Evaluating the Diagnostic Accuracy of the Alvarado Score and Abdominal Ultrasound for Acute Appendicitis: A Retrospective Single-Center Study

Saleh Al-wageeh,1 Qasem Abdulkarem Alyhari,1 Faisal Ahmed,2 Abdulfattah Altam,3 Gubran Alshehari,4 Mohamed Badheeb5 1Department of General Surgery, School of Medicine, Ibb University, Ibb, Yemen; 2Department of Urology, School of Medicine, Ibb University, Ibb, Yemen; 3Department of General Surgery, School of Medicine, 21 September University, Sana’a, Yemen; 4Student Research Committee, School of Medicine, Ibb University, Ibb, Yemen; 5Department of Internal Medicine, Yale New-Haven Health/Bridgeport Hospital, Bridgeport, CT, USACorrespondence: Faisal Ahmed, Department of Urology, School of Medicine, Ibb University of Medical Sciences, Ibb, Yemen, Email [email protected] Mohamed Badheeb, Internal Medicine, Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT, USA, Email [email protected]: Acute appendicitis is a complex diagnosis that often requires both clinical and radiological evaluation. Significant variations in diagnostic approaches are evident among clinicians and healthcare institutions. While certain guidelines advocate for risk stratification based on clinical characteristics, others emphasize the importance of pre-operative imaging. This study seeks to explore the accuracy of the Alvarado Score and abdominal ultrasound (AUS) in diagnosing acute appendicitis.Methods: Suspected cases of appendicitis admitted to Al-Thora Hospital in Ibb, Yemen, from Jan 2021 to July 2022 were evaluated. The demographics, clinical, and laboratory data were collected and analyzed. This study assessed Alvarado scores (calculated based on clinical evaluation and laboratory data) and pre-operative AUS findings, correlating them with post-operative and histopathology findings. The Alvarado scores and AUS sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were assessed using the ROC curve.Results: Out of 1021 cases of acute abdomen, 171 patients were suspected of appendicitis. Using AUS along with the Alvarado score, appendicitis was presumed in 137 patients who underwent appendectomy. 130 (94.9%) patients had positive intraoperative and histopathology findings while 7 (5.1%) had negative findings. The Alvarado Score had a sensitivity and specificity of 94.62% and 87.80% at cutoffs of 6, respectively [Area under the curve (AUC): 0.985; 95% confidence interval (CI), 0.954 to 0.998; p < 0.0001]. Abdominal US showed a sensitivity of 98.46% and specificity of 82.93% (AUC:0.907; 95% CI, 0.853 to 0.946; p < 0.0001).Conclusion: Alvarado’s score and AUS exhibited high sensitivity and specificity in diagnosing acute appendicitis. The substantial accuracy and efficacy of both the Alvarado score and AUS support their utilization as primary investigative tools in resource-limited settings. This approach can help avoid unnecessary appendectomies and minimize the financial burden on patients.Plain Language Summary: Acute appendicitis poses a diagnostic challenge, with a high rate of false-positive cases identified post-operatively. Computed tomography has been recommended by several surgical societies; however, it is limited by unaffordability and unavailability. Herein, we utilized the Alvarado score along with abdominal ultrasound as an alternative accurate, and cost-effective diagnostic approach. In this study, the negative appendectomy rate was 5.1%. The sensitivity of abdominal ultrasound in detecting appendicitis was 98.5%, with a specificity of 82.9%. The positive predictive value, negative predictive value, and accuracy were determined to be 94.8%, 94.4%, and 94.7%, respectively. The mean Alvarado score was 6.9± 2.4, with a sensitivity and specificity of 97.81% and 97.06% at cutoffs of 6, respectively. The area under the curve values of the ROC curve for Alvarado’s and abdominal ultrasound were 0.985 (95% CI, 0.954 to 0.998) and (AUC:0.907; 95% CI, 0.853 to 0.946), which was statistically significant (p < 0.0001).Keywords: Acute appendicitis, Alvarado’s score, sensitivity, specificity, ultrasoun

Iatrogenic Ureteral and Colonic Injuries During Emergency Cesarean Section: A Lesson Learned from a Surgical Catastrophe &ndash; A Case Report

Faisal Ahmed,1 Saleh Al-Wageeh,2 Mohamed Badheeb,3 Abdulfattah Altam,4 Afaf Alsharif5 1Department of Urology, School of Medicine, Ibb University of Medical Sciences, Ibb, Yemen; 2Department of General Surgery, School of Medicine, Ibb University of Medical Sciences, Ibb, Yemen; 3Department of Internal Medicine, Faculty of Medicine, Hadhramout University, Hadhramout, Yemen; 4Department of General Surgery, School of Medicine, 21 September University, Sana’a, Yemen; 5Department of Gynecology, School of Medicine, Jeblah University for Medical and Health Sciences, Ibb, YemenCorrespondence: Faisal Ahmed, Department of Urology, School of Medicine, Ibb University of Medical Sciences, Ibb, Yemen, Tel/Fax +967 4428950, Email [email protected]: Iatrogenic concomitant ureteral and colonic injury in emergency cesarean section (C-section) is an exceedingly rare, yet, catastrophic complication and has not been reported to our knowledge.Case Report: A 30-year-old woman presented with decreased urination for 2 days after a C-section. Ultrasonography showed severe left hydronephrosis and moderate abdominal free fluid. A ureteroscopy revealed a total occlusion of the left ureter, and subsequently, a ureteroneocystostomy was performed. Two days later, the patient was complicated with abdominal distension that necessitated re-exploration. The exploration revealed colonic injury (rectosigmoid), peritonitis, endometritis, and ureteral anastomosis disruption. A colostomy, repair of colonic injury, hysterectomy, and ureterocutaneous diversion were performed. The patient’s hospital stay was complicated, with stomal retraction requiring operative revision and wound dehiscence, which was treated conservatively. After 6 months, the colostomy was closed, and the ureter was anastomosed via the Boari-flap procedure.Conclusion: Injuries to the urinary and gastrointestinal tracts are serious complications of a cesarean section; concurrent involvement is exceedingly rare; however, delayed recognition and intervention can worsen the prognosis.Keywords: case report, cesarean section, colon injury, iatrogenic, ureteral injur

Complex Aerogels Generated from Nano-Polysaccharides and Its Derivatives for Oil–Water Separation

The complex aerogel generated from nano-polysaccharides, chitin nanocrystals (ChiNC) and TEMPO-oxidized cellulose nanofibers (TCNF), and its derivative cationic guar gum (CGG) is successfully prepared via a facile freeze-drying method with glutaraldehyde (GA) as cross-linkers. The complexation of ChiNC, TCNF, and CGG is shown to be helpful in creating a porous structure in the three-dimensional aerogel, which creates within the aerogel with large pore volume and excellent compressive properties. The ChiNC/TCNF/CGG aerogel is then modified with methyltrichlorosilane (MTCS) to obtain superhydrophobicity/superoleophilicity and used for oil&ndash;water separation. The successful modification is demonstrated through FTIR, XPS, and surface wettability studies. A water contact angle of 155&deg; on the aerogel surface and 150&deg; on the surface of the inside part of aerogel are obtained for the MTCS-modified ChiNC/TCNF/CGG aerogel, resulting in its effective absorption of corn oil and organic solvents (toluene, n-hexane, and trichloromethane) from both beneath and at the surface of water with excellent absorption capacity (i.e., 21.9 g/g for trichloromethane). More importantly, the modified aerogel can be used to continuously separate oil from water with the assistance of a vacuum setup and maintains a high absorption capacity after being used for 10 cycles. The as-prepared superhydrophobic/superoleophilic ChiNC/TCNF/CGG aerogel can be used as a promising absorbent material for the removal of oil from aqueous media