The clinical characteristics and outcomes of appendicitis in a population with a high HIV-infection prevalence
Introduction: In Botswana, the prevalence of HIV-infection is high (20.1%). Literature on characteristics of appendicitis in a high HIV-infection prevalence is limited. Method: A retrospective medical records review was conducted in patients admitted with a diagnosis of appendicitis and known HIV-in...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-12-01
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| Series: | African Journal of Emergency Medicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2211419X2200074X |
| _version_ | 1828221685211332608 |
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| author | Alemayehu Ginbo Bedada Alemayehu Bekele Eshetu |
| author_facet | Alemayehu Ginbo Bedada Alemayehu Bekele Eshetu |
| author_sort | Alemayehu Ginbo Bedada |
| collection | DOAJ |
| description | Introduction: In Botswana, the prevalence of HIV-infection is high (20.1%). Literature on characteristics of appendicitis in a high HIV-infection prevalence is limited. Method: A retrospective medical records review was conducted in patients admitted with a diagnosis of appendicitis and known HIV-infection status to adult surgical wards at Princess Marina Hospital from 2013 to 2019. Patients’ demographics, clinical characteristics, laboratory data, management and outcomes were analysed. Results: A total of 601 appendicitis patients with known HIV-infection status were identified. Males contributed 51.9%. The overall median age was 29-year: 25-year for HIV-negative patients (HIV-NP) and 36-year for HIV-positive patients. HIV-NP had significantly higher rate of WBC count >10,000/μL, p=0.034. Appendectomy was performed in 92.8% of the cases. Non-operative treatment failure rate in one year was 35.4%. A total of 58 complications were recorded including 20 surgical site infections (SSIs) and one mortality in HIV-NP and 11 SSIs and six mortalities in HIV-positive patients (HIV-PP). HIV-PP had significantly higher mortality than HIV-NP, p=0.010. The overall hospital stay between operated and non-operated patients, p=0.996 and hospital stay between HIV-NP and HIV-PP were not different, p=0.223. Female patients had a significantly higher normal appendix and chronic appendicitis rates than males, p=0.032 and p=0.018 respectively. Complex appendicitis was associated with longer pre-hospital symptom duration, p=0.008 and longer hospital stay, p= 0.001, but it was not related to mortality, p=1.000. Among operated HIV-PP, patients with CD4 count <200 had a significantly higher mortality rate than those with ≥200, p=0.043. Conclusion: In Botswana, the prevalence of HIV-infection in patients with appendicitis was higher than the rate in the general population. HIV-infection and low CD4 count had an adverse effect on the mortality of patients with appendicitis. The higher HIV-infection rate in appendicitis patients and the impact of antiretroviral drug and viral-load on the outcomes in HIV-PP worth investigating. |
| first_indexed | 2024-04-12T16:44:58Z |
| format | Article |
| id | doaj.art-203ee2feba564b76ac277d4e8b0db3ce |
| institution | Directory Open Access Journal |
| issn | 2211-419X |
| language | English |
| last_indexed | 2024-04-12T16:44:58Z |
| publishDate | 2022-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | African Journal of Emergency Medicine |
| spelling | doaj.art-203ee2feba564b76ac277d4e8b0db3ce2022-12-22T03:24:37ZengElsevierAfrican Journal of Emergency Medicine2211-419X2022-12-01124418422The clinical characteristics and outcomes of appendicitis in a population with a high HIV-infection prevalenceAlemayehu Ginbo Bedada0Alemayehu Bekele Eshetu1Department of Surgery, Faculty of Medicine, University of Botswana, Princess Marina Hospital, Gaborone, Botswana; Corresponding author.Department of Pathology, Faculty of Medicine, University of Botswana, Gaborone, BotswanaIntroduction: In Botswana, the prevalence of HIV-infection is high (20.1%). Literature on characteristics of appendicitis in a high HIV-infection prevalence is limited. Method: A retrospective medical records review was conducted in patients admitted with a diagnosis of appendicitis and known HIV-infection status to adult surgical wards at Princess Marina Hospital from 2013 to 2019. Patients’ demographics, clinical characteristics, laboratory data, management and outcomes were analysed. Results: A total of 601 appendicitis patients with known HIV-infection status were identified. Males contributed 51.9%. The overall median age was 29-year: 25-year for HIV-negative patients (HIV-NP) and 36-year for HIV-positive patients. HIV-NP had significantly higher rate of WBC count >10,000/μL, p=0.034. Appendectomy was performed in 92.8% of the cases. Non-operative treatment failure rate in one year was 35.4%. A total of 58 complications were recorded including 20 surgical site infections (SSIs) and one mortality in HIV-NP and 11 SSIs and six mortalities in HIV-positive patients (HIV-PP). HIV-PP had significantly higher mortality than HIV-NP, p=0.010. The overall hospital stay between operated and non-operated patients, p=0.996 and hospital stay between HIV-NP and HIV-PP were not different, p=0.223. Female patients had a significantly higher normal appendix and chronic appendicitis rates than males, p=0.032 and p=0.018 respectively. Complex appendicitis was associated with longer pre-hospital symptom duration, p=0.008 and longer hospital stay, p= 0.001, but it was not related to mortality, p=1.000. Among operated HIV-PP, patients with CD4 count <200 had a significantly higher mortality rate than those with ≥200, p=0.043. Conclusion: In Botswana, the prevalence of HIV-infection in patients with appendicitis was higher than the rate in the general population. HIV-infection and low CD4 count had an adverse effect on the mortality of patients with appendicitis. The higher HIV-infection rate in appendicitis patients and the impact of antiretroviral drug and viral-load on the outcomes in HIV-PP worth investigating.http://www.sciencedirect.com/science/article/pii/S2211419X2200074XAppendicitisClinical characteristicsHIV-infectionHistopathologyOutcomes |
| spellingShingle | Alemayehu Ginbo Bedada Alemayehu Bekele Eshetu The clinical characteristics and outcomes of appendicitis in a population with a high HIV-infection prevalence African Journal of Emergency Medicine Appendicitis Clinical characteristics HIV-infection Histopathology Outcomes |
| title | The clinical characteristics and outcomes of appendicitis in a population with a high HIV-infection prevalence |
| title_full | The clinical characteristics and outcomes of appendicitis in a population with a high HIV-infection prevalence |
| title_fullStr | The clinical characteristics and outcomes of appendicitis in a population with a high HIV-infection prevalence |
| title_full_unstemmed | The clinical characteristics and outcomes of appendicitis in a population with a high HIV-infection prevalence |
| title_short | The clinical characteristics and outcomes of appendicitis in a population with a high HIV-infection prevalence |
| title_sort | clinical characteristics and outcomes of appendicitis in a population with a high hiv infection prevalence |
| topic | Appendicitis Clinical characteristics HIV-infection Histopathology Outcomes |
| url | http://www.sciencedirect.com/science/article/pii/S2211419X2200074X |
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