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Aim: To evaluate Laparoscopic anterior 180° partial fundoplication for its good long-term relief forsymptoms of gastroesophageal reflux disease and association with adverse effects. Methods:Study design: Prospectively evaluated case series. Settings: Tertiary care centers Patients: Theclinical outcomes were determined for all patients who had undergone a laparoscopic anterior partialfundoplication by us between January 1, 2013 to March 31, 2021. Interventions: Clinical outcome,complications, and follow-up after laparoscopic anterior 180° partial fundoplication was obtainedusing a structured questionnaire. Results and Discussion: 228 procedures were performed. Theoutcome at 0 to 8 years (mean, 4 years) follow-up was determined for 195 patients. 1 death waslinked to the laparoscopic procedure and 2 patients died during follow-up due to unrelated causes.For 186 patients (95%) with clinical outcome data at late follow-up, gastroesophageal refluxsymptoms were significantly improved following surgery and were well controlled in 9 patients(4.5%). In a subset of 85 patients with more than 5 years of follow-up, relief of heartburn was foundin 59 patients (69%). Incidence and severity of heartburn were reduced after surgery in 22 patients(26%), decreased dyspepsia in 80 patients (94%). Normal belching was preserved in 84 patients(99%) and almost all patients were able to eat normally. Conclusion: Laparoscopic anterior 180°partial fundoplication is an effective procedure for the surgical treatment of gastroesophageal refluxand is associated with a high rate of patient satisfaction at late follow-up. Compared to Nissen'sfundoplication it is as good as control of recurrent reflux as well as reduced adverse effects. Thepatient goes home in 3-4 days. Hence we recommend it as the procedure of choice for refluxsymptoms.

An agronomic investigation was conducted during Kharif season 2019 at the research farm of Banda University of Agriculture and Technology, Banda (U.P) to study the effect of Integrated Nutrient Management on soil fertility and yield of Kharif Greengram (Vigna radiata L.) in Bundelkhand region. An experiment was laid out in randomized block design replicated thrice with 10 treatments comprised with application of organic and inorganic fertilizers and their combinations. Application of Rhizobium culture @ 25 g/kg of seed along with Vermicompost @ 2.5 t ha-1; FYM @5 t ha-1and 100% RDF was found to be responsible for highest availability of nitrogen (233.90 kg ha-1), phosphorous (21.19 kg ha-1) and potassium (239.20 kg ha-1) in soil after harvest of crop. It was also resulted in higher grain yield (11.41 q ha-1), straw yield (27.45 q ha-1) as compared to other combinations and control.

Background: Laparoscopic live-donor nephrectomy (LLDN) produces reduced donor's pain, early recovery, and a better cosmetic compared to open surgeries. We compared the analgesic efficacy of ropivacaine and levobupivacaine in unilateral ultrasound-guided transversus abdominis plane block (UTAPB) and port-site infiltration (PSI) in LLDN. Patients and Methods: The 120 donors, American Society of Anesthesiologists I-II, of either sex were randomly divided into two groups. The ropivacaine (Group-R = 60 patients given 20 ml of 0.2%) or levobupivacaine (Group-L = 60 patients, 20 ml, 0.25%) in unilateral UTAPB and 10 ml of either drug for PSI at the end of the surgery. All patients received intravenous (IV) patient-controlled analgesia pump (fentanyl) and IV paracetamol 1 g up to 48 h of study duration. Seventy-five milligram IV diclofenac was used as rescue analgesia. The duration of analgesia, time to the first requirement, and number of times rescue analgesia, total amount of fentanyl consumed and pain score Visual Analog Scale noted. Results: In UTAPB, the duration of sensory block in the levobupivacaine group was significantly longer to the ropivacaine group, 12.70 + 7.12 versus 10.55 + 6.64 h (P = 0.090), with lesser rescue analgesic requirement 37 versus 49 (of 60 patients) and lesser total fentanyl consumption 57.50 ± 53.54 mg versus 82.50 ± 65.63 mg. The first-time rescue analgesic delayed, 80.25 ± 137.78 versus 53.67 ± 79.85 min and a number of times rescue analgesic used significantly lesser in the levobupivacaine group 0.87 ± 0.84 versus 1.15 ± 0.92, with better patient satisfaction. Conclusion: Both the levobupivacaine and ropivacaine are effective in UTAPB for the management of postoperative pain after LLDN. The duration of sensory block was longer, total opioid consumption, and rescue analgesic requirement use were significantly lesser in the levobupivacaine group.

Providing anesthesia in a patient with maxillofacial trauma (FMT) or injury is a daunting task. The most important consideration for the anesthesiologist as well as the trauma surgeon is the assessment and management of predicted difficult airway because of trauma-related de-arrangements in anatomy and physiology. Inability to identify a compromised airway can be life-threatening. Considerations due to severe trauma and coexisting injuries to other parts of the body especially the head and neck, chest, abdomen as well as long bones is crucial during initial assessment of the patient. The resuscitation should be as per the Advanced Trauma Life Support (ATLS) guidelines that focuses on systematic approach of early management of airway and breathing, followed by shock and circulation because the mantra is “treat that first which kills first”. Successful resuscitation of patients with maxillofacial trauma along with polytrauma or severe trauma, needs a multidisciplinary team approach with horizontal resuscitation strategies. The various techniques to secure the airway in such a patient will depend on the type of injury, the type of surgery required, the level of difficulty in accessing the airway, as well as the expertise and training of the anesthesiologist. Preexisting comorbidities should also be taken into account in management of such cases. The chapter focuses on perioperative assessment and anesthetic considerations of the trauma patient specially focused on difficult airway rescue and management by the various intubation techniques, precautions during extubation, and postoperative care.

BACKGROUND End-stage renal diseases patients have a high risk of postoperative nausea and vomiting (PONV), which is multifactorial and need acute attention after renal transplantation for a successful outcome in term of an uneventful postoperative period. The study was done to compare the efficacy of palonosetron and ondansetron in preventing early and late-onset PONV in live donor renal transplantation recipients (LDRT). METHODS The prospective randomized double-blinded study was done on 112 consecutive patients planned for live donor renal transplantation. Patients of both sexes in the age group of 18-60 years were randomly divided into two groups: Group O (Ondansetron) and Group P (Palonosetron) with 56 patients in each group by computer-generated randomization. The study drug was administered intravenously (IV) slowly over 30 seconds, one hour before extubation. Postoperatively, the patients were accessed for PONV at 6, 24, and 72 hours using the Visual Analogue Scale (VAS) nausea score and PONV intensity scale. RESULTS The incidence of PONV in the study was found to be 30.35%. There was significant difference in incidence of PONV between Group P and Group O at 6 hours (12.5% vs. 32.1%, p = 0.013) and 72 hours (1.8% vs. 33.9%, p

The temperature rise in chips during machining process largely affects the tool life as well as the quality of the machined product. It also affects the power required for machining. Theref...

Background: Postoperative pain and cerebrospinal fluid (CSF) leak are common known complications of spinal surgery, both having a synergistic effect on each other. Thus, both need to be dealt simultaneously. Double drug impregnated autologous coagulum patch (DDIAC) is a novel method which reduced both incidences of postoperative CSF leaks as well as pain. Methodology: Twenty-seven patients undergoing lumbar disc surgery without instrumentation were included and randomized into DDIAC and single drug impregnated autologous coagulum patch (SDIAC) group. The patients were assessed postoperatively with visual analog scale (VAS). Results: There were 21 males and 6 females in the study. Seventeen (63%) patients got randomized for DDIAC patch application and other 10 (37%) patients entered the control arm group (SDIAC) patch use. Preoperative VAS was 5 in both the groups. The average postoperative VAS was 3.01 in DDIAC arm and 4.29 in control arm. The average analgesic shot required in the DDIAC group was 0.41 in 24 h and SDIAC group was 4.1 in 24 h. In DDIAC group, none of these patients had CSF leak from the surgical wound till discharge from the hospital. In the SDIAC group, one (10%, n = 10) patient had CSF leak. Conclusions: DDIAC patch was effective in controlling pain in the postoperative period; however, few patients may require analgesic shots for pain management. SDIAC patch may control some pain in the immediate postoperative period; however, this was not sufficient for a longer postoperative period.

Prevention of infection in ICU setting is very difficult and needs multidisciplinary approach to monitor and control it. The major infections of concern are central line associated blood-stream infection, ventilator-associated pneumonia, catheter-associated urinary tract infection, clostridium-difficile induced colitis, surgical site infection or infected decubitus ulcer, etc. increasing resistant micro-organisms due to prolonged unnecessary use of broad-spectrum antibiotics without dose adjustment, lack of following the protocols of isolation and hand hygiene with general preventive measures, failure to maintain surveillance strategies are major factors for failure to control infections in ICU. There is urgent need of teaching and training of health care workers regarding various type of infections, its mode of transmissions and effective way of its prevention in ICU like WHO hand hygine guidelines and other recomended bundle cares.Besides this environmental control including safe designing and manintence of ICU, antibiotics stewardship, effective teamwork and good communication are the key to success of infection prevention in ICU.

Energy-efficiency, Coverage-quality, and Fault-tolerance Issues (ECFI) are the three primary and crucial quality assurance standards in a Wireless Sensor Network (WSN). These three standards ensure the network design of a self-configurable and sustainable WSN. First, energy-efficiency mechanisms ensure the prolonging of the overall network lifetime. Second, the coverage quality means how well a region of interest (RoI) is covered. Third, fault-tolerance refers to the ability of a network to continue operating without interruption when one or more components fail. With rapid innovations and developments in Wireless Sensor Network (WSN) applications, many researchers' most sustainable objective is to provide an adeptly operational sensor network. A broad range of applications of WSNs can be seen in the fields of academic, military, industry, medical, and daily needs worldwide. This analysis and survey article's main objective is to highlight different promising challenges on various fundamental characteristics, designing limitations, and their impacts on applications of WSNs. The authors also highlight the energy depletion and energy-provision issues with a concise survey of coverage and fault-related issues in WSNs. The authors finally summarized with discussion and analysis of the overall impacts of ECFI and other parameters on WSNs with simulator availability and future research direction.

Background and Aims: Post-operative nausea and vomiting (PONV) is highly distressing and unpleasant symptom. Dexamethasone and palonosetron are effective antiemetics with minimal side effect profile. This study compares the efficacy of palonosetron or dexamethasone alone and their combination (palonosetron plus dexamethasone) for prevention of PONV after laparoscopic cholecystectomy. Methods: This prospective, randomised, double-blind trial was done on 187 adults, American Society of Anesthesiologists Grade I and II patients, aged 18–75 years undergoing laparoscopic cholecystectomy. They were allocated to three groups which were to receive either of the three treatment regimens: dexamethasone 8 mg (Group D, n = 57), palonosetron 0.075 mg (Group P, n = 66) or dexamethasone 8 mg plus palonosetron 0.075 mg (Group PD, n = 64). The primary outcome was incidence of PONV in 24 h and the secondary outcome was a number of rescue antiemetic required. One-way ANOVA test was used to compare the means amongst three groups. To compare the proportions in the groups, Chi-square test/Fisher's exact test/Two proportions Z-test was applied as appropriate. Results: Overall incidences of PONV in the study 24 h postoperatively were 23.4% in PD, 27.2% in P group and 56.14% in D group (P < 0.001). Requirement of rescue antiemetic was more in dexamethasone group than other two groups (PD = 1 time, P = 1.38 times and D = 1.5 times). Conclusion: Palonosetron alone and palonosetron-dexamethasone combination were equally effective in the prevention of PONV. Dexamethasone alone was least effective amongst the three groups. There is no difference between palonosetron and palonosetron-dexamethasone for PONV prevention.

Emergency Medicine (EM) is a fast upcoming medical speciality wherein patients presenting with emergent life-saving medical and surgical problems are managed. Emergency physicians are first-line providers of emergency care. They diagnose important clinical conditions even before completing patient assessment, order investigations, interventions, resuscitation and treatment for life-threatening acute conditions. There are several interesting sub-specialisations of EM like trauma care, disaster medicine, toxicology, ultrasonography, critical care medicine, hyperbaric medicine, etc. In some countries, the speciality of EM is a popular choice among medical students; whereas in some other countries, the speciality is now evolving. In India, the speciality is growing fast; Nonetheless, the National Medical Commission has made the existence of the department of EM compulsory in all medical colleges in India from the session of 2022-23. Anaesthesiologists suit the speciality of EM because they have quick decision making skills and swift reflexes as well as diverse knowledge and skills in the fields of critical care, resuscitation and pain management. This article written by anaesthesiologists working in the field of EM, attempts to guide the postgraduate students wanting to take up a career in EM.

We live in the genomic era of medicine, where a patient's genomic/molecular data is becoming increasingly important for disease diagnosis, identification of targeted therapy, and risk assessment for adverse reactions. However, decoding the genomic test results and integrating it with clinical data for retrospective studies and cohort identification for prospective clinical trials is still a challenging task. In order to overcome these barriers, we developed an overarching enterprise informatics framework for translational research and personalized medicine called Synergistic Patient and Research Knowledge Systems (SPARKS) and a suite of tools called Oncology Data Retrieval Systems (OncDRS). OncDRS enables seamless data integration, secure and self-navigated query and extraction of clinical and genomic data from heterogeneous sources. Within a year of release, the system has facilitated more than 1500 research queries and has delivered data for more than 50 research studies.

Transesophageal Doppler (TED)-guided intraoperative fluid therapy has shown to noninvasively optimize intravascular volume and reduce postoperative morbidity. The aim of this study was to compare the effects of Doppler-guided intraoperative fluid administration and central venous pressure (CVP)-guided fluid therapy on renal allograft outcome and postoperative complications. A prospective nonrandomized active controlled study was conducted on end-stage renal disease patients scheduled for living donor renal transplant surgery. 110 patients received intraoperative fluid guided by corrected flow time (FTc) and variation in stroke volume values obtained by continuous TED monitoring. Data of 104 patients in whom intraoperative fluid administration was guided by CVP values were retrospectively obtained for a control. The amount of intraoperative fluid given in the study group (12.20 ± 4.24 ml/kg/h) was significantly lower than in the controls (22.21 ± 4.67 ml/kg/h). The amount of colloid used was also significantly less and fewer recipients were seen to require colloid (69 vs 85 %). The mean arterial pressures were comparable throughout. CVP reached was 7.18 ± 3.17 mmHg in the study group. It was significantly higher in the controls (13.42 ± 3.12 mmHg). The postoperative graft function and rate of dysfunction were comparable. Side-effects like postoperative dyspnoea (4.8 vs 0 %) and tissue edema (9.6 vs 2.7 %) were higher in the controls. FTc-guided intraoperative fluid therapy achieved the same rate of immediate graft function as CVP–guided fluid therapy but used a significantly less amount of fluid. The incidence of postoperative complications related to fluid overload was also reduced. The use of TED may replace invasive central line insertions in the future.

Nasogastric tube (NGT) placement in anesthetized and intubated is sometimes very challenging with more than 50% failure rate in the first attempt. We describe a newer innovative Sahu's three in one, technique with use of GlideScope and forward placement of intubated trachea by external laryngeal maneuver, these both techniques lead to separation of trachea from esophagus so that endoscopic jejunal feeding tube guide wire strengthen NGT can be guided and manipulated to esophagus under direct vision. After informed consent, we used Sahu's three in one combo technique to insert NGT in adult anesthetized and intubated patients of both the sexes with high success in the first attempt. We found this technique easy, helpful, less time consuming with high success rate.

Background: Optimal intra-operative fluid therapy in renal transplantation (RT) is essential to ensure adequate graft function while preventing fluid overload related complications. This RCT was to compare the intraoperative goal directed fluid therapy (GDFT) based either on corrected flow time (CFT), measured by trans oesophageal Doppler (TED) or on the stroke volume variation (SVV), by FloTrac in patients undergoing living donor RT. Methods: This prospective, randomised controlled trial (RCT) was done on 60 end stage renal disease (ESRD) patients, American Society of Anaesthesiologists(ASA) grade III–IV, age 18 to 65 years of either sex, scheduled for living donor RT under general anaesthesia. They were randomly divided into two groups: TED group (n = 30) and FloTrac™ group (n = 30) and administered GDFT, based upon CFT (TED) and SVV (FloTrac™). The primary outcome was to compare the total fluid and number of fluid boluses administered intraoperatively, while the secondary outcomes were to compare any postoperative complications due to fluid overload and allograft function, assessed by serial serum creatinine levels up to 90 days postoperatively. Results: The mean total intra-operative fluid [3991.67 ± 856.32 vs. 3543.33 ± 1131.35, P = 0.089] and the amount of fluid administered per kg body weight per hour [13.32 ± 4.67 vs. 11.82 ± 4.76, P = 0.222] were lesser in the FloTrac compared to TED group, though not statistically significant. However, the postoperative incidence of allograft dysfunction, including rejection (P = 0.743) and acute tubular necrosis (ATN) (P = 0.999), and other complications (P = 0.643) were comparable. Conclusions: Both TED and FloTrac devices can be used effectively to guide GDFT in RT, However, lesser total fluid was required in the FloTrac group, which may lead to a lesser number of fluid-related postoperative complications.

Background: Quadratus lumborum block (QLB) has provided adequate analgesia and lowered postoperative opioid requirement in comparison to controls for some urological surgeries. Aims: The aim of this study was to assess the efficacy of postprocedure ultrasound-guided QLB in comparison to port-site infiltrations with local anesthetics (as control) in lowering postoperative pain after laparoscopic pyeloplasty. Settings and Design: This was a prospective, single-blinded, randomized controlled trial. Materials and Methods: Fifty-three adults undergoing laparoscopic pyeloplasty were randomly allocated to either anterior QLB group (n = 27) or port-site infiltration Group P (n = 26) with 20 mL of 0.5% ropivacaine. The primary outcomes were static and dynamic pain on the Visual Analog Scale (VAS) of 0–100 at the 30th min, 2nd, 6th, 12th, and 24th hour after surgery. The secondary outcomes were number of patients requiring rescue analgesics and having postoperative nausea or vomiting (PONV) in 24 hours after surgery. Statistical Analysis: Intergroup comparison of VAS was done with Student's t-test. Categorical data were analyzed using the Chi-square test. Results: The static VAS scores were found to be significantly lower in QLB group at the 2nd, 6th, and 12th hour, and the dynamic VAS was lower at all time points after the 30th min in the QLB group. The number of patients requiring rescue analgesics were significantly lower in the QLB group (13 as compared to 21 in Group P; P = 0.015). The incidence of PONV was comparable. No other side effects were seen. Conclusion: Ultrasound-guided anterior QLB is more effective in comparison to traditional technique of port-site local anesthetic infiltration for providing analgesia after laparoscopic pyeloplasty.

Background and Aims: Postoperative pain following renal transplantation is moderate to severe. Quadratus lumborum block (QLB) is a new block that can provide effective analgesia following abdominal and retroperitoneal surgeries. This study aimed to evaluate the analgesic efficacy of QLB for postoperative analgesia in patients undergoing renal transplantation. Methods: Patients were randomised into two groups of 30 each. In group A (block group), 20 mL of 0.25% bupivacaine and group B (placebo group), 20 mLof normal saline were injected. In the postoperative room, an intravenous patient controlled analgesia (IVPCA) pump with fentanyl was started in both the group. The postoperatively recorded parameters were numerical rating scale (NRS) pain score at rest and on movement and coughing, total fentanyl consumption, sedation score, postoperative nausea vomiting, limb weakness, paralytic ileus, and any other block-related complication. Data were analysed using SPSS software version 22.0. Categorical data were analysed using the Chi-square method. Student t test or Mann–Whitney U test was applied for the continuous data. Numerical data with normal distribution were displayed as mean (standard deviation), abnormal distribution was displayed in the median (interquartile range) values, and as a percentage for categorical variables. Results: Fentanyl consumption, numerical rating score, and sedation score were significantly less in group A when compared to group B at 1, 4, 8, 12, and 24 h (P < 0.001). Conclusion: Type-1 QLB significantly reduces fentanyl consumption and NRS pain score at 1,4,8,12, and 24 h in the postoperative period in renal transplant recipients.

Antineutrophil cytoplasmic autoantibody-associated vasculitis (AAV) is a common cause of rapidly progressive glomerulonephritis resulting in end-stage renal disease (ESRD). Wegener's granulamotosis (WG) is a rare disease of this group that have granulomatosis with polyangiitis, characterized by a triad of necrotizing granulomas in the upper and lower respiratory tracts, small vessel vasculitis, and glomerulonephritis. This case report illustrates the various concerns implicated in the anesthetic considerations of a patient of ESRD with Wegener's granulomatosis for renal transplant.

Computing is very fruitful area for today's business. It provide lot of advantages like reduction of hardware and software cost for organization. Organization not has to invest a lot of money for their infrastructure and they gain full benefit of their investment. Number of cloud provider also increasing some of which have their own data center and some also have virtual data centre to provide services over the internet. Cloud is a model where customer expects more services or services without interruption for their money and cloud provider expect more ROI (Return on investment). These thing depend enough on effective scheduling Cloud provider have many VM at their data centre so they must have a proper load balancing to utilize their all VM. At present time environment is becoming serious issue and in near future problem is increasing more and more. So scheduling algorithm must consider the issue of minimization of carbon emission. In our work we propose an algorithm which will address environment and load balancing issue for public cloud.

The acute blood transfusion reactions are responsible for causing most serious adverse events. Awareness about various clinical features of acute and delayed transfusion reactions with an ability to assess the serious reactions on time can lead to a better prognosis. Evidence-based medicine has changed today′ s scenario of clinical practice to decrease adverse transfusion reactions. New evidence-based algorithms of transfusion and improved haemovigilance lead to avoidance of unnecessary transfusions perioperatively. The recognition of adverse events under anaesthesia is always challenging. The unnecessary blood transfusions can be avoided with better blood conservation techniques during surgery and with anaesthesia techniques that reduce blood loss. Better and newer blood screening methods have decreased the infectious complications to almost negligible levels. With universal leukoreduction of red blood cells (RBCs), selection of potential donors such as use of male donors only plasma and restriction of RBC storage, most of the non-infectious complications can be avoided.

In this paper, we present a method for automatic recognition of Marathi handwritten numerals. The aim of handwritten numeral recognition (HNR) system is to classify input numeral as one of K classes. Handwritten numeral recognisation system have two component feature analysis & pattern classification The feature extraction is by using the chain code and Fourier Descriptor we determine the shape of numerals . After preprocessing the numeral image, the normalized chain code and the Fourier descriptors of the contour of the numeral are extracted. These features are then fed in the Support Vector Machine (SVM) for classification. The proposed method is experimented on a database of 12690 samples of Marathi handwritten numeral using fivefold cross validation technique. We have obtained recognition accuracy of 98.15%.

Gossypiboma or textiloma is used to describe a retained surgical swab in the body after an operation. Inadvertent retention of a foreign body in the abdomen often requires another surgery. This increases morbidity and mortality of the patient, cost of treatment, and medicolegal problems. We are reporting case of a 45-year-old woman who was referred from periphery with acute pain in abdomen. She had a surgical history of abdominal hysterectomy 3 years back, performed at another hospital. On clinical examination and investigation, twisted ovarian cyst was suspected. That is a cystic mass further confirmed by abdominal computerized tomography (CT). During laparotomy, the cyst wall was opened incidentally which lead to the drainage of a large amount of dense pus. In between pus, there was found retained surgical gauze that confirmed the diagnosis of gossypiboma.

In the management of a patient in cardiac arrest, it is sometimes the least experienced provider giving chest compressions, intubating the patient, and running the code during the most crucial moment in that patient′s life. Traditional methods of educating residents and medical students using lectures and bedside teaching are no longer sufficient. Today′s generation of trainees grew up in a multimedia environment, learning on the electronic method of learning (online, internet) instead of reading books. It is unreasonable to expect the educational model developed 50 years ago to be able to adequately train the medical students and residents of today. One area that is difficult to teach is the diagnosis and management of the critically ill patient, specifically who require resuscitation for cardiac emergencies and cardiac arrest. Patient simulation has emerged as an educational tool that allows the learner to practice patient care, away from the bedside, in a controlled and safe environment, giving the learner the opportunity to practice the educational principles of deliberate practice and self-refection. We performed a qualitative literature review of the uses of simulators in resuscitation training with a focus on their current and potential applications in cardiac arrest and emergencies.

Pediatric cardiac arrest is not a single problem. Although most episodes of pediatric cardiac arrest occur as complications and progression of respiratory failure and shock. Sudden cardiac arrest may result from abrupt and unexpected arrhythmias. With a better-tailored therapy, we can optimize the outcome. In the hospital, cardiac arrest often develops as a progression of respiratory failure and shock. Typically half or more of pediatric victims of in-hospital arrest have pre-existing respiratory failure and one-third or more have shock, although these figures vary somewhat among reporting hospitals. When in-hospital respiratory arrest or failure is treated before the development of cardiac arrest, survival ranges from 60% to 97%. Bradyarrthmia, asystole or pulseless electric activity (PEA) were recorded as an initial rhythm in half or more of the recent reports of in-hospital cardiac arrest, with survival to hospital discharge ranging from 22% to 40%. Data allowing characterization of out of hospital pediatric arrest are limited, although existing data support the long-held belief that as with hospitalized children, cardiac arrest most often occurs as a progression of respiratory failure or shock to cardiac arrest with bradyasystole rhythm. Although VF (Ventricular fibrillation, is a very rapid, uncoordinated, ineffective series of contractions throughout the lower chambers of the heart. Unless stopped, these chaotic impulses are fatal) and VT (Ventricular tachycardia is a rapid heartbeat that originates in one of the ventricles of the heart. To be classified as tachycardia, the heart rate is usually at least 100 beats per minute) are not common out-of-cardiac arrest in children, they are more likely to be present with sudden, witnessed collapse, particularly among adolescents. Pre-hospital care till the late 1980s was mainly concerned with adult care, and the initial focus for pediatric resuscitation was provision of oxygen and ventilation, with initial rhythm at the time of emergency medical services arrival being infrequently recorded. In the 1987 series, pre-hospital pediatric cardiac arrest demonstrated asystole in 80%, PEA in 10.5% and VF or VT in 9.6%. Only 29% arrests were witnessed, however, and death in many victims was caused by sudden infant death syndrome.

During war, sharp high-speed missiles have been driven inside the brain; however, in civilian practice it is rare to see such episodes. An approximately 10-cm long nail was driven inside the brain in an attempt to commit suicide by a schizophrenic patient. The case is being reported for its rarity in civilian practice and as a case of clinical interest. After investigating the patient by plain X-rays and a CT scan, he was operated by a neurosurgical team and the nail was successfully removed. In post-operative phase, patient was given medical and psychiatric care along with psychological counseling. The patient made good uneventful recovery in the post-operative phase.

Peripartum cardiomyopathy (PPCM) is a rare life-threatening cardiomyopathy of unknown cause that occurs in the peripartum period in previously healthy women. [1] the symptomatic patients should receive standard therapy for heart failure, managed by a multidisciplinary team. The diagnosis of PPCM rests on the echocardiographic identification of new left ventricular systolic dysfunction during a limited period surrounding parturition. Diagnostic criteria include an ejection fraction of less than 45%, fractional shortening of less than 30%, or both, and end-diastolic dimension of greater than 2.7 cm/m 2 body surface-area. This entity presents a diagnostic challenge because many women in the last month of a normal pregnancy experience dyspnea, fatigue, and pedal edema, symptoms identical to early congestive heart failure. There are no specific criteria for differentiating subtle symptoms of heart failure from normal late pregnancy. Therefore, it is important that a high index of suspicion be maintained to identify the rare case of PPCM as general examination showing symptoms of heart failure with pulmonary edema. PPCM remains a diagnosis of exclusion. No additional specific criteria have been identified to allow distinction between a peripartum patient with new onset heart failure and left ventricular systolic dysfunction as PPCM and another form of dilated cardiomyopathy. Therefore, all other causes of dilated cardiomyopathy with heart failure must be systematically excluded before accepting the designation of PPCM. Recent observations from Haiti [2] suggest that a latent form of PPCM without clinical symptoms might exist. The investigators identified four clinically normal postpartum women with asymptomatic systolic dysfunction on echocardiography, who subsequently either developed clinically detectable dilated cardiomyopathy or improved and completely recovered heart function.

Background and Aims: Catheter-related bladder discomfort (CRBD) has started to gain recognition as a problem in early postoperative care. Dexmedetomidine reduces bladder contractility via M3 muscarinic receptor antagonism and α-2 receptor agonism, apart from its concomitant therapeutic benefits, such as sedation and sympatholysis, in a postoperative period. We, therefore, evaluated the efficacy of dexmedetomidine in reducing incidence and severity of CRBD. Material and Methods: This prospective, randomized, double-blind, placebo-controlled trial done on 110 voluntary kidney donors for live related kidney transplantations were planned for laparoscopic donor nephrectomy. The donors were of ages 18–60 years, American Society of Anesthesiologists physical status I and II of either sex. The control group received 20 ml normal saline (NS) intravenous (IV) infusion over 15 min, whereas the dexmedetomidine group received dexmedetomidine 1 μg/kg made in 20 ml NS as IV infusion over 15 min. The incidence and severity of CRBD were recorded as primary endpoints up to 12 h in early postoperative period. The incidence of bladder discomfort was analysed by Fisher's exact test and severity of bladder discomfort by Mann Whitney U test. Results: The incidence of CRBD on arrival at postoperative care unit was 18% in dexmedetomidine group compared to 42% in control group (P < 0.05). The incidence and severity of CRBD reduced in dexmedetomidine group at 0, 2, and 4 h compared with control group (P < 0.05). Conclusions: Dexmedetomidine 1 μg/kg administered IV to patients 30 min before extubation reduces the incidence and severity of CRBD in early postoperative settings with no adverse effects.

Image restoration is the process of recovering the original image from the degraded or noisy image. We are using multiple images for processing, the identifier select the blur image for further process and restore after applying the algorithms. Our object is identifying the blur image and restores them by parallel distributed computing. We are using blind deconvolution algorithm for restoration process. In which PSF value is unknown that is the intensity value by which image is blurred. We are applying 3 approaches first one is blind deconvolution algorithm. Second is parallel computing and third one is distributed computing. In parallel computing approaches one local scheduler is working for distributing the job and restore result at once. In distributed computing each worker has their same program after running program send the result to the job manager. This overall architecture is depended upon the parallel distributed computing. Job manager handled the overall process done by the worker.

Subarachnoid hemorrhage is associated with a number of cerebral insults as a result of cerebral vasospasm. Various pharmacological and non-pharmacological techniques are used for relief of cerebral vasospasm. Papaverine, either intraarterially or intracisternally, is advocated for management of vasospasm; however, its use is associated with a number of complications. The case of a patient with an anterior communicating artery aneurysm, who received intracisternal papaverine by instillation after aneurysm clipping, is reported. It was associated with hypertension and tachycardia that was not responsive to usual treatment.

Wolff-Parkinson-White syndrome (WPW) is an uncommon cardiac disorder having an aberrant pathway between atria and ventricles. We are reporting a known case of WPW syndrome for hysterectomy under combined spinal epidural anaesthesia. Management of the present case is an important pearl to revisit management of WPW syndrome. The perioperative management should be tailored according to the nature of surgery and the clinical presentation of the patient.

Anisocoria is an uncommon entity in general postoperative intensive care. We present a case of a 45-year-old man suffering from severe acute pancreatitis with a past history of traumatic brain injury (TBI), who developed hypertension, bradycardia and anisocoria soon after re-exploration surgery under general anaesthesia. Computed tomography showed no new lesion. Measures directed towards reducing intracranial pressure resulted in amelioration in about 12 h. The possible role of old TBI in the causation of anisocoria during general anaesthesia and resuscitation has been explored in this report.

In today's era, most of the competitive exams are accomplished with the use of OMR System i.e. Optical Mark Recognition System, but this technique is not fully secure in terms of data tampering. Now these days, tampering in the data of the OMR sheet is really common and affects top level competitive exams as well, e.g. Medical entrance etc. Tampering can be easily done by filling more responses in the OMR sheet by third person so that the examinee gets passed in the examination. This form of data tampering is not detected by existing OMR systems. In this paper, we introduce a new method to detect OMR sheet tampering in order to enhance the security of the OMR system, using encrypted QR codes. Examinee details and number of responses for the asked questions they filled are embedded in the encrypted QR code which is printed on the OMR sheet, so that any alteration in the OMR sheet details is well observed. In our method, ECC i.e. Elliptic Curve Cryptographic algorithm is employed to encipher the data and encrypted QR code is generated with this data and is printed on the OMR sheet. Encryption is performed at the coordinating institute (where the exam is being carried out) using the private key of coordinating institute and public key of exam-evaluation center (where evaluation and result generation is being carried out), and decryption is performed on exam-evaluation center using its own private key and public key of coordinating institute. Thus, original data are kept in the Encrypted QR Code which is decoded successfully only at the exam-evaluation center, so if any modification in the OMR sheet data or in the QR code itself is performed, it will be easily detected. In our experiment, we use Bouncy Castle library to implement ECC algorithm and ZXing library for the encoding and decoding of QR Codes. The experiment was conducted by taking two cases under observation, one for the OMR sheet containing tampered data and another for the OMR sheet having genuine data. The result shows that tampering in OMR sheet is successfully detected in the case of tampered OMR sheet and OMR sheet having genuine data is successfully verified.

Intracranial meningioma during pregnancy challenges the skill of obstetricians, neurosurgeons and neuroanesthesiologists in resection of the tumor and to secure delivery of the baby. Advances in fetal and maternal monitoring, neuroanesthesia, and microsurgical techniques allow safe neurosurgical management of these patients. Urgent neurosurgical intervention is reserved for the management of malignancies, active hydrocephalus, and benign brain tumors associated with signs of impending herniation or progressive neurological defi cit. Particular attention is given to maintain stable maternal hemodynamics to avoid uterine hypo perfusion and fetal hypoxia intraoperatively. Therefore, the major challenge of neuroanesthesia during pregnancy is to provide an appropriate balance between competing, and even contradictory, clinical goals of neuroanesthesiology and obstetric practice.

Airway management in the operating room is the responsibility of anesthesiologists, although a variety of personnel may be responsible for airway management outside the operating room. Emergency department physicians are prominently involved in airway management in the emergency room both independently and with anesthesiologists. Airway management in trauma patients remains the domain of anesthesiologists. An 18-year old male patient was brought to our emergency room after an alleged history of suicidal attempt with gunshot under the chin. He was scheduled to undergo emergency tracheotomy, debridement, and closure of facial laceration under general anaesthesia, presenting a challenge for. He had to undergo emergency tracheotomy, debridement, and closure of facial lacerations under general anesthesia. The injuries made the patient′s airway management a complex issue. We present the use of the light wand to manage the difficult airway of this patient with complex facial trauma.

The VP Shunt is a common pediatric surgical procedure in our country. Hydrocephalus is commonly associated with meningomyelocele in Arnold Chiari malformation-II and the ventriculoperitoneal shunt insertion is the common surgical procedure for the management of hydrocephalus. The standard protocol is to rule out any hydrocephalus by preoperative MRI. If associated with hydrocephalus, insertion of the VP shunt is indicated before the repair of MMC whereas the absence of hydrocephalus indicates that the surgical repair of MMC is to be undertaken immediately. Anesthetic management of the patient during the insertion of ventriculoperitoneal shunt may pose problems. We report here two cases of ACM-II (lumbar MMC with associated hydrocephalus) who had respiratory depression / delayed emergence after an otherwise uneventful procedure. Although the VP shunt (first procedure) required postoperative ventilation which improved later, the phenomena of respiratory depression / delayed emergence did not occur after the MMC repair (second surgery). The possible mechanisms involved in these events and their various clinical aspects are discussed below.

Cardiovascular disease (CVD) is an important comorbidity of chronic kidney disease, and reducing cardiovascular events in this population is an important goal for the clinicians who care for chronic kidney disease patients. The high risk for CVD in transplant recipients is in part explained by the high prevalence of conventional CVD risk factors (e.g., diabetes, hypertension, and dyslipidemia) in this patient population. Current transplant success allows recipients with previous contraindications to transplant to have access to this procedure with more frequency and safety. Herein we provide a series of eight patients with dilated cardiomyopathy with poor ejection fraction posted for live donor renal transplantation which was successfully performed under regional anesthesia with sedation.

Security problem in MANET has been prevailing even after several researches by the various authors. Since application of security mechanism affects the system performance very much therefore there is always scope for further research in this area. Another major cause is fast technology growth in the area of MANET. Recent researches are focusing on another mechanism of security which involves trust management or Identity Based Cryptography (IBC) which has improved the security of the MANET to a great extent. This paper provides a modified trust mechanism for increasing the security over MANET using IBC along with reduced processing time and load on the system. It assigns keys to every incoming node which is used only once per communication between the nodes and hence high performance is assured.