complicated appendicitis, yielding a significant p-value of 0.0053 and a sensitivity of 62%. Direct bilirubin was elevated in 88% of cases of uncomplicated appendicitis and 96% in complicated cases, with a significant p-value of 0.05 and a sensitivity of 69%. Both alanine transaminase (ALT)and aspartate transaminase (AST) levels were increased in both groups, especially in the complicated group, with AST elevated in 53% of cases and ALT in 35%. Alkaline phosphatase (ALP) levels were raised in 81% of uncomplicated appendicitis and 82% of complicated appendicitis cases, showing a sensitivity of 70.5%. Conclusion: In summary, liver function tests (LFT) can assist in diagnosing, evaluating the severity, and predicting complications of acute appendicitis by showing increases in total bilirubin, direct bilirubin, and alkaline phosphatase.

Acute appendicitis is a common surgical emergency in children. Prior radiology studies have described Puylaert staging on ultrasound to determine the severity of appendicitis. We investigated the feasibility and utility of assessing Puylaert staging on emergency department (ED) point-of-care ultrasound (POCUS) to differentiate uncomplicated from complicated appendicitis in children. This was a pilot feasibility study of children ages 5-17 diagnosed with acute appendicitis in nine pediatric EDs. POCUS was performed by trained ED physicians. Puylaert staging of the submucosal layer was used to categorize the severity of appendicitis (stages 1-4) and was compared with surgical pathology reports. Test characteristics were computed to evaluate the accuracy of POCUS in differentiating appendicitis severity. Physicians recorded time to complete POCUS, ease of use, and their perception of acceptability by patients and families. Of 72 patients with complete data, all patients with uncomplicated appendicitis were accurately identified using POCUS (Puylaert stage 1 or 2). The sensitivity for identifying complicated appendicitis (Puylaert Stage 3 or 4) was 100% (95% CI: 77%-100%), and specificity was 65% (95% CI: 52%-78%). Ninety four percent of physicians agreed that the POCUS was easy to perform. One hundred percent agreed that it was well accepted by families. The average time to complete POCUS was 8 min. This study supports the feasibility and utility of assessing Puylaert staging by POCUS for children with appendicitis in the ED. High sensitivity to rule out complicated cases coupled with ease of use and perceived patient acceptance make this a potential adjunct to aid in the management of pediatric appendicitis.

BackgroundAcute appendicitis is one of the most common abdominal emergencies worldwide. Both environmental and genetic factors contribute to the disease. C-reactive protein (CRP) is an important biomarker in the diagnosis of acute appendicitis. CRP concentrations are significantly affected by genetic variation. However, whether such genetic variation is causally related to appendicitis risk remains unclear. In this study, the causal relationship between single-nucleotide polymorphisms (SNPs) associated with circulating CRP concentrations and the risk and severity of acute appendicitis was investigated.MethodsCRP concentrations in serum of appendicitis patients (n = 325) were measured. Appendicitis was categorized as complicated/uncomplicated and gangrenous/non-gangrenous. Imputed SNP data (n = 287) were generated. A genome-wide association study (GWAS) on CRP concentrations and appendicitis severity was performed. Intersection and colocalization of the GWAS results were performed with appendicitis and CRP-associated loci from the Pan-UKBB cohort. A functional-genomics approach to prioritize genes was employed.ResultsThirteen percent of significant CRP quantitative trait loci (QTLs) that were previously identified in a large cohort of healthy individuals were replicated in our small patient cohort. Significant enrichment of CRP-QTLs in association with appendicitis was observed. Among these shared loci, the two top loci at chromosomes 1q41 and 8p23.1 were characterized. The top SNP at chromosome 1q41 is located within the promoter of H2.0 Like Homeobox (HLX) gene, which is involved in blood cell differentiation, and liver and gut organogeneses. The expression of HLX is increased in the appendix of appendicitis patients compared to controls. The locus at 8p23.1 contains multiple genes, including cathepsin B (CTSB), which is overexpressed in appendix tissue from appendicitis patients. The risk allele of the top SNP in this locus also increases CTSB expression in the sigmoid colon of healthy individuals. CTSB is involved in collagen degradation, MHC class II antigen presentation, and neutrophil degranulation.ConclusionsThe results of this study prioritize HLX and CTSB as potential causal genes for appendicitis and suggest a shared genetic mechanism between appendicitis and CRP concentrations.

ABSTRACTObjectives:Environmental enteric dysfunction (EED) impairs zinc absorption from food, and zinc deficiency may contribute to the poor growth associated with EED. We examined zinc absorption from a standardized aqueous zinc dose, and habitual daily endogenous fecal zinc excretion (EFZ) and compared these outcomes between children grouped by the lactulose to mannitol ratio (L:M).Methods:Bangladeshi toddlers (18–24 months) with low (<0.09) and high (≥0.09) L:M were administered isotope-labeled 3 mg aqueous zinc in the fasted state. Fractional absorption of zinc (FAZ) and EFZ were measured by dual stable isotope tracer method and an isotope dilution method, respectively. Secondary aims included examining relationships of biomarkers of systemic and intestinal inflammation and gut function with FAZ and EFZ.Results:Forty children completed the study; nearly all had evidence of EED. No differences in zinc homeostasis measurements (mean ± SD) were observed between high and low L:M groups: FAZ was 0.38 ± 0.19 and 0.31 ± 0.19, respectively; both figures were within estimated reference range. Means of EFZ were 0.73 ± 0.27 and 0.76 ± 0.20 mg/day for high and low L:M, respectively, and were 10% to 15% above estimated reference range. Regression analyses indicated that biomarkers of systemic inflammation were directly associated with increasing FAZ, consistent with increased gut permeability. Biomarkers of intestinal inflammation were negatively associated with EFZ, consistent with low-zinc intake and chronic deficiency.Conclusions:In these children at risk of EED, endogenous zinc losses were not markedly increased. Results suggest that efforts to improve zinc status in EED should focus on substantially improving zinc intakes.

Acute appendicitis is a common surgical emergency. While clinical diagnosis is generally effective, it is not perfect, potentially leading to negative appendectomies or delayed treatment. This study investigated the histopathological patterns of appendectomy specimens in King Khalid Hospital, Hail Province, Saudi Arabia, correlating them with preoperative clinical diagnoses to assess diagnostic accuracy and guide optimal management. A retrospective analysis was conducted on 198 patients who underwent appendectomies between August 2023 and July 2024. Resected appendix specimens underwent histopathological examination and were categorized as inflamed, malignant, or benign. Clinical data and histopathological findings were compared using statistical analyses, including Fisher's exact test, to assess diagnostic accuracy and explore potential associations between patient demographics, appendicitis severity, and clinical presentation. The study cohort consisted predominantly of young males (78.8%, mean age: 26 ± 9.2 years), with no pediatric cases included. The most common histopathological finding was an inflamed appendix (99.5%), with acute inflammation being most prevalent (86.9%). Perforation (10.1%) and gangrenous changes (2.5%) were also observed. A rare case of negative appendectomy (0.5%) was attributed to a perforated Meckel's diverticulum. This study demonstrates a high preoperative diagnostic accuracy for acute appendicitis. However, the occurrence of negative appendectomies and complicated cases, particularly in young adult males, highlights the need for continuous vigilance and refinement of diagnostic approaches. Further research exploring age- and sex-specific risk factors for complicated appendicitis is crucial to optimizing patient management strategies and minimizing unnecessary surgical interventions.

Whole-grain foods have been reported to affect serum levels of inflammatory cytokines. However, we are aware of no study examining the effect of whole-grain intake on inflammatory biomarkers among children. The present study aimed to determine the effect of whole-grain intake on serum levels of inflammatory biomarkers in overweight or obese children. In this randomized crossover clinical trial, 44 overweight or obese girls aged 8-15 years participated. After a 2-week run-in period, subjects were randomly assigned to either whole-grain or control groups. Subjects in the whole-grain group were given a list of whole-grain foods and were asked to obtain half of their needed servings of grains from whole-grain foods each day for 6 weeks. Individuals in the control group were also given a list of whole-grain foods and were asked not to consume any of these foods during the intervention phase of the study. A 4-week washout period was applied following which subjects were crossed over to the alternate arm for an additional 6 weeks. Fasting blood samples were taken before and after each phase of the study to quantify markers of systemic inflammation. Mean age, weight, and BMI of study participants were 11.2 ± 1.49 years, 51.2 ± 10.2 kg, and 23.5 ± 2.5 kg/m(2) , respectively. No significant effect of whole-grain intake on weight and BMI was seen compared with the control group. We found a significant effect of whole-grain intake on serum levels of high-sensitive C-reactive protein (-21.8 versus +12.1%, p = 0.03), soluble intercellular adhesion molecule-1 (-28.4 versus +6.3%, p = 0.02), serum amyloid A (-17.4 versus +9.9%, p = 0.02), and leptin (-9.7 versus +39.2%, p = 0.02) after 6 weeks. A trend toward the significant effect of whole-grain intake on serum levels of soluble vascular cell adhesion molecule-1 (-36.2% versus -7.8%, p = 0.07) was also observed. This study provides evidence supporting the beneficial effects of whole-grain foods on biomarkers of systemic inflammation in obese children.

Background: One of the most frequent abdominal emergencies requiring emergency surgery is acute appendicitis, and appendectomy is the most common emergency procedure performed globally. There is an urgent need for a predictor of the severity of acute appendicitis since delayed identification and treatment of severe appendicitis are linked to higher risks of perforation and postoperative morbidity, mortality, and prolong hospital stay. Objectives: The aim of this study was to assess how the severity of acute appendicitis is predicted by hyperbilirubinemia. Methods: This descriptive cross-section study was carried out in the Department of Surgery at Combined Military Hospital (CMH), Cumilla, during March 2021 to Feb 2023. A total of 80 patients purposing were included in this study. Among them 30 were diagnosed as complicated appendicitis and rest 50 were simple appendicitis patients. Patients diagnosed with complicated appendicitis and simple appendicitis irrespective of age and sex were included in the study. Patients who were not given consent to participate in the study were excluded from the study. After taking consent and matching eligibility criteria, data were collected from patients on variables of interest using the predesigned structured questionnaire by interview, observation, clinical examination and hematological investigation of the patients. Statistical analyses of the results were obtained by using window based Microsoft Excel and Statistical Packages for Social Sciences (SPSS-26), where required. Results: In complicated appendicitis 40% were male and 60% were female. In simple appendicitis 40% were male and 60% were female. The mean T-Bil in complicated appendicitis was 1.187mg/dL and 1.00 mg/dL in simple appendicitis. About 46.0% patients had hyperbilirubinemia in complicated appendicitis and 32.5% in simple appendicitis. Here, 58.0% had fever &gt;37.30C in complicated appendicitis and 33.5% in simple appendicitis. About 69.7% had positive ..........