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

ASSESSMENT OF LIFE SKILLS AMONG COLLEGE UNDERGRADUATE-STUDENTS; IMPLICATION FOR ENHANCING STUDENTS ACADEMICS AND PERSONALITY DEVELOPMENT

The literature indicates that life skills assessment and development is endemic throughout the globe. However, lacking are national studies that have researched life skills assessment at the college level. The present investigation aimed to assess the level of life skills among college undergraduate-students of Khyber Pakhtunkhwa, Pakistan. Besides, the differences based on personal and demographic attributes in respect of life skills were also taken into consideration. A sample of (n=794) 5 % of the total population (15890) was selected and included in the survey. Life Skills Assessment Scale (LSAS) developed by (N.R. Prakash, S. Nirmala Devi, 2014) was used for collecting the required data. The gathered information was processed using (SPSS) version 24. Results of the study indicated that the overall nature of life skills among college students is moderate. The findings of the study indicated that the female-students reported less life skills compared to their counterparts’ male undergraduate-students (p .05). It is hoped that the results of this research will be more helpful for administrators, educators, curriculum designers and other social duties to improve teaching-learning and personality development for learners

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

IMPACT OF INNOVATIVNESS ON OPERATIONAL PERFORMANCE OF GOVERONMENT LEVEL COMPANIES (GLCs): A MODERATING ROLE OF INCENTIVE SCHEMES

Corporate Entrepreneurship (CE) is not a new strategy of fostering a firm’s performance and to increase customer satisfaction and market share, espoused by striving firms. However, studies on the effect of CE on the performance of GLCs are not common in literature, especially in the eastern world. The literature strongly indicates the requirement of more workable models of CE for GLCs in Pakistan, due to dearth in existing studies on the subject. Hence, the aim of this study is to gauge the impact of the most compelling element of CE on the operational performance of GLCs. This study has also been supplemented with the moderating role of incentive schemes in order to effectively gauge the motivational aspect in CE of GLCs. The analysis has been made through SMART PLS and structural equational modelling was used as the tool of analysis. Analysis indicated that innovation is perceived as one of the prime tools that may affect operational performance, although GLCs have different compensation structures and thus does not seem to be affecting the relationship of innovativeness and operational performance of GLCs

IMPACT OF INNOVATIVNESS ON OPERATIONAL PERFORMANCE OF GOVERONMENT LEVEL COMPANIES (GLCs): A MODERATING ROLE OF INCENTIVE SCHEMES

Corporate Entrepreneurship (CE) is not a new strategy of fostering a firm’s performance and to increase customer satisfaction and market share, espoused by striving firms. However, studies on the effect of CE on the performance of GLCs are not common in literature, especially in the eastern world. The literature strongly indicates the requirement of more workable models of CE for GLCs in Pakistan, due to dearth in existing studies on the subject. Hence, the aim of this study is to gauge the impact of the most compelling element of CE on the operational performance of GLCs. This study has also been supplemented with the moderating role of incentive schemes in order to effectively gauge the motivational aspect in CE of GLCs. The analysis has been made through SMART PLS and structural equational modelling was used as the tool of analysis. Analysis indicated that innovation is perceived as one of the prime tools that may affect operational performance, although GLCs have different compensation structures and thus does not seem to be affecting the relationship of innovativeness and operational performance of GLCs

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Abstract Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions. </jats:sec

Internal Drivers – The Nexus between Domestic Politics and Bilateral Relations: Exploring India-Pakistan, Pakistan-China, and China-India Dynamics

ABSTRACTForeign policy is an extension of domestic politics in myriad ways. However, no meta-theory offers a framework of analysis that could explain the nexus between domestic politics and foreign policy within the bilateral relations of three politically and culturally distinct states i.e. India, Pakistan, and China. In this paper, I explore the nexus between domestic politics and foreign policy to explain what do the contemporary domestic political trends in each state indicate about the future of bilateral relations. For this purpose, I first identify what in my view is the most relevant and important domestic political driver of bilateral relations in each case. I then discuss how it affects the bilateral relations in the respective dyads and what that means for the future of bilateral relations between India – Pakistan, Pakistan – China and China – India. I argue that the situations in which a small elite dominates both the discursive trends and policy making may result in malleable notions of national identity. This provides the elite, flexibility in shaping and reorienting foreign policy (when they want). On the other hand, the situations in which foreign policy is contingent upon national identity conception as articulated by the mainstream political parties with a strong support base among the masses are highly susceptible to the electoral pressures, shrinking the space for major shifts

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&nbsp;&nbsp; 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&nbsp; contains&nbsp; important&nbsp; diagnostic&nbsp;&nbsp; information&nbsp; and&nbsp; hence&nbsp; should&nbsp; always &nbsp;be included in&nbsp; the diagnostic&nbsp; workup of&nbsp; acute appendicitis.&nbsp; The sensitivity of&nbsp;&nbsp; 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

An Audit of Patients Undergoing Midline Emergency Laparotomy

Background: To study the frequency of trauma and peritonitis requiring emergency laparotomy .Methods: In this descriptive study patients undergoing midline emergency laparotomy were enrolled. Patients were divided into three groups, i.e., Group A(1-30 years of age), Group B ( 31-60 years of age) and Group C ( more than 61 years of age). Information regarding age, sex, presenting complaints and diagnostic findings were collected . Laparotomy through midline was performed in all patients .Results: Out of 440 patients, majority(63.6%) were male . Patients belonging to 1-30 years (Group A) were 58.18%. Majority (75.68%) were operated for peritonitis, rest (24.32%) were due to trauma. Enteric perforation (26.43%) was the commonest cause of peritonitisConclusion: Peritonitis is the leading cause of exploratory laparotomy in the surgical emergency at a tertiary care hospital in our setup. Enteric and tuberculous perforations are the major causes of peritonitis