Diagnostic performance of serum pentraxin-3 in pediatric acute appendicitis: a prospective diagnostic validation study.

INTRODUCTION: Pediatric acute appendicitis (PAA) is a pathology with a high rate of diagnostic error. The search for new diagnostic tools is justified by the high morbidity and healthcare costs associated with diagnostic error. METHODS: We designed a prospective study to validate serum pentraxin-3 (PTX3) as a diagnostic tool in PAA. Participants were divided into three groups: (1) patients with no underlying pathology (2) patients with non-surgical abdominal pain and (3) patients with a confirmed diagnosis of PAA. For further analyses, patients in group 3 were divided into complicated or uncomplicated PAA. Quantitative variables were expressed as medians and interquartile ranges and categorical variables as percentages. Quantitative variables were compared using the Kruskal-Wallis test and the Mann-Whitney U test. Diagnostic performance was evaluated with ROC curves. RESULTS: This study included 215 patients divided into group 1 (n = 63), group 2 (n = 53) and group 3 (n = 99). Median serum PTX3 values were 2.54 (1.70-2.95) ng/mL, 3.29 (2.19-7.64) ng/mL and 8.94 (6.16-14.05) in groups 1, 2 and 3, respectively (p = 0.001). Patients with complicated PAA showed significantly higher values than patients with uncomplicated PAA (p = 0.04). The AUC (group 2 vs. 3) was 0.77 (95% CI 0.69-0.85) and the best cut-off point was at 7.28 ng/mL, with a sensitivity of 61.3% and a specificity of 73.1%. The AUC (complicated vs. uncomplicated PAA) was 0.65 (95% CI 0.54-0.77) and the best cut-off point was 12.33 ng/mL, with a sensitivity of 51.72% and a specificity of 72.73%. CONCLUSIONS: The diagnostic ability of serum PTX3 in PAA is only moderate and therefore it cannot be considered a definitive diagnostic test. The discriminatory ability of PTX3 between complicated and uncomplicated PAA is poor. These findings, which contrast with those reported to date, should be validated with future properly designed prospective studies.

Encouraging natural ventilation to improve indoor environmental conditions at schools. Case studies in the north of Spain before and during COVID

The COVID pandemic has strongly affected daily life both in Spanish schools and worldwide. Providing the best environmental conditions for children allowing face-to-face learning with healthy and safe indoor spaces is a challenge. In the present study, empirical research about how these environmental conditions change with COVID is presented comparing the situation from March 2020 to January 2021. The methodology combines surveys conducted in nine schools with a case study in a selected school where a detailed monitoring of the building was developed during both heating seasons. This data analyzes the impact of the new COVID prevention protocols on indoor environmental conditions (especially those related to natural ventilation). Results show a mean CO2 reduction of 1,400ppm, having in the second term values around 1,000ppm, although temperatures diminished nearly 2°C to mean values of 18°C. Evolution of temperature and CO2 concentration throughout the day was also analyzed, being these indoor conditions especially important for the children with poorer health. Mechanical ventilation with heating recovery should complement natural ventilation, at least during the coldest months or hours of the day, although systems have to be carefully designed and installed to work effectively.