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

Ethnobotany and traditional medicine of the inhabitants of the Pantanal Negro sub-region and the raizeiros of Miranda and Aquidauna, Mato Grosso do Sul, Brazil

A survey on the use of medical plants was carried out in the rural communities of the Rio Negro sub-region of the Pantanal and the raizeiros from Aquidauana and Miranda municipalities, Mato Grosso do Sul, Brazil, in order to recover the ethnobotanical and ethnopharmacological knowledge of these communities. Structured questionnaires were run with the residents of eight farms and 12 raizeiros. The results reveal 25 botanical families, 45 genera and 48 species of medicinal plants used, six of which are indicated for kidney disturbances, six for urinary disturbances, five for inflammation treatment, 13 for stomach aches, 10 for respiratory disturbances, four for treating sprains, four for healing wounds, four as anti-diarrheaic and one as antipyretic, among other illnesses. The main family was Asteraceae, with 12 species used. The principal preparation methods of the medicinal herbs in the Rio Negro sub-region and surrounding areas were infusion (35) and, mostly, mixed with "chimarrão" or "mate quente", traditional beverage. Nineteen exotic species are used by the raizeiros, (39.58%), which indicates a strong influence of the urban environment. The traditional pantaneiros have greater knowledge of medicinal plants than the raizeiros, and they cited only five exotic species (16.1%)