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

Absonifibula estuarina sp. n. (Monogenea: Diclidophoridae) parasite of juvenile Cynoscion guatucupa (Osteichthyes) from southwestern Atlantic Ocean

Absonifibula estuarina sp. n. (Diclidophoridae, Absonifibulinae), is described from the gills of juvenile striped weakfish, Cynoscion guatucupa (Cuvier), from the southwestern Atlantic, Argentinean coast. This marine fish migrates to estuarine areas to spawn where exclusively juveniles are found parasitized; adult fish in marine water were never found to be parasitized by this monogenean. A. estuarina sp. n. is characterized mainly by the pedunculate clamps dissimilar in size, the shape of anterior jaw with sclerite 'a' attached to a sub-trapezoidal lamellate extension and fused to sclerites 'c' and 'd'. It differs from Absonifibula bychowskyi Lawler & Overstreet, 1976, the only known species of the genus, in the shape and arrangement of the genital corona, which is armed with six similar hooks disposed in circle and the sub-trapezoidal shape of lamellate extension ('b'). The restriction to juvenile sciaenids is a shared feature among the Absonifibulinae indicating an estuary-dependent life cycle

Updated list of bat species positive for rabies in Brazil Lista atualizada das espécies de morcegos positivas para raiva no Brasil

This paper presents an updated list of bat species positive for rabies in Brazil. It was developed based on database research via the internet, of international and national literature and annals of the most important technical and scientific meetings related to rabies and chiroptera in Brazil from 1996 to 2009. The new list of rabies positive bats consists of 41 species, belonging to 25 genera and three families: Phyllostomidae 43.9%, Vespertilionidae 29.3% and Molossidae 26.8%. In addition, questions were raised regarding the lack of data, including sex, age, circumstances and location of bat capture and incomplete and outdated species identification. Results of genetic and antigenic studies performed on Brazilian rabies positive bats were shown.<br>Esse artigo apresenta uma lista atualizada de espécies positivas para raiva no Brasil e foi desenvolvida a partir da base de dados na internet da literatura nacional, internacional e dos anais das mais importantes reuniões técnicas e científicas, envolvendo raiva e morcegos no Brasil durante o período de 1996 a 2009. A nova lista de morcegos positivos para raiva consiste de 41 espécies, pertencentes a 25 gêneros e três famílias: Phyllostomidae 43.9%, Vespertilionidae 29.3% e Molossidae 26.8%. Também foram discutidas questões como a falta de dados sobre sexo, faixa etária e circunstâncias de captura dos animais e identificação incompleta ou desatualizada das espécies. Resultados dos estudos genéticos e antigênicos realizados em amostras de morcegos brasileiros positivos para raiva foram apresentados