Tourniquet application in snake bite: are we aware?

Background: To assess the use of tourniquets as mentioned in National Snake Bite Management Protocol among peripheral health care providers.Methods: This was a prospective cross-sectional study conducted in a tertiary care institute between June 2016 to June 2017. A total of 36 patients of snake bite referred from peripheral health facility were enrolled in the study and were evaluated for : date and time of bite, site of bite, weather snake was seen, type of envenomation, first aid given in Govt facility/alternative practitioner, tourniquet applied/not applied, anti snake venom given/not given as first aid and outcome.Results: The mean age of the study population was 39 years (17.38) range 18 years to 75 years. 18 patients were male and 18 were female. 30 (83.3%) patients had site of bite over the extremities’. The venom was hemotoxic in 12 (33.3%) patients and neurotoxic 21 (58.3%). 30 (83.3%) patients  received first aid in the Government health facility  manned by qualified in healthcare practitioner and 6 (16.7%) were treated by traditional healers. 29 (80.6%) patients had a tight tourniquet tied to the site of the bite when seen in emergency department of institute. None of the patients had their limbs splinted. 31 (86.1%) patients had received anti snake venom (ASV) at the peripheral health facility. The mortality rate was 5.6% with only 2 deaths.Conclusions: The majority of peripheral health care providers both qualified and unqualified use tourniquets in patients suffering with snake bite. The peripheral health care providers are not aware of importance of limb splinting and immobilisation. Though the rate of instilling ASV is good, the health care providers in the peripheral institutes should be made aware of recommendations of national snake bite management protocol with regard to use of tourniquets and limb splitting in snake bite patients

Contribution by the Indian and Pakistani Authors to Library Philosophy and Practice: A Bibliometric Analysis 2008-2017.

A bibliometric analysis of the research papers explores different aspects of the contribution from an individual author to the country as a whole. The growth of publications, authorship patterns, paper lengths, referencing trends, prolific contribution of authors, etc. about a particular journal are includes in bibliometric studies. Keeping in mind the Indian contribution to a peer review e-journal namely Library Philosophy and Practice (e-Journal) this study began. Meanwhile, it is observed that already work has done on several related aspect. Further, it is also found that the same study has already conducted by Anwar, (2018), exploring the Pakistani contribution to the same journals from 2008-2017. Finally, the present study has designed to explore and compare the contribution of Indian and Pakistani authors to Library Philosophy and Practice (LPP) for a period of ten years from 2008-17. The India and Pakistan are two significant countries in South-East Asia those shares historical, political, and economic background together. This study is based on the bibliometric analysis on LPP covered a period from 2008-2017 in which 432 articles (86 articles from Pakistani & 346 articles from Indian authors) were published during the marked period. Study examines the various bibliometric parameters such as authorship pattern, geographical distribution, major authors, and length of articles. Study finds that 41.8% (181) articles were contributed by two authors. Further, the study found that 11-15 pages of articles published in majority by the authors in both countries

Ethical Purchasing Dissonance: Antecedents and Coping Behaviors

The pressure of oversight and scrutiny in the business-to-business purchasing process has the potential to cause psychological distress in purchasing professionals, giving rise to apprehensions about being ethically inappropriate. Utilizing depth interviews with public sector purchasing professionals in a phenomenological approach, the authors develop the notion of ethical purchasing dissonance to explain the psychological distress. An inductively derived conceptual framework is presented for ethical purchasing dissonance that explores its potential antecedents and consequences; illustrative propositions are presented, and managerial implications are discussed

Emission control in rotary kiln limestone calcination using Petri net models

Indiana University-Purdue University Indianapolis (IUPUI)The idea of emission control is not new. Different industries have been putting in a lot of effort to limit the harmful emissions and support the environment. Keeping our earth green and safe for upcoming generations is our responsibility. Many cement plants have been shut down in recent years on account of high emissions. Controlling SO2, NOx and CO emissions using the Petri net models is an effort towards the clean production of cement. Petri nets do not just give a pictorial representation of emission control, but also help in designing a controller. A controlled Petri net can be potentially implemented to control the process parameters. In Chapter 2, we discuss the Petri nets in detail. In Chapter 3, we explain the modeling of emissions using the Petri nets. A controlled emission model is given in Chapter 4. A general Petri net model is considered to design the controller, which can be easily modified depending on the specific requirements and type of kiln in consideration. The future work given at the end is the work in progress and a neural network model will likely be integrated with the Petri net model

A retrospective study of brochoscopic profile of patients in a tertiary care centre

Background: The purpose of this study was to find out the demographic profiles, indications, bronchoscopic findings and diagnosis of the patients who underwent bronchoscopic examination.Methods: A retrospective analysis of 200 consecutive fiber-optic bronchoscopies was performed at RMCH from June 2015 to June 2017 to find out the demographic and clinical profile of the patients who underwent this procedure. The instrument Olympus video bronchoscope was used for the procedure.Results: Among total of 200 patients, 131 (65.5%) were males and 69 (34.5%) patients were females. 150 (75%) patients were smokers and 50 (25%) patients were non- smokers. Cough was the most common presenting symptom in 180 (90%) of the patients followed by breathlessness 138 (69%), chest pain 114 (57%), hemoptysis 80 (40%), fever 66 (33%). The most common finding is endobronchial growth in 119 (59.5%) followed by nonspecific inflammation 40 (20%), inconclusive 21 (10.5%), normal 12 (6%), suspected growth 8 (4%).Out of 200 patient biopsy was done in 65 patients (32.5%) and most common histopathological diagnosis was malignancy 42 (64.61%), pulmonary tuberculosis 10 (15.38%), Infective pathology 9 (13.8%), inconclusive 4 (6.1%).Conclusions:Bronchoscopy is a safe and useful tool for making the diagnosis of a variety of pulmonary diseases. Endobronchial growth and malignancy were the commonest findings on bronchoscopy and histopathological examination respectively. Moreover, we would like to emphasize the importance of attempting biopsy from the abnormal segment of the lung even when bronchoscopy does not show frank mucosal growth.

METHOD TO SECURE TELEMETRY LOGS IN A MULTI-TENANT ENVIRONMENT

Modern service/hosting models utilize the concept of a multi-tenant infrastructure to share common network services while providing secure logical network segmentation between tenant customers. An on-going problem with network telemetry tools in multi-tenant and shared environments is that often they do not provide data confidentiality between tenants. Presented herein are techniques in which an access policy to telemetry logs can be generated in a multi-tenant environment through the use of role-based policy tokens that are attached to log entries as they are received at a collector

Evaluation of non-invasive ventilation compliance in obstructive sleep apnea syndrome or obesity hypoventilation syndrome patients: an observational study

Background: Recent times have seen the rise in obstructive sleep apnea syndrome/obesity hypoventilation syndrome (OSAS/OHS) patients across the globe. Availability of sleep study centers, questionnaires, and more awareness have made the diagnosis of OSAS/OHS early. But still, the majority of patients suffer from morbidity associated with OSAS/OHS despite the better diagnosis, the most common cause being non-adherence to (CPAP). This needs to be addressed more vigilantly and with utmost importance for successful management of OSAS/OHS.Methods: This is an observational study, we selected patients by reviewing sleep study records at a tertiary care center (Rohilkhand medical college and hospital) in Bareilly, India. All diagnosed patients with OSAS/OHS (i.e. AHI >5) were telephoned and enquired about symptoms and non-invasive ventilation (NIV) use. They were evaluated using a self-designed questionnaire.Results: In our study, we had total of 49 OSAS/OHS patients with mean age of 50.6 years and mean BMI of 35.63. Male patients were 37 (75.5%) and at the time of diagnosis AHI (mean) was 60.67 events/hour. In NIV users there were 24 patients (48.97%), 22 patients (91.7%) feel they have been benefitted from CPAP and 2 patients (8.3%) do not feel benefit from CPAP (NIV) use. Among NIV users there was significant drop of AHI (mean) to 8.07. Among NIV users there was a reduction in symptoms like excessive day time sleepiness in 18 patients (81.81%), witnessed apnea in 15 patients (88.23%), snoring in 21 patients (91.30%), blood pressure in 3 patients (21.42%), blood sugar levels in 2 patients (20%), morning headache in 5 patients (83.30%), depressive mood in 2 patients (40%), perceived memory loss in 3 patients (33.3%), sense of choking in 17 patients (94.4%) and weight loss in 19 patients (76%).Conclusions: CPAP significantly improves symptoms and provides objective as well as subjective benefit to OSAS/OHS patients but still significant proportion of patients hesitate to initiate the therapy. Poor education/awareness regarding OSAS/OHS and non-availability of affordable CPAP remains the leading cause of non-compliance. There is a need for early education, reinforcement and affordable CPAP therapy

Comparison of BACTEC MGIT with conventional methods for detection of Mycobacteria in clinically suspected patients of extra pulmonary tuberculosis in a tertiary care hospital

Background: Tuberculosis is an important public health problem in India and globally.  Extra pulmonary tuberculosis (EPTB) constitutes for approximately 15 to 20 per cent of all cases of tuberculosis in immunocompetent patients and accounts for more than 50 per cent of the cases in HIV- positive individuals. Main problem with the extra-pulmonary tuberculosis is the paucibacillary nature of the specimen, which makes the diagnosis difficult and delay the treatment. With this in background, this study aimed at the isolation of Mycobacteria from clinical specimens of patients suspected of extra pulmonary tuberculosis using BACTEC MGIT, Lowenstein Jensen (LJ) media and direct acid-fast bacilli smear examination.Methods: A total of 66 samples were processed for direct AFB smear examination, and culture on MGIT and LJ media. Acid fast staining of the specimens was done using the Ziehl-Neelsen method.Results: Among 66 specimens, MGIT gave a higher yield of mycobacteria (46.9%), lower contamination rate (3%) and shorter time to positive culture as compared to LJ media.Conclusions: MGIT gives higher yield and faster results

Definitive chemoradiation in non metastatic squamous cell carcinoma anal canal: a single institution experience

Background: To analyze the oncological outcomes in anal canal squamous cell carcinoma treated with concurrent chemoradiotherapy. Materials and Methods: A single centre retrospective hospital based study with sample size of 51 patients of anal canal Squamous cell carcinoma treated with concurrent chemoradiotherapy with mitomycin @10mg/m2 and 5FU based. Disease free survival (DFS), Colostomy free survival (CFS) and Overall survival (OS) rates were calculated by Kaplan-Meier method. Results: Among 51 eligible patients, after a median follow up of 46 months (range 10-68 months). The 3year Disease free survival (DFS) was 73.9%. 3patients developed locoregional recurrence while 1patient developed distant metastasis. At 3 years Overall survival (OS) rate was 77%. Out of 44 patients 6 patients lost to follow up while 2 patients died due to progressive disease and 2 due to non cancer causes. 3year Colostomy free survival (CFS) rate was 59%. Total 18 out of 44 patients underwent colostomy. No grade 3 or 4 late toxicities occurred after completion of treatment. Conclusion: This study concluded that definitive chemoradiotherapy achieves good local control, overall survival and colostomy free survival with acceptable toxicity and can be recommended as standard treatment in patients with carcinoma anal canal