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Abstract
Background: Acute Appendicitis is the most common cause of emergency cases worldwide, and it may have serious consequences. If there is no precise diagnosis, it poses a dreadful issue for the community. Researchers tried to use several markers to determine the definitive diagnosis of Appendicitis. Our research thus sought to determine the various Toll-like receptor TLR1, TLR4, and TLR5 concentrations in the blood of patients suspected of Appendicitis as a diagnostic predictor. Method: This study conducted a case-control analysis on patients diagnosed with Appendicitis in the operating room at Al-Sadr Teaching Hospital and Al-Shifaa Teaching Hospital in Basra, Iraq. The control group was randomly chosen between July 2023 and November 2023. a total of 88 samples were enrolled in the study. Seventy of these samples came from patients experiencing signs and symptoms of Appendicitis. In contrast, the remaining eighteen samples were collected from apparently healthy controls (AHC) who were identical to the patient's group in terms of age, gender, habitat, and other characteristics but did not experience any appendicitis symptoms. Ethical approval was obtained from the Basra Health Department for data collection. Results: According to the findings of this investigation, the immunological markers TLR1 and TLR4 were statistically significant at a level of (P≤0.05) between the serum samples of patients and the control groups. the median concentration of (TLR1 and TLR4) were (14.70 ,10.89 ng/ml) respectively than control group (8.15 ,6.98 ng/ml), statistically show highly significant (P-= 0.000), while the median concentration of TLR5 in appendicitis patients was lower (3.11 ng/ml) than control (3.77 ng\ml), without any significant differences (p=0.185). Conclusion: The serum concentration of TLR1 and TLR4 has the potential to predict the diagnosis of appendicitis.
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References
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References
A. A. Shah et al., “Daytime versus nighttime laparoscopic appendectomy in term of complications and clinical outcomes: A retrospective study of 1001 appendectomies,” Heliyon, vol. 8, no. 12, 2022.
S. Di Saverio et al., “Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines,” World J. Emerg. Surg., vol. 15, pp. 1–42, 2020.
M. K. Barman, K. Das, and K. Mukherjee, “Use of Ripasa Score in the Diagnosis of Acute Appendicitis: A Pilot Study from West Bengal,” India. J Med Sci Clin Res, 2019.
D. P. Wickramasinghe, C. Xavier, and D. N. Samarasekera, “The worldwide epidemiology of acute appendicitis: an analysis of the global health data exchange dataset,” World J. Surg., vol. 45, pp. 1999–2008, 2021.
T. Vos et al., “Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019,” Lancet, vol. 396, no. 10258, pp. 1204–1222, 2020.
N. Williams and P. R. O’Connell, Bailey & Love’s short practice of surgery. CRC press, 2008.
M. Y. Neufeld et al., “Where did the patients go? Changes in acute appendicitis presentation and severity of illness during the coronavirus disease 2019 pandemic: a retrospective cohort study,” Surgery, vol. 169, no. 4, pp. 808–815, 2021.
L. W. Lamps, “Infectious causes of appendicitis,” Infect. Dis. Clin., vol. 24, no. 4, pp. 995–1018, 2010.
Z. Pogorelić and T. Čohadžić, “A bizarre cause of acute appendicitis in a pediatric patient: An ingested tooth,” Children, vol. 10, no. 1, p. 108, 2023.
K. Harju, “Toll-like receptors (TLR) 4 and 2 regulate the innate immune response: study of endotoxin influence in mice,” 2004.
F. M. Mahmoud, N. M. Darwish, R. A. Hassan, and N. M. Abou Shady, “Evaluation of CD64 detection on neutrophils and TLR-2 on monocytes by flowcytometry as markers for early diagnosis of neonatal sepsis,” Int. J. Adv. Res., vol. 2, no. 7, pp. 1235–1247, 2014.
Y. Nouri, R. Weinkove, and R. Perret, “T-cell intrinsic Toll-like receptor signaling: Implications for cancer immunotherapy and CAR T-cells,” J. Immunother. Cancer, vol. 9, no. 11, 2021.
B. Sevinç, E. Turan, H. Kurku, and Ö. Karahan, “Role of CA125 in the Diagnosis of Acute Appendicitis,” Eurasian J. Emerg. Med., vol. 16, no. 2, p. 62, 2017.
N. Stankovic et al., “Possible cytokine biomarkers in pediatric acute appendicitis,” Ital. J. Pediatr., vol. 45, pp. 1–9, 2019.
B. B. Chittawadgi, S. C. Mhetre, and B. B. Chittawadgi, “A morphometric analysis of diameter of blood vessels in relation to degree of eosinophils and basophils (mast cells) infiltration for analysis of severity and prognosis of acute appendicitis,” Indian J Pathol Oncol, vol. 3, no. 3, pp. 463–469, 2016.
S. Bibi, K. Saqib, M. Saleem, A. Jaddan, H. Ahmad, and H. Rana, “Role of white blood cell count in diagnostic accuracy of acute appendicitis: WBC count for appendicitis,” J. Aziz Fatimah Med. Dent. Coll., vol. 3, no. 2, pp. 56–60, 2021.
K. Zuhoor, “A1-gaithy. Clinical value of total white blood cells and neutrophil counts in patients with suspected appendicitis: retrospective study,” World J Emerg Surg, vol. 7, p. 32, 2012.
A. Arlt et al., “Characteristic changes in microbial community composition and expression of innate immune genes in acute appendicitis,” Innate Immun., vol. 21, no. 1, pp. 30–41, 2015.
L. Alexopoulou et al., “Hyporesponsiveness to vaccination with Borrelia burgdorferi OspA in humans and in TLR1-and TLR2-deficient mice,” Nat. Med., vol. 8, no. 8, pp. 878–884, 2002.
N. T. Funderburg, J. K. Jadlowsky, M. M. Lederman, Z. Feng, A. Weinberg, and S. F. Sieg, “The Toll‐like receptor 1/2 agonists Pam3CSK4 and human β‐defensin‐3 differentially induce interleukin‐10 and nuclear factor‐κB signalling patterns in human monocytes,” Immunology, vol. 134, no. 2, pp. 151–160, 2011.
S. De Kivit, M. C. Tobin, C. B. Forsyth, A. Keshavarzian, and A. L. Landay, “Regulation of intestinal immune responses through TLR activation: implications for pro-and prebiotics,” Front. Immunol., vol. 5, p. 60, 2014.
M. M. Aboudounya and R. J. Heads, “COVID-19 and toll-like receptor 4 (TLR4): SARS-CoV-2 may bind and activate TLR4 to increase ACE2 expression, facilitating entry and causing hyperinflammation,” Mediators Inflamm., vol. 2021, pp. 1–18, 2021.
S. Liu et al., “The immune impact of mimic endoscopic retrograde appendicitis therapy and appendectomy on rabbits of acute appendicitis,” Oncotarget, vol. 8, no. 39, p. 66528, 2017.
X. He, H. Wang, T. Jin, Y. Xu, L. Mei, and J. Yang, “TLR4 activation promotes bone marrow MSC proliferation and osteogenic differentiation via Wnt3a and Wnt5a signaling,” PLoS One, vol. 11, no. 3, p. e0149876, 2016.
Z. PÉTerfi, K. Kovács, A. Antal, and B. Kocsis, “Anti‐lipopolysaccharide antibodies in acute appendicitis detected by ELISA,” Apmis, vol. 114, no. 4, pp. 265–269, 2006.
I. Smirnova, A. Poltorak, E. K. L. Chan, C. McBride, and B. Beutler, “Phylogenetic variation and polymorphism at the toll-like receptor 4 locus (TLR4),” Genome Biol., vol. 1, no. 1, pp. 1–10, 2000.
N. J. Carr, “The pathology of acute appendicitis,” Ann. Diagn. Pathol., vol. 4, no. 1, pp. 46–58, 2000.
G. F. G. Bezemer and J. Garssen, “TLR9 and COVID-19: a multidisciplinary theory of a multifaceted therapeutic target,” Front. Pharmacol., vol. 11, p. 601685, 2021.