Study of Portal vein Doppler indices and other noninvasive markers as predictors of esophageal varices in cirrhotic patients

INTRODUCTION: Portal hypertension commonly accompanies liver cirrhosis. The development of esophageal varices (EV) is one of the major complications of portal hypertension. The prevalence of EV in patients with liver cirrhosis ranges from 60% to 80%. The risk of bleeding from these varices is associated with the severity of the liver disease and the size of varices, which are the most important predictors of bleeding. Large EVs (LEVs) are more likely to bleed than small EVs (SEVs) due to high variceal wall tension. Guildlines recommend that all cirrhotic patients should be screened for the presence of EV when liver cirrhosis is diagnosed. Upper gastrointestinal endoscopy, which is the most common and accurate procedure for evaluation of varices, is at times inconvenient for patients and not cost effective. Investigators have attempted to identify characteristics that ‘noninvasively’ predict the presence of varices. These studies have shown that biochemical, clinical, and ultrasonographic parameters alone or together have good predictive value for noninvasively assessing the presence of EV. AIM OF THE STUDY: 1.To evaluate portal hypertension parameters in liver cirrhosis by using Doppler ultrasound. 2.To evaluate other non-invasive parameters in predicting esophageal varices. 3. To correlate portal hypertension parameters in predicting Esophageal varices and upper GI bleed from esophageal varices. MATERIALS AND METHODS: 99 Cirrhotic patients registered in liver clinic (both old and new patients), Dept. of medical gastroenterolgy, Govt. Stanley medical college were enrolled in this study. The study period from April 2010 to February 2010. Their clinical presentation, Child-Pugh status, co-morbid conditions, baseline blood parameters, liver function test, etiology and endoscopic grading of varices will be noted. All patients will be subjected to Doppler evaluation of portal system including portal venous velocity, portal vein diameter, portal vein cross sectional area, the pulsatility and resistive index of hepatic, splenic arteries, spleen size were determined. Other indices like Liver vascular index, congestion index, portal hypertensive index and presence of porto-systemic collaterals also noted. Platelet/spleen ratio, AST/platelet ratio were calculated. The results were analysed and compared between patients without varices and with small and large varices. RESULTS: The most common etiology of cirrhosis in this part of country is Alcohol related liver disease (29%), followed by cryptogenic and Hepatitis B related liver disease (28% & 21% respectively). Non-invasive parameters like Platelet count (114578 in patients without varices vs. 78113 in patients with large varices, P=0.049), Prothrombin time (16.53±4.3 vs. 18.18±4.5, P=0.030), Platelet count/spleen diameter ratio (957 vs. 627, P=0.011) predicted the presence of large esophageal varices. Among the Colour Doppler Ultrasound study parameters, the Portal vein mean velocity (15.44±4.63 vs. 11.91±3.97, P=0.019), Liver vascular index (14.38±5.56 vs. 9.38±4.01, P=0.001), Spleen size>16.2 cm (13.34±4.20 vs.16.29±3.42, P=0.05) predicted the presence of large esophageal varices, increasing the risk for upper gastrointestinal bleeding. Other non-invasive parameters like CTP score, MELD, AST/Platelet ratio, Bilirubin, and Doppler parameters like portal vein diameter, hepatic artery resistive & pulsatility index, splenic artery resistive index, congestive index, portal hypertensive index did not predict the presence of either small or large varices. CONCLUSION: Results of our study indicate that non-invasive tools like platelet count, prothrombin time, platelet/spleen diameter ratio, spleen size >16.2 cm, and Doppler parameters like portal vein velocity, liver vascular index are predictors of presence of large esophageal varices

Tamils beliefs and customs as found in an anthology of akananuru - the classical literature

Tamil literature is an ancient literature. It is also known as Cankam literature and classified as classical literature because from the earliest times it has not been expanded. This literature has a long history back to 3 A.D. Cankam literature as a classical literature included various anthologies and poems. The anthologies are Ettuttokai (Eight Anthology) and Pattuppattu (Ten Idylls) which contains more than two thousand poems. They are the main source of information to know about the Tamils history, their social life, economy activities, games, custom, beliefs, wars and religion. The purpose of this paper is to discuss about Tamils beliefs and customs during classical period as seen in Akananuru work. The discussion will use the anthology of Akananuru as main source with cankam poems as cross reference and will compare it with current one

Properties of 25Cr7Ni stainless steel fabricated through laser-powder bed fusion.

Stainless steel is a low carbon high alloyed system with higher concentrations of Cr& Ni, which impart high corrosion resistance to them. Alloys with approximately 25% Cr & 7% Ni in their chemical composition are commercially referred to as ‘Super Duplex Stainless Steel’. They have a unique phase composition of approximately 50% ferrite & 50% austenite, yielding a robust combination of high mechanical strength & corrosion resistance. They find extensive interest & application in the fields which demand a longer service life under intense mechanical / corrosive environment such as offshore oil rigs & pipelines in nuclear power plants. Traditional thermal processing and fabrication of super duplex stainless steel are fraught with limitations and shortcomings in terms of detrimental phase formation. Laser-Powder Bed Fusion is a form of additive manufacturing that involves layer wise addition and consolidation of metal powders in near net shape parts. The process is characterized by high cooling rates to the tune of 107 k/s. This unique characteristic allows for the suppression of formation of detrimental phases and is leveraged in processing of super duplex stainless steels. The available literature on L-PBF fabrication of super duplex stainless steel in comparison to conventional stainless steel alloys is quite lacking. This study quantitively established the influence of the Laser-Powder Bed Fusion (L-PBF) process parameters, starting powder attributes, chemical composition, inert atmosphere & Hot Isostatic Pressing (HIP) on the as-printed properties of the fabricated super duplex stainless steel samples. As-printed samples of a gas atomized super duplex stainless steel yielded the highest UTS, yield strength and comparable corrosion resistance to wrought-annealed, MIM, PM, L-PBF literature super duplex stainless steel. Economical water atomized super duplex stainless steel powder was used to fabricate samples which had higher UTS, yield strength & comparable corrosion resistance to wrought-annealed stainless steel

Matchings with lower quotas: Algorithms and complexity

We study a natural generalization of the maximum weight many-to-one matching problem. We are given an undirected bipartite graph G=(A∪˙P,E)G=(A∪˙P,E) with weights on the edges in E, and with lower and upper quotas on the vertices in P. We seek a maximum weight many-to-one matching satisfying two sets of constraints: vertices in A are incident to at most one matching edge, while vertices in P are either unmatched or they are incident to a number of matching edges between their lower and upper quota. This problem, which we call maximum weight many-to-one matching with lower and upper quotas (WMLQ), has applications to the assignment of students to projects within university courses, where there are constraints on the minimum and maximum numbers of students that must be assigned to each project. In this paper, we provide a comprehensive analysis of the complexity of WMLQ from the viewpoints of classical polynomial time algorithms, fixed-parameter tractability, as well as approximability. We draw the line between NPNP-hard and polynomially tractable instances in terms of degree and quota constraints and provide efficient algorithms to solve the tractable ones. We further show that the problem can be solved in polynomial time for instances with bounded treewidth; however, the corresponding runtime is exponential in the treewidth with the maximum upper quota umaxumax as basis, and we prove that this dependence is necessary unless FPT=W[1]FPT=W[1]. The approximability of WMLQ is also discussed: we present an approximation algorithm for the general case with performance guarantee umax+1umax+1, which is asymptotically best possible unless P=NPP=NP. Finally, we elaborate on how most of our positive results carry over to matchings in arbitrary graphs with lower quotas

Maximising the Benefits of Foreign Aid : Leveraging In-Country Financing

This Policy Brief outlines an alternative approach to maximising the benefit of donor aid in low income countries. It has policy implications for the allocation of aid by Non-Governmental Organisations (NGOs) and national governments

SIMPLE QUANTIFIED AND VALIDATED STABILITY INDICATING STRESS DEGRADATION STUDIES OF ORAL ANTI-DIABETIC AGENT DAPAGLIFLOZIN BY RP-HPLC METHOD

Objective: This method is focused on developing a precisely simplified and more accurate Reverse Phase–High Pressure Liquid Chromatography (RP-HPLC) method for the determination of Dapagliflozin in bulk and pharmaceutical dosage form as per guidelines of International Council for Harmonization (ICH). Methods: Evaluation and validation carried out using the RP-HPLC ZORBAX (C18) column (250 x 4.6 mm, 5 μm particle size) with a mobile phase consisting of Phosphate Buffer: Acetonitrile: Methanol in a ratio of 55:40:05 (v/v/v) at a flow rate of 1 ml/min with an injection volume of 10 μl. Results: Dapagliflozin was eluted at 2.12±0.05 min and detected at 225 nm. The regression equation y = 55762 x-29679 found to be linear with correlation coefficient r2 value of 0.9997. The developed RP-HPLC method was conveniently validated as per the ICH guidelines and found method was robust, sensitive, accurate, selective, specific, precise and linear. Conclusion: The proposed method was found to be accurate, precise, and robust for API and pharmaceutical dosage form as per experimentation analysis. The above developed method was found to be satisfied for Active Pharmaceutical Ingredient (API) and pharmaceutical formulation of Dapagliflozin to study its degradation products

An incremental algorithm for uncapacitated facility location problem

We study the incremental facility location problem, wherein we are given an instance of the uncapacitated facility location problem (UFLP) and seek an incremental sequence of opening facilities and an incremental sequence of serving customers along with their fixed assignments to facilities open in the partial sequence. We say that a sequence has a competitive ratio of k, if the cost of serving the first ℓ customers in the sequence is at most k times the optimal solution for serving any ℓ customers for all possible values of ℓ. We provide an incremental framework that computes a sequence with a competitive ratio of at most eight and a worst-case instance that provides a lower bound of three for any incremental sequence. We also present the results of our computational experiments carried out on a set of benchmark instances for the UFLP. The problem has applications in multistage network planning

Impact of Economic Recession on Cardiovascular Health Across 30 Major American Cities

Background: The economic recession from 2007 to 2009 created great fiscal challenges for American cities that have made them slow to recover. Economic instability causes increased unemployment rates forcing many to opt for compromised unhealthy lifestyles and increased mental stress. Therefore, the impact of economic recession on population's health has become a major concern. Objective: To study the impact of economic recession on cardiovascular disease (CVD) among urban population aged 18 years and older in 30 major cities in United States. Methods: The study with an ecological design was conducted using data from 2006-2012 Behavioral Risk Factor Surveillance System (BRFSS). Thirty largest cities by population were included in the analysis. Participants' health conditions including prevalence of CVD were defined on the basis of self-reported physician-diagnosis of disease. Differences in CVD prevalence across the 30 cities and associations of CVD with socioeconomic and behavior risk factors were examined using univariate and multivariate analysis approaches. All analysis was conducted using SAS 9.3 software. Results: Among 997161 participants of the total study sample, the prevalence of coronary heart disease (CHD) and stroke was 8.6% and 4.2%.Increasing age was a significant predictor for both the cardiovascular disease. Males had increased odds of developing CVD than females. Native Americans/Alaskan Indians followed by Blacks and had greater odds for CVD. Detroit, St. Louis and San Antonio had highest prevalence of CVD, while San Francisco, Seattle and Minneapolis had the lowest. Age adjusted results showed increased prevalence during economic recession period in all cities. Per capita real GDP, cigarette smoking, diabetes, depression, obesity, education, employment and income were significantly associated with CVD. Conclusion: The study confirms that in addition to the study of well-established CVD risk factors, such as smoking and obesity, economic recession has a significant impact on cardiovascular health among urban population. Further studies are needed to test the potential mechanisms by which economic recession causes the risk of CVD.M.P.H., Public Health -- Drexel University, 201

A comparative study between laparoscopic and open cholecystectomy in Chengalpattu Medical College

BACKGROUND: Gallstones occurrence is one of the commonest disease processes treated by general surgeon. In 1882 Carl Langenbuch performed the first cholecystectomy, enunciating a principal that the gall bladder needs to be removed not because it contains stones, but because it forms them. Over the years cholecystectomy has been the gold standard in the treatment of gall stone disease. Open cholecystectomy which had been performed unchallenged for over a century now faces an abrupt end with advent of laparoscopic cholecystectomy. In 1985 Philipe Mouret from France performed the first Human Lap Cholecystectomy. Patient acceptance, preference and demand for laparoscopic cholecystectomy is logical since this procedure gives less pain , need for less medication, far shorter hopitalisation and most important it permits an early return to family and normal work and activity. As an added bonus it has an excellent cosmetic result. Laparoscopic cholecystectomy further offers the long term benefit of negligible incidence of wound infection, incisional hernia, nerve entrapment and post operative adhesions. In the field of laparoscopy, laparoscopic cholecystectomy has been the first major surgery performed and has paved the path for laparoscopic intervention for other varied intra abdominal pathologies. So we will study both the techniques and their standing in present scenario. With the background of experience in open cholecystectomy we will commence our work on laparoscopic cholecystectomy. OBJECTIVES OF THE STUDY: 1. Comparative study of the duration of Surgery in both groups. 2. Comparative study of post operative hospital stay, drugs used, Time taken for return to work and Study of conversion rate to open surgery. 3. Comparative study of post-operative complications mortality and morbidity in both groups. MATERIALS AND METHODS: Source of data: Study is a prospective type which includes all patients admitted in Chengalpattu Medical College for elective cholecystectomy. Method of collection of data (including sampling procedure if any: Definition of a study subject: Patients admitted to Department of Surgery, Chengalpattu Medical College for Elective Cholecystectomy. The method of study consists of;- • Detail history taking & clinical examination as per the proforma. • Investigations after taking written informed consent. • Patients will be explained about types of surgeries available-laparoscopic or open cholecystectomy. • Intraoperatively careful note will be made about • Time latent for the procedure • Documentation of any complication encountered during procedure. • If laproscopic procedure converted to open cholecystectomy, reason for the same. • Post operative period will be divide into immediate or in hospital stay and follow up period during in hospital stay, following data will be collected: • Drain removal ,if put. • Post operative hospital stay. • Any complication if occurred. • Patients of both groups will be followed regularly up to 3 months. • Note will made of any complications, time taken to return to work and patients satisfaction. Inclusion criteria: 1. Patients with symptomatic gallbladder diseases 2. Symptomatic gallstones. 3. Acute or Chronic cholecystitis. 4. Mucocele/ Pyocele of gallbladder. Exclusion criteria: 1. Pregnancy. 2. Major bleeding disorder. 3. Cirrhosis with portal hypertension. 4. Generalised peritonitis. 5. Patient not fit for general anaesthesia. 6. Suspected gall bladder malignancy The following investigations will be done after taking written informed consent:- 1. Routine Investigations for General Surgical Procedure Blood Investigation and Urine Investigations :Hb%, TC , DC, Peripheral smear, ESR, Renal function tests, Liver function tests, Lipid profile, FBS/PPBS, HIV, HBsAg, , Urine for albumin, sugars, ketone bodies, microscopy, BT CT. Other investigations : X-ray of the chest, X-ray Erect Abdomen, Ultrasonogram of Abdomen, Serum amylase. In selected cases MRCP, ERCP, CT Abdomen CONCLUSION: The above study is to evaluate the superiority of laparascopic cholecystectomy over open cholecystectomy in Chengalpattu Medical College Hospital during the period September 2015 to October 2016