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.

Gene flow between natural and domestic populations of Lutzomyia longipalpis (Diptera: Psychodidae) in a restricted focus of American visceral leishmaniasis in Venezuela.

The epidemiology of the visceral leishmaniasis in the Americas is associated with both a natural and a domestic cycle. The existence of reproductively isolated populations of Lutzomyia longipalpis (Lutz & Neiva), and the scarcity of records of this species from natural habitats in areas where it has been associated with domestic habitats indicated that natural populations could be genetically distinct from domestic ones. Therefore, we compared the genetic structure and estimated the gene flow between L. longipalpis from domestic and peridomestic habitat and from an adjacent undisturbed natural environment along a 1.2-km transect. The analyses were performed on electrophoretic data from eight isozyme loci. The absence of fixed differences in the diagnostic loci Ak and Hk indicated that all specimens belonged to one of the two cryptic species identified in Venezuela. The average number of alleles per locus ranged from 2.0 to 2.9 and the average heterozygosity ranged from 7.8 to 13.4%. No differences were detected in the genetic structure of this species from domestic or peridomestic habitats and those trapped as far as 1.2 km from human dwellings. Nm, estimated from Wright's Fst, indicated that at least 208 individuals per generation migrated between the peridomestic habitat and a 1.2-km distant point to maintain the observed similarities in allelic frequencies. This high rate of gene flow indicated that this species has high migration rates between domestic and natural environments, and has the potential to transport for Leishmania from natural to domestic environments.