The Neutrophil-Lymphocyte Ratio as an Early Predictive Marker of the Severity of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

Background and objectives: Factors predictive of severe non-iatrogenic acute pancreatitis have been investigated, but few studies have evaluated prognostic markers of severe post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). The neutrophil–lymphocyte ratio (NLR) has been studied for predicting severe acute pancreatitis. We examined the predictive value of NLR in patients with PEP. Materials and Methods: From January 2012 to August 2021, 125 patients who developed PEP were retrospectively evaluated. The NLR was measured before, and on days 1 and 2 after, ERCP. PEP was categorized as mild, moderate, or severe according to consensus guidelines, based on the prolongation of planned hospitalization. Patients were divided into two groups, mild-to-moderate vs. severe PEP. Results: We analyzed 125 patients with PEP, 18 (14.4%) of whom developed severe PEP. The baseline NLR was similar between the two groups (2.26 vs. 3.34, p = 0.499). The severe PEP group had a higher NLR than the mild/moderate PEP group on days 1 (11.19 vs. 6.58, p = 0.001) and 2 (15.68 vs. 5.32, p < 0.001) post-ERCP. The area under the curve of the NLR on days 1 and 2 post-ERCP for severe PEP was 0.75 (95% confidence interval (CI), 0.64–0.86)) and 0.89 (95% CI, 0.81–0.97), respectively; NLR on day 2 had greater power to predict severe PEP. The optimal cutoff value of the NLR on days 1 and 2 after ERCP for prediction of severe PEP was 7.38 (sensitivity, 72%; specificity, 69%) and 8.17 (sensitivity, 83%; specificity, 83%), respectively. In a multivariate analysis, a Bedside Index of Severity in Acute Pancreatitis score ≥3 (odds ratio (OR) 9.07, p = 0.012) and NLR on day 2 > 8.17 (OR 18.29, p < 0.001) were significantly associated with severe PEP. Conclusions: The NLR on day 2 post-ERCP is a reliable prognostic marker of severe PEP.

The role of the BISAP score in predicting acute pancreatitis severity according to the revised Atlanta classification: a single tertiary care unit experience from Turkey

Background/Aims: In this study, we examine the utility of Bedside Index of Severity in Acute Pancreatitis (BISAP), which is an increasingly more commonly used simple and practical novel scoring system for predicting the prognosis and severity of the disease at presentation. Materials and methods: Consecutive patients diagnosed with AP between January 2013 and December 2020 were evaluated retrospectively. The AP severity was assessed using the revised Atlanta classification (RAC). BISAP score, demographic characteristics, pancreatitis etiology, pancreatitis history, duration of hospital stay, and mortality rates of the patients were recorded. Results: A total of 1000 adult patients were included, of whom 589 (58.9%) were female and 411 (41.1%) were male. The mean age in female and male patients was 62.15 ± 17.79 and 58.1 ± 16.33 years, respectively (p >0.05). The most common etiological factor was biliary AP (55.8%), followed by idiopathic AP (23%). Based on RAC, 389 (38.9%), 418 (41.8%), and 193 (19.3%) patients had mild, moderate, and severe AP. Of the 1000 patients, 42 (4.2%) died. Significant predictors of mortality included advanced age (>65 y) (p=0.003), hypertension (p=0.007), and ischemic heart disease (p=0.001). A BISAP score of ≥3 had a sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of 79.79%, 91.57%, 69.37%, and 94.99%, respectively, for determining SAP patients according to RAC. Conclusion: BISAP is an effective scoring system with a high NPV in predicting the severity of AP in the early course of the disease in a Turkish population.

Efficacy of Sigmoidoscopy for Evaluating Disease Activity in Patients With Ulcerative Colitis

Background: Endoscopic assessment of disease activity is a key parameter in the management of ulcerative colitis. Whether sigmoidoscopy alone is sufficient to evaluate the disease activity in ulcerative colitis lacks studies. Methods: We retrospectively analyzed the medical records and endoscopic results of patients with ulcerative colitis followed by colonoscopy in seven tertiary hospitals between January 2012 and December 2018. Endoscopic disease activity was scored using the Mayo Endoscopic Score (MES) and Ulcerative Colitis Endoscopic Index of Severity (UCEIS) for each segment from the colonoscopy images. Concordance was evaluated by comparing the highest MES and UCEIS in the rectosigmoid and proximal regions to confirm the usefulness of sigmoidoscopy. Results: A total of 500 colonoscopic examinations from 333 patients were enrolled. Only in 7.6% [k(kappa): 0.893, r(Spearman): 0.906, p<0.001] and 8.6% [k(kappa): 0.890, r(Spearman): 0.914; p<0.001] of cases, MES and UCEIS scored more severely in the proximal colon. Comparison of active disease (MES ≥2) in the rectosigmoid area and the entire colon showed a high concordance rate [k(kappa): 0.899, r(Spearman): 0.904, p<0.001]. Endoscopic healing (MES=0) also showed a high concordance rate [k(kappa): 0.882, r(Spearman): 0.887, p<0.001]. In 38 cases (7.6%) of patients with a higher MES in the proximal area, it was significantly higher in patients with previous extensive colitisConclusions: Sigmoidoscopy and colonoscopy showed a high concordance rate. Therefore, sigmoidoscopy is considered a sufficient substitute for colonoscopy. However, colonoscopy should be considered in patients with previous extensive colitis

PREDICTION OF THE RISK OF EMOTIONAL BURNOUT AMONG SECONDARY SCHOOL TEACHERS

The present study aims to identify the informative clinical and psychological variables for assessing the risk of emotional burnout syndrome among secondary school teachers. The relevance of the discussed issues is justified by statistical data of burnout among teachers and its consequences. Eighty-two teachers of secondary schools in Moscow, Chekhov and Saratov aged 21 to 66 years (average age of the group 46.81 ± 10.19) took part in the study. The diagnostic complex included methods for assessing the degree of emotional burnout; revealing the manifestations of stress; determining the features of emotional intelligence; analysis of empathic tendencies; self-assessment of the level of ontogenetic reflection; as well as determining indicators of a symptomatic response to stressful situations. The prognostic value of the indicators of the following questionnaires was revealed: Test for occupational stress, Symptomatic questionnaire SCL-90-R, Comprehensive assessment of manifestations of stress Yu.V. Shcherbatykh, D.V. Lyusin Emotional Intelligence Test, Self-assessment of the level of ontogenetic reflection. It was concluded that when assessing the psychological state of the teacher, it is necessary to pay attention to the indicators reflecting the symptomatology and intensity of experienced distress; emotional experiences corresponding to negative affective states. It is also necessary to take into account indicators reflecting the level of professional stress and the ability to analyze one’s past experience in terms of its success/failure. The combination of high scores on the scales “general index of severity of symptoms” and “self-assessment of the level of ontogenetic reflection” indicate the risk of developing burnout syndrome in teachers. In addition, the risk of emotional burnout can be talked about when, according to the results of psychodiagnostic examination, high scores are found on the scales “general index of severity of symptoms”, “occupational stress” and low scores on the scale “hostility”.

Preoperative Endoscopic Activity Predicts the Occurrence of Pouchitis After Ileal Pouch–Anal Anastomosis in Ulcerative Colitis: A Multicenter Retrospective Study in China

Background: Pouchitis is the most common long-term complication after ileal pouch–anal anastomosis (IPAA) in patients with ulcerative colitis (UC). Ulcerative colitis endoscopic index of severity (UCEIS) and Mayo endoscopic score (MES) are widely used indices to evaluate endoscopic activity. This study aimed to clarify the predictive value of preoperative endoscopic activity on the occurrence of pouchitis after IPAA.Methods: Data of patients with UC who underwent IPAA from January 2008 to January 2020 were collected retrospectively. UCEIS and MES were based on the preoperative colonoscopy findings of two independent endoscopists.Results: A total of 102 patients with a median follow-up of 5 (interquartile range, 2–9) years were included in the study. Among them, 21.6% developed pouchitis. Compared with MES, UCEIS had a stronger correlation with pouchitis disease activity index. UCEIS ≥ 7 had the most significant receiver-operating characteristic (ROC) curve area of 0.747 with a sensitivity of 68.2% and specificity of 81.2% in predicting pouchitis, which outperformed MES of 3 with an ROC area of 0.679 with a sensitivity of 54.5% and specificity of 81.2%. Furthermore, we found that UCEIS ≥ 7 was an independent risk factor for post-IPAA pouchitis [odds ratio (OR), 8.860; 95% CI, 1.969–39.865, p &lt; 0.001] with a higher risk than MES of 3 (OR, 5.200; 95% CI, 1.895–14.273; p = 0.001).Conclusion: Ulcerative colitis endoscopic index of severity performed better in predicting pouchitis after IPAA than MES. Earlier and more frequent postoperative colonoscopic surveillance should be considered in patients with preoperative UCEIS ≥ 7 to detect the occurrence of pouchitis earlier.

Further research on the clinical relevance of the ulcerative colitis colonoscopic index of severity for predicting 5-year relapse

Purpose The ulcerative colitis colonoscopic index of severity (UCCIS) evaluates the state of the entire colonic mucosa in ulcerative colitis. However, no cut-off values of scores for predicting clinical relapse in patients with ulcerative colitis have been established. This study aimed to determine the cut-off values for predicting clinical relapse in patients with ulcerative colitis. Methods The endoscopic scores (sum of Mayo endoscopic subscores (S-MES) and UCCIS) of 157 patients with ulcerative colitis experiencing clinical remission and their subsequent clinical course were retrospectively reviewed. The optimal cut-off values for predicting relapse and relapse-free rates were analyzed by receiver operating characteristic analysis. Results Forty patients with ulcerative colitis experienced relapse within 24 months. The median UCCIS for these patients at the time of study enrollment was significantly higher than that for patients with clinical remission (P < 0.001). The cut-off value of the UCCIS for predicting relapse was 9.8. The relapse-free rate was significantly lower in patients with UCCIS ≥ 9.8 than in those with UCCIS < 9.8 (log-rank test P < 0.001). For patients who experienced relapse within 5 years, the optimal cut-off values for the UCCIS and S-MES were 10.2 and 1, respectively (P = 0.004). Conclusions The data from this study indicate that the USSIC is a more relevant score than the S-MES for predicting the time to relapse in patients with ulcerative colitis in remission.

Clinical pneumonia in the hospitalised child in Malawi in the post-pneumococcal conjugate vaccine era: a prospective hospital-based observational study

Objective Assess characteristics of clinical pneumonia after introduction of pneumococcal conjugate vaccine (PCV), by HIV exposure status, in children hospitalized in a governmental hospital in Malawi. Methods and findings We evaluated 1,139 children ≤5 years old hospitalised with clinical pneumonia: 101 HIV-exposed uninfected (HEU) and 1038 HIV-unexposed, uninfected (HUU). Median age was 11 months (IQR 6-20), 59% were male, median mid-upper arm circumference (MUAC) was 14 cm (IQR 13-15) and mean weight-for-height z score was -0.7 (+/-2.5). The highest Respiratory Index of Severity in Children (RISC) scores were allocated to 10.4% of the overall cohort, respectively. Only 45.7% had fever, and 37.2% had at least one danger sign at presentation. The most common clinical features were crackles (54.7%), nasal flaring (53.5%), and lower chest wall indrawing (53.2%). Compared to HUU, HEU children were significantly younger (9 months v. 11 months), with lower mean birth weight (2.8 kg v. 3.0 kg) and MUAC (13.6 cm v. 14.0 cm), had higher prevalence of vomiting (32.7% v. 22.0%), tachypnoea (68.4% v. 49.8%), and highest RISC scores (20.0% v. 9.4%). Five children died (0.4%). However, clinical outcomes were similar for both groups. Conclusions In this post-PCV setting where prevalence of HIV and malnutrition is high, children hospitalised fulfilling the WHO Integrated Management of Childhood Illness criteria for clinical pneumonia present with heterogeneous features. These vary by HIV exposure status but this does not influence either the frequency of danger signs or mortality. The poor performance of available severity scores in this population and the absence of more specific diagnostics hinder appropriate antimicrobial stewardship and the rational application of other interventions.

AN ECONOMIC ANALYSIS OF PRODUCTION AND MARKETING OF MAJOR VEGETABLES IN PARSA DISTRICT, NEPAL

The survey research was conducted to analyze the economics of production and marketing of major vegetables in Parsa district of Nepal from December 2019 to April 2020. Primary data for the household survey were collected using a semi-structured questionnaire from sixty sampled respondents, sixteen from Pokhariya municipality, and forty-four from Bahudarmai municipality. Secondary data were collected through scientific journals, articles, and publications from agricultural organizations, projects, and programs. Average area under vegetable cultivation was found 12.68 Kattha. Out of five major vegetables under study average cost of production per kattha was found highest for pointed gourd (Rs. 11551.50) lowest for okra production (Rs. 6071/kata). The majority of production cost was covered by labor cost (>40%). The average productivity of cauliflower, okra,brinjal, chilli, and pointed gourd was 27.3 Mt/ha,19 Mt/ha,16.67 Mt/ha, 27.52Mt/ha, and 25.83Mt/ha respectively. B:C ratio of all the vegetables under study was higher than three which implies that vegetable farming in the study area is profitable farm business. Producers-wholesalers-retailers-consumers was the most used marketing channel. Market margin of cauliflower, okra, brinjal, chilli and pointed gourd was Rs. 13/kg, Rs. 7.73/kg, Rs. 7.86/kg, Rs. 28.07/kg and Rs. 8.69/kg respectively. Index of severity was constructed to rank the problems in the production and marketing of vegetables. Analysis of the problems identified shows the need for proper storage facilities, training related to vegetable farming and insect pest management, and subsidies on regular basis, and mechanization and modernization of the farming system through the introduction of technological knowledge and modern farm practice.

Psychological Flexibility Is Key for Reducing the Severity and Impact of Fibromyalgia

Fibromyalgia has a significant impact on the lives of patients; symptoms are influenced by psychological factors, such as psychological flexibility and catastrophizing. The objective of this study was to determine the importance of these variables in moderating the association between the severity and impact of fibromyalgia symptoms. A total of 187 patients from a general hospital population were evaluated using the Combined Index of Severity of Fibromyalgia (ICAF), the Fibromyalgia Impact Questionnaire (FIQ), the Acceptance and Action Questionnaire-II (AAQ-II), and the Pain Catastrophizing Scale (PCS). A series of multiple regression analyses were carried out using the PROCESS macro and decision tree analysis. The results show that psychological flexibility modulates the relation between severity and the impact of fibromyalgia symptoms. Catastrophism has residual importance and depends on the interaction with psychological flexibility. Interaction occurs if the severity of the disease is in transition from a mild to a moderate level and accounts for 40.1% of the variance in the sample. These aspects should be considered for evaluation and early intervention in fibromyalgia patients.