Seasonal variation of appendicitis in northern Saudi Arabia

Epidemiologic Features of Appendicitis

“…Most studies report a summer peak with a winter nadir; USA (Luckmann & Davis, 1991), Canada (Al-Omran, et al, 2003, Italy (Gallerani, et al, 2006), Israel (Freud, et al, 1988) and Russia (Khaavel & Birkenfeldt, 1978). Our own study in northern Saudi Arabia showed a winter low but a spring peak which coincides with the sandstorm season characterized by rise in infections and allergic conditions of the upper respiratory tract which concur with earlier studies on the spread of allergens during this season in Saudi Arabia (Kwaasi, et al, 1992a(Kwaasi, et al, , 1992b(Kwaasi, et al, , 1993(Kwaasi, et al, , 1998Sanda, et al, 2008). A similar seasonal variation to ours was reported four decades earlier in Britain (Ashley, 1967).…”

“…This figure is more than 12 times the rate in Ghana (Ohene-Yeboah & Abantanga, 2009). Saudi Arabia, another country that is attaining rapid improvement in health indices, maybe showing this trend as a post-hoc analysis of the data in our study shows that in the city of Hail with a population of around 356,000 an estimated average of 526 cases of appendicitis were recorded annually from 2000 to 2006 giving an incidence rate of 147/100,000 people; a figure that is similar to figures obtainable from European countries and higher than figures from sub-Saharan Africa by as much as a factor of 10 (Sanda, et al, 2008). This observation fits in with the hypothesis offering an explanation for the propensity of appendicitis in the age group with the most developed immune system and, conversely, explains its rarity at the extremes of age.…”

“…The presence of local infections probably stimulates the lymphoid follicles to hypertrophy and occlude the lumen of the appendix more commonly in this age group. The efficiency of the immune system in this age group is also a plausible explanation for the tendency for remote agents like air-pollution and sandstorms to be associated with significant variations in the incidence of appendicitis (Kaplan, et al, 2009;Sanda, et al, 2008). On the other hand the immaturity of the immune system before the age of five years and immunosenescence as well as the atrophy of the wall and obliteration of the lumen of the appendix as seen intraoperatively or at autopsy in aged individuals may explain why appendicitis is less common in these age groups.…”

An Audit of Appendectomies with Histopathological Correlations in A Single Centre

“…The study populations with histological reports of appendicitis were retrieved from the computer records. Negative appendectomy was defined as a post operative appendix specimen for suspected appendicitis that was however microscopically normal on histopathological examination without evidence of inflammation, tumor and parasite infestation [8][9][10][11]. Analysis of the data was carried out by IBM SPSS version 20.…”

Appendicitis as an immunological disease: Why it is uncommon in Africans

“…[9] Bacterial proliferation, luminal mucus elaboration and inflammatory mediators all have roles. The inciting cause may be intraluminal (fecalith, foreign bodies, [10] parasites, [11] barium [12] or colonoscopy [13,14] ), intramural (tumours, [15,16] dengue, [17] CMV, [18] HIV, [19] EBV, [20] campylobacteriosis, [21,22] tuberculosis, [23,24] salmonellosis, [25] brucellosis, [26] schistosomiasis, [16,27,28] amebiasis [11,29] and enterobiasis [16] ), extrinsic (trauma, [30] genital infections [31] or displaced Cu-T [32] ) or remote (sandstorm [33] and air-pollution [34] ).…”