Background: Acute appendicitis continues to be a primary reason for emergency abdominal surgery worldwide. Its diagnosis is often challenging due to variable clinical presentations and limited access to advanced imaging, especially in resource-constrained settings. Recent research has focused on identifying accessible laboratory markers such as monocyte-to-lymphocyte ratio (MLR) and monocyte-to-high-density lipoprotein ratio (MHR) to improve the overall diagnostic precision for acute appendicitis, extending beyond merely differentiating between uncomplicated and complicated instances.This research focused on assessing the diagnostic significance of the monocyte-to-lymphocyte ratio (MLR), the monocyte-to-high-density lipoprotein cholesterol ratio (MHR), and the Alvarado score for diagnosing acute appendicitis, as well as their effectiveness in distinguishing disease severity among patients at Hasahiesa Emergency Hospital, Gezira State, Sudan.
Methods: A cross-sectional hospital-based study was carried out, enrolling 100 patients diagnosed with acute appendicitis from October 2022 to March 2023. MLR, MHR, and Alvarado scores were assessed for each patient. Their diagnostic performance for acute appendicitis was assessed, and values were compared between uncomplicated and complicated cases. Statistical analysis was performed using SPSS v22.0.
Results: MLR, MHR, and Alvarado scores were significantly elevated in patients with acute appendicitis and showed strong associations with disease severity and ultrasound findings (P value <0.05). These markers demonstrated robust diagnostic value for detecting acute appendicitis in general, as well as for distinguishing between uncomplicated and complicated cases.
Conclusion: MLR, MHR, and Alvarado score are valuable, available aids for diagnosing acute appendicitis and assessing its severity. Their integration into clinical protocols can improve early detection, risk stratification, and clinical decision-making, particularly in settings where advanced imaging is limited.
Hypertension is both a cause and a consequence of chronic kidney disease (CKD), creating a bidirectional relationship that exacerbates cardiovascular and renal complications. The pathophysiology of hypertension in CKD is multifaceted, involving deregulation of the renin-angiotensin-aldosterone system (RAAS), endothelial dysfunction, volume overload, and increased arterial stiffness. Additionally, uremic toxins and oxidative stress further amplify vascular injury and inflammation, contributing to the progression of both hypertension and renal impairment. Traditional antihypertensive therapies, including RAAS inhibitors, calcium channel blockers, and diuretics, remain central to management; however, therapeutic challenges persist due to CKD-associated pharmacokinetic alterations and patient heterogeneity. Recent advancements in treatment approaches have introduced novel pharmacological and non-pharmacological interventions. These include using sodium-glucose cotransporter-2 (SGLT2) inhibitors, which have demonstrated Renoprotective and blood-pressure-lowering effects, and non-steroidal mineralocorticoid receptor antagonists, offering improved safety profiles. Emerging technologies such as renal denervation and baroreceptor activation therapy provide innovative, non-invasive options for resistant hypertension. Additionally, personalized medicine approaches, including genomics and biomarker-based risk stratification, hold promise for tailoring interventions to individual patient profiles. This review highlights the intricate interplay between hypertension and CKD pathophysiology, discusses recent advancements in therapeutic strategies, and underscores the need for a multidisciplinary approach to optimize patient outcomes. By integrating cutting-edge research with clinical practice, future strategy can mitigate the dual burden of hypertension and CKD, reducing morbidity and mortality in affected populations.
Background: Spacing in the midline of the natural dentition has long been a focus for Prosthodontists. The challenge often proves difficult, with the common approach being to incorporate the gap into the treatment plan, rather than attempting to eliminate it entirely. This is due to the fact that closing a midline diastema with a fixed prosthesis frequently leads to aesthetic compromises.
Case Presentation: In this article, 2 cases with excessive space in the anterior region are discussed. The prosthetic rehabilitation was done by using a modified FPD with loop connectors instead of a conventional FPD design. Using this method to restore patients’ natural smiles helped boost confidence and patient satisfaction.
Conclusion: Replacing a single anterior tooth is a complex and demanding procedure that can be successfully achieved using implant-supported restorations, conventional porcelain-fused-to-metal crowns, or resin-bonded fixed partial dentures. A range of aesthetic treatment options should be carefully considered when planning the best approach for such patients.
Background: Primary appendiceal lymphoma is exceedingly rare, representing less than 1% of appendiceal neoplasms. Its clinical presentation is usually indistinguishable from acute appendicitis, often leading to a diagnosis only after histopathological evaluation.
Case presentation: We report the case of a 14-year-old male who presented with acute right iliac fossa pain and underwent appendectomy for suspected appendicitis. The patient was operated on, and the tissue was sent for histopathology, where a diagnosis of primary appendiceal lymphoma was made. Histopathological analysis and immunohistochemistry revealed a diffuse large B-cell lymphoma that was immunopositive for CD20. The patient succumbed to death on the seventh post-operative day.
Conclusion: This case highlights the importance of routine histopathological examination of appendectomy specimens and the need for multidisciplinary management. A high suspicion of non-Hodgkin lymphoma is important for early diagnosis, so that patients will receive treatment in the early stage, which can lead to a better prognosis.
