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

In vitro characterization of solute transport in the spinal canal

This paper presents results of an experimental investigation of solute transport in a simplified model of the spinal canal. The work aims to provide increased understanding of the mechanisms responsible for drug dispersion in intrathecal drug delivery (ITDD) procedures. The model consists of an annular channel bounded externally by a rigid transparent tube of circular section, representing the dura mater, and internally by an eccentric cylindrical compliant insert, representing the spinal cord. The tube, closed at one end, is connected to a rigid acrylic reservoir, representing the cranial cavity. The system is filled with water, whose properties are almost identical to those of the cerebrospinal fluid. A programmable peristaltic pump is employed to generate oscillatory motion at frequencies that are representative of those induced by the cardiac and respiratory cycles. Laser induced fluorescence is used to characterize the dispersion of fluorescent dye along the canal and into the cranial cavity for different values of the relevant Womersley number and different eccentricities of the annular section. The present work corroborates experimentally, for the first time, the existence of a steady bulk flow, associated with the mean Lagrangian motion, which plays a key role in the transport of the solute along the spinal canal. The measurements of solute dispersion are found to be in excellent agreement with theoretical predictions obtained using a simplified transport equation derived earlier on the basis of a two-timescale asymptotic analysis. The experimental results underscore the importance of the eccentricity and its variations along the canal and identifies changes in the flow topology associated with differences in the Womersley number, with potential implications in guiding future designs of ITDD protocols

Guía de Práctica Clínica del Síndrome de Wolfram (DIDMOAD)

Esta Guía surge de la necesidad existente de facilitar información, tanto a profesionales de sanidad, como a investigadores y personas afectadas directa o indirectamente por el Síndrome de Wolfram. Esta obra pretende incrementar el conocimiento de los profesionales del Sistema Sanitario Público en este síndrome. Por lo tanto, esperamos que mejore la atención sanitaria al colectivo afectado por este síndrome. Así pues, esta Guía se plantea como un instrumento que permita orientar a los profesionales, implicados en la asistencia a pacientes que sufren la enfermedad, ayudándolos en la toma de decisiones y disminuyendo la variabilidad en la práctica clínica, al fundamentarse en una metodología rigurosa. Lo que repercutirá directamente en los afectados, ya que aumentará las posibilidades de que los profesionales puedan responder a los problemas y necesidades inherentes a dicha enfermedad. Así como, elaborar información personalizada según las características de cada afectado por el síndrome. Por último, esperaremos conseguir ayudar a los pacientes, familiares y allegados

Los Mayas de Quintana Roo y la economía de la identidad

The economic importance of tourism, its expansion to areas previously far from the accumulation processes and the use of ethnic and cultural diversity for tourist attraction purposes, is an unavoidable fact in the contemporary globalized world. This article analyzes the use of Mayan identity by a business group of great economic power. Its purpose is to discuss the identity economy among the Mayan peoples in Quintana Roo, Mexico, as one of the most refined examples of the use of indigenous cultures by the tourist capital and to draw attention to the instrumental use of ethnic identity by tourism companies that are part of the large global entertainment chains.La importancia económica del turismo en numerosos países, su expansión hacia áreas antes alejadas de los procesos de acumulación y el uso que se hace de la diversidad étnica y cultural con fines de atracción turística, es un hecho insoslayable en el mundo globalizado contemporáneo.  En este artículo se analiza el uso de la identidad maya por un grupo empresarial  de gran poder económico. Tiene el propósito de problematizar en torno a la economía de la identidad entre los pueblos mayas en Quintana Roo, México, como uno de los ejemplos más acabados sobre el uso de las culturas indígenas por  el capital turístico.  Con ello se busca llamar la atención sobre la uso instrumental de la identidad étnica por parte de las empresas turísticas que forman parte de las grandes cadenas globales del ocio y del espectáculo.