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

Microbial metabolites as biological control agents in food safety

Ensuring food safety and at the same time meeting such demands for retention of nutrition and quality attributes have resulted in increased interest in alternative preservation techniques for inactivating microorganisms and enzymes in foods. This increasing demand has opened new dimensions for the use of natural preservatives derived from plants, animals, or microflora. Extensive research has investigated the potential application of natural antimicrobial agents in food preservation. Especially the significance and use of microbes as producers of antimicrobial metabolites has increased significantly during the last decades. Reported studies have demonstrated that microbial metabolites from microorganisms exhibited a great numbers of diverse and versatile biological effects about antimicrobial activities. These microorganisms produce many compounds that are active against other microorganisms, which can be harnessed to inhibit the growth of potential spoilage or pathogenic microorganisms. These include fermentation end products (metabolites) such as organic acids, hydrogen peroxide, and diacetyl, biofilm, exopolysaccharides in addition to bacteriocins and other antagonistic compounds such as reuterin. Up to now, antimicrobial metabolites from lactic acid bacteria (such as nisin) have been mostly used in food preservation. In addition to lactic acid bacteria, some yeast, mold, and another bacteria species as well as some pathogenic bacteria can produce antimicrobial metabolites. Antimicrobial metabolites present in foods can extend the shelf life of unprocessed or processed foods by reducing the microbial growth rate or viability. This offers a new knowledge-based approach to the exploitation of bacteria for food production, from metabolic engineering of microorganisms to produce antimicrobials or nutritionals, to the molecular mining of activities as yet unknown but which could benefit food production. In addition, the availability of the genomes of many food pathogenic and spoilage bacteria may open up new possibilities for the design of novel antimicrobials which target essential functions of these problematic bacteria. In this chapter, antimicrobial metabolites from microorganism in food safety as a biocontrol agent reviewed. © 2014, Springer Science+Business Media New York