Conservative Versus Surgical Management of Acute Appendicitis: A Systematic Review.

Recent studies have discussed the role of antibiotic treatment in the conservative management of acute appendicitis and whether antibiotics are a safe option to replace appendicectomy, which has been the gold standard treatment of acute appendicitis for many years. The bibliographic databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, Embase, Medline, and PubMed comparing conservative versus surgical treatment of acute appendicitis were systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Twenty-one studies consisting of systematic reviews and meta-analyses involving 44,699 participants were identified. At least 17,865 participants were treated with antibiotics. Our studies compare antibiotic versus appendicectomy among acute appendicitis patients ranging from 7 to 94 years of age. In most studies, patients received parenteral antibiotics for a total of one to three days, and oral antibiotics such as oral cephalosporin plus metronidazole, oral amoxicillin/clavulanate, oral fluoroquinolones plus Tinidazole upon hospital discharge for a total of 7 to 10 days. The total course of antibiotics for both parenteral and oral regimes ranged from 2 to 16 days, with 10 days being the commonest duration. The recurrence rate following initial antibiotic treatment at one-year follow-up ranged from 13% to 38%, while the mean duration of recurrence ranged from three to eight months. The majority of the patients with recurrence underwent appendicectomy, while some patients were either given a repeat or different course of antibiotics due to the possible presence of antibiotic resistance; however, only 2.4% of the patients were successfully treated upon completion of the second course of antibiotics. Most of the studies concluded that appendicectomy remains the gold standard treatment for uncomplicated acute appendicitis, given its higher efficacy and lower complication rates. Although antibiotic treatment cannot be routinely recommended, it can be considered an appropriate alternative in selected patients with uncomplicated appendicitis who wish to avoid surgery and also acknowledge the risk of recurrence and the potential need for subsequent surgery at the same time.

A paleogenome from a Holocene individual supports genetic continuity in Southeast Alaska.

Many specifics of the population histories of the Indigenous peoples of North America remain contentious owing to a dearth of physical evidence. Only few ancient human genomes have been recovered from the Pacific Northwest Coast, a region increasingly supported as a coastal migration route for the initial peopling of the Americas. Here, we report paleogenomic data from the remains of a ∼3,000-year-old female individual from Southeast Alaska, named Tatóok yík yées sháawat (TYYS). Our results demonstrate at least 3,000 years of matrilineal genetic continuity in Southeast Alaska, and that TYYS is most closely related to ancient and present-day northern Pacific Northwest Coast Indigenous Americans. We find no evidence of Paleo-Inuit (represented by Saqqaq) ancestry in present-day or ancient Pacific Northwest peoples. Instead, our analyses suggest the Saqqaq genome harbors Northern Native American ancestry. This study sheds further light on the human population history of the northern Pacific Northwest Coast.

Overcoming health inequalities by using the Bug Busting 'whole-school approach' to eradicate head lice.

AIMS AND OBJECTIVES: The aim of this paper was to illustrate the socially inclusive nature of the Bug Busting 'whole-school approach' to head louse eradication. BACKGROUND: In the UK, Belgium and Denmark, persistent head lice in families of all socio-economic status (SES) is a problem. Since 1995 in the UK and 1998 elsewhere, an educational programme intended to teach families how to detect and treat head lice by using the Bug Busting wet combing method has been organized in some areas. Local schools lead this community strategy for prevention, known as a 'whole-school approach' (UK). DESIGN AND METHODS: We describe five studies applying the Bug Busting approach, four set in districts where some disadvantaged families live (UK and Belgium) and a fifth set in Denmark. Feasibility and consumer satisfaction are examined. One UK study analyses data on area prescribing for head lice and the impact in a deprived locality of raising the profile of Bug Busting. RESULTS: We find parental education in Bug Busting enables families of all SES to participate in a 'whole-school approach' to head lice. Best results are obtained when each family has a Bug Buster Kit. This provides all the combs necessary with full instructions on their use with ordinary shampoo and conditioner to detect lice, eradicate an infestation mechanically, or to check the success of any treatment. In the UK, the promotion of the Bug Busting approach is reducing primary care expenditure on treatment for head lice and professional time spent with worried parents. As a result, healthcare providers can give time to the few families who require one-to-one guidance. RELEVANCE TO CLINICAL PRACTICE: Incorporation of the Bug Busting approach to head lice into clinical practice in school communities contributes to sustainable control whilst overcoming health inequalities in participating families.