BACKGROUND: Appendicitis is the most common abdominal disease that requires surgery in children. The mortality rate in appendicitis is greatly affected by rupture or leakage of the appendix. In establishing the diagnosis of appendicitis, several modalities are needed, namely, with a pediatric appendicitis score and ultrasound. In addition to operative measures, non-operative therapeutic research is also developing, especially for cases of appendicitis without complications. Pathologically, the occurrence of complications in appendicitis is influenced by good vascularization for tissue healing through the process of angiogenesis by vascular endothelial growth factor (VEGF).
AIM: We aimed to see the effect of VEGF and folic acid levels on the occurrence of complicated appendicitis.
METHODS: This research method is laboratory experimental design. A total of 32 rabbits used were male rabbits weighing 2500–3000 g that met the inclusion and exclusion criteria. Samples were examined for VEGF levels and then the appendix lumen was obstructed with Silk No.-O thread. Thirteen hours later, blood samples are taken back to check VEGF and folic acid (FA) levels and an appendectomy is performed for histopathological examination.
RESULTS: There is a decrease of basal VEGF levels regarding histopathological results. In complicated appendicitis, the basal VEGF level was lower than acute appendicitis and normal; 8.61 (±4.87), 7.66 (±3.47), and 5.75 (±4.88), respectively. Similar trend was found in basal FA levels. In complicated appendicitis, it has a lower level than both acute appendicitis and normal; 2.00 (±2.08), 1.14 (±1.00), and 0.44 (±0.22) in order. However, there is no statistical significance in both trends (p = 0.775 and p = 0.058).
CONCLUSION: There was a trend showing low value of VEGF and FA that were a predictor of appendicitis and complicated appendicitis. Unfortunately, no statistical significance was shown in this study.
Acute appendicitis in paediatric patient is among the causal of abdominal emergency which requires immediate operation (Victor, et al, 2012; Ballester et al., 2009; Huckins et al., 2013). The incidence of acute appendicitis in paediatric patient in the world ranges from 1 to 8 % of all pediatric patients coming to the Emergency Department (ED) with acute abdominal pain (Jangra et al., 2013). Appendicitis is rare in children under 5 years, and very rare in the first year of life. In some instances, boys are more than girls around 55% to 65% of patients (Stevenson, Edward, 2003). The incidence rate of perforated appendicitis in the age group of children is about 30% to 40%. Appendicitis in the neonate is very rare, and the surgeon should be careful of the accompanying conditions, such as Hirschsprung’s disease and necrotic enterocolitis. (Stevenson, Edward, 2003).
Pesticide residue in food has been investigated since the growing demand of food safe. The determination of pesticides residues in food is becomes an essential requirement for consumers, producers, and authorities responsible for food quality control. Pesticides can poison humans through the mouth, skin, and breathing. Often unwittingly these toxic chemicals enter a person’s body without causing sudden pain and causing chronic poisoning. This study aimed to investigate the impact of pesticides residue to health problems from meta-synthesize, sourced from the Scopus and Sinta indexed articles and obtained 12 indexed articles that were used as references. Meta-synthesize result showed that there are some type of pesticide who used by farmers such as chlorphenapir, emamctin benzoate, abamectin, chlorpyrifos, mankozeb, chlorotalonil, and propineb. Continous use of pesticides can cause such as fatigue, excessive saliva, hard breathing, frequent urination, blurred vision, dizzinesss, and fingerpain. At the end, pesticides residue is adverse effect on human health problems.
BACKGROUND: Appendicitis is one of the most common abdominal emergencies that require surgery in children. The morbidity and mortality rate in appendicitis is greatly affected by rupture or leakage of the appendix. In establishing the diagnosis of appendicitis, several modalities are acknowledged, namely, pediatric appendicitis score and ultrasound. Pathologically, severity and complications of appendicitis occur related to good vascularization and tissue healing process through process of angiogenesis influenced by folic acid (FA) and vascular endothelial growth factor (VEGF). This is clinically important as currently non-operative and non-invasive therapies were developing in stratification of mild appendicitis.
AIM: This study aimed to review the determination of appendicitis from FA and VEGF levels in animal model.
METHODS: This study was conducted in accordance with the PRISMA guidelines for reporting systematic reviews. Articles were reviewed for relation of FA and VEGF in determining appendicitis in PubMed and Science Direct. Articles on experimental animal model published from 1990 to 2020 were included, while articles in English were excluded from the study.
RESULTS: The articles we reviewed conduct an assessment of appendicitis by FA and VEGF level in animal model. Three articles were reviewed ranging from 1990 to 2020. One article presented a significant association of decreased level of FA in determining appendicitis while the other two mentioned trends of decreased level of FA and VEGF in appendicitis without statistically significance.
CONCLUSION: Reduction of folate acid levels could be a critical prescient factor for the weight of muddled an appendicitis in animal model, however, there was a pattern demonstrating low estimation of VEGF as an indicator of appendicitis and convoluted appendix with no measurable note worthiness appeared.
In an inflammation, including appendicitis, vascular adequacy is required to supply anti-inflammatory substances and nutrition due to inflamed tissue remodeling. Normal tissue has balanced tissue regeneration and tissue destruction from apoptosis. While in inflammation, inflammatory substances tend to cause tissue destruction and lead to necrosis. This requires the tissue to increase cell regeneration to maintain tissue homeostasis in the appendix, induced mainly by oxygenation, nutrition, growth factors, and mainly anti-inflammatory substances that are obtained with vascular adequacy. This process needs active vascularization that can be achieved with neovascularization to ensure good vascularization to the tissue lacking from vascular damage. The ability of neovascularization is mainly related to growth factors acting in the endothelium and inducing neovascularization process. This mechanism is impaired in the process of inflammation by inflammatory substances causing endothelial dysfunction. As stated that vascular adequacy is related to growth factors such as vascular endothelial growth factors (VEGF) that may differ from one person to another, external and internal factors plays role in affecting individualized difference in adapting to inflammatory process, the expression of the VEGF may be a novel distinction to cut-off requirements of inflammation process in appendicitis would be self-limiting or continue to cause tissue necrosis and perforating appendicitis that urges surgical treatment to encounter the unstoppable inflammatory process in the appendix.
Acute appendicitis is one of the most abdominal acute causes that occurs in younger individuals but can also occur in any age range. Children are the most affected age by acute appendicitis. The age that most vulnerable to acute appendicitis is 10-20 years of age (Tian Y et all, 2015). In appendicitis, the severity of inflammation occurring in the appendix determines the severity of symptoms that occur in an individual who experiences it (Zarandiet all, 2014). One of the ways used to establish diagnosis of appendicitis is with PED (Pediatric Appendicitis Score). In a study by Thomas Rettenbacher, the outer diameter of the appendix ≥ 6 mm obtained on ultrasound examination may also indicate an acute appendicitis state with 100% sensitivity and a specificity of 60%. So in this study we analyzed the correlation relationship between the PAS score with the outer diameter of the appendix in the case of appendicitis.
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