Sensibilidad y especificidad del examen físico para el diagnóstico de apendicitis / Sensitivity an specificity of physical exam for the diagnosis of appendicitis

La apendicitis aguda es la emergencia quirúrgica más común en todo el mundo. En nuestra sala de emergencias, la discriminación inicial para el diagnóstico de la apendicitis se realiza basada únicamente en el examen físico del paciente. El objetivo del estudio es determinar la precisión del examen físico estandarizado para el diagnóstico de apendicitis aguda en el servicio de emergencia del Hospital General San Juan de Dios Diseño, lugar y partcipantes: todos los pacientes mayores de 12 años prospectvamente evaluados de abril a junio 2015 en el servicio de emergencia,cuyo motvo de consulta fue dolor abdominal y sospecha de apendicits. Se documentó la impresión clínica del examinador en base a la anamnesis y elexamen fsico estandarizado, la histopatología de los pacientes operados y el seguimiento a las 48h y a los 30 días de todos los pacientes.Resultados: se evaluaron 85 pacientes. El 61% de los pacientes fueron clasifcados por el investgador sin cuadro clínico de apendicits aguda. La sensibilidaddel examen fsico estandarizado para el diagnóstco de apendicits es de 75%, la especifcidad de 93%, el valor predictvo positvo de 92%, el valorpredictvo negatvo de 79%. El porcentaje de falsos positvos es de 3% y el porcentaje de falsos negatvos es del 12%.Conclusiones: el examen fsico estandarizado no es lo sufcientemente sensible para hacer el diagnóstco de apendicits aguda, por lo que es necesarioagregar estudios complementarios, así como considerar un período de observación intrahospitalaria antes de dar egreso a los pacientes basados únicamenteen el examen fisico.(AU)

Acute appendicits is the most common surgical emergency visit worldwide. In our emergency department, the inital evaluaton for thediagnosis of appendicits is made based solely on the physical examinaton. The aim of the study is to determine the accuracy of standardized physicalexaminaton for the diagnosis of acute appendicits in the emergency department of San Juan de Dios General Hospital.Design, Setng, and Partcipants: All patents over 12 evaluated from April to June 2015 in the emergency department, whose main complaint wasabdominal pain and suspected appendicits. Clinical diagnosis, histopathology and follow-up at 48h and 30 days for all patents were collected.Results: A total of 85 patents were studied, 61% were negatve for appendicits by clinical diagnosis. Standardized physical examinaton for the diagnosisof appendicits has 75% sensitvity, 93%specifcity, 92%positve predictve value, 79% negatve predictve value. The false positve rate is 3% andfalse negatve rate is 12%.Conclusions: the standardized physical examinaton is not sensitve enough for the diagnosis of acute appendicits. It is necessary to consider addingfurther studies as well as an observaton period before hospital discharge.

Ziprasidone in the treatment of delusional parasitosis.

Delusional parasitosis is characterized by a patient's fixed false belief of being infested with parasites or small creatures. The first-line treatment options are typical antipsychotics such as pimozide. However, the accompanying extrapyramidal side effects might limit their use. We report on a patient with a good response to pimozide combined with ziprasidone. Ziprasidone is an atypical antipsychotic drug with a lower risk of extrapyramidal symptoms; thus, it might be considered a good first or second treatment option for delusional parasitosis.

Association of CAPN1 316, CAPN1 4751 and TG5 markers with bovine meat quality traits in Mexico.

We examined allele and genotype frequencies for the molecular markers CAPN1 316, CAPN1 4751 and TG5, and determined whether they are associated with beef quality traits in Mexican cattle. One hundred and twenty-four longissimus dorsi muscle samples were collected from cattle from north, central and southern Mexico. CAPN1 316 and CAPN1 4751 frequencies were determined using the allelic discrimination assay and the TG5 marker was typed by PCR-RFLP. Meat quality traits included intramuscular fat content (IMF) and tenderness determined by Warner-Bratzler shear force (WBSF) at 24 h postmortem. The association test was made using a mixed model, including genotypes, genetic group, and sampling location as fixed effects. Least squares means and significant interactions were compared using least significant differences based on the mixed procedure. CAPN1 316 CC was found at a low frequency (0.03) and has been reported as a favorable genotype associated with tenderness meat. Genotype frequencies for CAPN1 4751 were similar in favorable (CC) and unfavorable (TT) genotypes (0.26 and 0.28, respectively). The TG5 CC genotype had a frequency of 0.73, while the TT genotype frequency was 0.01. The means for WBSF and IMF were 4.08 ± 1.35 kg and 5.23 ± 2.14%, respectively. Sampling site and the CAPN1 316 genotypes significantly affected WBSF (P < 0.05). Samples collected from Hermosillo, Sonora, had the lowest WBSF (P < 0.05), while those collected in Veracruz were toughest (WBSF = 5.267 kg). The effect of GG and TG5 genotypes on IMF was significant (P < 0.05). CAPN1 316 and TG5 markers were found to be significantly associated with beef quality traits and thus will be useful for Mexican beef characterization.

Unhealthy behaviours for self-management of HIV-related peripheral neuropathy.

The prevalence of peripheral neuropathy is frequent in HIV disease and is often associated with antiretroviral therapy. Unhealthy behaviours, particularly substance-use behaviours, are utilized by many HIV-positive individuals to manage neuropathic symptoms. As part of a larger study on self-care for symptoms in HIV disease, this study analyzed the prevalence and characteristics of unhealthy behaviours to self-manage peripheral neuropathy in HIV disease. Sociodemographic and disease-related correlates and unhealthy behaviours were examined in a convenience sample of 1,217 respondents who were recruited from data collection sites in several US cities, Puerto Rico, Colombia, and Taiwan. Results of the study indicated that respondents with peripheral neuropathy (n=450) identified a variety of unhealthy self-care behaviours including injection drug use, oral drug use, smoking cigarettes and alcohol ingestion. Specific unhealthy behaviours that participants reported to alleviate peripheral neuropathy included use of marijuana (n=67), smoking cigarettes (n=139), drinking alcohol (n=81) and street drugs (n=30). A subset of those individuals (n=160), who identified high levels of neuropathy (greater than five on a scale of 1-10), indicated significantly higher use of amphetamines and injection drug use in addition to alcohol use and cigarette smoking. For participants from Norway, substance use (using alcohol: 56%) was one of the most frequent self-management strategies. Implications for clinical practice include assessment and education of persons with HIV for self-care management of the complex symptom of peripheral neuropathy.

Characterization of beef semimembranosus and adductor muscles from US and Mexican origin.

The purpose of this study was to compare the chemical composition and sensory characteristics of two beef muscles (semimembranosus, SM and adductor, AD) from the inside round of Mexican and US origins. Inside rounds were obtained from 20 Mexican bull carcasses, representing beef of Mexican origin. Forty-vacuum packaged USDA Choice and Select inside rounds were purchased from a local trader, representing US beef. Muscles were analyzed for chemical composition, Warner-Bratzler shear force (WBSF), cooking loss percentage, instrumental color, textural profile, and consumer acceptability. Muscles imported from the US contained more intramuscular fat, had higher cooking loss percentages, lower shear force values, and higher consumer ratings for overall desirability than Mexican counterparts (P<0.05). Choice and Select beef samples had similar WBSF values (P>0.05). Consumers found differences in juiciness and tenderness ratings between the two muscles, with the SM being tougher and less juicy than the AD (P<0.05).

The effect of the limited availability of H2O2 in the competitive deposition of sulfur and oxidized nitrogen.

To understand the influence of the reduction of SO2 emissions from a single source in the S and N deposition around its local environment, the application of the Sulphur Transport Eulerian Model 2 (STEM-II) was introduced in this paper. Observed local deposition patterns were analysed and explained in terms of the main processes involved in the pollutants deposition. It was necessary to take into account the limited availability of H2O2 because of its influence on both S(IV) and oxidized nitrogen deposition. In order to estimate the quantitative relationship between the SO2 emissions reduction and the observed S and N deposition patterns, these processes were simulated for different meteorological conditions. Simulation results were in agreement with both observed deposition patterns and limited availability of H2O2, specially if significant changes in the S deposition patterns were considered. Both observed and estimated S deposition patterns changed their top value location from the Southwest (1990) to the Northwest (1997) of the domain, because of the reduction of dry deposition. The global reduction of total S depositions, estimated and observed, were in good agreement too. Model simulations could explain the higher S dry deposition reduction, considering the emissions reduction strategy applied.

[Perilymph gush. A complication of stapedectomy]. / Chorro de perilinfa. Complicación de la estapedectomía.

Report of an unusual complication of stapes surgery, called "perilymph gush", resolved with improved hearing and no vertigo.

[Subtypes of schizophrenics patients with attempted suicide]. / Subtipos de pacientes esquizofrénicos con tentativas suicidas.

INTRODUCTION: During the last decades, numerous research works have tried to determine what risk factors are associated with the schizophrenic patient's suicidal behavior but they have yielded contradictory results. Thus we hypothesized that these results' variability could be due, among other reasons, to the heterogeneity of suicidal schizophrenic population. MATERIAL AND METHOD: Thirty-two Schizophrenics patients who had made Attempted suicide were studied. They were assessed through a battery of Clinical scales for negative, positive, hopelessness, insight and depressive symptoms. RESULTS: Two suicidal subtypes were identified according to the reasons that patients stated for attempting suicide. These two subtypes showed significant differences in two of the analyzed variables, namely hopelessness and PANSS positive subscale. DISCUSSION: Clinical implications coming from these results are discussed in the present paper.

[Gushers. Perilymphatic leaks]. / Chorro de perilinfa. Complicación de la estapedectomía.

We report an unusual complication of stapedectomy called <>. It was resolved and the patient's hearing level improved without vertigo.

Hypofrontality in schizophrenia: influence of normalization methods.

1. Studies with Single Photon Emission Computed Tomography (SPECT) in schizophrenia research have utilized different approaches to normalization of data, such as cerebellar ratio and whole brain ratio methods, leading to conflicting findings. 2. The authors compared these two methods to test the hypofrontality hypothesis of schizophrenia. 3. Eighteen chronic and medicated DSM-IV schizophrenic patients and 10 healthy controls underwent two SPECT examinations using 99mTc HMPAO as a tracer at baseline and during frontal activation while applying the Wisconsin Card Sorting Test. 4. The hypofrontality hypothesis was supported with both indexes of relative perfusion, although the whole brain ratio method appeared to be more reliable and specific than the cerebellar ratio method. 5. Further studies are required to confirm these preliminary results on the specificity and sensitivity of both methods.