Prevention of altered hemodynamics after spinal anesthesia: A comparison of volume preloading with tetrastarch, succinylated gelatin and ringer lactate solution for the patients undergoing lower segment caesarean section

Background: Spinal anesthesia has replaced general anesthesia in obstetric practice. Hemodynamic instability is a common, but preventable complication of spinal anesthesia. Preloading the circulation with intravenous fluids is considered a safe and effective method of preventing hypotension following spinal anesthesia. We had conducted a study to compare the hemodynamic stability after volume preloading with either Ringer′s lactate (RL) or tetrastarch hydroxyethyl starch (HES) or succinylated gelatin (SG) in the patients undergoing cesarean section under spinal anesthesia. Materials and Methods: It was a prospective, double-blinded and randomized controlled study. Ninety six ASA-I healthy, nonlaboring parturients were randomly divided in 3 groups HES, SG, RL (n = 32 each) and received 10 ml/kg HES 130/0.4; 10 ml/kg SG (4% modified fluid gelatin) and 20 ml/kg RL respectively prior to SA scheduled for cesarean section. Heart rate, blood pressure (BP), oxygen saturation was measured. Results: The fall in systolic blood pressure (SBP) (<100 mm Hg) noted among 5 (15.63%), 12 (37.5%) and 14 (43.75%) parturients in groups HES, SG, RL respectively. Vasopressor (phenylephrine) was used to treat hypotension when SBP <90 mm Hg. Both the results and APGAR scores were comparable in all the groups. Lower preloading volume and less intra-operative vasopressor requirement was noted in HES group for maintaining BP though it has no clinical significance. Conclusion: RL which is cheap, physiological and widely available crystalloid can preload effectively and maintain hemodynamic stability well in cesarean section and any remnant hypotension can easily be manageable with vasopressor

Minimization of the process loss in condensate fractionation plant

In this paper, the optimum design, operation and control philosophy were studied to minimize the process losses in a condensate fractionation plant. Pinch analysis was done for optimum energy usage in the plant. Energy losses once identified can be reduced with little investment. Remarkable savings can be obtained through an energy saving program. Important savings can also be made with operational improvements in the process and better maintenance of production equipment such as distillation column, heaters, heat exchangers etc. Saving energy and proper maintenance of equipments in the process will also reduce the amount of gas emissions and fuel gas consumption and increase plant's lifetime. Aspen- HYSYS and Aspen Energy Analyzer was used as a process simulator and energy analyzer accordingly. Study on energy savings, operating conditions and its environmental impact in a local fractionation plant is presented

Neovaginoplasty using sigmoid colon flap technique

Background and objectives: Vaginoplasty is a procedure for the reconstruction of vaginal canal. Various surgical techniques have been described for vaginal reconstruction with variable success. The aim of this study was to assess the use of sigmoid colon in vaginal reconstruction of patients with disorders of sex development. Methods: Eleven patients were included in this study from January 2009 to December 2016. All patients underwent karyotyping, pelvi-abdominal ultrasonography, endocrine and psychiatric assessment. Sigmoid neo-vaginoplasty was the procedure chosen for all the cases. Surgical and functional outcomes were assessed post-operatively over a period of 6 month to 6 years. Results: The preoperative diagnosis included 9 cases of aplasia of the Mullerian ducts or Mayer-Rokitansky-Küster-Hauser syndrome (MRKH), 1 androgen insensitivity syndrome (AIS) and 1 pseudohermaphrodite case. The mean age of the study population was 22.5 years (range 15-30 yrs). No intra-operative or early postoperative complications occurred. The mean vaginal length achieved was 13.0 cm (range 10.5 – 15 cm). Long term follow-up showed introital stenosis in 2 cases (17%) which resolved well to vaginal dilatation. One patient had pelvic abscess and treated by surgery. Sexual satisfaction was achieved in 10 cases, as 1 case was unmarried. Conclusion: For patients with disorders of sex development of various etiologies, sigmoid vaginoplasty is the preferred technique for vaginal reconstruction. It is a safe technique and provides the patient with a cosmetic neovagina of adequate caliber with satisfactory functional outcome. IMC J Med Sci 2018; 12(1): 27-3

Nypa Fruticans As A Potential Low Cost Adsorbent To Uptake Heavy Metals From Industrial Wastewater

Nypa fruticans locally known as Gol leaves (GL) was demonstrated in the present study as a potential low cost adsorbent for the removal of heavy metals, especially Cr(VI) from aqueous solution. A series of batch tests were conducted and the influence of initial metal ion concentration, contact time, pH of the solution and adsorbent dosage was investigated. The adsorbent was characterized by Fourier transform infrared (FTIR) spectroscopy and Brunauer–Emmett–Teller (BET) to confirm the mechanism of the retention of heavy metals. The adsorption process was found to be strongly pH dependent and a value of 4 was optimized for the utmost recovery. The adsorption isotherm data were fitted with Langmuir equation and the maximum adsorption capacity was found to be 76.92 mg/g. Therefore, GL can be employed as an efficient and cost-effective adsorbent for the removal of heavy metals present in industrial wastewater