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

TWO NEW SPECIES OF CERCARIAE CERCARIA VII AND VIII N. SP. FROM FRESHWATER SNAILS IN MALABAR, KERALA

Two new species of cercariae, Cercaria sp. VII Malabarn. Sp. and Cercaria sp. VIII Malabarn.sp. infecting Thiara tuberculata and IndoplanOrbis exustus, respectively are described and their systematic position discusssed. The Snails were collected from irrigation canals at Kanhilleri in Malabar. Kerala

TWO NEW SPECIES OF CEPHALINE GREGARINES (APICOMPLEXA : CEPHALINA) FROM COMMERCIAL MARINE PRAWNS

Two species of cephaline gregarines, Nematopsis dobsonin.sp. and N. kannurensis n.sp. infecting the marine prawns, Metapenaeus dobsoni and M. monoceros have been reported, respectively

Two new species of furcocercous cercariae infecting the fresh water snail, Thiara tuberculata (Muller) in Kozhikode and Malappuram districts of Kerala

Two new species of furcocercous cercariae, Cercaria sp. XVI Malabar n. sp. and Cercaria sp. XVII Malabar n. sp. were recovered from the freshwater snail, Thiara tuberculata in the Malabar region of Kerala. Cercaria sp. XVI Malabar n. sp., a pharyngeate, longifurcate furcocercous cercaria with two pairs of penetration glands and 10 pairs of flame cells was recovered from T. tuberculata collected from Kundayithode in Kozhikode district and Nilambur in Malappuram district of Kerala. Cercaria sp. XVII Malabar n. sp., another pharyngeate, longifurcate cercaria with a rudimentary ventral sucker was recovered from the same snail host collected from Nilambur in Malappuram district. Sporocysts of Cercaria sp. XVI Malabar n. sp. developed in the hepatopancreas, while that of Cercaria sp. XVII Malabar n. sp. were found developing in both hepatopancreas and stomach wall. The present paper describes the new species of cercariae in detail and compares them with related species to establish their systematic position

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Not AvailableTwo new species of furcocercous cercariae, Cercaria sp. XVI Malabar n. sp. and Cercaria sp. XVII Malabar n. sp. were recovered from the freshwater snail, Thiara tuberculata in the Malabar region of Kerala. Cercaria sp. XVI Malabar n. sp., a pharyngeate, longifurcate furcocercous cercaria with two pairs of penetration glands and 10 pairs of flame cells was recovered from T. tuberculata collected from Kundayithode in Kozhikode district and Nilambur in Malappuram district of Kerala. Cercaria sp. XVII Malabar n. sp., another pharyngeate, longifurcate cercaria with a rudimentary ventral sucker was recovered from the same snail host collected from Nilambur in Malappuram district. Sporocysts of Cercaria sp. XVI Malabar n. sp. developed in the hepatopancreas, while that of Cercaria sp. XVII Malabar n. sp. were found developing in both hepatopancreas and stomach wall. The present paper describes the new species of cercariae in detail and compares them with related species to establish their systematic position.Not Availabl

Two new species of xiphidiocercariae from the apple snail Pila virens in Malabar, Kerala

Two new species of xiphidiocercariae, Cercaria sp. XIV Malabar n. sp. and Cercaria sp. XV Malabar n. sp. were recovered from the apple snail Pila virens collected from freshwater bodies in the Malabar region of Kerala. Cercaria sp. XIV Malabar n. sp. was recovered from P. virens collected from Modakkallur in Kozhikode district and Cercaria sp. XV Malabar n. sp. from the same snail species collected from Payyanur in Kannur district. Sporocysts were also recovered from the infected snail hosts. The two new species of cercariae are described in detail and compared with related species to establish their systematic position

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Not AvailableTwo new species of xiphidiocercariae, Cercaria sp. XIV Malabar n. sp. and Cercaria sp. XV Malabar n. sp. were recovered from the apple snail Pila virens collected from freshwater bodies in the Malabar region of Kerala. Cercaria sp. XIV Malabar n. sp. was recovered from P. virens collected from Modakkallur in Kozhikode district and Cercaria sp. XV Malabar n. sp. from the same snail species collected from Payyanur in Kannur district. Sporocysts were also recovered from the infected snail hosts. The two new species of cercariae are described in detail and compared with related species to establish their systematic position.Not Availabl

Four new species of virgulate xiphidiocercariae infecting the freshwater snail, Bithynia (Digoniostoma) pulchella (Benson, 1836) in Malabar, Kerala

The present paper describes four new species of virgulate xiphidiocercariae infecting the freshwater gastropod, Bithynia (Digoniostoma) pulchella (Benson, 1836) collected from Malabar, Kerala. Cercaria sp. XXII Malabar n. sp. has a spinose body and tail; four pairs of penetration glands; short, narrow oesophagus; a pair of short, unequal caeca; bicornuate excretory vesicle and 18 pairs of flame cells. Cercaria sp. XXIII Malabar n. sp. is characterized by an oval, spinose body; aspinose tail; dagger-shaped stylet; medially fused virgula; globular pharynx; short oesophagus; three pairs of penetration glands; bicornuate, ‘V’-shaped excretory bladder, and 18 pairs of flame cells. Cercaria sp. XXIV Malabar n. sp. has a spinose body and tail, medially fused virgula, muscular pharynx, short prepharynx and oesophagus; four pairs of penetration glands; bicornuate, ‘V’-shaped excretory bladder, and 12 pairs of flame cells. Cercaria sp. XXV Malabar n. sp. has a spinose body, aspinose tail, sac-like virgula; globular pharynx, narrow oesophagus; short caeca; four pairs of penetration glands; transversely elongated, bicornuate excretory bladder, and 12 pairs of flame cells. All four cercariae developed in sporocysts within the digestive gland of B. (D.) pulchella. Morphology and morphometry of the cercariae are compared with related species to establish their systematic position