28 research outputs found

    Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

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    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

    Genotype effects on energy and protein requirements in growing male goats.

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    Goat genotype may alter the net energy and protein requirements for maintenance (NEm and NPm, respectively) and weight gain (NEg and NPg).This study was designed to investigate and quantify the effect of goat type on NEm, NPm, NEg and NPg, and quantify the net requirements for energy and protein for dairy, meat and indigenous growing male goats. For that, comparative slaughter studies were gathered and a meta-analytical approach was used. Two distinct databases were organized: one composed of 233 individual records from 11 studies of meat (n = 81), dairy (n = 97) and indigenous (n = 55) growing male goats weighing from 4.50 to 51.0 kg, to depict NEm and NPm; and another database composed of 239 individual records from nine studies of meat (n = 87), dairy (n = 97) and indigenous (n = 55) growing male goats weighing from 4.30 to 51.0 kg, to depict NEg and NPg. Our findings showed that NEm of meat goats was 8.5% greater (336 ± 10.8 kJ/kg0.75 of empty BW; EBW) than dairy and indigenous goats (310 ± 8.20 kJ/kg0.75 EBW; P &lt; 0.05). Whereas, NPm was not affected by goat type (1.92 ± 0.239 g/kg EBW; P = 0.91). The NPg was 185.1 ± 1.82 g/kg of EBW gain for goats weighing 5 kg BW and 192.5 ± 4.33 g/kg of EBW gain for goats weighing 45 kg BW, and thus did not change across goat type (P = 0.12). On the other hand, NEg increased from 7.29 ± 0.191 to 11.9 ± 0.386 MJ/kg of EBW in male dairy goats, and from 7.32 ± 0.144 to 15.7 ± 0.537 MJ/kg of EBW in meat and indigenous growing male goats weighing between 5 and 45 kg BW. When body protein was used as a predictor in the allometric equation instead of EBW seeking to account for the degree of maturity, goat type differences disappeared; however, this predictor showed a high variation among individuals. In conclusion, energy and protein requirements for gain in distinct goat types reflect on body composition differences. Future research should focus on better understanding the maturity degree and its consequences in the energy requirement of growing male goats and better depict the goat type effect on it, as well as on the efficiency of utilization
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