Hyponatremia—A New Diagnostic Marker for Complicated Acute Appendicitis in Children: A Systematic Review and Meta-Analysis

Anand, Sachit; Krishnan, Nellai; Birley, Jana Ròs; Tintor, Goran; Bajpai, Minu; Pogorelić, Zenon

doi:10.3390/children9071070

Cited by 20 publications

(22 citation statements)

References 57 publications

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“…The former being weak (r = – 0.28) and the latter, moderate (r = –0.46). Hyponatremia is a well-known alteration in complicated PAA, which agrees with our findings [ 18 ]. On the other hand, we expected the correlation between CK and creatinine to be positive.…”

Section: Discussionsupporting

confidence: 93%

Alterations and diagnostic performance of capillary ketonemia in pediatric acute appendicitis: a pilot study

et al. 2022

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Introduction The diagnostic performance of capillary ketonemia (CK) has been previously evaluated in context of pediatric acute gastroenteritis. To our knowledge, there is no literature on its performance in the setting of pediatric acute appendicitis (PAA). Materials and methods In this study, 151 patients were prospectively included and divided into two groups: (1) patients with non-surgical abdominal pain in whom the diagnosis of PAA was excluded (n = 53) and (2) patients with a confirmed diagnosis of PAA (n = 98). In 80 patients (Group 1, n = 23 and group 2, n = 57) a CK was measured at the time of diagnosis. The PAA group was further classified into complicated (n = 18) and uncomplicated PAA (n = 39). Quantitative variables were compared between groups using the Mann–Whitney U test. Diagnostic performance of CK was evaluated with ROC curves. Results CK values were 0.3 [0.1–0.9] mmol/L in group 1 and 0.7 [0.4–1.4] mmol/L in group 2 (p = 0.01). Regarding the type of PAA, CK values were 0.6 [0.4–0.9] mmol/L in uncomplicated PAA and 1.2 [0.8–1.4] mmol/L in complicated PAA (p = 0.02). The AUC for the discrimination between groups 1 and 2 was 0.68 (95% IC 0.53–0.82) (p = 0.24) and the AUC for the discrimination between uncomplicated PAA and complicated PAA was 0.69 (95% IC 0.54–0.85) (p = 0.04). The best cut-off point (group 1 vs group 2) resulted in 0.4 mmol/L, with a sensitivity of 80.7% and a specificity of 52.2%. The best cut-off point (non-complicated vs complicated PAA) resulted in 1.1 mmol/L, with a sensitivity of 61.1% and a specificity of 76.9%. Conclusions This study found significantly higher levels of CK in patients with PAA than in those with NSAP. Similarly, significantly higher levels were observed in patients with complicated than in those with uncomplicated PAA. Nevertheless, the diagnostic performance of CK was only moderate in the two settings analyzed. The potential usefulness of CK determination as a tool to guide the preoperative rehydration regimen of patients with PAA to prevent postoperative hyporexia and vomiting is a promising line of research and should be evaluated in future studies.

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Section: Discussionsupporting

confidence: 93%

Alterations and diagnostic performance of capillary ketonemia in pediatric acute appendicitis: a pilot study

et al. 2022

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“…For animals, it has been recognized that a certain concentration of extracellular sodium ions can resist the invasion of microorganisms. For example, in human body, the development of perforated appendicitis is related to the relatively low blood sodium [34][35][36][37]. It was also found that the seasonal low blood sodium of an American bat was related to its infection with a coronavirus and massive death [38,39].…”

Section: Out Of the Ideological Way Of Traditional Immunological Theo...mentioning

confidence: 99%

Why Are There So Many Puzzles in Fighting against COVID-19 Pandemic?

Dai¹

2022

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The novel coronavirus (SARS-CoV-2) and its variety that causes coronavirus disease 2019 (COVID-19) have had a great impact on human health and society since it was epidemic in 2019. The traditional immunological theories believe that human body resists the invasion of exogenous substances, such as different kinds of pathogenic microorganisms, through natural immunity and acquired immunity. We have greatly understood the underlying mechanisms of these two kinds of immunities, which are achieved through cellular and humoral immunity. Immune cells mainly include B and T cells. B cells produce specific antibodies and participate in the humoral immune response, while T cells have more extensive immune effects related to the cellular immune response. Therefore, such traditional immunological theories allow us habitually believe that the human body can resist the attack of virus as long as we have established the so-called normal cellular and humoral immune functions, however, in fact, this is not the case. The traditional ideas make us ignore the most critical, but simple and important defense system in our body to fight against the attack of foreign microorganisms, and that is the intracellular potassium ions (K + ) and extracellular sodium ions (Na + ), in particular, the intracellular potassium ions, called "K + /Na + natural immune system". The abnormality of this system, in particular, the intracellular relative deficiency of potassium ions, may have a very important relationship with the susceptibility and pathogenesis of the body to viral infection, and could explain a series of confusing phenomena that appeared during SARS-CoV-2 pandemic and provide new ideas for the prevention and treatment of COVID-19.

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“…In addition to physical examination and image diagnosis, numerous laboratory markers such as white blood cells, neutrophil granulocytes, C-reactive protein, interleukins, sodium, bilirubin, red blood cell distribution width, mean platelet volume, etc. [4][5][6][7][8], as well as various scoring scales, help us to diagnose acute appendicitis [9][10][11]. Although acute appendicitis is the most common surgical abdominal pathology in children, it is still a challenge and diagnostic dilemma for pediatric surgeons despite all available diagnostic modalities.…”

Section: Introductionmentioning

confidence: 99%

A Bizarre Cause of Acute Appendicitis in a Pediatric Patient: An Ingested Tooth

Pogorelić

Čohadžić

2023

Children

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(1) Background: Among all possible causes, foreign bodies are the rarest cause of appendicitis in the pediatric population. In the majority of cases, ingested foreign bodies pass through the gastrointestinal tract without causing symptoms. However, those foreign bodies that pass through the lumen of the vermiform appendix cannot re-enter the colon and may cause acute appendicitis. So far, various foreign bodies have been described to enter the appendix and cause acute appendicitis, such as seeds, needles, toothpicks, plant material, or even hair. Tooth or dental implants as a cause of acute appendicitis have been described in only a few cases. To our knowledge, this is the first described case of the tooth causing acute appendicitis in the pediatric population. (2) Case presentation: A 14-year-old male patient presented to the emergency department complaining of pain in the right lower quadrant of the abdomen and vomiting that persisted for approximately 24 h. Until then, the patient was healthy and had no concomitant diseases. Physical examination revealed guarding and tenderness in the right lower abdominal quadrant. The white blood cell count was 17.1 × 109/L with a neutrophil count of 91.1% and a C-reactive protein of 39.3 mg/dL. Ultrasonography of the abdomen revealed a thickened, inflamed appendix with a diameter of 11 mm and free periappendicular fluid. A 9 × 6 mm foreign body at the base of the appendix was visualized. The patient was diagnosed with acute appendicitis, and an emergency laparoscopic appendectomy was performed on the same day. Intraoperatively, gangrenous appendicitis was noted and removed without complications. Upon examination of the removed specimen, it was determined that the patient’s appendicitis had been caused by an ingested tooth. As it later turned out, the patient had broken a lateral incisor while playing sports the day before admission without knowing that he had swallowed it. The patient recovered well and was discharged the day after surgery. (3) Conclusion: Although an extremely rare event, acute appendicitis can be caused by a swallowed tooth. This case highlights the importance of a thorough history in pediatric patients who present to the emergency department with suspected acute appendicitis to determine if there is a precipitating event that may have caused acute appendicitis.

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Hyponatremia—A New Diagnostic Marker for Complicated Acute Appendicitis in Children: A Systematic Review and Meta-Analysis

Cited by 20 publications

References 57 publications

Alterations and diagnostic performance of capillary ketonemia in pediatric acute appendicitis: a pilot study

Alterations and diagnostic performance of capillary ketonemia in pediatric acute appendicitis: a pilot study

Why Are There So Many Puzzles in Fighting against COVID-19 Pandemic?

A Bizarre Cause of Acute Appendicitis in a Pediatric Patient: An Ingested Tooth

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