An Analytical Study to Test the Validity of the New Questionnaire for the Diagnosis of Irritable Bowel Syndrome

INTRODUCTION: Irritable bowel syndrome (IBS) is a functional bowel disorder in which abdominal pain or discomfort is associated with defecation or a change in bowel habit. Bloating, distension, and disordered defecation are commonly associated features. IBS is a common condition, affecting approximately 3% to 15% of the general population based on various diagnostic criteria. There seem to be differences in disease epidemiology between the eastern and the western world. As data from larger Asian epidemiological studies begin to surface, however, such differences appear to be less marked. Irritable bowel syndrome is a relapsing functional bowel disorder defined by symptom-based diagnostic criteria, in the absence of detectable organic causes. The symptomatic array is not specific for IBS, as such symptoms may be experienced occasionally by almost every individual. To distinguish IBS from transient gut symptoms, experts have underscored the chronic and relapsing nature of IBS and have proposed diagnostic criteria based on the occurrence rate of symptoms. The global picture of IBS prevalence is far from complete, with no data available from several regions. The prevalence of IBS is increasing in countries in the Asia–Pacific region, particularly in countries with developing economies. Estimates of the prevalence of IBS (using the Rome II diagnostic criteria) vary widely in the Asia–Pacific region. In addition, comparisons of data from different regions are often problematic due to the use of different diagnostic criteria, as well as the influence of other factors such as population selection, inclusion or exclusion of co morbid disorders (e.g., anxiety), access to health care, and cultural influences. Several attempts have been made to define the diagnostic criteria for IBS. Each attempt implies shortcomings in the previous ones. So , is the new questionnaire proposed by the WGO for diagnosis for Health Care Professionals to diagnose IBS. Present study was undertaken to find the usefulness of this questionnaire against the existing Rome III criteria. AIMS AND OBJECTIVES: 1. To study the validity of the questionnaire in patients with IBS 2. To compare against Rome III criteria. 3. To study the usefulness in delineating patients with IBS and other bowel diseases like IBD, Colonic cancer when compared with Rome III criteria. MATERIALS AND METHODS: This study is an analytical study conducted in a major public hospital from June 2009 to September 2009 and included a total of 52 patients. The reference population is Tamil speaking population belonging to lower and low middle socio – economic status attending government hospitals. The study population was taken from the Medical Gastroenterology out patient department and wards. Inclusion Criteria: Males and females with chronic abdominal pain / discomfort with duration of >3 months associated with disturbed defecation. Exclusion Criteria: 1. Those with known Ulcerative Colitis. 2. Those with known Crohn’s disease. 3. Those with known thyroid dysfunction. 4. Those with known abdominal malignancy. 5. Those with known abdominal tuberculosis. 6. Pregnant women. The questionnaire released by the World Gastroenterology Organization consists of 21 questions with points for questions 1 -16. The questions were translated into Tamil with the help of a team consisting of two non medicos with proficiency in Tamil, two non medicos with proficiency in English and two medicos. The questions were asked from the Tamil version to patients. And literate persons who volunteered to fill the questionnaire themselves were also encouraged to do so. A standardized pro forma was used to cover the subject’s age, education, duration of illness, past medical & surgical illness and concurrent medications. Also included were history of upper GI symptoms like bloating, dyspepsia & nausea. History of passing worms in stools was also elicited. CONCLUSIONS: 1. Comparing this questionnaire with ROME III criteria, the sensitivity of Rome(97%) was slightly higher than questionnaire (93%). 2. The specificity was much higher for questionnaire (83%) than Rome (14%). 3. The predictive value of a positive test and negative test were definitely higher with the questionnaire (98% and 62%) as against the Rome (88% and 50%). 4. The percentage of false positives was low with questionnaire (16%) against (86%) Rome. 5. The percentage of false negatives was only slightly higher in questionnaire (6%) than Rome (2%). Thus it is concluded that, The new questionnaire is definitely useful in identifying patients with IBS. Also it is more specific for IBS, reducing the need for invasive and costly procedures. And with this questionnaire the disadvantage of missing organic bowel disease is eliminated making this recommendable in patients with bowel disturbance of all age group. And this questionnaire can be used by primary care physicians and also paramedical staff and thereby guide those patients who will need further assessment by a Gastroenterologist. Therefore, the new questionnaire released by the WGO is better than the currently existing Rome III criteria

Influence of Beta Blockers on Complications of Cirrhosis

INTRODUCTION: Histologically cirrhosis, a chronic liver disease is characterized by fibrosis and the alteration of normal liver architecture into abnormal nodules. In the west, it is the leading cause of mortality, particularly affecting the productive age population. In our country, an estimated 188,575 cirrhosis related death in 2010 which is 18.3% of the universal burden of the disease. And the deaths due to cirrhosis increased globally from 2005 to 2015, whereas age-standardized cirrhosis mortality rates fell during the same period. The economic burden, the disease poses on the family of the patient and the patient’s loss of productive life has been overseen largely. The complications of cirrhosis are protean including portal hypertension, ascites, hepatorenal syndrome, hepatic encephalopathy, portal vein thrombosis, hepatocellular carcinoma and eventually death. Besides the complications that are disease driven, certain complications are worsened by the therapies instituted for the management of cirrhosis, of which beta blockers which have been used for managing portal hypertension since the 1980s when Lebrec et al. first demontsrated the usefulness of non selective beta blockers in a randomized controlled trial involving 74 patients with variceal bleeding, has recently drawn the interest of researchers and hepatologists worldwide, when concerns of its safety in advanced cirrhosis was raised by Serste. AIM OF THE STUDY: Aimed to analyze the impact of beta blockers on the following complications in cirrhosis: 1. Spontaneous bacterial peritonitis (SBP), 2. Refractory ascites, 3. Hepatorenal syndrome (HRS) and 4. Hepatic encephalopathy (HE). In patients who did or did not take non-selective beta blockers and thereby to test the null hypothesis that beta blockers cause worsening of the above mentioned complications. MATERIALS AND METHODS: Study Design: Single centre, case control retrospective study. Study centre: Department Of Digestive Health and Diseases, Kilpauk Medical College and Hospital, Kilpauk Medical College, Chennai. Period of Study: 2 years (January 2015 to January 2017). Study population: In Patients and Outpatients having cirrhosis and portal hypertension who were registered with the Department of Digestive Health and Disease between the period January 2009 to January 2016. Inclusion criteria: Patients having cirrhosis with portal hypertension. Exclusion criteria : Patients who had significant cardiovascular disease, extrahepatic malignancy, intrinsic renal disease and those not willing to provide consent were excluded from this study. METHODOLOGY Patients were identified from a prospectively collected data base. The following parameters were recorded at the time of enrollment to study: age, sex, duration of disease, number of hospital admissions for cirrhosis related illnesses, history of diabetes, history of upper gastrointestinal bleeding, presence of cirrhotic cardiomyopathy, portal vein thrombosis. Biochemical parameters such as complete blood count, renal function test, and liver function test were done. The MELD[5] and CTP[6,7] score were calculated based on the bilirubin, creatinine, PT/INR, albumin, presence of ascites and Hepatic Encephalopathy. RESULTS: A total of 82 patients were included in this study. The mean age of the entire cohort was 47.91 years. Predominantly our cohort had male patients (n=65, 79.3%). The overall mean duration of disease was 1.5 years. The common etiology for liver cirrhosis was ethanol (n = 61, 74.39%), followed by Chronic viral Hepatitis B (n = 9, 10.97%) cryptogenic, non alcoholic steatohepatitis and Hepatitis C. Four patients had both Hepatitis B and significant alcohol consumption. CONCLUSIONS: In this study , no significant statistical association was found between the NSBB group versus the non NSBB group in terms of the following 4 complications of cirrhois: 1. Spontaneous Bacterial peritonitis, 2. Refractory Ascites, 3. Hepatorenal syndrome, 4. Hepatic encephalopathy, To conclude, in this study non selective beta blockers are neither protective nor a risk factor for spontaneous bacterial peritonitis, refractory ascites, hepatorenal and hepatic encephalopathy. And therefore, we suggest that beta blockers can be continued safely in cirrhotics

DatChain -- Blockchain implementation in Data transfer for IoT Devices

Currently, the IoT ecosystem is comprised of fully connected smart devices that exchange data to provide more automated, precise, and fast decisions. This idealised situation can only be accomplished if a system for data transactions is processed efficiently and security is ensured with high scalability and practicability. The integrity of data must be maintained during the exchange or transfer of data between entities. We propose to make a application called DatChain that responds to the above situation. The application stores data sensed by the Iot sensors in the backend after encrypting it and when the data is required for any purpose it can be exchanged using a suitable blockchain network that can keep up with the transfer rate even at high traffic in a secure environment.Comment: Keywords - Blockchain, Internet of Things, IOTA, Tangle, Data transfer, IoT Data Analytic

EVALUATING THE EFFECTIVENESS OF THE TREE OF LIFE INTERVENTION ON AGGRESSION MANAGEMENT AND ACADEMIC PERFORMANCE ENHANCEMENT AMONG ADOLESCENTS IN SELECTED SCHOOLS, CHENNAI

Background: This study investigates the Tree of Life intervention's effectiveness in managing aggression and enhancing academic performance among adolescents. By fostering resilience and self-esteem through narrative therapy, the intervention aims to empower students to reduce aggression, ultimately improving their educational outcomes and creating a more supportive learning environment. Aim: The study evaluates the Tree of Life intervention's effectiveness in managing aggression and enhancing academic performance among adolescents, supporting better behavioral and educational outcomes. Methods: Utilizing a true experimental pretest-posttest control group design, the study was conducted in selected schools in Chennai, Tamil Nadu, targeting adolescents aged 13-16 years. Sixty participants, evenly divided by gender and grade (8-10), were randomly assigned to an experimental group (Tree of Life intervention) or a control group. Data collection included demographic questionnaires, the Modified Buss-Perry Aggression Questionnaire, and academic performance assessments. The intervention lasted four weeks, featuring weekly 60-minute sessions encouraging personal reflection through creative activities, while the control group maintained regular routines. Findings: The demographic analysis revealed comparable distributions across both groups, with the experimental group exhibiting a higher prevalence of mild aggression. Posttest scores indicated substantial improvements in the experimental group, supported by a significant p-value of 0.001, demonstrating the intervention's effectiveness. A negative correlation between aggression and academic performance was observed, indicating that as aggression levels decrease, academic performance improves. Conclusion: The Tree of Life intervention significantly reduced aggression and enhanced academic performance among adolescents. The control group’s lack of change underscores the intervention’s effectiveness, suggesting its potential benefits for student well-being and academic success in schools. Further research should explore long-term effects and additional influencing factors

BioRT‐HBV 1.0: A Biogeochemical Reactive Transport Model at the Watershed Scale

Reactive Transport Models (RTMs) are essential tools for understanding and predicting intertwined ecohydrological and biogeochemical processes on land and in rivers. While traditional RTMs have focused primarily on subsurface processes, recent watershed‐scale RTMs have integrated ecohydrological and biogeochemical interactions between surface and subsurface. These emergent, watershed‐scale RTMs are often spatially explicit and require extensive data, computational power, and computational expertise. There is however a pressing need to create parsimonious models that require minimal data and are accessible to scientists with limited computational background. To that end, we have developed BioRT‐HBV 1.0, a watershed‐scale, hydro‐biogeochemical RTM that builds upon the widely used, bucket‐type HBV model known for its simplicity and minimal data requirements. BioRT‐HBV uses the conceptual structure and hydrology output of HBV to simulate processes including advective solute transport and biogeochemical reactions that depend on reaction thermodynamics and kinetics. These reactions include, for example, chemical weathering, soil respiration, and nutrient transformation. The model uses time series of weather (air temperature, precipitation, and potential evapotranspiration) and initial biogeochemical conditions of subsurface water, soils, and rocks as input, and output times series of reaction rates and solute concentrations in subsurface waters and rivers. This paper presents the model structure and governing equations and demonstrates its utility with examples simulating carbon and nitrogen processes in a headwater catchment. As shown in the examples, BioRT‐HBV can be used to illuminate the dynamics of biogeochemical reactions in the invisible, arduous‐to‐measure subsurface, and their influence on the observed stream or river chemistry and solute export. With its parsimonious structure and easy‐to‐use graphical user interface, BioRT‐HBV can be a useful research tool for users without in‐depth computational training. It can additionally serve as an educational tool that promotes pollination of ideas across disciplines and foster a diverse, equal, and inclusive user community

EVALITA Evaluation of NLP and Speech Tools for Italian - December 17th, 2020

Welcome to EVALITA 2020! EVALITA is the evaluation campaign of Natural Language Processing and Speech Tools for Italian. EVALITA is an initiative of the Italian Association for Computational Linguistics (AILC, http://www.ai-lc.it) and it is endorsed by the Italian Association for Artificial Intelligence (AIxIA, http://www.aixia.it) and the Italian Association for Speech Sciences (AISV, http://www.aisv.it)

The evolution of lung cancer and impact of subclonal selection in TRACERx

Lung cancer is the leading cause of cancer-associated mortality worldwide. Here we analysed 1,644 tumour regions sampled at surgery or during follow-up from the first 421 patients with non-small cell lung cancer prospectively enrolled into the TRACERx study. This project aims to decipher lung cancer evolution and address the primary study endpoint: determining the relationship between intratumour heterogeneity and clinical outcome. In lung adenocarcinoma, mutations in 22 out of 40 common cancer genes were under significant subclonal selection, including classical tumour initiators such as TP53 and KRAS. We defined evolutionary dependencies between drivers, mutational processes and whole genome doubling (WGD) events. Despite patients having a history of smoking, 8% of lung adenocarcinomas lacked evidence of tobacco-induced mutagenesis. These tumours also had similar detection rates for EGFR mutations and for RET, ROS1, ALK and MET oncogenic isoforms compared with tumours in never-smokers, which suggests that they have a similar aetiology and pathogenesis. Large subclonal expansions were associated with positive subclonal selection. Patients with tumours harbouring recent subclonal expansions, on the terminus of a phylogenetic branch, had significantly shorter disease-free survival. Subclonal WGD was detected in 19% of tumours, and 10% of tumours harboured multiple subclonal WGDs in parallel. Subclonal, but not truncal, WGD was associated with shorter disease-free survival. Copy number heterogeneity was associated with extrathoracic relapse within 1 year after surgery. These data demonstrate the importance of clonal expansion, WGD and copy number instability in determining the timing and patterns of relapse in non-small cell lung cancer and provide a comprehensive clinical cancer evolutionary data resource

Genomic–transcriptomic evolution in lung cancer and metastasis

Intratumour heterogeneity (ITH) fuels lung cancer evolution, which leads to immune evasion and resistance to therapy. Here, using paired whole-exome and RNA sequencing data, we investigate intratumour transcriptomic diversity in 354 non-small cell lung cancer tumours from 347 out of the first 421 patients prospectively recruited into the TRACERx study. Analyses of 947 tumour regions, representing both primary and metastatic disease, alongside 96 tumour-adjacent normal tissue samples implicate the transcriptome as a major source of phenotypic variation. Gene expression levels and ITH relate to patterns of positive and negative selection during tumour evolution. We observe frequent copy number-independent allele-specific expression that is linked to epigenomic dysfunction. Allele-specific expression can also result in genomic–transcriptomic parallel evolution, which converges on cancer gene disruption. We extract signatures of RNA single-base substitutions and link their aetiology to the activity of the RNA-editing enzymes ADAR and APOBEC3A, thereby revealing otherwise undetected ongoing APOBEC activity in tumours. Characterizing the transcriptomes of primary–metastatic tumour pairs, we combine multiple machine-learning approaches that leverage genomic and transcriptomic variables to link metastasis-seeding potential to the evolutionary context of mutations and increased proliferation within primary tumour regions. These results highlight the interplay between the genome and transcriptome in influencing ITH, lung cancer evolution and metastasis

The evolution of non-small cell lung cancer metastases in TRACERx

Metastatic disease is responsible for the majority of cancer-related deaths. We report the longitudinal evolutionary analysis of 126 non-small cell lung cancer (NSCLC) tumours from 421 prospectively recruited patients in TRACERx who developed metastatic disease, compared with a control cohort of 144 non-metastatic tumours. In 25% of cases, metastases diverged early, before the last clonal sweep in the primary tumour, and early divergence was enriched for patients who were smokers at the time of initial diagnosis. Simulations suggested that early metastatic divergence more frequently occurred at smaller tumour diameters (less than 8 mm). Single-region primary tumour sampling resulted in 83% of late divergence cases being misclassified as early, highlighting the importance of extensive primary tumour sampling. Polyclonal dissemination, which was associated with extrathoracic disease recurrence, was found in 32% of cases. Primary lymph node disease contributed to metastatic relapse in less than 20% of cases, representing a hallmark of metastatic potential rather than a route to subsequent recurrences/disease progression. Metastasis-seeding subclones exhibited subclonal expansions within primary tumours, probably reflecting positive selection. Our findings highlight the importance of selection in metastatic clone evolution within untreated primary tumours, the distinction between monoclonal versus polyclonal seeding in dictating site of recurrence, the limitations of current radiological screening approaches for early diverging tumours and the need to develop strategies to target metastasis-seeding subclones before relapse