A Study on Hepatic Trauma: Single Centre Experience in Rajiv Gandhi Government General Hospital, Chennai

INTRODUCTION: Liver injuries are common in any high volume trauma center. Our knowledge in its management has improved in the past three decades. Recent advances and minimally invasive techniques play a vital role in the conservative approach. It is very difficult for a trauma surgeon to control massive bleeding occurring in the liver following trauma. The bleeding structure is very tough to find out, and the crucial period of time to save the trauma victim before the onset of hypothermia, acidosis, and coagulopathy—the markers of an irreversible physiologic insult. Usual techniques of elective hepato-biliary surgery like segmental resection do not apply in hostile environment where the timing of intervention is a major factor in saving the life of the patient. It is very clear that the management of hepatic trauma has been a formidable challenge to all surgeons. The evolvement of the management of hepatic trauma over the recent years is a reflection of the rapid understanding of the key parameters deciding the line of management in hepatic trauma. There were poor outcomes in patients where resection was done but future learning of the injured patient’s patho-physiology paved way for the concept of damage control that has been the key in modern trauma management. Meanwhile better learning of the outcome of various liver injuries in clinically stable patients has increased the conservative line of approach by using the modern imaging and minimally invasive procedures. AIMS AND OBJECTIVES: 1. To identify clinical and imaging parameters to decide upon the line of management in hepatic trauma. 2. To study the clinical course of patients managed conservatively. 3. To study the profile of various other associated injuries in liver trauma. MATERIALS AND METHODS: Sample Size: 35 cases. Study Design: Observational study (Prospective & Retrospective). Study Population: 35 cases. Study period: Oct 2015 to Sep 2016. Study Centre: Madras Medical College and Rajiv Gandhi Government General Hospital , Chennai. Subject Selection: Inclusion Criteria: All trauma victims sustaining blunt and penetrating trauma to the liver with or without associated injuries. Exclusion criteria: Abdominal trauma with isolated injury to the extra hepatic biliary tree or other visceral structures without liver trauma . ASSESSMENT OF PARAMETERS: All Patients who fit the inclusion criteria were observed and following data collected 1. Routine blood investigations, Hemoglobin, Hematocrit, Liver Function Test. All these were done serially. 2. USG Abdomen. 3. CECT Abdomen (i.v. contrast)/plain CT for all cases. 4. AAST grading system was the standard methodology to assess severity of liver injury. 5. Patients managed conservatively were followed up prospectively and till discharge. 6. Conclusions were drawn based on the above parameters. CONCLUSION: From this study it is clear that all hemodynamically stable patients can be subjected to conservative line of management irrespective of the grade of the injury. • Those managed conservatively must be subjected to serial monitoring. If there are findings of sepsis like biloma, infected necrosis, liver abscess at any point of time the first option of intervention will be minimally invasive procedures like image guided drainage. • If there are features of peritonitis then laparotomy must be considered without any delay. • Non operative management is employed for hemodynamically unstable patients. • The first step will always be a Pringles maneuver to identify the possible source of bleeding which can be from either the portal vein or hepatic artery and hemostasis can be achieved by topical hemostatic agents like gel foam etc. • If the patients hemodynamic status is in jeopardy then Perihepatic packing serves as the best operative intervention in reversing the patients hemodynamic status to normalcy

REVIEW: A RECENT REVIEW IN APPLICATIONS OF HETEROCYCLIC COMPOUNDS AS ANTIMICROBIAL AGENT

A wide development in the field of multidrug resistance in antimicrobial activity which enhance the search for development of new medicinal drugs with high potential. Schiff base heterocyclic metal complex with imine moiety, act as important antimicrobial agents due to their versatile properties such as chelation, adaptability of fine structure for a specific biological action, and chemotheraptic drugs. Schiff base compounds derived from various heterocyclic platforms have been competently reviewed.Â

Effectiveness of Foot Pronation Correction Exercises in Classical Ballet Dancers with Posterior Ankle Impingement Syndrome

INTRODUCTION: The art of performing Ballet is very stressful and demanding on the body. Dancers must be able to execute complicated dance portions and still maintain grace and flow as they move from one position to the next. Dancing on the balls of the feet or tip of toes in extremely demanding causing considerable biomechanical load on the skeletal elements of the lower leg and the foot. AIM OF THE STUDY: The main goal of this research is to understand Posterior Ankle Impingement Syndrome clinical and functional features within the dance practice, especially considering classic ballet. The aim is to modify the essentials for designing targeted strategies in prevention of Recurrent treatment. To provide stability increase ROM, and to maintain correct posture by recruiting some of the correction exercises. METHODOLOGY: Study Design: Experimental study design. Study setting: The study was conducted in Jelly fish dance company, Smasher sport academy, 372, 5th link Road Nehru nagar, Alwarpet. Study duration: 14 Weeks. Sample Size: Thirty subjects from the population where selected by two different groups of methods. (15 each). Sampling Technique: Convenient sampling technique. 30 patients diagnosed with PAIS through hyper plantar flexion test-into two groups, Group A and Group B. Group A - OKCE, CKCE along with strengthening exercise, Balance exercise, and Stretching exercises done for 15subjects. Group B - OKCE, CKCE along with correction exercises for 15 subjects as a conservative management. Sampling criteria: Inclusion Criteria: Age 18-25 yrs, Commonly affects females than males, Current symptoms pain and stiffness (6 months) during weight Bearing activities, Early morning stiffness subsiding within 30 minutes on activity. Exclusion Criteria: Radiating pain to the upper limb, Malignancy, Infection, Osteoporosis, Recent surgeries of lower limb, Extremity mainly foot and ankle joint. RESULT: The study was done on 30 subjects, which consisted of 15 subjects each for 14 weeks duration. The result shows that Mean value of independent variable between pre and post score for posterior impingement syndrome treatment shows less difference improvement, in group A. Mean value of different variable between pre and post score for conventional treatment shows kinematic difference in improvement. Paired ‘t’ tests value of pre and post score shows significant difference in posterior ankle impingement syndrome in dancers group. Paired ‘t’ tests value of pre and post score shows foot corrective changes in posture as a conservative treatment. In paired ‘t’ tests posterior Impingement shows highly significant difference in improving pain and disability in dancer’s heel. CONCLUSION: Hence, it is concluded that the conventional therapy with OKCE and CKC exercise program in addition with foot correction exercises has improved the functional ability of foot in patients with Posterior Ankle Impingement Syndrome

Mining Privacy-Preserving Association Rules based on Parallel Processing in Cloud Computing

With the onset of the Information Era and the rapid growth of information technology, ample space for processing and extracting data has opened up. However, privacy concerns may stifle expansion throughout this area. The challenge of reliable mining techniques when transactions disperse across sources is addressed in this study. This work looks at the prospect of creating a new set of three algorithms that can obtain maximum privacy, data utility, and time savings while doing so. This paper proposes a unique double encryption and Transaction Splitter approach to alter the database to optimize the data utility and confidentiality tradeoff in the preparation phase. This paper presents a customized apriori approach for the mining process, which does not examine the entire database to estimate the support for each attribute. Existing distributed data solutions have a high encryption complexity and an insufficient specification of many participants' properties. Proposed solutions provide increased privacy protection against a variety of attack models. Furthermore, in terms of communication cycles and processing complexity, it is much simpler and quicker. Proposed work tests on top of a realworld transaction database demonstrate that the aim of the proposed method is realistic

Characterization and identification of isolated bacteria from ice-ice disease infected seaweed Kappaphycus alvarezii

1286-1290Ice-ice disease occurs in cultivated algal seaweed Kappaphycus alvarezii due to pathogenic bacterial infections. This seaweed has rich source of carrageenan widely known as the kappa carrageenan. Generally, ice-ice disease leads to whitening of the branches initiated with colour changes of the thalli, which become transparent in the end. This study was aimed to isolate and identify the bacteria based on morphology and biochemical characterization on ice-ice diseased K. alvarezii from three different places, namely, Kottapatinam, Thondi and Rameswaram. The bacterium was isolated in Zobell Marine Agar (ZMA) and thiosulfate-citrate-bile saltsucrose (TCBS) agar. Morphological and biochemical characterizations revealed that the isolated bacteria causing ice-ice disease were closely related to the genera Bacillus in ZMA and Vibrio species in TCBS. Total viability count, physical and chemical properties of the bacteria by gram staining and morphological analysis were done for all species isolated from three places

Highlighting dissimilarity in medical images using hierarchical clustering based segmentation (HCS).

Tissue abnormality in a medical image is usually related to a dissimilar part of an otherwise homogeneous image. The dissimilarity may be subtle or strong depending on the medical modality and the type of abnormal tissue. Dissimilarity within an otherwise homogeneous area of an image may not always be due to tissue abnormality. It might be due to image noise or due to variability within the same tissue type. Given this situation it is almost impossible to design and implement a generic segmentation process that will consistently give a single appropriate solution under all conditions. Hence a dissimilarity highlighting process that yields a hierarchy of segmentation results is more useful. This would benefit from high level human interaction to select the appropriate image segmentation for a particular application, because one of the capabilities of the human vision process when visualising images is its ability to visualise them at different levels of details.The purpose of this thesis is to design and implement a segmentation procedure to resemble the capability of the human vision system's ability to generate multiple solutions of varying resolutions. To this end, the main objectives for this study were: (i) to design a segmentation process that would be unsupervised and completely data driven. (ii) to design a segmentation process that would automatically and consistently generate a hierarchy of segmentation results. In order to achieve these objectives a hierarchical clustering based segmentation (HCS) process was designed and implemented. The developed HCS process partitioned the images into their constituent regions at hierarchical levels of allowable dissimilarity between the different spatially adjacent or disjoint regions. At any particular level in the hierarchy the segmentation process clustered together all the pixels and/or regions that had dissimilarity among them which was less than or equal to the dissimilarity allowed for that level. The clustering process was designed in such a way that the merging of the clusters did not depend on the order in which the clusters were evaluated.The HCS process developed was used to process images of different medical modalities and the results obtained are summarised below: (i) It was successfully used to highlight hard to visualise stroke affected areas in T2 weighted MR images confirmed by the diffusion weighted scans of the same areas of the brain. (ii) It was used to highlight dissimilarities in the MRI, CT and ultrasound images and the results were validated by the radiologists. It processed medical image data and consistently produced a hierarchy of segmentation results but did not give a diagnosis. This was left for the experts to make use of the results and incorporate these with their own knowledge to arrive upon a diagnosis. Thus the process acts as an effective computer aided detection (CAD) tool.The unique features of the designed and implemented HCS process are: (i) The segmentation process is unsupervised, completely data driven and can be applied to any medical modality, with equal success, without any prior information about the image data(ii) The merging routines can evaluate and merge spatially adjacent and disjoint similar regions and consistently give a hierarchy of segmentation results. (iii) The designed merging process can yield crisp border delineation between the regions

Entanglement, avoided crossings and quantum chaos in an Ising model with a tilted magnetic field

We study a one-dimensional Ising model with a magnetic field and show that tilting the field induces a transition to quantum chaos. We explore the stationary states of this Hamiltonian to show the intimate connection between entanglement and avoided crossings. In general entanglement gets exchanged between the states undergoing an avoided crossing with an overall enhancement of multipartite entanglement at the closest point of approach, simultaneously accompanied by diminishing two-body entanglement as measured by concurrence. We find that both for stationary as well as nonstationary states, nonintegrability leads to a destruction of two-body correlations and distributes entanglement more globally.Comment: Corrections in two figure captions and one new reference. To appear in Phys. Rev.