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

Tract-specific analysis improves sensitivity of spinal cord diffusion MRI to cross-sectional and longitudinal changes in amyotrophic lateral sclerosis

© 2020, The Author(s). Amyotrophic lateral sclerosis (ALS) is a late-onset fatal neurodegenerative disease that causes progressive degeneration of motor neurons in the brain and the spinal cord. Corticospinal tract degeneration is a defining feature of ALS. However, there have been very few longitudinal, controlled studies assessing diffusion MRI (dMRI) metrics in different fiber tracts along the spinal cord in general or the corticospinal tract in particular. Here we demonstrate that a tract-specific analysis, with segmentation of ascending and descending tracts in the spinal cord white matter, substantially increases the sensitivity of dMRI to disease-related changes in ALS. Our work also identifies the tracts and spinal levels affected in ALS, supporting electrophysiologic and pathologic evidence of involvement of sensory pathways in ALS. We note changes in diffusion metrics and cord cross-sectional area, with enhanced sensitivity to disease effects through a multimodal analysis, and with strong correlations between these metrics and spinal components of ALSFRS-R

The determinants of the choice of treatment of pregnant women in Cameroon

This paper seeks to identify the determinants of the choice of treatment of pregnant women in Cameroon. Theoretically, the methodology is based on a discrete choice model with random utility. Empirically, the econometric specification is a Nested Multinomial Logit Model. The data used comes from the Demographic Health Survey (DHS) organized in 2011 by the National Institute of Statistics. The results reveal that uneducated women or those having only a primary education prefer to meet the traditional midwives than seek modern maternal health services. Moreover, the absence of a paid job for the pregnant woman, the large size of the household, Islamic or animist religion, poverty, high costs of healthcare and transportation are constraints which make the pregnant woman to prefer the services of traditional midwives to modern services of maternal health. The use of modern healthcare services by pregnant women in Cameroon can therefore be improved by at least two means: firstly, by improving on the level of education of women and economically empowering them. Secondly, in a context where the costs of healthcare services are paid directly by the pregnant women themselves or by their families, it is important to put in place health insurance schemes in order to guarantee proper follow-up of pregnant women until delivery as well as taking care of complicated cases

A virological investigation into declining woylie populations

The woylie (Bettongia penicillata ogilbyi) is a critically endangered small Australian marsupial that is in a state of accelerated population decline for reasons that are currently unknown. The aim of the present study was to elucidate the involvement of several viral pathogens through strategic serological testing of several wild woylie populations. Testing for antibodies against the Wallal and Warrego serogroup of orbiviruses, Macropod herpesvirus 1 and Encephalomyocarditis virus in woylie sera was undertaken through virus neutralisation tests. Moreover, testing for antibodies against the the alphaviruses Ross River virus and Barmah Forest virus and the flaviviruses Kunjin virus and Murray Valley encephalitis virus was undertaken through virus neutralisation tests and ELISA mainly because of the interest in the epidemiology of these important zoonoses as it was considered unlikely to be the cause of the decline. Between 15 and 86 samples were tested for each of the four sites in south-western Australia (Balban, Keninup, Warrup and Karakamia). Results indicated no exposure to any of the viral pathogens investigated, indicating that all populations are currently naïve and may be at risk if these pathogens were to be introduced

Assessing the Continuum of Care Pathway for Maternal Health in South Asia and Sub-Saharan Africa

OBJECTIVE: We assess how countries in regions of the world where maternal mortality is highest - South Asia and Sub-Saharan Africa - are performing with regards to providing women with vital elements of the continuum of care. METHODS: Using recent Demographic and Health Survey data from nine countries including 18,036 women, descriptive and multilevel regression analyses were conducted on four key elements of the continuum of care - at least one antenatal care visit, four or more antenatal care visits, delivery with a skilled birth attendant and postnatal checks for the mother within the first 24 hours since birth. Family planning counseling within a year of birth was also included in the descriptive analyses. RESULTS: Results indicated that a major drop-out (more than 50%) occurs early on in the continuum of care between the first antenatal care visit and four or more antenatal care visits. Few women (less than 5%) who do not receive any antenatal care go on to have a skilled delivery or receive postnatal care. Women who receive some or all the elements of the continuum of care have greater autonomy and are richer and more educated than women who receive none of the elements. CONCLUSION: Understanding where drop-out occurs and who drops out can enable countries to better target interventions. Four or more ANC visits plays a pivotal role within the continuum of care and warrants more programmatic attention. Strategies to ensure that vital services are available to all women are essential in efforts to improve maternal health