scholarly journals Effectiveness of Dual Antibacterial Therapy and Effectiveness of Recommendation Criteria as a Diagnostic Tool in Children with Uncomplicated Acute Appendicitis

2020 ◽  
Vol 18 (1) ◽  
pp. 31-35
Author(s):  
Liene Taurina ◽  
Zane Liepina ◽  
Astra Zviedre ◽  
Arnis Engelis ◽  
Aigars Petersons
Keyword(s):  
Emergency Department ◽  
Acute Appendicitis ◽  
Antibacterial Therapy ◽  
Moderate Correlation ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Group A ◽  
Group B ◽  
Uncomplicated Acute Appendicitis ◽  
Suspected Acute Appendicitis

SummaryIntroductionAcute appendicitis (AA) – acute inflammation and infection of the appendix – is one of the most common cause for abdominal surgery in pediatrics. Appendectomy has been the gold standard since 1735, but in recent years there have been several studies that investigate antibacterial therapy for uncomplicated acute appendicitis. In 2016 new recommendations for suspected AA were implemented in emergency department setting of Children's Clinical University Hospital (CCUH).Aim of the StudyTo evaluate whether diagnostic criteria for patients with a suspected acute appendicitis is effective as a diagnostic tool and to evaluate whether dual antibacterial therapy is safe and effective as first line treatment for children with diagnosis of uncomplicated acute appendicitis in CCUH.Material and methodsA retrospective study was made in CCUH from January 2017 to December 2017. Patients aged 7 to 18 with suspected uncomplicated acute appendicitis were identified and data were collected from an internal hospital management system and patients’ medical records. Patients were divided into two groups – A and B. In group A were patients who met the criteria of uncomplicated AA, and in group B – patients who met the criteria of complicated AA. Both groups received ampicillin and metronidazole. For statistical analysis IBM SPSS Statistics 22 program was used.ResultsFrom 98 patients majority were boys (51% (n=50)) with mean age 12.6 years. As a result of antibacterial therapy clinical condition improved in 93% (n=89) of patients who were discharged without surgery. 7 patients did not improve and underwent surgery within 48 hours after admission, another 2 had elective appendectomy. There was a significant positive moderate correlation between C–reactive protein (CRP), white blood cell count (WBC), basophil granulocytes (BASO) and appendix diameter at admisson and after 48 hours of dual antibacterial therapy (r=0.31, p=0.003 vs. r=0.37, p<0.001 vs. r=0.41, p=0.017 vs. r=0.51, p=0.013). In group A (68% (n=67)) there was a significant positive moderate correlation between CRP, WBC and appendix diameter at admission and after 48 hours of dual antibacterial therapy (r=0.31, p=0.003 vs. r=0.37, p<0.001 vs. r=0.51, p=0.013). In group B (30% (n=31)) 7 patients underwent appendectomy and 2 patients received a broad spectrum antibacterial therapy prior to elective appendectomy. There is evidence of significant association between ALVARADO score (p=0.004), rebound tenderness (p<0.001), WBC (p=0.004), CRP (p<0.001) and stage in which appendicitis has progressed to.ConclusionsAntibiotic-alone treatment may be a safe and effective initial management choice in children with uncomplicated acute appendicitis. However, to fully evaluate effectiveness of antibacterial therapy and diagnostic criteria, further follow–up research is needed.A normal C–reactive protein value does not rule out uncomplicated acute appendicitis, therefore it can not act as a single marker to diagnose AA or to differentiate between complicated and uncomplicated AA.Recommendations of treatment of UCAA are acceptable for use in emergency department as they act as a unified tool that allows pediatricians and pediatric surgeons to quickly assess suspected acute appendicitis.

scholarly journals Role of total leukocyte count and C-reactive protein in diagnosis of acute appendicitis

2018 ◽  
Vol 5 (3) ◽  
pp. 883
Author(s):  
Anuradha Dnyanmote ◽  
Sagar Ramesh Ambre ◽  
Foram Doshi ◽  
Snehal Ambre
Keyword(s):  
Acute Appendicitis ◽  
Sensitivity And Specificity ◽  
Leukocyte Count ◽  
Total Leukocyte Count ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Surgical Emergencies ◽  
Group A ◽  
Negative Appendicectomy ◽  
Group B

Background: Acute appendicitis is still one of the most common surgical emergencies. This study was conducted to check the sensitivity and specificity of Total leukocyte count (TLC) and C Reactive Protein (CRP) of acute appendicitis. Aim and objectives were to check the sensitivity and specificity of total leukocyte count in diagnosis of acute appendicitis and to check the sensitivity and specificity of CRP in diagnosis of acute appendicitis. To determine TLC and CRP efficacy in diagnosis of acute appendicitis.Methods: TLC and CRP were calculated in all patients who were planned to undergo appendectomy. Appendectomies were performed independent of results of TLC and CRP levels. For statistical purpose the patients were assigned into 2 groups- Group-A Patients with inflamed/perforated/gangrenous appendix, Group-B patients with Normal appendix. The normal TLC and CRP values, raised TLC, raised CRP, and raised both TLC and CRP values calculated in each of these groups. Sensitivity and Specificity were calculated. The cut off value for TLC was 11x106/L. This value was selected arbitrarily as it corresponds to the elevated TLC. The CRP levels were calculated and cut off value was taken as 1.7mg/dl.Results: Out of 75 cases, 55 were male and 20 were female. Age ranged from 13 to 58 years. CRP was raised in 82.14% of inflamed appendix cases TLC was raised in 76.79% of inflamed appendix cases and both was raised in 92.5% of inflamed appendix cases.Conclusions: TLC and CRP are useful in diagnosis of acute appendicitis. Negative appendicectomy rate can be decreased.

scholarly journals C-Reactive Protein Predicts Progression of Peripheral Arterial Disease in Patients with Type 2 Diabetes: A 5-Year Follow-Up Study

2014 ◽  
Vol 33 (4) ◽  
pp. 347-355
Author(s):  
Ljiljana Popović ◽  
Katarina Lalić ◽  
Olga Vasović ◽  
Danijela Drašković Radojković ◽  
Nataša Rajković ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Group A ◽  
Hs Crp ◽  
Group B ◽  
Peripheral Arterial

Summary Background: Previous studies have indicated that high sensitivity C-reactive protein (hs-CRP) is a risk factor for the peripheral arterial disease (PAD) in diabetes. This study aimed to evaluate the possible predictive significance of hs-CRP for the development and progression of PAD in patients with type 2 diabetes (T2D). Methods: The study included 80 patients previously diagnosed with T2D, aged 45–70 years, divided into group A (T2D patients with PAD; n=38) and group B (T2D patients without PAD; n=42). After five years, all the patients were re-examined and divided into subgroups depending on de novo development of PAD or progression of previously diagnosed PAD. Ankle-Brachial Index (ABI) measurement was used for PAD diagnosis and hs-CRP was determined by nephelometry. Results: We found significantly higher hs-CRP levels in group A compared to group B, but only at baseline. Among the patients in group A, those with later progression of PAD (subgroup A1) had the highest levels of hs-CRP at baseline, although not significantly different from those in subgroup A2 (non-progressors). In contrast, hs-CRP level was significantly higher in subgroup B1 (progressors) in comparison to subgroup B2 (non-progressors) at both the first and second exam. Of all the investigated metabolic parameters, hs-CRP was the only independent predictor of PAD progression (OR=0.456, 95% CI=0.267–0.7815, p=0.004). The cut-off point for hs-CRP was 2.5 mg/L (specificity 75% and sensitivity 73.3%) with the relative risk for PAD of 2.93 (95% CI=1.351–6.3629). Conclusions: Our study implies that hs-CRP can be used as a reliable predictor for the progression of PAD in patients with T2D.

scholarly journals Study of High sensitive C - reactive protein and Gamma-glutamyl transferase in Type 2 Diabetes Mellitus with Hypertension

2020 ◽  
Vol 11 (3) ◽  
pp. 3478-3483
Author(s):  
Ramya S ◽  
Sureka Varalakshmi V ◽  
Uma Maheswari K ◽  
Chandan Bala R
Keyword(s):  
Diabetes Mellitus ◽  
Gamma Glutamyl Transferase ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Significant Difference ◽  
Group A ◽  
Hs Crp ◽  
Group B ◽  
Glutamyl Transferase

C-reactive protein (CRP), produced by the hepatocytes is a primary inflammatory marker of T2DM. Higher levels of gamma-glutamyl transferase enzyme (GGT) and Hs CRP (High sensitive CRP)are associated with the complication of poor glycemic control.This study was aimed to find the association of Hs CRP and GGT for cardiovascular risk factors in Type 2 diabetes mellitus (T2DM)and Hypertension in the suburbs of Chennai. This study includes 57 subjects with T2DM and Hypertension (Group A) and 62 subjects with T2DM (GroupB) within the age group of 40-60 years. FBS, HbA1C, Hs CRP, GGT and blood pressure were determined. Statistical analysis was performed using Statistical Package for the SPSS 17 version. Mean values of FBS, blood HbA1C, Hs CRP and GGT were significantly higher among participants of Group A than Group B. Significant difference of FBS, HbA1C were found between the two groups. In contrast, no significant difference of GGT was found between the groups. Differences were considered statistically significant at two-sided P < 0.05. Within the group, Hs CRP shows the significance and positive correlation with FBS, SBP and DBP. Still, GGT does not show any significance in Group A. In contrast, in Group B, both Hs CRP and GGT shows the importance and positive correlation with FBS and HbA1C.It is concluded that high levels of HsCRP are associated with T2DM and Hypertension, indicating increased cardiovascular risk, and it should be included in regular monitoring of type-2 diabetic patients.

scholarly journals Diagnostic accuracy of combining C-Reactive protein and Alvarado Score among 2-to-20-year-old patients with acute appendicitis suspected presenting to Emergency Departments

2021 ◽  
Author(s):  
Kinda Altali Alhames ◽  
Francisco Javier Martín-Sánchez ◽  
Pedro Ruiz-Artacho ◽  
Francisco Javier Ayuso ◽  
Victoria Trenchs ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Emergency Departments ◽  
Low Risk ◽  
C Reactive Protein ◽  
Alvarado Score ◽  
Old Patients ◽  
Reactive Protein ◽  
Surgical Data ◽  
Suspected Acute Appendicitis

Objective. Main objective was whether the combination of C-Reactive Protein (CRP) and Alvarado Score (AS) increase the diagnosis accuracy of AS among 2-to-20-year-old patients with suspected acute appendicitis presenting to Emergency Departments. Materials and methods. This is a secondary analysis of prospective cohort study consecutively including all patients from 2 to 20 years of age attended for suspected acute appendicitis in 4 Spanish Emergency Departments during 6-month period. We collected demographic, clinical, analytic and radiographic, and surgical data. AS categories were retrospectively calculated as low (0-4 points), intermediate (5-6 points) or high (7-10 points). The cut-off levels were >0.5 mg/dl for CRP. The outcome was diagnosis of acute appendicitis within 14 days of the index visit. Results. A total of 331 patients with suspected of acute appendicitis (mean age 11.8 (SD 3.8) years; 52.9% males) were recruited. According to AS, 108 (32.6%) were at low risk, 76 at (23.0%) intermediate risk and 147 (44.4%) at high risk of acute appendicitis. One hundred and sixteen (35.0%) cases had confirmed histopathological diagnosis of acute appendicitis. The AUCs of ROC were 0.76 (0.70-0.81) for AS and 0.79 (95% CI 0.75-0.84) for CRP-AS being the difference statistically significant (p=0.003). The CRP for diagnosis acute appendicitis in low risk AS group had negative predictive value of 95.8% (95%CI 87.3-98.9) and likelihood ratio negative of 0.4 (95%CI 0.2-1.0). Conclusions. CRP-AS has shown to increase the diagnostic accuracy of AS for acute appendicitis. This approach may be useful to rule out the diagnosis of acute appendicitis in paediatric patients attended for abdominal pain suggestive of acute appendicitis.

scholarly journals A study of high sensitive C-reactive protein in rheumatoid arthritis patients

2020 ◽  
Vol 9 (1) ◽  
pp. 139
Author(s):  
Priyanka Meena ◽  
Sourabh Goswami ◽  
Ajay Mathur ◽  
Ramji Sharma
Keyword(s):  
Rheumatoid Arthritis ◽  
C Reactive Protein ◽  
Dmard Therapy ◽  
Random Blood Sugar ◽  
Reactive Protein ◽  
Early Ra ◽  
Group A ◽  
The Mean ◽  
Hs Crp ◽  
Group B

Background: Rheumatoid arthritis (RA) is not only merely limited to joints but has many extraarticular features. The major cause of mortality in RA is cardiovascular disease (CVD). Inflammation in RA predispose them to succumb to CVD. The aim of this study to observe whether therapy with disease-modifying anti-rheumatic drugs (DMARD) decreases inflammation and if it does so than it can be said that decrease the risk to develop CVD. Aim and objectives were to assess hs-CRP level in early and established RA both at diagnosis and again at 3 months of DMARD therapy and compare between them.Methods: Total 58 early RA (group A) and 58 established (group B) DMARD naïve RA patients were included in the study. Age, BMI, haemoglobin, random blood sugar, lipid profile, ESR, hs-CRP, RA factor and anti-CCP were measured. All of them were treated with DMARD and hs-CRP was again assessed after 3 months.Results: The mean hs-CRP level at diagnosis was 6.14±1.90 mg/l in group A while it was 10.39±3.13 mg/l in group B. The mean hs-CRP level after 3 months of DMARD was 2.56±1.35mg/l in group A while it was 7.91±3.13 mg/l in group B. The mean reduction in hs-CRP level in early RA (3.58±0.99 mg/l) was statistically significantly (p<0.001) higher than that in established RA (2.48±0.09 mg/l).  Conclusions: DMARD decreases level of inflammation in RA more efficiently if initiated early in the course of the disease.

scholarly journals Aprepitant as a combinant with Dexamethasone reduces the inflammation via Neurokinin 1 Receptor Antagonism in severe to critical Covid-19 patients and potentiates respiratory recovery: A novel therapeutic approach

2020 ◽  
Author(s):  
Riffat Mehboob ◽  
Fridoon Jawad Ahmad ◽  
Ahad Qayyum ◽  
Muhammad Asim Rana ◽  
Syed Amir Gilani ◽  
...  
Keyword(s):  
Receptor Antagonist ◽  
Clinical Outcomes ◽  
C Reactive Protein ◽  
Neurokinin 1 Receptor ◽  
Reactive Protein ◽  
Link Type ◽  
Group A ◽  
Critical Patients ◽  
Neurokinin 1 ◽  
Group B

AbstractCorona virus infection is a respiratory infection, compromising the normal breathing in critical patients by damaging the lungs. The aim of this study was to evaluate the clinical outcomes of Substance P receptor Neurokinin 1 antagonist in Covid-19 patients against the usual treatments as controls.MethodsIt is a randomized clinical trial, open label, having two arms, one receiving normal management and care while other receiving Neurokinin-1 Receptor antagonist, Aprepitant, in addition. Dexamethasone, a corticosteroid is also administered orally to both the groups. PCR positive, hospitalized patients with more than 18 years of age, both genders, moderate to critical phase were included. 41 patients were randomly allocated in both arms, having 21 patients in group A and 20 patients in group B. Lab investigations were performed in both the groups before and after the intervention.ResultsMean age of patients in group A was 50 ±18 years while 55±11 years in group B. There were 14/21 males in group A and 15/20 in group B. There were 3 critical patients in group A and 5 in group B. Biochemical and hematological parameters in both groups didn’t show much difference except the C-reactive protein reduction in the intervention group, indicative of a reduced inflammation.ConclusionsThe findings of this current study give a strong clue for the therapeutic potential of Aprepitant. Patients who received a combination therapy of Aprepitant and Dexamethasone showed improved clinical outcomes, laboratory findings and reduced C-reactive protein which is an inflammatory marker.Trial RegistrationThis trial is registered inclinicaltrials.gov(NCT04468646). To Determine the Efficacy of Neurokinin 1 Receptor Antagonist as a Therapeutic Tool Against Cytokine Storm and Respiratory Failure in Covid-19 Patients

scholarly journals Ultrasonography as a diagnostic tool in acute appendicitis: Rural setup

2017 ◽  
Vol 4 (5) ◽  
pp. 1546
Author(s):  
Yamanur P. Lamani ◽  
Bhimanagouda V. Goudar ◽  
Eshwar B. Kalburgi ◽  
Bheemappa K. Bhavi ◽  
Mohmmedgouse Karikazi
Keyword(s):  
Emergency Department ◽  
Acute Appendicitis ◽  
Clinical Assessment ◽  
Lower Abdominal Pain ◽  
First Line ◽  
Chronic Appendicitis ◽  
Technological Advances ◽  
Uncomplicated Acute Appendicitis ◽  
A Prospective Study ◽  
Suspected Acute Appendicitis

Background: Despite technological advances the diagnosis of appendicitis is still based primarily clinical assessment. The diagnosis of atypical appendicitis remains clinically challenging and is one of the most commonly missed problems in the emergency department. Ultrasonography is highly operator dependent with a consequently wide reported sensitivity range.Methods: This is a prospective study conducted in the department of surgery. All patients with right lower abdominal pain, admitted to HSK hospital Bagalkot, in whom acute appendicitis was suspected were analysed from January 2013 to June 2014.Results: In the present study appendix was visualized in 85% of the patients and periappendiceal collection was found in 7% of patients. Faecolith was found only in 1 case. Out of these 74 cases were uncomplicated acute appendicitis. Perforated acute appendicitis was diagnosed in 6 cases. One case was diagnosed as appendicular abscess and 4 cases were diagnosed as chronic appendicitis. Based on clinical assessment 4 patients were subjected to surgery after 48hours.Conclusions: Graded compression US remains our first line method in rural setup in the evaluation of patients referred with clinically suspected acute appendicitis.

scholarly journals Accuracy of Alvarado Scoring System and Selective Computed Tomography in Diagnosis of Suspected Cases of Acute Appendicitis

2020 ◽  
Vol 1 (2) ◽  
pp. 01-11
Author(s):  
Abbas AR Mohamed ◽  
Safaa A Mobarki ◽  
Ashwag H Al Qabasani ◽  
Nusiba A Al Shingiti ◽  
Alaa A El Sayed
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Ct Scan ◽  
Scoring System ◽  
Oral Contrast ◽  
Middle Group ◽  
Group A ◽  
Group B

Objective: To evaluate the diagnostic accuracy of combined Alvarado scoring system and selective computed tomography (CT) in the diagnosis of suspected cases of acute appendicitis. Material and methods: This study was conducted during the period March 2018 to January 2020 at Prince Mohammed bin Abdul-Aziz hospital (NGHA) in Al Madinah, KSA. It is a prospective study involving 100 consecutive patients attending the emergency department with right iliac fossa pain, excluding children below the age of 14 years and pregnant women. All patients were initially assessed by the Alvarado scoring system, and the result of each patient was recorded in a separate predesigned data sheath. Based on the patient's calculated Alvarado scores, patients were stratified into three groups: Group A (score ≤ 4), Group B (score 5-6), and group C (score ≥ 7). All patients in group A were discharged from the emergency department with instruction to return if their symptoms persist or get worse while all patients in group B had an abdominal multidetector CT scan (MDCT) with IV contrast and no oral contrast to help the diagnosis. Group C patients had surgery without further investigation. Alvarado scores were compared to intraoperative findings and histopathological examination of the removed appendix in those who were operated. The sensitivity, specificity, positive and negative predictive values of the scoring system in each group were calculated with special reference to the role of CT scan in improving the diagnostic accuracy of the scoring system in the middle group (group B). Result: 58 patients were male and 42 were female. Age range between 14 and 43 years with median age 24 years. Out of the 100 patients, 14 (8 males, 6 females) belonged to Group A, 23 (11 males, 12 females) to Group B and 63 (39 males, 24 females) to group C. Two patients from group A (one male and one female) were returned with worsening symptoms and subsequently operated for acute appendicitis. CT scan established the diagnosis of acute appendicitis in 16 out of the patients of group B with subsequent histological confirmation of acute appendicitis in 15 of them. Histopathology confirmed the diagnosis of acute appendicitis in 32 out of 63 patients of group C. Conclusion: Alvarado score has a high accuracy of ruling in and out acute appendicitis at the extremes of the score (≤7 and ≥4), however, the accuracy of the score to confirm or rule out acute appendicitis in the middle group (5 -6) is significantly low. Selective utilization of CT scan in patients in the middle of the score improves the diagnostic accuracy of the score and limits overutilization of CT scan in the other patients at the extremes of the score saving patients unnecessary exposure to radiation and health authorities’ time and cost without increasing the rate of negative appendectomy.

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