Validation and comparison of two new scoring systems for the prediction of complicated versus uncomplicated appendicitis

OBJECTIVES

To validate the Atema and APSI scoring systems in the diagnosis of complicated vs uncomplicated appendicitis. To compare these scoring systems with computed tomography (CT) imaging alone to establish which method provides most accurate prediction of complicated vs uncomplicated appendicitis.

METHODS

This was a retrospective review of a sample of 160 patients that underwent appendicectomy and CT imaging for suspected appendicitis between 2018 and 2021 in a tertiary university teaching hospital. Each scoring system was applied to all patients and results analysed and compared with the effectiveness of CT imaging, RESULTS: 32.5% (n = 52) were found to have complicated appendicitis and 67.5% (n = 108) uncomplicated appendicitis. Application of the Atema score to our cohort of patients resulted in a sensitivity 76.9% [CI (64.2, 87.5), specificity 58.7% [CI (48.9, 68.1)], PPV 47.1% [CI (40.5, 53.8) and NPV 84.2% [CI (76.0, 89.9)]. By comparison, the APSI yielded a sensitivity 50.9% [CI (36.6, 65.4)], specificity 76.1% [CI (67.0, 87.8)], PPV 50% [CI (39.2, 60.6)] and NPV 76% [CI (71.1, 81.7)]. Radiology prediction of complicated vs uncomplicated appendicitis with CT imaging showed sensitivity 46% [CI (32.2, 60.5)], specificity 79%; [CI (69.8, 86)], PPV 51% [CI (39.6, 62.5)] and NPV 75% [CI (69.8, 79.9)].

CONCLUSION

By comparing the APSI and Atema et al. scoring systems with CT reporting in our hospital, it appears that the Atema may confer some benefit in stratifying patient risk of complicated versus uncomplicated appendicitis. Further larger scale prospective studies are required.

Evaluation of the Functional Treatment of Patients With Skeletal Class II Malocclusion Using Low-Level Laser Therapy-Assisted Twin-Block Appliance: A Three-Arm Randomized Controlled Trial

Background

Different techniques have been used to reduce functional treatment time including low-level laser therapy (LLLT), and the majority of studies have been conducted on animals. Therefore, the aim of the current study was to evaluate the effects of LLLT on improving orthodontic functional treatment using the Twin-Block (TB) appliance.

Materials and methods

This study was a three-arm, parallel-group randomized controlled trial. Patients were selected using the following inclusion criteria: skeletal Class II Division 1 malocclusion resulting from mandibular retrognathia (angle between the anterior cranial base and the NB plane (i.e., SNB angle): 73°-78°), the sagittal skeletal discrepancy angle (ANB angle) between 4° and 9°, and overjet between 5 and 9 mm. Forty-eight patients were randomly allocated into three equal groups. In the LLLT-TB group, the low-level laser device was used with a wavelength of 808 nm and power of 250 mW in addition to functional treatment with a Twin-Block appliance. The laser was applied on the skin at the bilateral temporomandibular joint (TMJ) regions, at five points, each point received 5 J of the laser for 20 seconds. The laser course was twice a week in the first month, every two weeks in the second month, and every three weeks up to the end of the treatment. The second group (the TB group) received functional treatment with a Twin-Block appliance, while patients in the third group (the untreated control group (UCG)) were observed for nine months without any intervention.

Results

There were statistically significant differences in treatment periods between the LLLT-TB group and the TB group (129 days and 235 days, respectively, P-value<0.001). The change in the effective mandibular length (Co-Gn) was the highest in the LLLT-TB group compared with the TB and the UCG groups (4.41 mm, 3.66 mm, and 1.07 mm, respectively; P-value<0.001).

Conclusions

The application of low-level laser therapy on the condylar regions accelerated the functional treatment in skeletal Class II malocclusion patients by approximately 45% and increased the bone growth and mandibular length. The improvement in the SNB angle was similar in both interventional groups. Irradiation of low-level laser stimulated bone growth at the condyles and did not cause anterior movement of the temporomandibular joint following functional orthopedic correction.

Look, but to the left: A rare case of gallbladder sinistroposition and comprehensive literature review

Left-sided gallbladder (LSGB) is a rare anatomic variation that, while benign in the context of its transposition, is of significant intraoperative importance. Due to its association with other anatomic anomalies involving key structures in the hepatobiliary system, discovering it intraoperatively as opposed to preoperatively suddenly increases the difficulty of a gallbladder procedure.

1)

Left-sided gallbladder (LSGB) is a rare anatomic variation that, while benign in the context of its transposition, is of significant intraoperative importance.

2)

Although laparoscopic cholecystectomy of a LSGB is safe, it is associated with higher risk of complications such as common bile duct injury.

3)

Most cases of a LSGB are diagnosed intraoperatively, and this sudden discovery during the procedure can increase the difficulty, duration, and stress of the procedure due to the other potential anatomic anomalies that LSGB is associated with in the hepatobiliary system.

Chilaiditi syndrome: A structural displacement in a heart failure patient

Background

Chilaiditi's sign is often found incidentally on chest or abdominal radiograph and can be accompanied by clinical symptoms such as abdominal pain, gastrointestinal complications, and less commonly associated with dyspnea.

Case presentation

In this interesting case, we discover lingering dyspnea in our 79 year old male with a past medical history of asthma and heart failure with preserved ejection fraction admitted for acute heart failure exacerbation with reduced ejection fraction along with a new incidental finding of Chilaiditi's sign on chest radiograph. Patient received optimal diuretics and guideline-directed medical treatment for heart failure exacerbation, but mild dyspnea with pleuritic chest pain persisted. Dyspnea with pleurisy was likely attributed to a structural anatomical defect (Chilaiditi's sign) that can be picked up on imaging.

Conclusion

Chilaiditi syndrome can be an incidental cause of ongoing persistent dyspnea, and if symptoms are severe, intervention can be warranted for symptomatic resolution.

Learning objective

Chilaiditi syndrome should be considered as a possible diagnosis among patients with a history of heart failure and incidental Chilaiditi's sign on chest radiographic imaging who suffer from persistent dyspnea and pleurisy despite optimal diuretics and guideline-directed medical treatment.

•

Chilaiditi's sign in an incidental finding on chest or abdominal radiograph associated with gastrointestinal symptoms and less commonly associated with dyspnea.

•

Chilaiditi's sign with underlying heart failure is not well understood.

•

Chilaiditi syndrome should be considered as a possible diagnosis among patients with a history of heart failure and incidental Chilaiditi's sign on chest radiographic imaging who suffer from persistent dyspnea and pleurisy despite optimal diuretics and guideline-directed medical treatment.

COVID-19 and mucormycosis superinfection: Exploring the missing pathophysiological links

The coronavirus disease 2019 continues to unearth new facets that portend grave clinical implications. In recent times, there has been mounting fervor regarding coronavirus disease 2019 and mucormycosis superinfection. While the correlation between the two is conspicuous, the underlying pathophysiological mechanisms that render a patient with coronavirus disease 2019 susceptible to mucormycosis, or vice versa, are still elusive.

Surgical Versus Medical Management of Necrotizing Enterocolitis With and Without Intestinal Perforation: A Retrospective Chart Review

Background

Necrotizing enterocolitis (NEC) is a debilitating disease that predominantly afflicts premature neonates, although it can also affect term neonates. The clinical features of the ailment vary widely and range from transient feed intolerance to life-threatening complications such as septicemia and disseminated intravascular coagulation. While surgery is usually only reserved for severe cases, such as those presenting with intestinal perforation, the role of surgical management in cases of NEC without perforation remains elusive.

Methods

A retrospective chart review of patients, three years in duration, was conducted and studied confirmed cases of NEC. The clinical presentations studied included cases of NEC with pneumatosis intestinalis, fixed bowel loop, pneumoperitoneum, and abdominal wall erythema. The patients were divided with regards to their intestinal perforation status and with pertinence to the treatment modality employed (medical or surgical). The results in either group were eventually analyzed in terms of the overall survival rate.

Results

A total of 48 patients were included in the study, of which 79.16% presented without perforation and 20.83% with perforation. Of the study participants included, 26 were females and 22 were males. Pertinently, no gender predominance was appreciated. In patients without perforation, medical management was noted to boast a lower mortality rate when compared with surgical intervention (15.6% vs 50.0%, respectively). In patients with perforation, the overall mortality was noted to hover at 50.0%, which was higher than that encountered in the non-perforation group.

Conclusion

In patients with NEC without perforation, surgical treatment confers no comparative therapeutic advantage when compared with medical management alone. Conservative management with broad-spectrum antibiotics including metronidazole yields equally favorable outcomes in such cases.

Effects of low-intensity pulsed ultrasound (LIPUS) applied on the temporomandibular joint (TMJ) region on the functional treatment of class II malocclusion: A randomized controlled trial

BACKGROUND

Low-intensity pulsed ultrasound (LIPUS) is considered one of the techniques used to improve the mandibular growth. Many animal studies have reported that significant results can be obtained using LIPUS therapy with functional appliances.

OBJECTIVES

This research aimed to evaluate the dentoskeletal changes produced by the combination of LIPUS therapy and functional treatment during the correction of skeletal class II malocclusion.

MATERIAL AND METHODS

Forty-five patients aged 10.5-14 years with skeletal class II division 1 malocclusion were randomly divided into 3 equal groups: the LIPUS group, treated with a Twin-Block appliance in combination with LIPUS therapy; the TB group, treated with a Twin-Block appliance only; and the control group, which was observational and received no treatment. Cephalometric changes were compared between the 3 groups using the analysis of variance (ANOVA) and Tukey's post hoc tests at p < 0.05.

RESULTS

A greater significant decrease in the ANB (A point, nasion, B point) angle was observed in the treated groups (-2.67° for the LIPUS group and -2.11° for the TB group) as compared to the control group (p < 0.001). A greater improvement in the mandibular length and position was observed in the LIPUS group than in the TB group (p < 0.001). The changes in the control group as a result of continuing growth were minimal and clinically non-significant.

CONCLUSIONS

The application of LIPUS therapy in combination with functional treatment can have a great effect on growth stimulation during the correction of class II malocclusion. In addition, LIPUS was effective in reducing the duration of functional treatment.

Efficiency of Corticision in Accelerating Leveling and Alignment of Crowded Lower Anterior Teeth in Young Adult Patients: A Randomised Controlled Clinical Trial

Introduction: The evaluation of flapless corticision in conjunction with the conventional treatment in the non-extraction decrowding of lower anterior teeth has not been performed yet in any randomised clinical trial, particularly in terms of treatment time and periodontal indices. Aim: The aim of the study was to compare the duration of leveling and alignment of mild and moderate crowding cases in the lower dental arch between the corticision-assisted fixed orthodontic treatment and the traditional method; and to compare the periodontal indexes between the two groups. Materials and Methods: A parallel-group Randomised Controlled Clinical Trial (RCT) was conducted on 60 patients (mean age 2 1.40±1.63 years). Patients were randomly assigned to either the corticision group or the control group (30 each). Immediately after fixed appliance bonding, three radiographic-guided incisions were performed on the labial surfaces of the alveolar bone between lower anterior teeth by reinforced scalpels and mallets in order to accelerate alignment for patients in the corticision group. Patients in the control group were treated with conventional orthodontics. The outcome measures were the overall time needed for leveling and alignment, periodontal parameters such as Plaque Index (PI), Probing Depth (PD), Gingival Index (GI), and the width of the attached gingiva. Results: The overall treatment time was significantly shorter in the corticision group than the control group. The average leveling and alignment period for the corticision group was 116.46±15.97 days, while it was 159.69±13.76 days in the control group. Comparing the groups, a significant reduction of about 27% was found in the leveling and alignment duration of the corticision group. There were no significant differences in the periodontal parameters (PI, PD, GI, the width of attached gingiva) at the end of leveling and alignment phase in both the groups. Conclusion: Corticision seems to be an effective method to accelerate leveling and alignment in cases of mild and moderate crowding. It did not cause negative effect on the periodontal tissues.

Ceftriaxone versus clavulanate-potentiated amoxycillin for prophylaxis against post-operative sepsis in biliary surgery: a prospective randomized study in 200 patients

A prospective study was carried out in 200 consecutive patients undergoing biliary surgery to compare the prophylactic effectiveness of ceftriaxone and clavulanate-potentiated (CP-) amoxycillin. Patients were assigned in a randomized fashion to two groups and received ceftriaxone (2 g intravenously pre-operatively), or CP-amoxycillin (1200 mg, to be repeated for 2 more doses in the case of patients undergoing procedures other than elective cholecystectomy). Post-operative wound infection occurred in 4% of patients in each group. Administration of ceftriaxone was associated with a lower incidence of post-operative pyrexia and chest infection as well as with a shorter hospital stay.