2 articles
Introduction
Acute appendicitis is among the three most frequent surgical diseases. The lifetime likelihood of developing acute appendicitis is around 7%. The incidence of acute appendicitis reduces with age after adolescence. Several studies evaluated the relevance of the current scores to the general population, mostly children, but a limited number of studies have studied the elderly population. This study aims to assess the clinical effectiveness of the new diagnostic score for the elderly population in comparison to both the Alvarado score and the non-standardized score.
In order to evaluate the effectiveness of the diagnostic score of acute appendicitis, we examined 78 patients who were admitted to emergency unit of the Saint Archangel Michael Municipal Clinical Hospital during 2018-2021 with the presumptive diagnosis of acute appendicitis. Of all patients admitted, Acute Appendicitis was confirmed on pathological examination in 22 (28.2%) patients. The average age of patients was 73.5±13.5 years (minimum - 60 years, maximum - 87 years). The ratio of males to females was 1:1.6.
Comparative evaluation of the new diagnostic score of acute appendicitis and the non-standardized clinical-echographic examination for acute appendicitis diagnosis showed better performance indicators of the new diagnostic score of acute appendicitis compared to the non-standardized clinical method for acute appendicitis diagnosis. The high sensitivity of the new diagnostic score of acute appendicitis was statistically demonstrated (ƛ2 = 4.32; p < 0.05), a lower rate of missed acute appendicitis cases in the new diagnostic score of acute appendicitis (ƛ2 = 4.32; p < 0.05), the „grey area” is lower in the new diagnostic score of acute appendicitis (ƛ2 = 5.28; p < 0.05), than in the non-standardized diagnosis. It was shown to have a lower rate of acute appendicitis cases in the „grey area” of the total number of acute appendicitis cases (ƛ2 = 4.9; p < 0.05). Benchmarking indicators such as specificity and diagnostic accuracy showed no statistically significant differences. At the same time, a definite increase in specificity and accuracy was observed for the new diagnostic score of acute appendicitis compared to non-standardized clinical diagnosis.
Diagnosing acute appendicitis in elderly patients remains challenging due to the numerous potential diagnoses with similar clinical manifestations that are observed in this patient population. It was necessary to utilize clinical risk-scoring systems that could aid in the prompt identification of patients with acute appendicitis. This study concludes that the New diagnostic score has higher clinical efficiency in diagnosing acute appendicitis in elderly patients. It has a sensitivity of up to 93.15%, compared to the unstandardized clinical method and the Alvarado diagnostic score, and is independent of „risk factors” such as obesity and atypical vermiform appendix localization.
Chronic obstructive pulmonary disease (COPD) is considered an important disease in the structure of morbidity and mortality and a rising public health problem with increasing global age prevalence. Exacerbation of COPD in the elderly has a significant negative impact on the clinical and paraclinical picture, daily activity capacity, and quality of life. The need for correct diagnostic management is dictated by the severity of the pathology in the elderly and the high frequency of cardiac complications. Studying the clinical-paraclinical picture and the diagnostic capacity of natriuretic peptides in COPD patients with cardiovascular complications was the aim of the present research.
We conducted an analytical, observational, case-control study with the use of modern research methods. The study included 194 elderly patients (≥ 65 years old) divided into two study groups: those with only COPD (COPD group) and those with associated pulmonary hypertension (PHCOPD group). Patients underwent clinical, paraclinical, and functional investigation methods with subsequent mathematical-statistical data processing.
The study groups were similar according to socio-demographic data. The clinical assessment revealed that PHCOPD patients had, in comparison with COPD patients, statistically significantly more frequent and severe complaints. The objective examination determined that in PHCOPD patients, the values of the objective examination indices were much more affected than in the COPD group. At the complex geriatric assessment, the COPD group of patients shows a lower degree of dependence and less cognitive impairment. The multidimensional assessment of COPD reflected more severe impairment according to the CAT, SGRQ, CCQ, mMRC, BODE questionnaires, and 6MWT test in the PHCOPD group compared to the COPD group. Spirographic, radiographic, ultrasonographic, and echocardiographic evaluations correlated with age, inflammatory syndrome, and natriuretic peptide level.
The PHCOPD group patients present a clinical picture, exercise capacity, objective data, complex geriatric assessment scores, and a multidimensional assessment of COPD that is statistically more frequent and severely affected compared to the COPD group. The impact of hemodynamic disturbances in COPD could be confirmed by the correlation of paraclinical data, such as the inflammatory response syndrome, increased natriuretic peptides, echocardiography data, and indices of internal organ ultrasound examination.