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

Produtividade e teor de sólidos solúveis de frutos de cultivares de morangueiro em ambiente protegido Yield and soluble solids contents of fruits of strawberry cultivars in protected cultivation

O cultivo protegido é uma alternativa para controlar variações climáticas em diferentes locais e épocas de plantio, entretanto, seus efeitos e interações com a cultura do morangueiro ainda são pouco conhecidos. O objetivo desse trabalho foi avaliar a influência de três sistemas de cultivo (túnel alto, túnel baixo e a campo) na produtividade, massa média de frutos e no teor de sólidos solúveis dos frutos das cultivares de morango Dover, Camarosa, Sweet Charlie e Oso Grande em Guarapuava-PR. Quanto à produtividade e massa média de frutos, a cultivar Camarosa foi a melhor nos cultivos em túnel, tanto alto quanto baixo, pelo seu excelente desempenho. Os frutos da cultivar Sweet Charlie apresentaram o maior teor de sólidos solúveis nos três ambientes de cultivo. A produtividade e a massa média dos frutos foram significativamente superiores nos cultivos em túneis, alto e baixo, quando comparados ao cultivo a campo. O ambiente que propiciou maior acúmulo de sólidos solúveis nos frutos foi o túnel alto, diferindo significativamente dos demais ambientes de cultivo.<br>Protected cultivation is an alternative to control the climatic effects in different places and times of planting, however, its effects and interactions with the strawberry crop are little known. The goal of this study was to evaluate the effects of three cropping systems (high tunnel, low tunnel and field) on yield, mean fruit mass and the soluble solids contents of strawberry cultivars Dover, Camarosa, Sweet Charlie and Oso Grande in Guarapuava. Camarosa cultivar presents an excellent performance regarding yield and mean fruit mass in high and low tunnel cultivation; hence, these cropping system can be indicated. Fruits of Sweet Charlie cultivar had the highest content of soluble solids in all the cultivation environments. Yield and mean fruit mass obtained from high and low tunnels were significantly higher than in the field. The environment high tunnel allowed greater accumulation of soluble solids, differing significantly from other evaluated environments

Efect of antiseptic gels in the microbiologic colonization of the suture threads after oral surgery

Te work was supported by the Oral Medicine, Oral surgery and Implantology Unit. School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain.Three diferent bioadhesive gels were evaluated in a double-blind randomized clinical trial in which microbial growth in the suture thread was assessed following post-surgical application of the aforementioned gels. Also assessed in this trial were, the intensity of post-surgical pain as well as the degree of healing of the patients’ surgical wounds. A total of 21 patients (with 42 wisdom teeth) participated in this trial. Chlorhexidine gel, chlorhexidine-chitosan gel, and hyaluronic acid gel were evaluated, with a neutral water-based gel serving as the control agent. The aerobic and facultative anaerobic bacterial recovery on blood agar was lower in the placebo group than in the experimental groups. The most signifcant diference (p=0.04) was observed in the chlorhexidine-chitosan group. in which the growth of Blood Agar and Mitis Salivarius Agar was signifcantly higher than in the placebo group. The intensity of post-surgical pain was very similar among all the groups. Signifcantly better healing rates were observed in the patients treated with chlorhexidine-chitosan gel when compared with those who used the placebo gel (p=0.03), and in particular when compared with those patients who used hyaluronic acid gel (p=0.01). Through our microbiological analyses, we were able to conclude that none of the bioadhesive gels tested resulted in benefcial reductions in the bacterial/fungal populations. However, the healing rates of patients who were treated with chlorhexidine-chitosan were better than those of the patients who used either the placebo gel or the hyaluronic acid gel