sandeep kumar

Laryngoscopy, endotracheal intubation, pneumoperitoneum creation and extubation is stressful event marked by hemodynamic changes during laparoscopic procedures. This increases secretion of many biochemical stress markers for example, cortisol levels, TNF-alpha levels, CRP levels, blood Sugar levels. Aim of the study was to compare magnesium sulphate and dexmedetomidine for attenuation of stress response in patients undergoing laparoscopic cholecystectomy under general anaesthesia by measuring biochemical markers of stress response.

60 patients, age between 18 to 60 years of either sex, who were undergoing Laparoscopic cholecystectomy randomized into two groups of 30 patients each by computer generated random number. Group M-received magnesium sulphate 50 mg/kg and group D -received dexmedetomidine 1 μg/kg.

The demographic data were comparable in both groups. Cortisol levels rise in both the groups but significantly more in group M than group D at 30 minute (p-value < 0.001) and 4 hours (p-value < 0.001). CRP levels rise in both the groups but significantly more in group M than group D at 30 min (p-value 0.013) and 4 hours (p-value 0.020). Blood sugar levels rise in both the groups but significantly more in group M than group D at 30 min, 4 hours and 24 hours (p-value <0.001). TNF-alpha levels rise in both the groups but significantly more in group M than group D at 30 min (p-value 0.005) and 4 hours (p-value 0.007).

We conclude that biochemical stress marker levels (Cortisol levels, TNF-alpha, levels, CRP levels, Blood Sugar levels) were more increased in the magnesium sulphate group compared with the dexmedetomidine group. Heart rate and Mean arterial pressure were higher in the Magnesium sulphate group than the Dexmedetomidine group. Dexmedetomidine is better than magnesium sulphate in attenuating the stress of surgery in patients undergoing laparoscopic cholecystectomy.ResearchArticle

The combined spinal-epidural (CSE) anesthesia technique gives a reliable subarachnoid block as well as the flexible epidural block. One of the modified technique of CSE is epidural volume expansion (EVE) in which normal saline or local anesthetic (LA) is instilled though epidural catheter leading to increase in level of sensory blockade. Aim of the study was to compare two different volumes of normal saline for enhancing the effects ofspinal anaesthesia in adult patients undergoing elective lower limb surgeries.

90 patients were randomly divided into two group. Group A -45 patients who were received intrathecal 2.0ml of 0.5% hyperbaric bupivacaine and epidural 10ml of 0.9% normal saline for EVE using CSE technique. Group B -45 patients who were received intrathecal 2.0ml of 0.5% hyperbaric bupivacaine and epidural 15ml of 0.9% normal saline for EVE using CSE technique.

The demographic data were comparable in both groups. Significant difference was seen in total duration of sensory blockade between group A (192.11±9.80) and group B (Mean ± SD 215.33±17.57minutes) (p<0.0001). Total duration of motor blockade was longer in group B (Mean± SD: 181.91± 16.42) as compared to group A (Mean ± SD: 162.48 ± 9.35 minutes) (p<0.0001).

We conclude that epidural volume expansion (EVE) with 15 ml epidural normal saline was associated with faster onset, higher level and early achieve maximum level of sensory blockade, longer two segment regression time, early onset and longer duration of motor blockade as compared to EVE with 10 ml epidural normal saline.

Sepsis and septic shock are leading cause of mortality in ICU patients. Prognostication and early intervention forms most integral part of management of septic shock. There many validated score to assess the critical state of septic shock patients. APACHE2 and SOFA scores are widely used world over. Multiple parameters used in the score and complexity involved have lead researchers to search for more convenient and simple markers. Lactate albumin Ratio (L/A ratio) turns out to be one such marker, combining two easily available parameters and abbreviating fallacies associated with both parameters when assessed individually. We aimed to assess L/A ratio as predictor of all cause 28 days’ mortality in septic shockpatients and correlated L/A ratio to the SOFA score to assess organ dysfunction.

It was a prospective observational study. 130 patients admitted in the state of septic shock were studied. L/A ratio was obtained at 24 hours after admission in the ICU. SOFA score was also calculated at 24 hours. ROC curve was plotted for L/A ratio to evaluate diagnostic accuracy, as predictor of 28 days’ mortality. Multivariable analysis of L/A ratio with other significant parameters was performed. Spearman rank correlation coefficient was used for correlation of L/A ratio with SOFA score.

L/A ratio at 24 hours (AUC 0.99; 95% CI: 0.95 to 0.99), p value =0.0001, was significant predictor of mortality at 28 days, at cut off point of >1.15. Significant positive correlation was found between L/A ratio and SOFA score at 24 hours, with correlation coefficient of 0.828, p value=0.0001.

L/A ratio was found to be independent predictor of 28 days’ Mortality in Septic Shock Patients. Also strong correlationwas obtained of L/A ratio to SOFA score to assess organ dysfunction in septic shock patients.

Psyllaephagus malloticolae Rawat & Kumar sp. nov. a parasitoid of Trioza malloticola (Crawford) (Hemiptera, Psylloidea, Triozidae) causing galls on leaves of the Kamala tree, Mallotus philippensis Muell, 1865 is described from India. An updated key to all the known allied species of Psyllaephagus Ashmead from India is also provided. The new species comes close to P. garuga Sudhir & Singh, 2011 but differs from it in having Funicular V the longest segment, mid-tibial spur longer than basitarsus, and the exserted ovipositor sheath.

Psychoacoustics includes studying the perceived effects of changes in sound intensity, temporal, and frequency aspects that are critical for speech perception. Psycon is one such software used in studies to assess psychoacoustic abilities. Psycon has the potential for wide clinical applications in psychoacoustic research and relies on Auditory syntaX (AUX), a program designed specifically to handle auditory signals. The current study aimed to determine the test-retest reliability of the Psycon application for differential sensitivity measures of frequency, intensity, duration and silence.

The study included 39 participants with normal hearing sensitivity. Psychoacoustic measures, namely, gap detection threshold, duration discrimination threshold, difference limen of intensity, and difference limen of frequency, were used to assess test-retest reliability. The test-retest reliability of all measures was checked in two separate sessions within one day.

The reliability of each measure was measured using Cronbach’s alpha. Test-retest reliability of various psychoacoustic tests measured with Psycon ranges from good to excellent. difference limen of frequency had the highest reliability, followed by duration discrimination thresholds, difference limen of intensity, and gap detection thresholds.

Psycon appears to be a reliable tool for assessing different psychoacoustic abilities.

Perioperative pain in pediatric population is a special concern and Caudal block is easy to perform extensively safe if used in children, resulting in low pain scores and when combined with general anaesthesia, it reduces the requirement for volatile agents, opioids, improved postoperative analgesia, and earlier extubation. Ultrasound guided caudal block has reduced the complication rates such as inadvertent dural or vascular puncture. Aim of the study was to compare the success rate of ultrasound guided with conventional landmark technique caudal block in pediatric patients undergoing lower abdominal surgery under general anaesthesia.

Hundred pediatric patients, ASA class I, age between 6 months to 7 years of either sex, posted for lower abdomen surgery under general anaesthesia were randomly divided in to two groups. In group C- The group with caudal block using conventional landmark technique was used and Group U- The group with caudal block using ultrasound technique was used. Primary objectives of the study to find out the success rate of block in both the groups.

The demographic data were comparable in group C and group U. Significant difference was seen in the distribution of successful block between group C and group U. (p value 0.008) block was successful in 96% of patients in group U which was significantly higher as compared to group C (76%). significant difference was seen in the distribution of number of attempts between group C and group U. (p value 0.001).

We conclude that Caudal block by ultrasound technique increases the first puncture success rate, decreases the number of multiple needle puncture attempts and overall success rate when compared to the conventional landmark technique in pediatric patients undergoing lower abdomen surgery.

Pain is defined as a subject’s conscious perception of modulated nociceptive impulses that generate an unpleasant experience associated with actual or potential tissue damage. General anaesthesia, when combined with regional anaesthesia provides effective perioperative analgesia. Aim of the study was to study the effect of intravenous dexamethasone on duration of post-operative analgesia when given along with intra operative caudal block in paediatric day care infra umbilical surgeries under general anesthesia.

Sixty paediatric patients, American Society of Anesthesiologist’s class I and II, patients were randomly divided in to two groups. In Group D - 30 paediatric patients who were given intravenous dexamethasone in a dose of 0.2 mg/kg iv in 5 ml normal saline along with caudal block with 0.75ml/kg of 0.25% bupivacaine. Group S - 30 paediatric patients who were given 5 ml of normal saline intravenously along with caudal block with 0.75ml/kg of 0.25% bupivacaine. Primary objective of the study was to determine the duration of post-operative analgesia.

The demographic data were comparable in both groups. There were no significant difference of mean (SD) Heart Rate and Mean arterial pressure (mmHg) at baseline, post-operative 1st hour, post-operative 2nd hour, post-operative 3rd hour, post-operative 4th hour (p value >0.05). Time for rescue analgesia (minutes) to be given was more in group D when compared to group S (190.67 ± 41.76 versus 181.17± 37.97) however it was not statistically significant. Total duration of analgesia(minutes), i.e., including both intra-operative and post-operative period was more in group D when compared to group S (266.83 ± 37.69 versus 255.73 ± 42.83). However, there was no significant difference between them. (p value=0.188).

We conclude that a single bolus dose of intravenous dexamethasone (0.2 mg/kg) given along with caudal block with 0.75 ml/kg of 0.25% bupivacaine did not prolong the duration of postoperative analgesia in paediatric patients.

Hemostasis refers to the harmless practice of any surgical procedure or any other chronic ulcer which immediately requires therapy to prevent substantial blood loss and mortality from extreme hemorrhage in surgery/emergency conditions. Various natural, semi-synthetic as well as synthetic biopolymers are available with excellent hemostatic activity and further offer biodegradable and biocompatible nature with the live cells. Now a day’s biopolymers have become the most significant hemostatic agents used in emergency operations and surgical procedures. However, to date, there is no comprehensive report evaluating natural hemostatic materials based on biopolymers. Therefore, this current review attempts to combine the most advanced methods and secondly reviews various biopolymers including their preparation, origin, and composition, as well as safety and biodegradability. Insights on the various commercially available products based on biopolymers exhibiting hemostatic activity are well discussed. Thus, the paper summarizes the latest research work on commonly used biopolymers as the most widely used materials and provides an orientation for further research and development in this field.

Day by day demand for object tracing is increasing because of the huge scope in real-time applications. Object tracing is one of the difficult issues in the computer vision and video processing field. Nowadays, object tracing is a common problem in many applications specifically video footage, traffic management, video indexing, machine learning, artificial intelligence, and many other related fields. In this paper, the Enhanced Method of Object Tracing Using Extended Kalman Filter via Binary Search Algorithm is proposed. Initially, the background subtraction method was used for merge sort and binary search algorithm to identify moving objects from the video. Merge sort is to divide the regions and conquer the algorithm that arranges the region in ascending order. After sorting, the binary search algorithm detects the position of noise in sorted frames and then the next step extended the Kalman Filter algorithm used to predict the moving object. The proposed methodology is linear about the valuation of mean and covariance parameters. Finally, the proposed work considered less time as compared to the state of art methods while tacking the moving objects. Its shows less absolute error and less object tracing error while evaluating the proposed work.

The reconstruction of 3D images is always a difficult task for the researchers. The 3D reconstruction of the image is a core technique of various fields such as Computer graphics, computer vision, CAD systems, medical science, computer application, etc. Reconstruction of the 3D image allows us to gather the quantitative features of the objects such as the shape, size, and volume of the objects. The existing computer algorithms need spatial dimension information to make the distinguished inference from the given 3D image which is not always possible. This paper simplifies the 3D reconstruction of the image. This research paper introduced a novel algorithm for the representation of the Three Dimensional images into a textual form. The syntactic approach is used for the extraction of the features of the image and these are called knowledge vectors. The knowledge vector consists of the direction information and length information. This a new approach in the field of image processing where images can be represented as a knowledge vector and it could be a great contribution in the field where security is a major concern. Further, the knowledge vector is used for the reconstruction of the 3D image. The performance of the algorithm is evaluated on the PASCAL 3D + and example-based Synthesis of the 3D Object Arrangements dataset. According to the obtained results, the proposed methodology is having better accuracy, and the processing time of reconstruction of the original 3D image is 1.02 Seconds. Single-pass is sufficient for reconstructing the original image

Iatrogenic Cushing’s syndrome develops due to chronic exposure to excess glucocorticoids and is associated with increased morbidity and mortality if it remains unrecognized and untreated. Cushing’s syndrome resulting from long-term use of exogenous glucocorticoids is the commonest cause of iatrogenic Cushing’s syndrome. In India, cases of iatrogenic Cushing’s syndrome are commonly encountered, owing to the steroid abuse for respiratory conditions and chronic pains along with poor access to health care.

This study was conducted in the Department of Respiratory Medicine, Himalayan Institute of Medical Science (HIMS), Swami Ram Nagar, Dehradun. Over a period of 12 months, subjects were recruited from the patients presenting to HIMS, Dehradun” with the primary diagnosis of obstructive airway disease after taking written informed consent.

After a detailed history and examination and applying the inclusion and exclusion criteria, 384 consecutive patients diagnosed with Obstructive airway “disease were enrolled. Demographic data was recorded. Diagnosis of Iatrogenic Cushing syndrome was made on the basis of history of use of glucocorticoids and clinical examination. Most of the patients in the study population were   > 60 years of age (34.29%) There was a male predominance in our study with 243 (63.28%) males and 141 (36.72%) females. Smoking was the major risk factor for COPD in comparison to biomass fuel, present in 85.05% and 15.95%, of patients respectively.

In our study, prevalence of iatrogenic Cushing syndrome in obstructive airway disease was 7.81%. This study highlights role of screening for iatrogenic Cushing syndrome in patients with obstructive airway disease with early intervention to prevent the side effects of chronic indiscriminate use of steroids.

The exploitation of naturally obtained resources like biopolymers, plant-based extracts, microorganisms etc., offers numerous advantages of environment-friendliness and biocompatibility for various medicinal and pharmaceutical applications, whereas hazardous chemicals are not utilized for production protocol. Plant extracts based synthetic procedures have drawn consideration over conventional methods like physical and chemical procedures to synthesize nanomaterials. Greener synthesis of nanomaterials has become an area of interest because of numerous advantages such as non-hazardous, economical, and feasible methods with variety of applications in biomedicine, nanotechnology and nano-optoelectronics, etc.

Several inventory models were proposed for manufacturer and retailer which included competition and cooperation between manufacturer and retailer to maximize their profits. Esmaeili M et al. (2009) developed the relationship between manufacturer and Retailer for non co-operative and cooperative games. But the model did not involve any shortage cost as no shortage was allowed. In this paper researcher consider market demand is affected by marketing expenditure and price charged by retailer. This research, presented in this paper, allows shortages for the infinite planning horizon and investigates 1.The non co-operative game for manufacturer-Stackelberg model allowing shortage when manufacturer is the leader and would like to maximize his profit.2.retailer-stackelberg model when retailer is the leader and would like to maximize his profit.3.The co-operative game approach to obtain Pareto Efficient solution. Model is verified through some numerical examples.

Simultaneous fracture of lateral condyle and medial epicondyle of humerus along with elbow dislocation is very rare injury in adults. Only a few cases have been reported in literature in pediatric age groups. The authors describe a case report of fracture of lateral condyle and medial epicondyle of humerus along with elbow dislocation in a young adult. The patient sustained injury in the form of fall from bike. Clinically the patient had swelling and deformity of the elbow joint. There were contusions present in the skin around the elbow joint. There was no distal neuro-vascular deficit. Appropriate radiological investigations were done. The elbow joint was then reduced and found to be unstable. Hence, patient was taken up for surgery in the form of open reduction and internal fixation. The functional outcome of the surgery is presented in the case report. Open reduction and internal fixation are the treatment of choices in these types of cases.

Available DNA isolation methods for Plasmodium involve numerous processing steps, adding to the cost and conferring risk of contamination. Here we devise a simple and cost-effective method for direct extraction of Plasmodium DNA from dried filter paper spot (DBS), appropriate for resource-limited setups. The protocol involves simple freezing and thawing of DBS, neither involves any purification step nor any chemical reagent. The method was assessed in terms of DNA quantity, PCR detection sensitivity, time requirement, cost effectiveness, labor intensiveness and degree of shearing. The reliability of this method was confirmed by comparing it with other in use methods for Plasmodium DNA isolation. Pure DNA was obtained with this method, as exemplified by the absorbance ratio (260nm /280nm) of 1.2. The protocol produced digestible, PCR-grade genomic DNA, also found to be suitable for sequencing. DNA isolated remained stable and retained its integrity after storage for one month at 4 0C. Our process substantiated as efficient, reproducible, simple, fast, and inexpensive. Development of this optimized freeze-thaw based DNA extraction method for malaria parasite may provide a valuable tool for molecular analysis in resource-limited setups. This is the first report of DNA extraction from DBS of Plasmodium utilizing freeze-thaw.

Pharmaceutical Co-crystals are not new, they have gained much attention since the last decade among scientists and pharmaceutical industry. Pharmaceutical co-crystals are multicomponent systems composed of two or more molecules and held together by non-covalent interactions. The development of pharmaceutical co-crystals, a new solid crystalline form, offer superior physico-chemical properties (such as melting point, stability, solubility, permeability, bioavailability, taste masking, etc.) without altering the pharmacological properties. Recently, with the upsurge in the growth of Pharmaceutical co-crystals, the major concern is over the regulatory status of co-crystals. With the new guidelines from United States Food and Drug Administration (USFDA) and European Medicines Agency (EMA), the status has become even more complicated due to significantly different opinions. This review highlights whether co-crystals fulfil the requirements for the grant of a patent or not and how cocrystals are going to affect the present scenario of pharmaceuticals

Statement of the Problem: Despite of many studies conducted on toothbrushes and toothpaste to find out the culprit for abrasion, there is no clear cut evidence to pin point the real cause for abrasion. An in vitro assessment of the role of different types of toothbrushes (soft/ medium/hard) in abrasion process when used in conjunction with and without a dentifrice. Forty five freshly extracted, sound, human incisor teeth were collected for this study. Enamel specimens of approximately 9 mm2 were prepared by gross trimming of extracted teeth using a lathe machine (Baldor 340 Dental lathe; Ohio, USA). They were mounted on separate acrylic bases. The specimens were divided into three groups, each group containing 15 mounted specimens. Group 1 specimens were brushed with soft toothbrush; Group 2 brushed with medium toothbrush and Group 3 with hard toothbrush. Initially, all the mounted specimens in each group were brushed using dentifrice and then the same procedure was repeated with water as control. Profilometric readings were recorded pre and post to tooth brushing and the differences in readings served as proxy measure to assess surface abrasion. These values were then compared to each other. Kruskal Wallis and Mann-Whitney U test were performed. The results showed that brushing, with water alone, caused less abrasion than when toothpaste was added (p< 0.008). When brushed with water, the harder toothbrush caused more abrasion (higher Ra-value), but when toothpaste was added, the softer toothbrush caused more abrasion (p< 0.001). Besides supporting the fact that toothpaste is needed to create a significant abrasion, this study also showed that a softer toothbrush can cause more abrasion than harder ones. The flexibility of bristles is only secondary to abrasion process and abrasivity of dentifrice has an important role in abrasion process.