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      Comparison of acute appendicitis before and within lockdown period in COVID-19 era: A retrospective study from rural Nepal

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          Abstract

          Introduction

          The world has been engulfed with the pandemic of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which have created significant impact in the emergency surgical health delivery including acute appendicitis. The main aim of this study was to compare the demographic and clinical parameters between two cohorts before the onset of lockdown and within the pandemic.

          Methods

          A retrospective analysis was performed between two groups A and B, who presented with acute appendicitis three months prior to and after initiation of lockdown on March 24 2020 respectively in one of the tertiary centers of Nepal. These two cohorts were compared in demographics, clinicopathological characteristics and surgical aspects of acute appendicitis.

          Results

          There were 42 patients in group A and 50 patients in group B. Mean age of the patients was 31.32±17.18 years with male preponderance in group B (N = 29). Mean duration of pain increased significantly in group B [57.8±25.9(B) vs 42.3±25.0(A) hours, P = 0.004] along with mean duration of surgery [51.06±9.4(B) vs 45.27±11.8(A) minutes, P = 0.015]. There was significant decrease in post-operative hospital stay among group B patients [3.04±1.1(B) vs 3.86±0.67(A) days, P = 0.0001]. Complicated cases increased in group B including appendicular perforation in 10 cases. Similarly, mean duration of presentation to hospital significantly increased in group B patients with perforation [69.6±21.01 vs 51.57±17.63 hours, P = 0.008].

          Conclusion

          During the adversity of the current pandemic, increased number of cases of acute appendicitis can be dealt with surgery as the chances of late presentation and complexity of the lesion exists.

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          Most cited references 18

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          Endoscopic appendectomy.

           K. Semm (1983)
          These newly developed endoscopic methods in gynaecology for haemostasis during surgical pelviscopy (Endocoagulation Roeder-loop ligation, endoligature, endo-suture with intra- and extracorporeal knotting) make it possible to carry out appendectomy by endoscopy for any of the following indications: Postoperative adhesion of the appendix especially in "sterility" patients, elongated appendix extending into the small pelvis, endometriosis of the appendix, subacute and chronic appendicitis. The instrument-set employed in this method permits the performance of all the usual classical operative steps (purse-string suture, and Z-suture acc. to McBurney and Sprengel). The point for resection has to be sterilized over 20-30 sec. at 212 degrees F using the crocodile forceps (endocoagulation procedure) before division and extraction of the appendix is effected.
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            Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

            Background and aims Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of non-operative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and peri-operative antibiotic therapy. Methods This executive manuscript summarizes the WSES guidelines for the diagnosis and treatment of AA. Literature search has been updated up to 2019 and statements and recommendations have been developed according to the GRADE methodology. The statements were voted, eventually modified, and finally approved by the participants to the consensus conference and by the board of co-authors, using a Delphi methodology for voting whenever there was controversy on a statement or a recommendation. Several tables highlighting the research topics and questions, search syntaxes, and the statements and the WSES evidence-based recommendations are provided. Finally, two different practical clinical algorithms are provided in the form of a flow chart for both adults and pediatric (< 16 years old) patients. Conclusions The 2020 WSES guidelines on AA aim to provide updated evidence-based statements and recommendations on each of the following topics: (1) diagnosis, (2) non-operative management for uncomplicated AA, (3) timing of appendectomy and in-hospital delay, (4) surgical treatment, (5) intra-operative grading of AA, (6) ,management of perforated AA with phlegmon or abscess, and (7) peri-operative antibiotic therapy.
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              The novel coronavirus outbreak in Wuhan, China

               Hengbo Zhu,  Li Wei,  Ping Niu (2020)
              The novel coronavirus (2019-nCoV, or COVID-19) epidemic first broke out in Wuhan and has been spreading in whole China and the world. The numbers of new infections and deaths in Wuhan are still increasing, which have posed major public health and governance concerns. A series of mandatory actions have been taken by the municipal and provincial governments supported by the central government, such as measures to restrict travels across cities, case detection and contact tracing, quarantine, guidance and information to the public, detection kit development, etc. Challenges such as lacking effective drugs, insufficient hospital services and medical supplies, logistics, etc. have much alleviated with the solidarity of the whole society. The pandemic will definitely be ended with the continuous efforts of both national and international multi-sectoral bodies.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: InvestigationRole: MethodologyRole: SoftwareRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Supervision
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                6 January 2021
                2021
                6 January 2021
                : 16
                : 1
                Affiliations
                Department of Surgery, Lumbini Medical College, Tansen, Palpa, Nepal
                Ohio State University Wexner Medical Center Department of Surgery, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Article
                PONE-D-20-24725
                10.1371/journal.pone.0245137
                7787439
                33406126
                © 2021 Baral et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Figures: 0, Tables: 3, Pages: 8
                Product
                Funding
                The author(s) received no specific funding for this work.
                Categories
                Research Article
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Laparoscopy
                Medicine and Health Sciences
                Gastroenterology and Hepatology
                Appendicitis
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Medicine and Health Sciences
                Epidemiology
                Pandemics
                Medicine and Health Sciences
                Medical Conditions
                Infectious Diseases
                Viral Diseases
                Covid 19
                Medicine and Health Sciences
                Health Care
                Health Care Facilities
                Hospitals
                Medicine and Health Sciences
                Clinical Medicine
                Signs and Symptoms
                Pain
                Abdominal Pain
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Digestive System Procedures
                Appendectomy
                Custom metadata
                All relevant data are within the manuscript and its Supporting information files.
                COVID-19

                Uncategorized

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