Serum Magnesium Level in critically ill patients

INTRODUCTION: Magnesium is a very essential element of life and it is the second most abundant intracellular cation in the human body. Magnesium is known as fifth forgotten electrolyte. Intracellular Magnesium contributes to 99% of the total body Magnesium. Diet which consist of large amount of vegetables and fruits is a rich source of Mg. Excess intake of fibre and sugar will affect serum magnesium level. Magnesium absorption from gastrointestinal tract is influenced by taking excess fibre. By causing magnesiuria, excess sugar causes low serum magnesium level. Magnesium is primarily absorbed from the duodenum and the rectum and sigmoid colon can also absorb magnesium. Around 40% of the dietary magnesium is getting absorbed. AIM OF THE STUDY: To study the level of Serum Mg in critically ill patients admitted in Intensive medical care unit and correlating the outcome with APACHE II scoring. MATERIALS AND METHODS: I have done a prospective observational study in 100 critically ill patients admitted in a Intensive medical care unit, Government Stanley Medical College & Hospital during the period of March 2016 to September 2016. Acute Physiology And Chronic Health Evaluation (APACHE II) score have been calculated for each patient on the day of admission to Intensive care unit. Critically ill adult patients aged more than 18years were included. Written and informed consent was obtained from all patients. Patients who had received blood products, magnesium or calcium infusions before sampling have been excluded from the study. Inclusion of the patients in this study did not affect the routine patient care in the IMCU. Venous blood samples of around 4.5ml was taken to assess serum magnesium levels, within the first 24hours of admission in to the IMCU. Patient details recorded were: Age, gender, presenting symptoms and signs,diagnosis, relavant investigation reports, treatment, duration of stay in IMCU, any complications thereof, use of mechanical ventilation and its duration. Patients were followed up till discharge or death. The final analysis is made at the end of the study to achieve the aforementioned goals. Inclusion criteria: 1.Critically ill adult patients above the age of 18 years, admitted in IMCU. 2. with APACHE II score of 18 or more. Exclusion criteria: 1.Patients who had received blood products. 2.Patients who had received magnesium infusion. 3. Patients who are not willing to participate in this study. RESULTS: There was significantly increased rate of death in hypomagnesemic patients 59% compared to normal magnesium patients. 11 (21%) patients had delayed recovery in hypomagnesemic patients compared to normal magnesium patients 9 (19%). Rate of recovery patients was higher in normal magnesium patients 20 (42%) than hypomagnesemia patients 2 (4%) Hypomagnesemic patients had statistically significant difference in PCV values (p < 0.0105) when compared to normomagnesemic patients. Hypomagnesemia patients had higher acute physiological scoring, chronic health point and total score. Hypomagnesemic patients had significant hyponatremia. No statistically significant difference between both groups with respect to potassium and serum creatinine. Hypomagnesemic patients had significantly lower temperature than patients who had normal magnesium levels

TO STUDY THE DRUG UTILIZATION PATTERN OF ANTIBIOTICS IN POST-OPERATIVE PATIENTS IN THE DEPARTMENT OF OBSTETRICS AND GYNECOLOGY AT TERTIARY CARE TEACHING HOSPITALS.

ABSTRACT:Objectives: The study is carried out to determine possible irrational use of drugs,antibiotic sensitivity pattern,minimize adverse events,drug-drug interactions.Methodology: It is a prospective observational study carried out in department of Obstetrics and Gynecology, Bhaskar General Hospital after obtaining permission from the institutional human ethics committee. It is carried out on 50 patients of post-operative cases for duration of two months by obtaining their case-sheet data. The prescriptions were assessed for patient's demographic data, antimicrobial preference, dose, duration, route of administration, categorization of drugs according to FDA, rationality score as per WHO, prescribing indicators score as per WHO.Results: The average number of drugs per patient is 3. The most frequently prescribed drugs were Metronidazole (dose:400mg-TID;100%), Tinidazole (dose:500mg-BD;90%), Ceftriaxome (dose:200mg-BD;100%),Amoxicillin+Clavulinic acid (dose:625mg-TID;14%).The brand drugs used are 100%,Generic drugs-0%, Essential drugs-87.5%,Non essential drugs-12.5%,Category B drugs-100%.Conclusion: Drug use pattern is rational with few exceptions. All the drugs were prescribed according to FDA category B. Hence we conclude that 20% of prescriptions were under polypharmacy and 80% were according to prescription indicator of WHO

CLUSTER HEAD ELECTION MECHANISM-BASED ON FUZZY LOGIC (CHEF) WITH TDMA IN WSN

Wireless sensor networks (WSN) are being used for huge range of applications where the traditional infrastructure based network is mostly infeasible. The most challenging aspect of WSN is that they are energy resource-constrained and that energy cannot be replenish. the wireless sensor network of power limited sensing devices called sensor deployed in a region to sense various types physical information from the environment, when these sensors sense and transmit data to other sensors present in the network, even the cluster head is elected according to check their residual energy considerable amount of energy will drain automatically to overcome this drawback by considering the protocol a fuzzy logic approach is used to elect the cluster head based on three descriptors-energy, centrality & distance and second CH is elected according to TDMA to overcome the data lost during energy drain occur in the CH .NS-2 simulation shows that proposed protocol provides higher energy efficiency. This paper proposes the mechanism or device is capable of utilizing its own system of control simply called as self-configurable clustering mechanism to detect the disordered CHs and replace them with other nodes. And results have been derived from simulator ns-2 to show the better performance

UWB Slotted Circular Disc Monopole Antenna with Inverted U Shaped Defected Ground Plane for Brain Cancer Detection

In this paper the new design of UWB inscribed slotted circular disc monopole antenna  is used in the detection of brain cancer is presented. The proposed antenna design  consists of circular patch and the bandwidth is increased to cover the UWB frequency range of 3.2 GHZ to 10.6GHZ by embedding  square shaped slot cut at the centre and a  pair of inverted U shaped cut in the  ground plane which gives a defected ground structure that provides the fractional bandwidth  more than 110%[3.2 -10.6GHZ]. The proposed antenna is designed and fabricated for brain cancer detection. FR4 substrate is used with printed circular monopole radius of 15mm and with finite ground plane of (60mm x 50mm). It is designed with thick substrate with the  thickness of h=1.6mm and high dielectric constant of εr=4.4. The voltage standing wave ratio is of (1-1.5). The proposed antenna design provides minimum return loss, better fractional bandwidth, satisfactorily radiation pattern

Tumors around the ankle: a reconstructive challenge

Tumors around the ankle can be either bone or soft tissue sarcomas. The aggressive nature of these tumors and the complex anatomy of the ankle mortice make for a challenging reconstructive ladder. We have explored four different histological tumors which required tailor made resection and reconstruction. All our patients had reasonably good functional outcomes

SECURE ROUTE DISCOVERY FOR DYNAMIC SOURCE ROUTING IN MANETs

Mobile ad hoc networks (MANETs) are collections of wireless mobile devices with restricted broadcast range and resources and no fixed infrastructure. Communication is achieved by communicating data along suitable routes that are dynamically discovered and maintained through association between the nodes. Discovery of such routes is a major task both from good organization and security points of view. Recently a security model tailored to the specific requirements of MANETs. A novel route discovery algorithm called endairA is also proposed together with a claimed security proof within the same model. In this paper we show the security proof for the route discovery algorithm endairA is malfunctioning and moreover this algorithm is vulnerable to a hidden channel attack. We also analyze the security framework that is used for route discovery and argue the compos ability is an essential feature for ubiquitous applications. We conclude by discussing some of the major security challenges for route discovery in MANETs

Kaempferol Treatment after Traumatic Brain Injury during Early Development Mitigates Brain Parenchymal Microstructure and Neural Functional Connectivity Deterioration at Adolescence.

Targeting mitochondrial ion homeostasis using Kaempferol, a mitochondrial Ca2+ uniporter channel activator, improves energy metabolism and behavior soon after a traumatic brain injury (TBI) in developing rats. Because of broad TBI pathophysiology and brain mitochondrial heterogeneity, Kaempferol-mediated early-stage behavioral and brain metabolic benefits may accrue from diverse sources within the brain. We hypothesized that Kaempferol influences TBI outcome by differentially impacting the neural, vascular, and synaptic/axonal compartments. After TBI at early development (P31), functional magnetic resonance imaging and diffusion tensor imaging (DTI) were applied to determine imaging outcomes at adolescence (2 months post-injury). Vehicle and Kaempferol treatments were made at 1, 24, and 48 h post-TBI, and their effects were assessed at adolescence. A significant increase in neural connectivity was observed after Kaempferol treatment as assessed by the spatial extent and strength of the somatosensory cortical and hippocampal resting-state functional connectivity (RSFC) networks. However, no significant RSFC changes were observed in the thalamus. DTI measures of fractional anisotropy (FA) and apparent diffusion coefficient, representing synaptic/axonal and microstructural integrity, showed significant improvements after Kaempferol treatment, with highest changes in the frontal and parietal cortices and hippocampus. Kaempferol treatment also increased corpus callosal FA, indicating measurable improvement in the interhemispheric structural connectivity. TBI prognosis was significantly altered at adolescence by early Kaempferol treatment, with improved neural connectivity, neurovascular coupling, and parenchymal microstructure in select brain regions. However, Kaempferol failed to improve vasomotive function across the whole brain, as measured by cerebrovascular reactivity. The differential effects of Kaempferol treatment on various brain functional compartments support diverse cellular-level mitochondrial functional outcomes in vivo

Improvement in Electrochemical Performance of Lithium Rich Li2RuO3 Cathode With Co-doping Strategy

Lithium-rich layered oxides based on Ru are interesting as cathode materials because they have high energy density and reversible capacity. However, due to the problems of weak structural stability and voltage decay, their commercial utility is limited. To address this, we use a DFT+U quantum mechanics to investigate the co-doping strategy on Li2RuO3 (LRO) for improved battery performance. In particular, the effect of two co-dopants Ti and Co has been studied. The co-doping strategy has been found to significantly improve the structural and thermal stability of LRO. By slowing the oxygen removal reaction, Ti and Co improve structural stability. Co-doping with Ti and Co increases the maximum open circuit voltage at least by 5.5% and decreases the voltage reduction by a minimum of 44%. Bandgap is also increased by a minimum of 6% with co-doping. In particular, Li2Ru0.5Ti0.375Co0.125O3 &nbsp;provides the highest maximum voltage of 4.4V with 61% decrease in the voltage reduction and 40% lower bandgap (0.45eV)