ACUTE EFFECTS OF SMOKING ON VENTRICULAR REPOLARIZATION

Objective: Cigarette smoking, modifiable and preventable risk factor of death due to cardiovascular changes globally. As the frequency increases, this alters the ventricular repolarization and sympathetic tone lead to ventricular arrhythmogenesis. The aim and objective of the study are to evaluate the effects of smoking (before and immediately after smoking) on ventricular repolarization by recording the Tp-e interval, Tp-e/QTc ratio by using an electrocardiogram, since it is an accurate, less expensive, and non – invasive tool. Methods: Around 40 healthy male volunteers who are smokers aged between 18 and 25 years were recruited in this study. All subjects were non-alcoholics, non–tobacco chewers took no drugs, and had a uniform pattern of diet and activity. The acute effect of smoking on the heart was determined by measuring the electrocardiographic parameter before and immediately after smoking a king-size cigarette. Results: The analysis showed that there was a statistically significant increase in heart rate immediately after smoking compared to baseline values in smokers. TP interval and Tp-e interval were increased immediately after smoking and were highly significant. Conclusion: Our study has proven that there was a remarkable change in cardiac activity immediately after smoking. Tp-e Interval may serve as a better risk factor to predict sudden cardiac arrest in the future especially in chronic smokers. Smoker’s heart is already injured due to its injurious chemicals, adding on to that every new cigarette increases the burden on cardiovascular health. Hence, it is never late to quit smoking rather than suffering from its injurious effect

Experimental Analysis of Tensile and Flexural Strength of Water Lily Fiber Reinforced Polyester Resin Composite

Ethiopia has abundant invasive aquatic plants like water hyacinth and water lily. Large masses of these invasive plants have a negative impact on the water bodies specifically at Lake Tana, in Ethiopia by infesting and deteriorating water quality and reducing the quantity of water.  In this research work, an attempt was made to fabricate a natural fiber reinforced composite in which water lily fiber was used as reinforcing material in the polyester resin matrix. Chopped water lily fiber reinforced polyester resin composites were prepared by varying the fiber weight percentage as 20%, 40% and 60%. The mechanical properties such as tensile strength and flexural strength were evaluated as per ASTM standards to evaluate the influence of fiber concentrations. The experimental result shows that an increase in fiber concentration enhanced the mechanical properties of water lily fiber reinforced polyester composite. It was found that the composite with 40 wt% of fiber exhibited a superior strength which could be suitably used for different applications

Experimental Analysis of Tensile and Flexural Strength of Water Lily Fiber Reinforced Polyester Resin Composite

Ethiopia has abundant invasive aquatic plants like water hyacinth and water lily. Large masses of these invasive plants have a negative impact on the water bodies specifically at Lake Tana, in Ethiopia by infesting and deteriorating water quality and reducing the quantity of water.  In this research work, an attempt was made to fabricate a natural fiber reinforced composite in which water lily fiber was used as reinforcing material in the polyester resin matrix. Chopped water lily fiber reinforced polyester resin composites were prepared by varying the fiber weight percentage as 20%, 40% and 60%. The mechanical properties such as tensile strength and flexural strength were evaluated as per ASTM standards to evaluate the influence of fiber concentrations. The experimental result shows that an increase in fiber concentration enhanced the mechanical properties of water lily fiber reinforced polyester composite. It was found that the composite with 40 wt% of fiber exhibited a superior strength which could be suitably used for different applications

Long-term experience with implanted intrathecal drug administration systems for failed back syndrome and chronic mechanical low back pain

BACKGROUND: Continuous intrathecal drug delivery has been shown in open studies to improve pain and quality of life in those with intractable back pain who have had spinal surgery. There is limited data on long term effects and and even less for patients with mechanical back pain without prior spinal surgery. METHODS: We have investigated spinal drug administration systems for patients with failed back syndrome and chronic mechanical low back pain by patient questionnaire study of the efficacy of this therapy and a case notes review. RESULTS: 36 patients (97% of 37 approached) completed questionnaires, 24 with failed back syndrome and 12 with chronic mechanical low back pain. Recalled pre-treatment levels with current post-treatment levels of pain and a range of quality of life measures (recorded on 11-point numerical rating scales) were compared. Pain improved significantly in both groups (Wilcoxan signed ranks test, p < 0.005). The majority of quality of life measures improved significantly in the failed back syndrome group (Wilcoxan signed ranks test, p < 0.005) although work interruption and the effect of pain on sex life did not change. There was a trend towards improvement in the majority of quality of life measures in the mechanical back pain group but this did not reach statistical significance due to the smaller numbers in this cohort (p > 0.005, Wilcoxan signed ranks test with Bonferroni correction). Diamorphine was used in all 37 patients, bupivacaine in 32, clonidine in 27 and baclofen in 3. The mean dose of diamorphine increased for the first 2 years but did not change 2–6 years post implant, averaging 4.5 mg/day. Revision surgery was required in 24% of cases, but reduced to 12% in the later years of our experience. CONCLUSIONS: We conclude that spinal drug administration systems appear to be of benefit in alleviating pain in the failed back syndrome and chronic mechanical low back pain but need to be examined prospectively

Functioning of Deep Lobe of the Parotid Gland after Superficial Parotidectomy

INTRODUCTION: Salivary fistula rarely occurs after superficial parotidectomy, an incidence of 0.02%. This is an unusually low incidence considering the surgical procedure of cutting across the gland. It is postulated that: 1. The innervation of the deep lobe is through the superficial lobe, branches from the auriculo-temporal nerve. While removing the superficial part these nerves are severed and the deep lobe loses its innervation. As a result of this there is no secretion of saliva and the deep part gradually atrophies. 2. The duct arises mainly from the deep lobe and the superficial lobe secretions drain into the main duct via small ductules that cross the facio-venous plane of Patey to enter the deep part. Hence there is preferential flow which remains intact. 3. Fistula formation is based on multiple branching pattern of the Stenson’s duct. There are no definite studies or trials on the above postulates. This study attempts to focus on the reduction in function of the deep part of the parotid gland following superficial parotidectomy, proving hypothesis number one. AIMS AND OBJECTIVES: To assess the functioning of the remnant deep lobe of the parotid gland after superficial parotidectomy. MATERIALS AND METHODS: Based on this background knowledge, a prospective analytical study was designed to assess the function of the remnant deep lobe of the parotid gland after superficial parotidectomy in the Department of General Surgery, Christian Medical College and Hospital, Vellore. Lesions were confirmed clinically and all of them had Fine needle aspiration Cytology done prior to surgery. The same surgical technique of superficial was adapted in all the cases. During the period , May 2006 to July 2007, men and women undergoing superficial parotidectomy for all diseases of the parotid gland fulfilling the inclusion criteria were subjected to a prospective trial to assess the functioning of the remnant deep lobe of the parotid gland as compared to the opposite non-operated side deep lobe after superficial parotidectomy by Technetium - 99 scan on the tenth day and sixth week after surgery and on the on the same days, salivary secretion from the remnant gland was quantified by modified Saxon’s test. All patients were included in the trial after obtaining written informed consent. Details were documented in the proforma made for the purpose. Exclusion criteria: 1. Recurrent disease, 2. Patients requiring post operative radiation, 3. Patients who had previous radiation in the head and neck region, 4. Deep lobe involvement, 5. Malignancy – intermediate and high grade, 6. Pregnancy, 7. Subtotal superficial parotidectomy, 8. Tuberculosis of the parotid gland. Sample size: Based on the criteria set out, 20 patients were enrolled in the study after obtaining written informed consent. Statistical methods: The data was described using summary statistics such as mean, median, range and standard deviation. Univariate and bivariate graphs were plotted. Mann – Whitney test was used for analyzing unpaired groups and Wilcoxon signed rank test was used for paired data analysis. A ‘p’ value of less than 0.05 at 95% confidence intervals was considered significant. The data analysis was performed using SPSS 11.0 for windows. CONCLUSIONS: 1. The deep lobe of the parotid gland has significant decrease in function at six weeks following superficial parotidectomy but there is no atrophy, disproving the hypothesis. 2. There is significant decrease in the function if duct is ligated. 3. Long term assessment may be required to show whether there is regeneration of the remnant gland or if it remains the same. 4. The auriculo-temporal nerve is in same plane of the facial nerve or medial to it or communicating with it, hence the fibres are not likely to be severed during superficial parotidectomy. 5. There was no salivary fistula in any of these cases

A Study of Mortality among 6130 hospitalizations in General Medicine wards in Atertiary Care Hospital

INTRODUCTION : Today’s health-care delivery is highly complex. Care is often delivered in a pressurized and fast-moving environment, involving a vast array of technology and several individual decisions and judgements by health-care professionals. In such circumstances things can, and do go wrong. Sometimes unintentional harm comes to a patient during a clinical procedure or as a result of a clinical decision. Errors in the process of care can result in injury. Sometimes the harm caused is serious and can even be fatal. This problem of adverse events in health care is not new. There were studies done as early as the 1950s and 1960s on adverse events, but the subject remained largely neglected. A body of evidence started to emerge in the early 1990s with the publication of the results of the Harvard Medical Practice Study in 1991. Subsequent research in Australia, the United Kingdom of Great Britain and Northern Ireland (UK)4 and the United States of America (USA) and in particular the 1999 publication “To err is human: building a safer health system by the Institute of Medicine (IOM)”, provided further data and brought the subject to the top of the policy agenda and the forefront of public debate worldwide. Today more countries, including Canada, Denmark, the Netherlands, and Sweden are taking a serious look at this problem. New Zealand and Canada8 have recently published research into adverse events in public Hospitals. AIMS : To study the profile of causes of deaths among hospitalizations in General Medical wards. To perform a systematic analysis of the recorded causes and classify possible medical error related deaths. OBJECTIVES : The main objectives of the study are; 1. To study the profile of causes of deaths among hospitalizations by the general medicine units. 2. To determine frequency of occurrence of medical error related deaths and factors contributing to it. METHODS : Study design: A one-year cross-sectional study. Study setting : The study was conducted during 1st January 2005 through 31st December 2005 in The Christian Medical College Vellore. In that year there were 68,872 hospitalizations and 1,758 deaths were recorded. In the wards under general medicine units there were 6130 hospitalizations and among them 496 deaths. Study subjects : All 496 deaths occurring in the medical wards and the medical ICU were included. Study materials : Data on all in-hospital deaths such as diagnosis, elective or emergency hospitalization, duration of stay in hospital prior to death and details as mentioned in annexure 1(enclosed) were collected. The cause of death as recorded by the treating senior house officer/post graduate physician/intensivist trainee and verified by the supervising physician was noted. The cause of death is as defined by the International WHO death certificate form as the “underlying disease eventually leading to death”. The immediate cause of death is the “disorder precipitating death”. The diagnosis was coded based on system involved using the International Classification of Diseases-10 (ICD-10 WHO 2000). DISCUSSION : There were 6130 admissions in the year 2005 with a median age of 47 years and a mode of 65 years. The age distribution suggests that the majority of the admissions are in the young (12yrs - 40 yrs) and the elderly (>60yrs) populations with male predominance. Infectious diseases admissions account for majority of the admissions and among this group tuberculosis is the leading cause followed by HIV and AIDS related diseases (non tuberculous) and diarrhoeal diseases. This profile reflects the burden of infectious diseases in our country.28The second group involves the circulatory system disorders inclusive of cerebrovascular accidents. This is on par with the cause of death in the developed nations. Neoplasm or malignancy relates are only 5 % in this study while in the West it is the leading cause. The elderly28 (>60yrs) presented with mostly non-communicable diseases like complications of hypertension, diabetes, malignancies. The younger (12yrs - 40 yrs) population28 presented with tuberculosis, AIDS ands its opportunistic infections, suicidal attempts mostly with organophosphorus (OP) compounds. This disease profile also gives us an insight into the lifestyle changes that are happening with increasing incidence of non-communicable diseases and its complications. CONCLUSION : The summary of the results of this study are I. Disease burden in general medical wards in our hospital in 2005 were similar to our country’s profile with infectious disease being the leading cause. The death rate in general medical wards was 8.1%. II. a. The likely medical error related deaths occurred in 11% of all deaths in the general medical wards. b. 75% of the medical error related occurred due to system faults. Nosocomial infections(42%) are the predominant cause. c. The occurrence of a likely medical error related deaths increases as the duration of stay in hospital becomes longer than seven days

A prospective study of mortality from cryptococcal meningitis following treatment induction with 1200 mg oral fluconazole in Blantyre, Malawi.

OBJECTIVE: We have previously reported high ten-week mortality from cryptococcal meningitis in Malawian adults following treatment-induction with 800 mg oral fluconazole (57% [33/58]). National guidelines in Malawi and other African countries now advocate an increased induction dose of 1200 mg. We assessed whether this has improved outcomes. DESIGN: This was a prospective observational study of HIV-infected adults with cryptococcal meningitis confirmed by diagnostic lumbar puncture. Treatment was with fluconazole 1200 mg/day for two weeks then 400mg/day for 8 weeks. Mortality within the first 10 weeks was the study end-point, and current results were compared with data from our prior patient cohort who started on fluconazole 800 mg/day. RESULTS: 47 participants received fluconazole monotherapy. Despite a treatment-induction dose of 1200 mg, ten-week mortality remained 55% (26/47). This was no better than our previous study (Hazard Ratio [HR] of death on 1200 mg vs. 800 mg fluconazole: 1.29 (95% CI: 0.77-2.16, p = 0.332)). There was some evidence for improved survival in patients who had repeat lumbar punctures during early therapy to lower intracranial pressure (HR: 0.27 [95% CI: 0.07-1.03, p = 0.055]). CONCLUSION: There remains an urgent need to identify more effective, affordable and deliverable regimens for cryptococcal meningitis

Study on the Mechanical Properties of Water Hyacinth Fiber Reinforced High Density Polyethylene Composite

Natural fibers have recently gained attention due to low environmental impact, biodegradability, low cost and easy availability. In this research work, water hyacinth (WH) fiber was used as reinforcement in the fabrication of the natural fiber composites. WH plant fiber reinforced high-density polyethylene (HDPE) thermoplastic composites were fabricated by compression molding process. Fabrication parameters such as water hyacinth content, alkali treatment concentration, treatment time and coupling agent amount were varied in three levels and composites specimens were fabricated according to Taguchi’s L9 orthogonal array. Grey Relation Analysis (GRA) was used to optimize the fabrication parameters. The results showed that the increase in WH fiber volume fraction, NaOH concentrations and treatment time increased the tensile and flexural strength of the composite up to some point and after that, it decreased. However, the strength of the composite was found to decrease with the increase of NaOH concentration and decrease of coupling agent concentration. ANOVA analysis revealed that the water hyacinth particle content had the highest contribution to tensile and flexural strength, followed by coupling agent dosage, treatment time, and NaOH concentration in order. Mechanical properties were optimized when the WH/HDPE composite fabricated with 30% water hyacinth fiber treated with 5wt% NaOH concentration for 12 hours and mixed with 15% coupling agent. The simultaneous effects of fabrication parameters on tensile and flexural strength of the WH/HDPE composites were studied. The fabricated WH/ HDP composite can be used as a viable alternative material for making furniture, ceiling, tile and partition boards