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

The reservoir status of rabbits for the maintenance of Ehrlichia ruminantium

The reservoir status of rabbits for a strain of Ehrlichia ruminantium was investigated using six experimental and four controlled rabbits. Each of the experimental animals was intraperitoneally inoculated with 1.5 ml of infective blood from a febrile goat. The effect of the parasite on body weight, packed cell volume, total protein and daily morning rectal temperature was monitored. Analysis of variance (ANOVA) revealed significant differences (p < 0.05) in packed cell volume, total protein and daily morning rectal temperature between the experimental and controlled rabbits. However, LSD test showed no differences between the samples. Following apparent non-reaction to the parasite after 28 days, 4 ml of pooled whole blood from the experimental rabbits was used to inoculate a susceptible goat in order to ascertain the potency of the parasite. The goat died after 15 days and brain squash smears prepared were positive for Ehrlichia ruminantium. The results of the current study indicate that rabbits might harbour the parasite without coming down with infection while retaining its infectivity. The study, therefore, suggests that rabbits might be useful in the maintenance of Ehrlichia ruminantium. Keywords: rabbits, reservoir status, Ehrlichia ruminantium. Nigerian Journal of Parasitology Vol. 29 (2) 2008: pp. 67-7

Transcultural Homo- and Transphobia

Negative attitudes toward homosexual and transsexual people are grounded on a number of reasons, ranging from sociocultural to psychological issues. Education, political and religious beliefs, and life experiences undoubtedly play pivotal roles. However, various factors weave together to cause discriminatory behavior toward lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals, with such discrimination currently identified as homophobia and transphobia. Moreover, those exhibiting sexual and gender variations are often ostracized by various components of society: schools and work places as well as health services. Thus, despite Western media attention often aimed at diminishing homophobia and transphobia, negative attitudes and behaviors toward LGBT people persist, and may have actually increased due to expanded coverage of the issue. Therefore, homophobia and transphobia prevention campaigns need to employ rigorous methods that include assessing possible risk factors that give rise to homophobic and transphobic attitudes and behaviors within culturally defined contexts. In this regard, an accurate and specific sociocultural and transcultural reflection should be undertaken so as to prevent discrimination of sexual minorities worldwide