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

Impacts of ocean acidification on multiplication and caste organisation of parasitic trematodes in their gastropod host

Ocean acidification is predicted to impact the structure and function of all marine ecosystems in this century. As focus turns towards possible impacts on interactions among marine organisms, its effects on the biology and transmission potential of marine parasites must be evaluated. In the present study, we investigate two marine trematode species (Philophthalmus sp. and Parorchis sp., both in the family Philophthalmidae) infecting two marine gastropods. These trematodes are unusual in that their asexually multiplying stages within snails display a division of labour, with two distinct castes, a large-bodied morph producing infective stages and a smaller morph playing a defensive role against other competing parasites. Using a potentiometric ocean acidification simulation system, we test the impacts of acidified seawater (7.8 and 7.6 pH) on the production of free-living infective stages (cercariae), the size and survival of encysted resting stages (metacercariae), and the within-host division of labour measured as the ratio between numbers of the two morphs. In general, low pH conditions caused an increase in cercarial production and a reduction in metacercarial survival. The ratio of the two castes within snail hosts tended to shift towards more of the smaller defensive morphs under low pH. However, the observed effects of reduced pH were species specific and not always unimodal. These results suggest that ocean acidification can affect the biology of marine parasites and may also impact transmission success and parasite abundance of some trematodes, with possible consequences for marine communities and ecosystems