A Comparative Study between Two Different Current Strengths for Supraclavicular Block Using Nerve Stimulator in Elective Upper Limb Surgeries Below Elbow

INTRODUCTION : Painless surgery is the ultimate goal for all anaesthesiologists and the heartfelt wish of all patients undergoing any type of surgery. Regional anaesthetic technique like nerve blocks offer pain free surgical field during and after the intra operative period to patients with a lot of other advantages over general anaesthesia. Early approach to nerve blocks followed the dictum of Moore which states “No Paraesthesia; No anaesthesia”. The “art” of peripheral nerve blockade performed by gifted individuals has now turned into a “science” with the help of peripheral nerve stimulators and ultrasound imaging. AIM : To study the quality of blockade while using two different current strengths for supraclavicular block with nerve stimulator in elective upper limb surgeries below elbow. DESIGN : Prospective randomized double blinded study conducted at Department of Anaesthesiology, Chengalpattu medical college & hospital. MATERIALS AND METHODS : After obtaining Institutional Ethical Committee approval, 60 patients belonging to ASA I or II in the age group of 16 to 60 years undergoing elective upper limb surgeries below elbow were selected. Written informed consent was obtained. The patients were divided into two groups based on computerised randomisation. All the patients received supraclavicular block by subclavian perivascular approach of Winnie with 15 ml of 2% Lignocaine with 1 : 2,00,000 adrenaline plus 15 ml of 0.5% bupivacaine. In Group A (0.5 mA), the nerve stimulator was initially set to deliver a current of 0.9 mA. After obtaining twitch of hand or fingers in flexion or extension, the current strength was gradually reduced till response was similarly obtained with 0.5 mA and the drug was injected. In Group B (0.9 mA), the nerve stimulator was initially set to deliver a current of 0.9 mA. After obtaining twitch of hand or fingers in flexion or extension, the drug was injected. The following parameters were noted by a blinded observer – duration of surgery, number of attempts to perform the block, time taken to perform the block, time of onset of sensory blockade, time of onset of motor blockade, total duration of sensory blockade, total duration of motor blockade, time taken for Rescue analgesia and complications. STATISTICAL ANALYSIS : The data were analyzed using the SPSS (version 16) software. The parametric data were analyzed with Student’s ‘t’ test and the nonparametric data were analyzed with Chi-square test. A p < 0.05 was considered statistically significant. OBSERVATION AND RESULTS : The two groups showed no significant difference with regard to demographic data like age, sex and weight. Time taken to perform the block was similar in both groups at 3.87±1.224 minutes in Group A and 3.33±0.844 minutes in Group B with a ‘p’ value of 0.054. The onset of sensory blockade was similar at 6.47±2.33 minutes in Group A and 6.36±2.438 minutes in Group B with a ‘p’ value of 0.862. The onset of motor blockade was also similar at 11.67±2.975 minutes in Group A and 11±2.694 minutes in Group B with a ‘p’ value of 0.376. The duration of motor blockade was 363.33±19.357 minutes in Group A and 364.64±24.416 minutes in Group B with a ‘p’ value of 0.821 which was statistically insignificant. The time for first rescue analgesia was statistically insignificant at 412.67±18.742 minutes in Group A and 410.36±22.849 minutes in Group B with a ‘p’ value of 0.675. There were no complications in both the groups. CONCLUSION : Supraclavicular block performed at 0.5 and 0.9 mA using nerve stimulator for upper limb surgeries below elbow is comparable in terms of attempts at block performance, time taken to perform block, onset of block and duration of block. The success rate was 100 % with no complications in both groups. Hence, nerve stimulator guided blocks may be performed at the initial seeking current itself (< 1 mA) to avoid multiple attempts and unnecessary needle manipulations which may prove harmful to the patient

Corrosion Protection of Steel Using Nonanomalous Ni-Zn-P Coatings

A novel technique for obtaining nonanomalous Ni-Zn-P coatings with high Ni content (74 wt % as compared to 15-20 wt % in the conventional plating method) has been developed. These coatings show promise as a replacement for Cd in sacrificially protecting steel. Ni-Zn-P coatings were deposited using an electroless method from a solution containing NiSO4, complexing agent and ammonium chloride. Varying the concentration of ZnSO4 in the bath controls the final amount of Zn in the deposit. The Zn content in the coating was optimized based on the corrosion resistance of the final deposit. Coatings with 16.2 wt % Zn were found to display a potential of –0.652 V vs. SCE that is more electronegative to steel and hence can be used as a sacrificial coating for the protection of steel. Deposition parameters like pH and temperature have been optimized based on composition of the coating and the surface morphology. Corrosion studies in corroding media show that Ni-Zn-P coatings obtained using the electroless method show a higher barrier resistance and better stability as compared to cadmium coatings

Study of Sn-Coated Graphite as Anode Material for Secondary Lithium-Ion Batteries

Tin-graphite composites have been developed as an alternate anode material for Li-ion batteries using an autocatalytic deposition technique. The specific discharge capacity, coulombic efficiency, rate capability behavior, and cycle life of Sn-C composites has been studied using a variety of electrochemical methods. The amount of tin loading and the heating temperature have a significant effect on the composite performance. The synthesis conditions and Sn loading on graphite have been optimized to obtain the maximum reversible capacity for the composite electrode. Heating the composite converts it from amorphous to crystalline form. Apart from higher capacity, Sn-graphite composites possesses higher coulombic efficiency, better rate capability, and longer cycle life than the bare synthetic graphite. Current studies are focused on reducing the first cycle irreversible capacity loss of this material

Cardiovascular risk in chronic myeloid leukaemia: A multidisciplinary consensus on screening and management

INTRODUCTION: Tyrosine kinase inhibitors (TKIs) have become the mainstay of treatment for chronic myeloid leukaemia (CML), but cardiovascular (CV) risk and exacerbation of underlying risk factors associated with TKIs have become widely debated. Real-world evidence reveals little application of CV risk factor screening or continued monitoring within UK CML management. This consensus paper presents practical recommendations to assist healthcare professionals in conducting CV screening/comorbidity management for patients receiving TKIs. METHODS: We conducted a multidisciplinary panel meeting and two iterative surveys involving 10 CML specialists: five haematologists, two cardio-oncologists, one vascular surgeon, one haemato-oncology pharmacist and one specialist nurse practitioner. RESULTS: The panel recommended that patients commencing second-/third-generation TKIs undergo formal CV risk assessment at baseline, with additional investigations and involvement of cardiologists/vascular surgeons for those with high CV risk. During treatment, patients should undergo CV monitoring, with the nature and frequency of testing dependent on TKI and baseline CV risk. For patients who develop CV adverse events, decision-making around TKI interruption, cessation or change should be multidisciplinary and balance CV and haematological risk. CONCLUSION: The panel anticipates these recommendations will support healthcare professionals in implementing CV risk screening and monitoring, broadly and consistently, and thereby help optimise TKI treatment for CML

Development of a Novel Electrochemical Method to Deposit High Corrosion Resistant Silicate Layers on Metal Substrates

A novel method for electrodepositing silicates on metallic substrates from aqueous solutions has been developed. The technique is demonstrated by forming a passive film on galvanized steel. The silicate layer was deposited cathodically from a bath containing PQ Corporation N sodium silicate solution (3.22 weight ratio sodium silicate, 37.5% solution in water). A post-treatment drying process increased the Si content in the coating and improved the corrosion characteristics of the silicate layer. Deposition parameters like bath concentration and temperature have been optimized using corrosion characteristics and surface morphology of the final coating. Finally, stability studies show that the silicate coatings obtained using this method have higher barrier resistance and better stability as compared to chrome passivates. The technique developed here shows promise as an alternative to chrome passivation for corrosion protection of metals

Ecological and cultural factors underlying the global distribution of prejudice

Prejudiced attitudes and political nationalism vary widely around the world, but there has been little research on what predicts this variation. Here we examine the ecological and cultural factors underlying the worldwide distribution of prejudice. We suggest that cultures grow more prejudiced when they tighten cultural norms in response to destabilizing ecological threats. A set of seven archival analyses, surveys, and experiments (∑N = 3,986,402) find that nations, American states, and pre-industrial societies with tighter cultural norms show the most prejudice based on skin color, religion, nationality, and sexuality, and that tightness predicts why prejudice is often highest in areas of the world with histories of ecological threat. People’s support for cultural tightness also mediates the link between perceived ecological threat and intentions to vote for nationalist politicians. Results replicate when controlling for economic development, inequality, conservatism, residential mobility, and shared cultural heritage. These findings offer a cultural evolutionary perspective on prejudice, with implications for immigration, intercultural conflict, and radicalization.publishedVersio

A multicenter, community-based, mixed methods assessment of the acceptability of a triple drug regimen for elimination of lymphatic filariasis

BackgroundMany countries will not reach elimination targets for lymphatic filariasis in 2020 using the two-drug treatment regimen (diethylcarbamazine citrate [DEC] and albendazole [DA]). A cluster-randomized, community-based safety study performed in Fiji, Haiti, India, Indonesia and Papua New Guinea tested the safety and efficacy of a new regimen of ivermectin, DEC and albendazole (IDA).Methodology/principal findingsTo assess acceptability of IDA and DA, a mixed methods study was embedded within this community-based safety study. The study objective was to assess the acceptability of IDA versus DA. Community surveys were performed in each country with randomly selected participants (>14 years) from the safety study participant list in both DA and IDA arms. In depth interviews (IDI) and focus group discussions (FGD) assessed acceptability-related themes. In 1919 individuals, distribution of sex, microfilariae (Mf) presence and circulating filarial antigenemia (CFA), adverse events (AE) and age were similar across arms. A composite acceptability score summed the values from nine indicators (range 9-36). The median (22.5) score indicated threshold of acceptability. There was no difference in scores for IDA and DA regimens. Mean acceptability scores across both treatment arms were: Fiji 33.7 (95% CI: 33.1-34.3); Papua New Guinea 32.9 (95% CI: 31.9-33.8); Indonesia 30.6 (95% CI: 29.8-31.3); Haiti 28.6 (95% CI: 27.8-29.4); India 26.8 (95% CI: 25.6-28) (PConclusions/significanceIDA and DA regimens for LF elimination were highly and equally acceptable in individuals participating in the community-based safety study in Fiji, Haiti, India, Indonesia, and Papua New Guinea. Country variation in acceptability was significant. Acceptability of the professionalism of the treatment delivery was highlighted