Nuetrophil-To-Lymphocyte Ratio (NLR) as a Predictor of Acute Appendicitis

Objective: To determine the diagnostic accuracy of (NLR) neutrophil-to-lymphocyte ratio to prognosticate severe/ complicated appendicitis by taking histopathology of the appendix as a gold standard.Methodology: This cross-sectional validation study was conducted at the department of surgery and western vascular institute, University College Hospital Galway, Irelandretrospectively for a period of 6 months i.e. from 05/06/2016 to 05/01/2016. For sampling in this study, non-probability purposive convenience technique was used. An informed consent was taken from each patient. All data were analyzed on SPSS version 21.Results: The mean age of patients in this study was 29.15±9.54 years, the ratio of male to female was 1:1.7. The sensitivity, Specificity was 97.1% and 25.2% respectively and diagnostic accuracy of NLR was 38.7% taking histopathology as gold standard.Conclusion: According to our study results the (NLR) neutrophil-to-lymphocyte ratio is a highly sensitive tool to predict severe/ complicated appendicitis by taking histopathology as the gold standard, but with low value of diagnostic accuracy in terms of specificity

Clinical Accuracy of Inflammatory Markers Combined with Ultrasound in Acute Appendicitis

Objective: To determine the clinical accuracy of inflammatory markers combined with ultrasound, in acute appendicitis keeping histopathology as gold standard.Study design: Cross Sectional (validation) study.Study setting: Surgical B ward, Department of Surgery Khyber teaching hospital Peshawar.Duration of Study: 07 months i.e from 1st September 2014 to 31st of Mar, 2015Methodology: All patients having acute appendicitis were subjected to blood sampling for CRP, TLC and neutrophil%. After that all these patients were subjected to ultrasonography to detect the presence or absence of appendicitis. All removed appendices were sent for histopathology which was taken as the gold standard.Results In the present study, TLC had the highest sensitivity (77.68%) followed by neutrophil% (69.96%), CRP (67.10%) and U/Sound (62.96%) respectively. While U/Sound had the highest specificity (70.59%) followed by CRP and TLC (64.71% each) and neutrophil% (58.82%) respectively. When all the four tests were combined   the sensitivity, specificity, (99.17% and 98.45%) increased significantly. It was seen that when all the four tests were negative, appendicitis could be safely ruled out and surgery could be deferred in these patients.It would reduce the rate of negative appendicectomies.Conclusion: TLC  contains  important  diagnostic   information  and  hence  should  always  be included in  the diagnostic  workup of  acute appendicitis.  The sensitivity of   CRP and Neut. % is low individually, but when combined with TLC and u/sound the sensitivity and specificity increases significantly. But it is stressed that history and clinical examination by a skilled surgeon still remain important in diagnosing acute appendicitis, and its importance cannot be denied. The investigations can be used as an adjuvant to a surgeon’s clinical diagnosis

¿Puede el Estado de derecho ser una herramienta eficiente de planificación de políticas para el desarrollo sostenible en Asia?

Sustainable Development is currently overriding problem in UN Millennium agenda of 21st century. Recently, is considered purely a matter of rule of law. Rule of law are now considered as bedrock for Sustainable Development in Asia. Keeping in view, this study evaluates the importance of Rule of law for Sustainable Development policy planning in after taking into consideration of 12 Asian countries over the period of 1984 up to 2012. The analysis depicts that rule of law is primarily important for Sustainable Development policy planning in Asia. For empirical analysis, we estimated the results through dynamic panel data model approach.El Desarrollo Sostenible actualmente es el principal problema en la agenda del Milenio de las Naciones Unidas del siglo XXI. Recientemente, se considera puramente una cuestión de estado de derecho. El estado de derecho ahora se considera la piedra angular del desarrollo sostenible en Asia. Teniendo en cuenta, este estudio evalúa la importancia del Estado de derecho para la planificación de políticas de desarrollo sostenible después de tener en cuenta a 12 países asiáticos durante el período de 1984 a 2012. El análisis muestra que el estado de derecho es principalmente importante para la política de desarrollo sostenible planificación en Asia. Para el análisis empírico, estimamos los resultados a través del enfoque del modelo de datos de panel dinámico

EVALUATION OF AQUEOUS FRUIT EXTRACT OF TAMARINDUS INDICA (L) FOR INHIBITION OF TUMOR NECROSIS FACTOR-a AND CYCLO OXYGENASE ENZYMES IN EXPERIMENTAL ANIMAL

 Objective: The main objective of this study was to assess tumor necrosis factor-α (TNF)-α and cyclooxygenase enzymes (COX) inhibition potency of Tamarindus indica Linn. in comparison to standard drug (indomethacin).Methods: Three plants are selected for the studies, namely: Aloe vera (L.), Terminalia chebula Reitz., and T. indica Linn. Estimation of TNF-α in serum (at 1:10 dilution in PBS) was performed using the immunoenzymatic (ELISA) technique. COX inhibitor screening assay kits were used for estimation of COX.Result: All three plant extracts showed a potent significant inhibition of the COX enzyme as compared to the positive control and standard drug when the animal was administered with 400 mg/kg. These studies indicate that the T. indica plant extract showed significant COX inhibition even at low dose. All the extracts were effective anti-inflammatory in nature, however, T. indica extracts at a dose of 400 mg/kg were found to be most potent. It was found to be comparable with that of Indomethacin 10 mg/kg body weight.Conclusion: The anti-inflammatory activity expressed by all the three plants A. vera (L.), T. chebula Reitz., and T. indica L. Among all three plants T. indica (L) was found to be more active against both TNF-α and COX, and it was comparable to standard drug Indomethacin. Need further studies to elucidate the exact secondary metabolite by which these plants express this activity

Tourists’ Attitude Towards Cultural Heritage and their Willingness to Pay to Visit: a Case Study of Lahore, Pakistan

Tourists’ interest in traveling to Lahore (more specifically to the Badshahi Mosque and the Royal fort) has increased in recent years and is expected to continue. Despite this, very few facts are known about an individual's attitude towards cultural heritage. This study looks at the pre- and post- visit factors that encourage tourists to come to the cultural heritage sites and also identifies variables that help to estimate their willingness to pay (WTP) for admission to visit them. The data from 200 tourists was collected through a well-prepared questionnaire and then used in the final analysis. The contingent valuation method (CVM), considered to be the most useful, with a dichotomous choice question, was used to estimate the WTP. Two models were used in estimating the WTP, i.e. binary regression and ordinary least squares (OLS). The findings acknowledged that tourists were interested in retaining happy memories, experiences and knowledge through the visit. More than 75% of the tourists were willing to pay for cultural heritage, had a positive attitude toward it and would like to visit these destinations again. Tourists’ income was a positive and significant determiner of WTP; the total cost of the visit and environmental issues were negatively related to WTP. As tourism provides an important source of income, the findings of this study point to some practical recommendations that may be implemented in the future by local authorities.L'interesse dei turisti a recarsi a Lahore (più specificamente alla moschea di Badshahi e al Forte reale) è aumentato negli ultimi anni e l’incremento dovrebbe continuare. Nonostante ciò, si hanno pochissime informazioni sull'atteggiamento delle persone nei confronti del patrimonio culturale. Questo studio esamina i fattori pre e post visita che incoraggiano i turisti a recarsi nei siti del patrimonio culturale e identifica anche variabili che aiutano a stimare la loro disponibilità a pagare (WTP) per visitarli. I dati di 200 turisti sono stati raccolti attraverso un questionario ben preparato e poi utilizzati nell'analisi finale. Il metodo di valutazione contingente (CVM), considerato il metodo più utile, con una domanda a scelta dicotomica, è stata utilizzato per stimare il WTP. Per la stima del WTP sono stati utilizzati due modelli, ovvero la regressione binaria e i minimi quadrati ordinari (OLS). I risultati hanno evidenziato che i turisti erano interessati a conservare ricordi, esperienze e conoscenze positive durante la visita. Più del 75% dei turisti è disposto a pagare per il patrimonio culturale, ha un atteggiamento positivo nei suoi confronti e vorrebbe visitare nuovamente queste destinazioni. Il reddito dei turisti è stato un fattore positivo determinante e significativo del WTP; il costo totale della visita e le questioni ambientali erano correlate negativamente al WTP. Poiché il turismo fornisce un'importante fonte di reddito, i risultati di questo studio forniscono alcune raccomandazioni pratiche che potrebbero essere implementate in futuro dalle autorità locali

Psychological Assessment of Health Care Workers in Intensive Care Units During the COVID-19 Pandemic

ABSTRACT Background Fear and depression are common to any pandemic particularly in healthcare workers as they are in the front line to treat the diseased. Such a state directly affects the performance of the health system and the patients who are seeking care. This study aimed at assessing the psychological effect of COVID-19 among the healthcare workers in the intensive care units of two tertiary care hospitals of Rawalpindi & Islamabad.   Methods It was a descriptive cross-sectional study, conducted over five months i.e., 1st July 2020 to 1st November 2020. Non-probability consecutive sampling technique was used for recruiting health care workers. PHQ-9 tool was used including 9 questions (items) related to the depression due to COVID-19. Other tool Fear of COVID-19 scale was based on 5 points Likert scale as ‘strongly disagree’, ‘disagree’, ‘neutral’, ‘agree’ and ‘strongly agree’. Besides descriptive frequencies, mean and standard deviation, Spearman correlation (r) was applied to check the correlation between fear of COVID-19 with age (years) and professional experience (years).   Results Out of 382 healthcare workers (doctors, nurses & other staff) recruited in the study, around 50% were found to be suffering from severe depression and have developed a fear of the disease. A significant positive correlation was observed between the age of the healthcare worker and the degree of fear of COVID-19 (p<0.05). Similarly, a significant positive correlation was observed between the number of professional experience and the fear of COVID-19 (p<0.05).   Conclusion It is concluded that healthcare workers in ICU are at risk of depression because of fear of COVID-19. The current situation highlights the areas that need attention. Special training or orientation must be arranged for a situation of an outbreak or a pandemic and skills for keeping one’s psychological wellbeing and mental health must be imparted. KEYWORDS: Fear; Depression; Psychological impact; COVID-19, Healthcare workers, Pakista

Fundamentals of Density Functional Theory: Recent Developments, Challenges and Future Horizons

Density Functional Theory (DFT) is a powerful and commonly employed quantum mechanical tool for investigating various aspects of matter. The research in this field ranges from the development of novel analytical approaches focused on the design of precise exchange-correlation functionals to the use of this technique to predict the molecular and electronic configuration of atoms, molecules, complexes, and solids in both gas and solution phases. The history to DFT’s success is the quest for the exchange-correlation functional, which utilizes density to represent advanced many-body phenomena inside one element formalism. If a precise exchange-correlation functional is applied, it may correctly describe the quantum nature of matter. The estimated character of the exchange-correlation functional is the basis for DFT implementation success or failure. Hohenberg-Kohn established that every characteristic of a system in ground state is a unique functional of its density, laying the foundation for DFT, which is being utilized to explore the novelty of materials. This chapter is aimed to present an overview of DFT by explaining the theoretical background, commonly used approximations as well as their recent developments and challenges faced along-with new horizons

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability