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

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Eco-Sustainable Use of Industrial Wastes as Cement-Partial Alternate in Concrete Composition

This study explores an innovative approach to enhancing the eco-sustainability of concrete by incorporating industrial byproducts—cement kiln dust (CKD), silica fume (SF), steel slag (SS), and coal ash (CA)—as partial cement replacements. Unlike conventional studies that focus on single waste materials, this research uniquely evaluates the combined effects of multiple industrial byproducts on concrete strength, durability, and chemical composition. SF and SS were selected due to their pozzolanic properties, availability, and potential to enhance mechanical performance. Concrete specimens with varying substitution ratios were examined in the laboratories of the Civil Engineering Department, Al-Azhar University, Qena. The assessment involved slump tests (ASTM C143) to evaluate workability and compressive strength tests conducted at 7 and 28 days to investigate early age and long-term mechanical performance. X-ray fluorescence (XRF) analysis was conducted to determine the oxide composition and its impact on durability. Results indicate that while higher CKD, SS, or SF levels generally reduce concrete strength and durability, CA enhances strength up to 5% substitution. CKD improves compressive and tensile strength at optimal ratios, while SF increases strength up to 15%. A combined SS and CA substitution (10%-15%) shows minimal impact on strength. XRF analysis reveals that CKD raises SO3, Cl, K2O, and MgO concentrations, while SF and CA have little effect on Cl levels up to 15%. SS reduces Cl oxide content with increased dosage. This study provides novel insights into optimizing multi-material substitutions for sustainable concrete, offering a pathway toward greener construction practices. Future research should explore long-term durability and environmental implications of these substitutions

Machine learning risk prediction of mortality for patients undergoing surgery with perioperative SARS-CoV-2: the COVIDSurg mortality score

To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.</jats:p