WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis

Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the WSES, held in Jerusalem (Israel), a panel of experts including an Organizational Committee and Scientific Committee and Scientific Secretariat, participated to a Consensus Conference where eight panelists presented a number of statements developed for each of the eight main questions about diagnosis and management of AA. The statements were then voted, eventually modified and finally approved by the participants to The Consensus Conference and lately by the board of co-authors. The current paper is reporting the definitive Guidelines Statements on each of the following topics: 1) Diagnostic efficiency of clinical scoring systems, 2) Role of Imaging, 3) Non-operative treatment for uncomplicated appendicitis, 4) Timing of appendectomy and in-hospital delay, 5) Surgical treatment 6) Scoring systems for intra-operative grading of appendicitis and their clinical usefulness 7) Non-surgical treatment for complicated appendicitis: abscess or phlegmon 8) Pre-operative and post-operative antibiotics.Peer reviewe

Survey of Borreliae in ticks, canines, and white-tailed deer from Arkansas, U.S.A.

<p>Abstract</p> <p>Background</p> <p>In the Eastern and Upper Midwestern regions of North America, <it>Ixodes scapularis</it> (L.) is the most abundant tick species encountered by humans and the primary vector of <it>B. burgdorferi,</it> whereas in the southeastern region <it>Amblyomma americanum</it> (Say) is the most abundant tick species encountered by humans but cannot transmit <it>B. burgdorferi.</it> Surveys of Borreliae in ticks have been conducted in the southeastern United States and often these surveys identify <it>B. lonestari</it> as the primary <it>Borrelia</it> species, surveys have not included Arkansas ticks, canines, or white-tailed deer and <it>B. lonestari</it> is not considered pathogenic. The objective of this study was to identify <it>Borrelia</it> species within Arkansas by screening ticks (n = 2123), canines (n = 173), and white-tailed deer (n = 228) to determine the identity and locations of Borreliae endemic to Arkansas using PCR amplification of the flagellin (<it>flaB)</it> gene.</p> <p>Methods</p> <p>Field collected ticks from canines and from hunter-killed white-tailed were identified to species and life stage. After which, ticks and their hosts were screened for the presence of <it>Borrelia</it> using PCR to amplify the <it>flaB</it> gene. A subset of the positive samples was confirmed with bidirectional sequencing.</p> <p>Results</p> <p>In total 53 (21.2%) white-tailed deer, ten (6%) canines, and 583 (27.5%) Ixodid ticks (252 <it>Ixodes scapularis</it>, 161 <it>A. americanum</it>, 88 <it>Rhipicephalus sanguineus</it>, 50 <it>Amblyomma maculatum,</it> 19 <it>Dermacentor variabilis,</it> and 13 unidentified <it>Amblyomma</it> species) produced a <it>Borrelia flaB</it> amplicon. Of the positive ticks, 324 (22.7%) were collected from canines (151 <it>A. americanum,</it> 78 <it>R. sanguineus</it>, 43 <it>I. scapularis,</it> 26 <it>A. maculatum,</it> 18 <it>D. variabilis</it>, and 8 <it>Amblyomma</it> species) and 259 (37.2%) were collected from white-tailed deer (209 <it>I. scapularis,</it> 24 <it>A. maculatum,</it> 10 <it>A. americanum,</it> 10 <it>R. sanguineus</it>, 1 <it>D. variabilis</it>, and 5 <it>Amblyomma</it> species). None of the larvae were PCR positive. A majority of the <it>flaB</it> amplicons were homologous with <it>B. lonestari</it> sequences: 281 of the 296 sequenced ticks, 3 canines, and 27 deer. Only 22 deer, 7 canines, and 15 tick <it>flaB</it> amplicons (12 <it>I. scapularis</it>, 2 <it>A. maculatum</it>, and 1 <it>Amblyomma</it> species) were homologous with <it>B. burgdorferi</it> sequences.</p> <p>Conclusions</p> <p>Data from this study identified multiple Borreliae genotypes in Arkansas ticks, canines and deer including <it>B. burgdorferi</it> and <it>B. lonestari;</it> however, <it>B. lonestari</it> was significantly more prevalent in the tick population than <it>B. burgdorferi</it>. Results from this study suggest that the majority of tick-borne diseases in Arkansas are not <it>B. burgdorferi.</it></p