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

Chemical constituents and pharmacological profile of Gunnera manicata L. extracts

Gunnera perpensa L. (Gunneraceae) is a native South African plant widely used in traditional medicine as an antibacterial and antifungal. In southern Brazil there is the native species called Gunnera manicata L. that also belongs to the Gunneraceae. Nevertheless, there is no information about chemical and pharmacological properties of South American Gunnera species. Therefore this study aimed at assessing the phytochemical and pharmacological profiles of aqueous and methanol Brazilian G. manicata extracts. The results showed that antimicrobial activity in an agar diffusion assay was effective against Staphylococcus aureus and Candida albicans . Phenolic compounds were investigated by liquid chromatography coupled with a tandem mass spectrometer (LC-MS/MS) and all extracts presented gallic acid and only the methanol extract obtained from the leaves exhibited hyperoside. Rutin, quercetin and chlorogenic acid were not found in the samples analysed. Total phenolic content was higher in methanol extract and total flavonoid content was low in all extracts. Antioxidant activity was evaluated by the 2,2-diphenyl-1-picryl-hydrazyl (DPPH) radical test, and all samples presented good to moderate antioxidant activity. These results encourage complementary studies on the chemical composition of the plant extracts focusing on isolation and structure elucidation of their active compounds