The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

خدیجہ مستور کے ناول ’’آنگن‘‘اور’’زمین‘‘ میں طبقاتی نظام کی عکاسی

The novel is based on reality and nature. The subject of the novel is man. Many writers have also highlighted the conflict between different class in their novels. In Khadija Mastoor’s famous novel “Angan” and “Zameen”, various aspects of the class system are seen to be interwoven. She has elevated her art by bringing out many hidden facts in her novels. Many writers have shown the reflection of reality from different aspects. “Aangan” and “Zameen” reflects the division of the subcontinent. many hidden facts of the caste system are seen in both the novels of the author

A retrospective study to analyze symptomatology among h.pylori positive patients at a tertiary care hospital

Introduction: Infection with H. pylori infection is common. About two-thirds of the population in the world carry H pylori in their bodies. The infection was acquired in childhood and persists despite local and systemic immune response. Materials and Methods: This was a prospective observational study done on 1000 patients at a tertiary health care hospital in Jammu, India, over a period of 04 years (March 2016 to March 2020). Written and informed consent regarding the purpose, procedures, and risks was obtained from all patients. Data were collected by conducting a personal interview and doing a complete physical examination of the participants of the study. All patients underwent basic investigations as per symptoms and comorbidities. UGIE was performed on all the study participants using a video gastroscope. Gross features of the upper GI tract were noted and biopsies were obtained from the stomach (antrum, body, and fundus), and the second part of the duodenum. One antral and one corpus biopsy sample each were used for the rapid urease test (RUT). Results: A total of 1000 patients underwent UGIE for a different set of complaints. The most common complaint in this study group was epigastric pain (43%) followed by dyspepsia (33.2%) and 80.23% and 78.61% of patients were positive for H pylori on RUT. On UGI endoscopy duodenal ulcer was seen in 430 patients and among them 85.34% were H pylori positive on RUT, the gastric ulcer was seen in 240 patients, and among them, 73.33% were H pylori positive. The most common comorbidity was hypertension in the study group and among these patients, 138(88.46%) were H pylori positive, 2nd common comorbidity was Diabetes mellitus and among them 133(91.86%) were H pylori positive. The overall prevalence of H pylori manifestation in the study group was seen in 78.5% of patients. Conclusion: Among all symptomatic patients enrolled in this study the most symptom was epigastric pain followed by dyspepsia and the most common comorbidities in the study group were HTN and Diabetes mellitus. A rapid urease test was performed on UGI endoscopic biopsy specimen for H pylori infestation and 78.5% of patients were found to be positive

Prevalence of comorbidities amongest h.pylori-positive patients at a tertiary care hospital, Jammu

Introduction: Helicobacter pylori is a gram-negative, microaerophilic bacterium usually found in the stomach. The bacterium is transmitted by feco oral route and is associated with peptic ulcer, duodenal ulcer, and gastric carcinoma. The scope of this study is to determine the prevalence of comorbidities amongest H.pylori-positive patients at a tertiary care hospital, in Jammu, which can give a better picture of the current situation and estimate the at-risk population of gastric carcinoma. Materials and Methods: This was a prospective observational study done at a tertiary healthcare hospital in Jammu, India, over 04 years (March 2016 to March 2020). Written and informed consent regarding the purpose, procedures, and risks was obtained from all patients. Data were collected by conducting a personal interview and doing a complete physical examination of the participants of the study. A structured pro forma was used and filled out after interviewing and examining the patient. The following information was collected for all the participants: age, gender, symptoms, duration, comorbidities, and durations, and any treatment patient has received. Results: Most common comorbidity was hypertension in the study group and among these patients, 138(88.46%) were H pylori positive, 2nd common comorbidity was Diabetes mellitus and among them 133(91.86%) were H pylori positive and 04 patients had CRPF and all of them were H pylori positive. Conclusion: Among all symptomatic patients enrolled in this study the most symptom was epigastric pain followed by dyspepsia and the most common comorbidities in the study group were HTN and Diabetes mellitus. A rapid urease test was performed on UGI endoscopic biopsy specimen for H pylori infestation and 78.5% of patients were found to be positive

Exposure of Electrically Driven Vehicles and Smart Vehicle-to-Grid Technology

Electric vehicles are considered as an asset to the smart grid to maximize economic and environmental performance under a variety of operating conditions. It is more important to maintain network resiliency during emergency conditions and disruptive events. This paper discusses the impact of smart grid-to-vehicle (G2V) and vehicle-to-grid (V2G) implementation on distribution systems and examines current scenarios. The V2G system has a strong impression on the main factors of the utility network such as the efficiency, reliability, loss of lines, and durability of the system. The paper also highlights the economic merits of the V2G concept that heavily doped on the scheme of charging/discharging and vehicle participation. The use of artificial intelligence techniques would also increase the performance of network connectivity soon. Moreover, the V2G technology is incorporated in the charging scenarios to convalesce the payback program of the existing solar grid system

Association between breast cancer and tumour necrosis factor-related apoptosis-inducing ligand (TRAIL) gene 1595C/T SNP in a Pakistani population

Aim of the Study: TRAIL-mediated signalling has emerged as an extensively studied biological mechanism reported to differentially induce apoptosis in cancer cells. However, overwhelmingly increasing experimentally verified data is shedding light on resistance against TRAIL-induced apoptosis in cancer cells. Moreover, genetic and epigenetic mutations also exert effects on the functionality of TRAIL and its receptors. In this study we investigated the association between breast cancer and polymorphisms in tumour necrosis factor-related apoptosis-inducing ligand (TRAIL) in a Pakistani Population

Association between breast cancer and tumour necrosis factor-related apoptosis-inducing ligand (TRAIL) gene 1595C/T SNP in a Pakistani population

Aim of the Study : TRAIL-mediated signalling has emerged as an extensively studied biological mechanism reported to differentially induce apoptosis in cancer cells. However, overwhelmingly increasing experimentally verified data is shedding light on resistance against TRAIL-induced apoptosis in cancer cells. Moreover, genetic and epigenetic mutations also exert effects on the functionality of TRAIL and its receptors. In this study we investigated the association between breast cancer and polymorphisms in tumour necrosis factor-related apoptosis-inducing ligand (TRAIL) in a Pakistani Population. Material and methods: Genotyping for TRAIL gene 1595 C/T polymorphism was done for 363 breast cancer patients and 193 age- and sex-matched healthy controls. DNA was extracted using standard organic methods. PCR-RFLP analysis was done for C/T polymorphism at position 1595 in exon 5 of the TRAIL gene using site-specific primers and restriction enzyme. The results were statistically evaluated by SPSS14. Results : In this study, CC homozygotes were 46.3% in patients and 49.7% in controls, p = 0.729 with OR value 0.8705 (95% CI: 0.6137–1.2348). CT was statistically insignificant, p = 0.837 with OR value 0.9242 (95% CI: 0.6494–1.3154). However, the minor allele or risk allele genotype TT had a higher percentage among breast cancer patients (12.1%) than in the control group (6.7%). Since there was a statistically insignificant difference (p = 0.212, OR value 1.9098 with 95% CI 1.0019 to 3.6406) of TT genotype between the two groups, the contrastingly higher percentage of TT genotype in breast cancer patients seems to be a risk factor for the disease. Moreover, the frequency of minor allele T was also found to be higher in the patients (0.329) than in the controls (0.285). Conclusions : The TRAIL gene 1595 C/T SNP has a contradictory role in cancer development in different populations. In our population group although the percentage of homozygous risk allele TT was higher in patients it was statistically non-significant. The raised T allele and TT genotype in patients may suggest its association with breast cancer in the Pakistani population

Use of Social Media as a Platform for Education and Support for People With Diabetes During a Global Pandemic.

BACKGROUND Patient education is a fundamental aspect of self-management of diabetes. The aim of this study was to understand whether a social media platform is a viable method to deliver education to people with diabetes and understand if people would engage and interact with it. METHODS Education sessions were provided via 3 platforms in a variety of formats. "Tweetorials" and quizzes were delivered on the diabetes101 Twitter account, a virtual conference via Zoom and video presentations uploaded to YouTube. Audience engagement during and after the sessions were analyzed using social media metrics including impressions and engagement rate using Twitter analytics, Tweepsmap, and YouTube Studio. RESULTS A total of 22 "tweetorial" sessions and 5 quizzes with a total of 151 polls (both in tweetorial and quiz sessions) receiving a total of 21,269 votes took place. Overall, the 1-h tweetorial sessions gained 1,821,088 impressions with an engagement rate of 6.3%. The sessions received a total of 2,341 retweets, 2,467 replies and 10,060 likes. The quiz days included 113 polls receiving 16,069 votes. The conference covered 8 topics and was attended live by over 100 people on the day. The video presentations on YouTube have received a total of 2,916 views with a watch time of 281 h and 8,847 impressions. CONCLUSION Despite the limitations of social media, it can be harnessed to provide relevant reliable information and education about diabetes allowing people the time and space to learn at their own pace