Dexmedetomidine premedication in cataract surgery under topical anaesthesia: to assess patient and surgeon satisfaction

Background: Dexmedetomidine is a potent non-opioid analgesic that may enhance analgesia for cataract surgery under topical anaesthesia. This study was undertaken to assess sedation and analgesia provided by dexmedetomidine and evaluating patients’ satisfication. Secondary aims were: (1) To study the effect of dexmedetomidine in decreasing the intraocular pressure. (2) The impact on surgeons' satisfaction. (3) Hemodynamic effectsMethods: We conducted a prospective randomized study on ASA I/II patients presenting for cataract surgery under topical anesthesia. Patients were randomly assigned to two groups: group D received dexmedetomidine premedication 1 mcg/kg over 10 minutes and group C received saline at the same rate. Sedation and pain score, intraocular pressure, patient and surgeon satisfaction score and hemodynamics were monitored and compared.Results: There was a significant increase in sedation assessed by the Ramsay sedation score at all times in group D after receiving dexmedetomidine (p< 0.0001). However, pain scores (numeric rating scale) were similar in both groups (p>0.05). Dexmedetomidine decreased the intraocular pressure and the difference was statistically highly significant (p< 0.0001). Group D had better patient and surgeon satisfaction score as against group C (p=0.0001). Noticably, the incidence of dry mouth was higher in group D. Hemodynamic parameters were well maintained in both groups with no adverse events in either group. Conclusions: Dexmedetomidine can be used safely for cataract surgery under topical anesthesia surgery. Administration of dexmedetomidine was associated with better patient and surgeon satisfaction

SYNTHESIS AND ANTIMICROBIAL ACTIVITY OF NOVEL 5-((1H-INDOL-3-YL) METHYLENE)-2-((4-(3A, 4, 5, 6, 7, 7A-HEXAHYDRO-4, 7-METHANEBENZO[D] ISOOXAZOL-3-YL) PHENYL) IMINO)-3-METHYLTHIAZOLIDIN-4-ONE DERIVATIVES

Abstract-A series of novel 5-((1H-indol-3-yl) methylene)-2- ((4-(3a, 4, 5, 6, 7, 7a-hexahydro-4, 7-methanebenzo[d] isooxazol-3-yl) phenyl) imino)-3-methylthiazolidin-4-one derivatives were synthesized and evaluated for their antibacterial and antifungal activity. The structures of the synthesised compounds were determined by IR, NMR, mass spectroscopy and elemental analysis. They were screened for activities against bacterial and fungal strains. Amongst the synthesised compounds 9b, 9e, 9i, 10g, 10h & 10i were found to be active

A realist analysis of hospital patient safety in Wales:Applied learning for alternative contexts from a multisite case study

Background: Hospital patient safety is a major social problem. In the UK, policy responses focus on the introduction of improvement programmes that seek to implement evidence-based clinical practices using the Model for Improvement, Plan-Do-Study-Act cycle. Empirical evidence that the outcomes of such programmes vary across hospitals demonstrates that the context of their implementation matters. However, the relationships between features of context and the implementation of safety programmes are both undertheorised and poorly understood in empirical terms. Objectives: This study is designed to address gaps in conceptual, methodological and empirical knowledge about the influence of context on the local implementation of patient safety programmes. Design: We used concepts from critical realism and institutional analysis to conduct a qualitative comparative-intensive case study involving 21 hospitals across all seven Welsh health boards. We focused on the local implementation of three focal interventions from the 1000 Lives+ patient safety programme: Improving Leadership for Quality Improvement, Reducing Surgical Complications and Reducing Health-care Associated Infection. Our main sources of data were 160 semistructured interviews, observation and 1700 health policy and organisational documents. These data were analysed using the realist approaches of abstraction, abduction and retroduction. Setting: Welsh Government and NHS Wales. Participants: Interviews were conducted with 160 participants including government policy leads, health managers and professionals, partner agencies with strategic oversight of patient safety, advocacy groups and academics with expertise in patient safety. Main outcome measures: Identification of the contextual factors pertinent to the local implementation of the 1000 Lives+ patient safety programme in Welsh NHS hospitals. Results: An innovative conceptual framework harnessing realist social theory and institutional theory was produced to address challenges identified within previous applications of realist inquiry in patient safety research. This involved the development and use of an explanatory intervention–context–mechanism–agency–outcome (I-CMAO) configuration to illustrate the processes behind implementation of a change programme. Our findings, illustrated by multiple nested I-CMAO configurations, show how local implementation of patient safety interventions are impacted and modified by particular aspects of context: specifically, isomorphism, by which an intervention becomes adapted to the environment in which it is implemented; institutional logics, the beliefs and values underpinning the intervention and its source, and their perceived legitimacy among different groups of health-care professionals; and the relational structure and power dynamics of the functional group, that is, those tasked with implementing the initiative. This dynamic interplay shapes and guides actions leading to the normalisation or the rejection of the patient safety programme. Conclusions: Heightened awareness of the influence of context on the local implementation of patient safety programmes is required to inform the design of such interventions and to ensure their effective implementation and operationalisation in the day-to-day practice of health-care teams. Future work is required to elaborate our conceptual model and findings in similar settings where different interventions are introduced, and in different settings where similar innovations are implemented. Funding: The National Institute for Health Research Health Services and Delivery Research programme

FABRICATION & TESTING OF AQUA SILENCER FOR DIESEL ENGINE

An Aqua Silencer’s main purpose isto deal withemissionand noise control from engine exhaust. This system uses water hence it is named as Aqua silencer .This project is an attempt to reduce the toxic content of engine exhaust, before it is emitted to the air. The main pollutants exhausted by automobiles are CO, UBHC, Nox and Lead etc, other sources such as electric powerplant,industrial processing.With the use of charcoal, perforated block and outer shell aqua silencer ismade. An aqua silencer is fitted at the end of exhaust pipe of the engine. The charcoalpurifies the harmful sulphur and nitrous content produced from engine. Sound produced under water is less hearable than its produced in atmosphere. It is tested in diesel engine. The smoke level and noise is considerable less than the conventional silencer. An aqua silencer is an attempt in this direction; its mainly deals with control the emissionand noise

Synthesis and evaluation of 3-cyano-4-imino-2-methylthio-4H-pyrido[1,2-a]pyrimidine derivatives as potent antioxidant agents

The bis (methylthio) methylene malononitrile (1) on treatment with 2-amino pyridine (2) in N,N-dimethyl formamide (DMF) and anhydrous potassium carbonate, gives 3-cyano-4-imino-2-(methylthio)-4H-pyrido[1,2-a]pyrimidine (3). The latter were further reacted with selected N-, O- and C-nucleophiles such as aryl amines, hetryl amines, substituted phenols and compounds containing active methylene groups

Synthesis and Antimicrobial Activity of 3-Cyano-4-imino-9-methoxy-4H-pyrimido [2, 1-b] pyrimido [4, 5-b] quinoline and 2-Substituted Derivatives

The 2-amino-7-methoxypyrimido[4,5-b]quinoline (1) on treatment with bis(methylthio)methylene malononitrile (2) in ethyl alcohol and catalytic amount of TEA gives 3-cyano-4-imino-9-methoxy-2-methythio-4H-pyrimido[2,1-b]pyrimido[4,5-b]quinoline (3). The latter were further reacted with selected N-, O-, and C-nucleophiles such as aryl amines, hetryl amines, substituted phenols, and compounds containing an active methylene group