Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Comparison of the volatile antioxidant contents in the aqueous and methanolic extracts of a set of commercial spices and condiments

Spices are of great interest because their aromatic properties and to preserve food, with no or low nutritional value, and also as components of a healthy diet. The composition of the methanolic and aqueous extracts of commercial samples of Basil, Cinnamon powder, Cinnamon sticks, Clove, Cumin, Turmeric, Ginger, Nutmeg, Oregano, Rosemary and Thyme was studied as a first step in the relation of their antioxidant activities with the composition. Methods used were Gas Chromatography coupled with Mass Spectrometry (GC-MS) and High Performance Liquid Chromatography (HPLC). Extracts were prepared with an amount of the sample suspended in ultrapure water preheated at 100 oC or methanol at 60 ºC, stirring at room temperature and filtering; for GC-MS the extracts were dried and re-dissolved in methanol. To solve the problem in GC-MS with the flash-points of some compounds, both techniques have been combined. The contents in antioxidants of the different species are compared finding spices having much higher antioxidant contents in the methanolic extract than in water, other with aqueous extracts much rich in antioxidants than the alcoholic extracts, and spices with low antioxidant content in both extracts. For Clove, Turmeric, Ginger, Cinnamon, Rosemary and Cumin, it is recommended the use of lipid and/or alcoholic fractions for the food preparation. For Basil, Oregano, Thyme and Nutmeg, to extract most of their antioxidant content only water must be used. Knowledge of the composition in antioxidants can aid the food industry in the design of healthy foods and food preparations