Evaluation of Validity of Scoring Systems in Diagnosing Acute Appendicitis in South Indian Population

BACKGROUND: Acute appendicitis is one of the most common surgical emergencies worldwide, the diagnosis of which is still a challenging job for the surgeon. Both delayed diagnosis resulting in perforation (20%) and negative appendectomy (2-30%) have their own complications. Hence there is need for an accurate preoperative diagnosis. Even though CT has a high sensitivity and specificity in diagnosing appendicitis, the cost, availability and time delay become its limitations. Several scoring systems using clinical, laboratory data have been designed to diagnose acute appendicitis. An ideal scoring system would increase the accuracy of decision making and at the same time reduces the need of potentially harmful and expensive imaging. The scoring system must recognize patients in need of urgent surgery without delay and on the other hand, must avoid the unnecessary risks and cost of negative appendectomy. More than 10 such systems have been developed since the beginning of 1980s. In our study we consider 4 such scoring systems. The aim of our study is to assess and compare the diagnostic accuracy of these scoring systems on South Indian population and to study their role in diagnosing a case of acute appendicitis. AIMS & OBJECTIVES: 1. To assess the diagnostic value of different scoring systems in acute appendicitis and their role in improving accuracy. 2. To identify the most reliable scoring system for South Indian population. METHODOLOGY: This is a prospective and observational study. Patients admitted in Rajiv Gandhi Government General Hospital with the right iliac fossa pain suspicious of acute appendicitis are included in the study. Detailed clinical history is taken and physical examination is done for each patient. All patients underwent laboratory investigations such as complete blood count, blood urea, serum creatinine and electrolytes, urine routine, C-reactive protein and imaging tests like Chest X ray, Abdomen X ray erect, Ultrasound abdomen and pelvis. Using the above data, the probability of acute appendicitis is calculated using the Alvarado, Tzanaki, RIPASA and AIR scores. Patients will be taken up for emergency/elective appendicectomy based on the surgeon’s clinical judgement. The intraoperative findings will be noted. Intraoperatively normal appearing appendix and presence of other diagnosis will be excluded from the study. Following surgery, the histopathological reports of the patients will be collected. The various preoperative scores and the HPE reports will be correlated to calculate the Sensitivity, Specificity, PPV, NPV, diagnostic accuracy and negative appendicectomy rates. This will prove the validity of scoring systems in the diagnosis of acute appendicitis and provides the most reliable system applicable in South Indian population. RESULTS: The following results are obtained. 1. Out of 100 patients, majority belong to the age group 20 – 30 years with a female sex predominance. 2. Majority of the patients in the study have Alvarado scores of 7 and above, Tzanaki scores of 10 and above, RIPASA scores of 8.5 and above and AIR scores of 9 and above. 3. Sensitivity and Specificity of various scores are as follows: ALVARADO - SENSITIVITY - 84.61% ; SPECIFICITY - 82.35%, TZANAKI - SENSITIVITY - 100% ; SPECIFICITY - 23.5%, RIPASA - SENSITIVITY - 97.5% ; SPECIFICITY - 64.7%, AIR – SENSITIVITY - 87.9% ; SPECIFICITY - 82.35%. 4. Positive and Negative predictive value of various scores are as follows: ALVARADO - PPV : 96.25% ; NPV - 70%, TZANAKI - PPV - 86.45% ; NPV - 100%, RIPASA - PPV - 93.1 % ; NPV - 84.6%, AIR - PPV - 96.05% ; NPV - 58.33%. 5. In 17 patients, appendix is not inflamed intraoperatively and among these only 4 have no histopathological evidence of inflammation. CONCLUSION: 1. From the study on validation of diagnostic accuracy of scoring systems for acute appendicitis, the scoring system which has high positive predictive value and high negative predictive value is considered best to diagnose as well as to rule out acute appendicitis based on the clinical scoring system. 2. It is the Alvarado score which is still considered best in terms of statistical equivalents and it is better than Appendicitis Inflammatory Response Score. 3. Tzanaki Score is the most easy to use score in emergency situations and low scores almost excludes acute appendicitis

CHEMICAL CHANGES OF PADDY DURING METAL SILO STORAGE

ABSTRACTObjective: To study the chemical changes of paddy stored at metal silo for a period of 6-month.Methods: The peroxide value (PV) and free fatty acids (FFAs) were analyzed by titrimetry method. The total fatty acid profile was analyzed throughgas chromatography-mass spectrometry (GC-MS) (Scion 436-GC Bruker model coupled with a triple quadrupole mass spectrophotometer) andNational Institute Standard and Technology-MS library.Results: The PV of paddy at the 1st month of storage is 0.62 mEq/kg and at the 6 month the value increases to 5.11 mEq/kg and initial FFA wasrecorded as 0.49% and final value of 2.28%. In accordance with these data, the GC-MS study of rice bran oil (RBO) proved that polyunsaturated fattyacid percentage is decreasing over the period of storage time.thConclusion: With the results and findings, the overall chemical change during the 6-month storage of paddy at metal silo does not affect the RBOquality significantly.Keywords: Free fatty acids, Peroxide value, Metal silo, Gas chromatography-mass spectrometry

Monitoring the spread of water hyacinth (Pontederia crassipes): challenges and future developments

Water hyacinth (Pontederia crassipes, also referred to as Eicchornia crassipes) is one of the most invasive weed species in the world, causing significant adverse economic and ecological impacts, particularly in tropical and sub-tropical regions. Large scale real-time monitoring of areas of chronic infestation is critical to formulate effective control strategies for this fast spreading weed species. Assessment of revenue generation potential of the harvested water hyacinth biomass also requires enhanced understanding to estimate the biomass yield potential for a given water body. Modern remote sensing technologies can greatly enhance our capacity to understand, monitor and estimate water hyacinth infestation within inland as well as coastal freshwater bodies. Readily available satellite imagery with high spectral, temporal and spatial resolution, along with conventional and modern machine learning techniques for automated image analysis, can enable discrimination of water hyacinth infestation from other floating or submerged vegetation. Remote sensing can potentially be complemented with an array of other technology-based methods, including aerial surveys, ground-level sensors, and citizen science, to provide comprehensive, timely and accurate monitoring. This review discusses the latest developments in the use of remote sensing and other technologies to monitor water hyacinth infestation, and proposes a novel, multi-modal approach that combines the strengths of the different methods

Effectiveness of using newspapers to improve students vocabulary in essay writing among form three students

Vocabulary learning is one of the major challenges that second language learners’ face during the process of learning a language. In Malaysia, many students have difficulty in writing due to the lack of vocabulary. Thus, this study seeks to investigate whether the use of newspapers can help to enhance student’s vocabulary to improve their essay writing. Twenty Form Three students from a secondary school were selected for this study to seek the effectiveness of using newspapers to teach vocabulary to improve student’s essay writing. This study is a quasi-experimental design. For the purpose of this study, two sets of instruments were used to gather the data. The first was a pre-test and a post-test of writing an essay and the second was an interview to seek student’s opinion regarding the use of newspaper to teach vocabulary to improve their essay writing. For the intervention, six treatments were administered. They consists of a rational cloze passage, matching words to its meaning, building words at sentence level and constructing sentences at paragraph level. After the intervention, students sat for the post test of writing an essay. The results were then computed using SPSS. The findings of the study showed positive results of employing newspapers to teach vocabulary when students showed improvement for their essays in the post-test. Furthermore, the vocabulary learning strategies have also helped the students to acquire vocabulary from the newspapers efficiently. Lastly, the findings from the interview showed that students enjoyed learning vocabularies from the two newspaper articles because it had brought benefits when they could the use lexical words in the right context from the newspaper articles for the post test

Molecular Heterogeneity in Colorectal Cancer: Insights from Genetic Profiling

The high heterogeneity has become apparent in metastatic colorectal cancer (CRC) and the solitary leading causes of cancer mortality worldwide. Tumor from benign to malignancies derives by gradual and progressive genetic alterations develop into a collection of neoplastic diseases. The parameters are assessed to indicate the extent and prognosis of the disease such as tumor node metastasis stage, tumor grade, microsatellite status, lymphovascular invasion. It is investigated KRAS mutation status in a metastatic to predict the response to anti-epidermal growth factor.  CRC has been described that have prognostic and therapeutic relevance at a distinct molecular level. In the present study, the researcher recruited 65 CRC patients with different stages of the tumor at the right-sided colon, left-sided colon and rectum. We have also recognized left-sided was more complex than right sided CRC patents. In CRC, it has revealed the major differences in the characterization of inflammatory infiltrations and cells location in tumor types. All the patients were stratified into different prognostic and therapeutic groups with the help of these parameters. Though, CRC show intra-tumor heterogeneity due to not clear-cut stratification. However, several CRC patients with single tumor mutations show differences in their mutational status, morphology, inflammatory infiltrate and gene expression. In conclusion, the primary focus on the concept of molecular heterogeneity their metastases and clinical implication in CRC

Teacher professionalism : behaviour and practices of teachers in a neighbourhood secondary school

The teachers' sense of professionalism cannot be mandated but it can be nurtured by establishing the necessary support, processes, systems and structures within the work environment which is the responsibility of every individual, more so the school leader. Defined as the commitment to professional behaviours and engagement in professional development, it is an important aspect to nurture in teachers. The research focused on a government neighborhood secondary school. Commitment to professional behaviours examined behaviours demonstrating personal commitment, student-directed commitment and commitment to quality teaching and learning demonstrated through competence in (a) subject pedagogy and (b) managing learning. The dimension on professional development studied were teachers' engagement in reflective practices, independent learning, in-service learning and cooperative learning. The Teacher Professionalism Instrument gathered responses that indicated that there is no significant correlation between years of teaching experience and teacher professionalism, as well as its two dimensions of commitment to professional behaviour and engagement in professional development.Master of Arts (Educational Management

Detecting Water Hyacinth Infestation in Kuttanad, India, Using Dual-Pol Sentinel-1 SAR Imagery

Water hyacinth (Pontederia crassipes, also known as Eichhornia crassipes) is a highly invasive aquatic macrophyte species, indigenous to Amazonia, Brazil and tropical South America. It was introduced to India in 1896 and has now become an environmental and social challenge throughout the country in community ponds, freshwater lakes, irrigation channels, rivers and most other surface waterbodies. Considering its large speed of propagation on the water surface under conducive conditions and the adverse impact the infesting weed has, constant monitoring is needed to aid civic bodies, governments and policy makers involved in remedial measures. The synoptic coverage provided by satellite imaging and other remote sensing practices make it convenient to find a solution using this type of data. While there is an established background for the practice of remote sensing in the detection of aquatic plants, the use of Synthetic Aperture Radar (SAR) has yet to be fully exploited in the detection of water hyacinth. This research focusses on detecting water hyacinth within Vembanad Lake, Kuttanad, India. Here, results show that the monitoring of water hyacinth has proven to be possible using Sentinel-1 SAR data. A quantitative analysis of detection performance is presented using traditional and state-of-the-art change detectors. Analysis of these more powerful detectors showed true positive detection ratings of ~95% with 0.1% false alarm, showing significantly greater positive detection ratings when compared to the more traditional detectors. We are therefore confident that water hyacinth can be monitored using SAR data provided the extent of the infestation is significantly larger than the resolution cell (bigger than a quarter of a hectare)