Is it time for global adoption of endoscopic retrograde appendicitis therapy of acute appendicitis?

Acute appendicitis is a common abdominal surgical emergency worldwide. Abraham Groves performed the first documented open appendectomy in 1883. Although appendectomy is still the most effective treatment in cases of acute appendicitis, it causes a range of complications and carries the risk of negative appendectomy. In the awake of covid-19, the latest guidelines recommend antibiotic therapy as an acceptable first line treatment for acute appendicitis. However, patients treated with antibiotics have a recurrence risk of up to 30% at 1 year. Endoscopic retrograde appendicitis therapy (ERAT) has emerged as promising non-invasive treatment modality for acute uncomplicated appendicitis (AUA) which involves cannulation, appedicography, appendiceal stone extraction, appendiceal lumen irrigation, and stent insertion. ERAT aims to relieve the cause of appendicitis (e.g., obstruction or stenosis of the appendiceal lumen) and thus effectively prevent the recurrence of appendicitis. In addition, it can make a definitive diagnosis of acute appendicitis during endoscopic retrograde appendicography. Studies have shown that 93.8 to 95% of AUA patients did not have a recurrence following ERAT. In this study, we aim to summarize the current body of evidence on ERAT to situate it alongside currently established therapies for acute appendicitis, in particular, AUA.

Long-term effects of appendectomy in humans: is it the optimal management of appendicitis?

INTRODUCTION: Appendectomy remains the gold standard for treating uncomplicated and complicated appendicitis. However, the vermiform appendix may play a significant role in the immune system (secondary immune function) and maintain a reservoir of the normal microbiome for the human body. The aim of this study was to summarize the long-term effects after appendectomy and discuss whether appendectomy is suitable for all appendicitis patients. AREAS COVERED: A comprehensive and unbiased literature search was performed in PubMed. The terms 'appendix,' 'appendicitis,' 'appendectomy,' and 'endoscopic retrograde appendicitis therapy' were searched in the title and/or abstract. This review summarizes the long-term effects of appendectomy on some diseases in humans and describes three methods including appendectomy, medical treatment, and an 'organ-sparing' technique, named endoscopic retrograde appendicitis therapy (ERAT) to treat appendicitis. EXPERT OPINION: Appendectomy remains the first-line therapy for appendicitis. The patient's problem is appendix, not appendicitis. If we treat appendicitis, the problem should be resolved. During COVID-19, an initial antibiotic treatment of mild appendicitis represents a promising strategy. For patients who are worried about the long-term adverse effect after appendectomy and have a strong desire to preserve the appendix and are aware of the risk of appendicitis recurrence, medical treatment, or ERAT could be proposed.

The Food-Trade Associated Spreading of COVID-19 Outbreak from a Contaminated Super Wholesale Food Market in Beijing (preprint)

Background: The re-emerging outbreak of COVID-19 in Beijing China in summer of 2020 was originated from a contaminated super food wholesale market. The transmission mechanism was analyzed. Methods: We hypothesized that the Xinfadi outbreak was associated with activities of food-trade. Therefore, all the confirmed cases were divided into groups of sellers, buyer, seller transmitted and buyer transmitted. Data for each case were georeferenced and aggregated to the 500m-spaced hexagon grids using geodata and base maps, road networks, urban points of interest from OpenStreetMap. The Xinfadi-related trade activity data were derived using Python crawling scripts. The spatial association of the outbreak was studied with Moran’s I statistic method and a Susceptible-Infected-Recovered (SIR) coupled Agent-Based Model (ABM). Findings: Of 335 cases reported, 177 (45·3%) were sellers who worked for the Market, 83 (23·7%) were buyers who visited the Market, and 74 were transmitted by either of the infected buyers or sellers. The Market was the outbreak center, which were spreading along the urban rapid transit lines. The areas with a high incidence were concentrated across neighborhoods in the southwest of Beijing's Fifth Ring Road and the west section of the Fourth Ring of southwestern Beijing, and the west portion of Fuxing Road. The highest number of seller transmission hubs were located in Market neighborhood, however the buyer transmission hubs extended to cover more than three different districts. Our SIR-ABM model analysis suggested that the trade-distancing strategy effectively reduced the R0. The retail shops closure strategy reduced nearly half number of visitors to market. The Buy-local policy option reduced more than 70% infection in total. Interpretation: The Xinfadi outbreak was associated contaminated super food market by people's movements for food-trade, including their interactions in related activities. Therefore, the retails closures and buy-local policy could reduce size of the outbreak and prevent possible outbreak in future.Funding Statement: Ministry of Science and Technology China (Grant number 2018ZX10712001-017 and 2018ZX10712001-018), Chinese Academy of Medical Sciences (2018RU010), Chinese Academy (2020-XZ-37) and the National Natural Science Foundation of China (71603253 and 72074209).Declaration of Interests: All authors declare no competing interests.

Global evaluation of echocardiography in patients with COVID-19.

AIMS: To describe the cardiac abnormalities in patients with COVID-19 and identify the characteristics of patients who would benefit most from echocardiography. METHODS AND RESULTS: In a prospective international survey, we captured echocardiography findings in patients with presumed or confirmed COVID-19 between 3 and 20 April 2020. Patient characteristics, indications, findings, and impact of echocardiography on management were recorded. Multivariable logistic regression identified predictors of echocardiographic abnormalities. A total of 1216 patients [62 (52-71) years, 70% male] from 69 countries across six continents were included. Overall, 667 (55%) patients had an abnormal echocardiogram. Left and right ventricular abnormalities were reported in 479 (39%) and 397 (33%) patients, respectively, with evidence of new myocardial infarction in 36 (3%), myocarditis in 35 (3%), and takotsubo cardiomyopathy in 19 (2%). Severe cardiac disease (severe ventricular dysfunction or tamponade) was observed in 182 (15%) patients. In those without pre-existing cardiac disease (n = 901), the echocardiogram was abnormal in 46%, and 13% had severe disease. Independent predictors of left and right ventricular abnormalities were distinct, including elevated natriuretic peptides [adjusted odds ratio (OR) 2.96, 95% confidence interval (CI) 1.75-5.05) and cardiac troponin (OR 1.69, 95% CI 1.13-2.53) for the former, and severity of COVID-19 symptoms (OR 3.19, 95% CI 1.73-6.10) for the latter. Echocardiography changed management in 33% of patients. CONCLUSION: In this global survey, cardiac abnormalities were observed in half of all COVID-19 patients undergoing echocardiography. Abnormalities were often unheralded or severe, and imaging changed management in one-third of patients.