Entrapment of guidewire during central venous catheterization

Central venous catheterization (CVC) is common in the setting of ICU for various reasons like monitoring of CVP, fluid administration and vasopressor or drug infusions. Guidewires are routinely used in the Seldinger technique during central venous catheter placement CVC placement is not innocuous as numerous complications may occur, with varying frequency and severity

Probing the Gravitational Wave Signature from Cosmic Phase Transitions at Different Scales

We present a new signature by which to one could potentially discriminate between a spectrum of gravitational radiation generated by a self-ordering scalar field vs that of inflation, specifically a comparison of the magnitude of a flat spectrum at frequencies probed by future direct detection experiments to the magnitude of a possible polarization signal in the Cosmic Microwave Background (CMB) radiation. In the process we clarify several issues related to the proper calculation of such modes, focusing on the effect of post-horizon-crossing evolution.Comment: 4 pages, Phys. Rev D version (revised in response to referee's comments

Effects of Prestorage Leukoreduction on the Rate of Febrile Nonhemolytic Transfusion Reactions to Red Blood Cells in a Tertiary Care Hospital

Background: Febrile nonhemolytic transfusion reactions (FNHTRs) are relatively common complications associated with allogenic transfusion. White blood cells (WBCs or leukocytes) are considered to be an important cause of FNHTRs; the rate of WBC derived pro.inflammatory cytokines increase with storage due to active synthesis of cytokines by these cells. The removal of the WBCs before storage will prevent the accumulation of cytokines during storage that leads to a reduction in the number of FNHTRs. Aim: We have conducted a retrospective analysis comparing the rate of FNHTRs in prestorage leukoreduced (PrSLR) and non leukoreduced RBCs transfusion.Subjects and Methods: A retrospective review of all the transfusion reactions (TRs) reported to the department over a period of 2 years from July 2012 to June 2014 was done. Patients were stratified by the date of reaction and by component received and then divided into two groups: (1) Patients who received allogeneic PrSLR RBCs and (2) nonleukoreduced RBCs. For the PrSLR RBC units, leukoreduction was performed by using buffy coat method of component preparation by quadruple bags and integral bags containing SepacellR Pure RC filters (Fenwal. France). Results: 37,232 RBCs units were transfused and out of which 14149 (38% i.e. is 14149/37232) were prestorage leukoreduced (PrSLR) and 23083 (62%) were non leukoreduced. A total of 142 (0.38%) TRs were reported during that time period, of which 62 (0.17%) were classified as FNHTRs. In the nonleukoreduced group 124 TRs were reported, of which 55 were classified as FNHTRs to RBCs and the overall rate of FNHTR to RBCs was 0.24%. In pre storage leukoreduced group, 18 TRs were reported, of which 7 were classified as FNHTRs to RBCs and the overall rate of FNHTR to RBCs was 0.05% (P . 0.001). This represents a significant reduction in the rate of FNHTR after institution of prestorage leukoreduction.Conclusion: The rate of FNHTRs to allogenic RBC units after the implementation of prestorage leukoreduction has decreased significantly. Cytokines and chemokines accumulating during storage of cellular blood products are responsible for residual FNHTRs.Keywords: Febrile nonhemolytic transfusion reaction, Leukoreduction, Transfusion reaction

Extra note of music in anaesthesia

Role of music has been identified since ancient times for alleviating anxiety. Music has been known for its potential to produce a sense of wellbeing and peace. Anaesthesia and surgery are major stress factors for any person. Preoperative anxiety is a usual phenomenon in patients posted for various surgical interventions as well as those admitted to intensive care units (ICU). Literature shows ample evidence regarding neurohormonal disturbances related to stressful situations like preoperative, intraoperative and post-operative periods. Music has been shown to attenuate release of various biochemical molecules leading to relaxing and sedative effects on the brain. Not only patients under regional anaesthesia who are awake have a positive impact, even patients under general anaesthesia have also been shown to benefit from listening to music intraoperatively. Music is a hazard free intervention which can be added to various drug combinations used by anaesthesiologists

Design and Development of Vibration Testing Fixtures

This paper deals with the Design of Vibration Testing Fixtures for Random Vibration loads as specified by the MIL 810 military standards. Following selection of the right material and configuration of the fixtures, CAD models are generated and numerically checked for natural frequencies and mode shapes using Finite Element Analysis. Based on these results, the response of the fixtures to the MIL 810 standard Random Vibration profile input is measured using Finite Element Analysis and the transmissibility is calculated.Finally, the fixture is tested experimentally for to the MIL 810 standard Random Vibration profile input and based on these values; transmissibility of the fixture is computed. The experimental result is compared to the Finite Element results and thus, found that the fixture can be used for testing missile packages at the Defense Research and Development Laboratory (DRDL), Hyderabad

Probable fluoxetine-induced hepatomegaly: a case report

Depressive disorder is a common behavioural, psychiatric disorder. Among various antidepressants selective serotonin reuptake inhibitors (SSRIs) are preferred drugs for the treatment of depression. When second-generation antidepressants SSRIs and serotonin-norepinephrine reuptake inhibitors (SNRIs) are used to treat depression, 0.5–1% of patients develop mildly altered liver function without any symptoms. Various degrees of organ dysfunction are linked with drug-induced liver injury, which is unpredictable and might result from exposure to a drug. We reported suspected fluoxetine-induced hepatomegaly secondary to nine weeks of treatment with an SSRI fluoxetine. Upon cessation of the agent, the patient recovered symptomatically. The evidence is vital that the hepatomegaly in this patient was caused by fluoxetine