Background: Identification of patients at risk for mortality early in the course of acute pancreatitis (AP) is an important step in improving outcome. Methods: Using Classification and Regression Tree (CART) analysis, a clinical scoring system was developed for prediction of in-hospital mortality in AP. The scoring system was derived on data collected from 17 992 cases of AP from 212 hospitals in 2000-2001. The new scoring system was validated on data collected from 18 256 AP cases from 177 hospitals in 2004-2005. The accuracy of the scoring system for prediction of mortality was measured by the area under the receiver operating characteristic curve (AUC). The performance of the new scoring system was further validated by comparing its predictive accuracy with that of Acute Physiology and Chronic Health Examination (APACHE) II. Results: CART analysis identified five variables for prediction of in-hospital mortality. One point is assigned for the presence of each of the following during the first 24 h: blood urea nitrogen (BUN) >25 mg/dl; impaired mental status; systemic inflammatory response syndrome (SIRS); age >60 years; or the presence of a pleural effusion (BISAP). Mortality ranged from >20% in the highest risk group to <1% in the lowest risk group. In the validation cohort, the BISAP AUC was 0.82 (95% Cl 0.79 to 0.84) versus APACHE II AUC of 0.83 (95% Cl 0.80 to 0.85). Conclusions: A new mortality-based prognostic scoring system for use in AP has been derived and validated. The BISAP is a simple and accurate method for the early identification of patients at increased risk for in-hospital mortality.

The early prediction of mortality in acute pancreatitis : a large population-based study. Commentary

Objective Our aim was to prospectively compare the Accuracy of Acute Physiology and Chronic Health Evaluation (APACHE) II, Bedside Index of Severity in Acute Pancreatitis (BISAP), Ranson's score and modified Computed Tomography Severity Index (CTSI) in predicting the severity of acute pancreatitis based on Atlanta 2012 definitions in a tertiary care hospital in northern India. Methods Fifty patients with acute pancreatitis admitted to our hospital during the period of March 2015 to September 2016 were included in the study. APACHE II, BISAP and Ranson's score were calculated for all the cases. Modified CTSI was also determined based on a pancreatic protocol contrast enhanced computerized tomography (CT). Optimal cut-offs for these scoring systems and the area under the curve (AUC) were evaluated based on the receiver operating characteristics (ROC) curve and these scoring systems were compared prospectively. Results Of the 50 cases, 14 were graded as severe acute pancreatitis. Pancreatic necrosis was present in 15 patients, while 14 developed persistent organ failure and 14 needed intensive care unit (ICU) admission. The AUC for modified CTSI was consistently the highest for predicting severe acute pancreatitis (0.919), pancreatic necrosis (0.993), organ failure (0.893) and ICU admission (0.993). APACHE II was the second most accurate in predicting severe acute pancreatitis (AUC 0.834) and organ failure (0.831). APACHE II had a high sensitivity for predicting pancreatic necrosis (93.33%), organ failure (92.86%) and ICU admission (92.31%), and also had a high negative predictive value for predicting pancreatic necrosis (96.15%), organ failure (96.15%) and ICU admission (95.83%). Conclusion APACHE II is a useful prognostic scoring system for predicting the severity of acute pancreatitis and can be a crucial aid in determining the group of patients that have a high chance of need for tertiary care during the course of their illness and therefore need early resuscitation and prompt referral, especially in resource-limited developing countries.

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A comparison of APACHE II, BISAP, Ranson’s score and modified CTSI in predicting the severity of acute pancreatitis based on the 2012 revised Atlanta Classification

Background: The management of the moderate and severe forms of acute pancreatitis (AP) with necrosis and multiorgan failure remains a challenge. To predict the severity and mortality of AP multiple clinical, laboratory-, and imaging-based scoring systems are available. Aim: To investigate, if the computed tomography severity index (CTSI) can predict the outcomes of AP better than other scoring systems. Methods: A systematic search was performed in three databases: Pubmed, Embase, and the Cochrane Library. Eligible records provided data from consecutive AP cases and used CTSI or modified CTSI (mCTSI) alone or in combination with other prognostic scores [Ranson, bedside index of severity in acute pancreatitis (BISAP), Acute Physiology, and Chronic Health Examination II (APACHE II), C-reactive protein (CRP)] for the evaluation of severity or mortality of AP. Area under the curves (AUCs) with 95% confidence intervals (CIs) were calculated and aggregated with STATA 14 software using the metandi module. Results: Altogether, 30 studies were included in our meta-analysis, which contained the data of 5,988 AP cases. The pooled AUC for the prediction of mortality was 0.79 (CI 0.73-0.86) for CTSI; 0.87 (CI 0.83-0.90) for BISAP; 0.80 (CI 0.72-0.89) for mCTSI; 0.73 (CI 0.66-0.81) for CRP level; 0.87 (CI 0.81-0.92) for the Ranson score; and 0.91 (CI 0.88-0.93) for the APACHE II score. The APACHE II scoring system had significantly higher predictive value for mortality than CTSI and CRP (p = 0.001 and p < 0.001, respectively), while the predictive value of CTSI was not statistically different from that of BISAP, mCTSI, CRP, or Ranson criteria. The AUC for the prediction of severity of AP were 0.80 (CI 0.76-0.85) for CTSI; 0.79, (CI 0.72-0.86) for BISAP; 0.83 (CI 0.75-0.91) for mCTSI; 0.73 (CI 0.64-0.83) for CRP level; 0.81 (CI 0.75-0.87) for Ranson score and 0.80 (CI 0.77-0.83) for APACHE II score. Regarding severity, all tools performed equally. Conclusion: Though APACHE II is the most accurate predictor of mortality, CTSI is a good predictor of both mortality and AP severity. When the CT scan has been performed, CTSI is an easily calculable and informative tool, which should be used more often in routine clinical practice.

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Computed Tomography Severity Index vs. Other Indices in the Prediction of Severity and Mortality in Acute Pancreatitis: A Predictive Accuracy Meta-analysis

The pressure and vacuum metrology group of National Physical Laboratory (NPL) has a strong role in metrological research and development in India because of its importance to the nation’s economy as well as the constitutional obligation following NPL charter of developing and maintaining national standards of pressure and vacuum measurements. Although, the group is successfully fulfilling its national duties, providing national calibration and measurement services since last 35 years, admittedly still there is lack of awareness, misinformation, and penetration of Calibration and Measurement Capabilities (CMCs) to the end users, grass root level industries, academician and Govt. laboratories. Occasionally, we are receiving feedbacks of such grey areas of awareness. Therefore, it was considered appropriate to compile the information of all these CMCs, expertise, training potential and available developed technologies in this article. The present paper also describes the summary of some of the results obtained in recent international key comparison exercises which have helped us to improve the quality in pressure metrology with a measure of technical efficiency.

Role of National Pressure and Vacuum Metrology in Indian Industrial Growth and Their Global Metrological Equivalence

Computer simulation of a 1.0 GPa piston–cylinder assembly using finite element analysis (FEA)

The present paper describes the effect of different pressure-transmitting fluids (PTFs) on the systematic characterization of an oil-operated controlled clearance piston gauge (nominal diameter of the piston, 2.5?mm) in the pressure range up to 1000?MPa (1?GPa). Pure PTFs and mixtures of different PTFs are studied and four of them will be discussed here: namely (a) pure normal hydraulic oil (J-13), (b) a mixture of J-13 and an aviation turbine fuel (ATF), (JATF), (c) a pure di-ethyl-hexyl-sebacate oil (BIS) and (d) a mixture of white gasoline (G), J-13 and sebacate (GJBIS).The characterization is the measurement of the fall-rate of the piston as a function of applied jacket pressure (pj) with various PTFs using the method of Heydemann and Welch (HW model) (Heydemann and Welch 1975 Experimental Thermodynamics vol II, ed B Leneindre and B Voder (London: Butterworths) p 147). The analysis of the results is the determination of the cube root of the piston fall-rate (v1/3) with pj at different loads or measured pressures (pm). The linear portion of this v1/3?pj curve is extrapolated towards the null value of fall-rate, and the stall jacket pressure (pz) at different pm is obtained. It is observed that reasonably good fall-rate data could be obtained for J-13, JATF and BIS up to maximum pressures of 500?MPa, 700?MPa and 650?MPa, respectively. For GJBIS, these fall-rate data can be obtained up to a maximum pressure of 1?GPa. From the values of pz at different pm and also the values of the jacket pressure coefficient (d) along with other characteristic parameters in the HW model (Newhall et al 1979 Rev. Sci. Instrum. 50 964?8, Bandyopadhyay and Olson 2006 Metrologia 43 573?82), we have determined the relative standard uncertainties in the effective area (u(Ae)/Ae) for GJBIS up to 1?GPa for pj = 0 (free deformation mode) and pj/pm = 0.3. It is interesting to note that for pj = 0, at a pm of 100?MPa, u(Ae)/Ae is 74 ? 10?6, while at a pm of 1?GPa, u(Ae)/Ae is 248 ? 10?6. However, for pj/pm = 0.3, at a pm of 100?MPa, u(Ae)/Ae is 67 ? 10?6, while at a pm of 1?GPa, u(Ae)/Ae is 125 ? 10?6. A comparative study of u(Ae)/Ae has been elaborated with the four PTFs investigated. We have shown that at a pm of 100?MPa, u(Ae)/Ae is 202 ? 10?6, 114 ? 10?6, 66 ? 10?6 and 67 ? 10?6, for J-13, JATF, BIS and GJBIS, respectively, while at a pm of 500?MPa, u(Ae)/Ae is seen to be 97 ? 10?6, 57 ? 10?6, 46 ? 10?6 and 56 ? 10?6 for J13, JATF, BIS and GJBIS, respectively. Our measurements show that GJBIS is a convenient PTF for working up to 1?GPa. Finally, the results of the characterization are compared with the NPLI pressure scale through calibration of a NPLI secondary standard which is traceable to the LNE (France) pressure scale though direct comparison and participation in a recently concluded bilateral comparison with NIST (USA).

http://iopscience.iop.org/article/10.1088/0026-1394/44/3/009/pdf

The effect of pressure-transmitting fluids in the characterization of a controlled clearance piston gauge up to 1 GPa

Objective: Our aim was to prospectively evaluate the accuracy of the bedside index for severity in acute pancreatitis (BISAP) score in predicting mortality, as well as intermediate markers of severity, in a tertiary care centre in east central India, which caters mostly for an economically underprivileged population. Methods: A total of 119 consecutive cases with acute pancreatitis were admitted to our institution between November 2012 and October 2014. BISAP scores were calculated for all cases, within 24 hours of presentation. Ranson’s score and computed tomography severity index (CTSI) were also established. The respective abilities of the three scoring systems to predict mortality was evaluated using trend and discrimination analysis. The optimal cut-off score for mortality from the receiver operating characteristics (ROC) curve was used to evaluate the development of persistent organ failure and pancreatic necrosis (PNec). Results: Of the 119 cases, 42 (35.2%) developed organ failure and were classified as severe acute pancreatitis (SAP), 47 (39.5%) developed PNec, and 12 (10.1%) died. The area under the curve (AUC) results for BISAP score in predicting SAP, PNec, and mortality were 0.962, 0.934 and 0.846, respectively. Ranson’s score showed a slightly lower accuracy for predicting SAP (AUC 0.956) and mortality (AUC 0.841). CTSI was the most accurate in predicting PNec, with an AUC of 0.958. The sensitivity and specificity of BISAP score, with a cut-off of � 3 in predicting mortality, were 100% and 69.2%, respectively. Conclusions: The BISAP score represents a simple way of identifying, within 24 hours of presentation, patients at greater risk of dying and the development of intermediate markers of severity. This risk stratification method can be utilized to improve clinical care and facilitate enrolment in clinical trials.

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Predicting morbidity and mortality in acute pancreatitis in an Indian population: a comparative study of the BISAP score, Ranson’s score and CT severity index

Pandemic caused by novel coronavirus has created an unprecedented situation of lockdown in India. This retrospective study was undertaken to evaluate the impact of COVID-19 restrictions on cases of maxillofacial trauma and its etiologic variation by comparing it with the previous year archived data. Patients with maxillofacial fracture visiting during the lockdown period (Phase) were compared to the patient’s record during the same time period in the year 2019 (Control). They were subcategorised based on the etiology of trauma, i.e., road traffic accident (RTA), self-fall, physical assault and animal attacks. Age and gender variations were also assessed. Degree of significance was calculated using t test and p value obtained. Mean age of trauma patients during lockdown and control period was 32.66 and 27.93 years, respectively. Number of cases of overall trauma had significantly decreased. Cases of RTA and self-fall were 22 and 4 in lockdown compared to 135 and 16 during control phase. Cases of physical assault increased by 50%, i.e., from 9 to 6 on comparison of both the phases. Animal attack maxillofacial injuries were 2 in each group. RTA and subsequent drop in numbers of maxillofacial trauma can be shown as the benefit of lockdown nonetheless on the other side increase in number of physical assaults also shows how isolation and restrictions have psychological negative impact on society.

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Incidence of Maxillofacial Trauma Amid COVID-19: A Comparative Study.

The proficiency testing (PT), a quality control, provides an additional means to ensure quality of laboratory testing results. The primary objective of organizing PT is to assess laboratory's technical competence to perform measurements. This paper describes PT of 11 laboratories, nine accredited by National Accreditation Board for Testing and Calibration of Laboratories (NABL), having best measurement capabilities (< 0.25 % of full-scale pressure) by means of interlaboratory comparison using pressure dial gauge (5-70 MPa) as an artifact. This programme was identified by code number NABL-Pressure-PT003. National Physical Laboratory (NPLI), New Delhi coordinated this programme (February 2003-March 2004) and acted as a reference laboratory. The comparison was carried out at 14 arbitrarily chosen pressure points (5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65 and 70 MPa) throughout the entire pressure range (5-70 MPa). Out of the total 145 measurement results, 86 (59.31 %) results were found in good agreement with the results of reference laboratory, NPU, New Delhi. The relative deviations of the laboratories values with reference values were found almost well within the uncertainty band of the reference values (44.14 % pressure points), within their combined uncertainty band (59.31% pressure points) and within their best measurement capabilities (80.34 % pressure points). Since most of the laboratories have underestimated their measurement uncertainties, 40.69 % measurement results were found out of the combined uncertainty band during this comparison. Overall, results were reasonably good being the first PT for all the participating laboratories. This exercise gives an opportunity to calibration laboratory to demonstrate its technical competence of routine calibration services rendered to clients and to have the measurement traceability to the national metrology institute, NPLI, New Delhi.

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Proficiency testing through interlaboratory comparison in the pressure range up to 70 MPa using pressure dial gauge as an artifact

Present paper describes studies carried out on an industrial dead weight tester (pressure range, up to 330 MPa; calibration; 3 times: period, 6 years), one pressure dial gauge (pressure range, up to 70 MPa; calibration, 3 times; period, 3 years), and one digital pressure calibrator (pressure range, up to 200 MPa; calibration, 4 times; period, 6 years). A small change was observed in the short-term stability but the change was prominent in case of long-term stability in all the instruments. Stability of dead weight tester and pressure dial gauge was well within their claimed manufacturer uncertainties while it was found to be beyond claimed uncertainty in case ol'digital pressure calibrator.

http://nopr.niscair.res.in/bitstream/123456789/4944/1/JSIR%2065%289%29%20721-724.pdf

Om Prakash

Papers

The effect of pressure-transmitting fluids in the characterization of a controlled clearance piston gauge up to 1 GPa

Predicting morbidity and mortality in acute pancreatitis in an Indian population: a comparative study of the BISAP score, Ranson’s score and CT severity index

Incidence of Maxillofacial Trauma Amid COVID-19: A Comparative Study.

Proficiency testing through interlaboratory comparison in the pressure range up to 70 MPa using pressure dial gauge as an artifact

Studies on the stabilities of various types of industrial pressure measuring devices