Comparison of the prevalence of perforated appendicitis during and before COVID19 pandemic.

Objective: Coronavirus disease 2019 has significantly impacted the rate of emergency department visits among patients with the non-repository disease. Patients with acute appendicitis are also likely to delay their visit to the health care center, which can lead to complications including perforated appendicitis. The aim of this study was to compare the prevalence of perforated appendicitis during the COVID19 and pre-pandemic periods. Methods: This retrospective study was performed on all appendectomies performed during COVID-19, Group A, and one year earlier, Group B. A questionnaire comprising demographic variables (age, gender, occupation, education), clinical variables (white blood cell count, fever), location and type of appendicitis, the status of appendectomy, and duration of hospitalization was completed for all the patients included in the study. Results: The demographic variables were not significantly different among the two groups. The perforation appendicitis rate during the COVID19 pandemic increased compared to the previous year, The difference was not statistically significant. The number of negative appendectomy in group A was significantly less compared to group B. The mean time from the onset of pain to the time of referral was significantly lesser in group A. The mean length of hospital stay in group B was longer than in group A. In terms of fever, patients with perforated appendicitis in group B had a higher fever than in group A, which was statistically significant. Conclusion: A non-significant increase in the number of perforated appendicitis cases during the pandemic period. Duration of hospitalization and fever was significantly greater in pre-pandemic perforated appendicitis cases.

Thymulin treatment attenuates inflammatory pain by modulating spinal cellular and molecular signaling pathways.

Thymulin is a peptide hormone which is mainly produced by thymic epithelial cells and it has immune-modulatory and anti-inflammatory effects. In this study, we investigated the effects of different doses and various timings of thymulin intraperitoneal administration on spinal microglial activity and intracellular pathways in an inflammatory rat model of Complete Freund's adjuvant (CFA). Thymulin treatment was implemented following CFA-induced inflammation for 21 days. After conducting behavioral tests (edema and hyperalgesia), the cellular and molecular aspects were examined to detect the thymulin effect on inflammatory factors and microglial activity. We demonstrated that thymulin treatment notably reduced thermal hyperalgesia and paw edema induced by CFA. Furthermore, molecular investigations showed that thymulin reduced CFA-induced activation of microglia cells, phosphorylation of p38 MAPK and the production of spinal pro-inflammatory cytokines (TNF-α, IL-6) during the study. Our results suggest that thymulin treatment attenuates CFA-induced inflammation. This effect may be mediated by inhibition of spinal microglia and production of central inflammatory mediators which seems to be associated with the ability of thymulin to reduce p38 MAPK phosphorylation. These data provide evidence of the anti-hyperalgesic effect of thymulin on inflammatory pain and characterize some of the underlying spinal mechanisms.