A Study on Decompressive Craniectomy in Moderate to Severe Head Injury patients

INTRODUCTION: An injury to the brain may cause edema and produce swelling of brain. Pressure within the skull then increases as the brain has no room to expand; this excess pressure, known as high intracranial pressure, can cause further secondary brain injury. High intracranial pressure is the most frequent cause of death and disability in brain-injured patients. The management of increased intracranial pressure is common clinical scenario in neurosurgery. If high intracranial pressure (ICP) cannot be controlled using general or First-line therapeutic measures, second-line treatments are initiated, one of these procedure is decompressive craniectomy (DC) and also performed while intracranial hematoma evacuation. DC involves the removal of a section of skull so that the brain has room to expand and the ICP decreased. There is however still clinical uncertainty regarding the use of DC and a lack of consensus on the optimal management of traumatic brain injury. The present study was undertaken to analyze the factors that affects the patient’s outcome in our setup, and to analyze the role of decompressive craniectomy and also the factors predicting the outcome. OBJECTIVES: Decompressive craniectomy (DC) is widely used to treat intracranial hypertension following traumatic brain injury (TBI). Decompressive craniectomy performed alone or in conjunction with evacuation of the mass lesion, can reduce the raised intra cranial pressure (ICP). The present study was undertaken to analyze the factors that affects the patient’s outcome, and to analyze the role of primary decompressive craniectomy and also the factors predicting the outcome. METHODS: It is a prospective analytical study; study period is from August 2009 to February 2012 in the Institute of Neurology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai. All Patients admitted in our hospital trauma ward with moderate to severe head injury who are undergoing primary decompressive craniectomy according to brain trauma foundation guidelines are included in this study. Entry was determined using the inclusion and exclusion criteria after resuscitation, and data were entered in proforma. The postoperative GCS and GOCS (Glasgow outcome score) at discharge from the hospital were noted, primary and secondary outcomes were analyzed. RESULTS: In our present study there were 136 cases underwent decompressive craniectomy, of these 90% were males and the remaining 10% were females. The most common mode of injury was road traffic accident (76%). Out of 136 patients 56 patients were survived (41%), of whom 30 patients had good recovery (22.1%), 19 patients had mild disability (14%), 4 patients had moderate disability (2.9%) and 3 patients were in vegetative state (2.2%) at the time of discharge. 80 patients died accounting for a mortality rate of 58.8%. Favourable outcome rate was 36.1% (GOS 4&5), unfavourable outcome rate was 63.9%(GOS1, 2 & 3). CONCLUSION: The age, mode of injury, timing of surgery, clinical parameters like Glasgow coma score, associated injury, pupillary status, adequacy of bone removal and duraplasty, are important in predicting the outcome of decompressive craniectomy. A generous craniotomy and augmented duraplasty facilitating ICP reduction and better outcome of decompressive craniectomy

Two stage chain sampling plans clisp-(0,2) and chsp-(l,2) - part 2

Tables based on the Poisson model are presented for the construction of chain sampling plans ChSP-(0,2) and ChSP-(1,2). It is shown how the tables can be used to construct plans under three different sets of criteria: given the sample size and one point on the operating characteristic (OC) curve, given two points on the OC curve, and given the AOQL and one point on die curve. procedures are also given for computing the AOQL and values on the OC curves for known ChSP-(0,2) and ChSP-(1,2) plans

Reduced Complexity by Combining Norm based Ordering MMSE-BSIDE Detection in MIMO Systems

The breadth first signal decoder (BSIDE) is well known for its optimal maximum likelihood (ML) performance with lesser complexity. In this paper, we analyze a multiple-input multiple-output (MIMO) detection scheme that combines; column norm based ordering minimum mean square error (MMSE) and BSIDE detection methods. The investigation is carried out with a breadth first tree traversal technique, where the computational complexity encountered at the lower layers of the tree is high. This can be eliminated by carrying detection in the lower half of the tree structure using MMSE and upper half using BSIDE, after rearranging the column of the channel using norm calculation. The simulation results show that this approach achieves 22% of complexity reduction for 2x2 and 50% for 4x4 MIMO systems without any degradation in the performance

A Comparative study of laparoscopic versus open cholecystectomy in Coimbatore Medical College and Hospital, Coimbatore

INTRODUCTION: The modern era of laparoscopic surgery has evoked remarkable changes in approaches to surgical diseases. The trend toward minimal access surgery (MAS) has prompted general surgeons to scrutinize nearly all operations for possible conversion to laparoscopic techniques. AIM OF THE STUDY: Our aim of the study is to compare laparoscopic cholecystectomy with that of open cholecystectomy by the following factors: 1. The technique of surgery, 2. Duration of surgery, 3. Post operative morbidity, 4. Analgesic requirement, 5. Antibiotic requirement, 6. Post operative hospital stay, 7. Complications, 8. Resumption of normal diet, 9. Return to normal activity, 10. Cosmesis. MATERIALS AND METHODS In our CMCH we are doing both open and laparoscopic cholecystectomy. This study is done between January 2004 to February 2006. In this period I have selected 25 cases of laparoscopic cholecystectomy to compare with 25 cases of open cholecystectomy. Common indications for surgery were chronic calculous cholecystitis, acalculous cholecystitis, cholelithiasis, biliary colic and acute cholecystitis. The following factors are compared in laparoscopic and open cholecystectomy: Technique of surgery, Duration of surgery, Post operative pain, Analgesic requirements, Duration of antibiotics given, Intra operative and post-op Complications, Resumption of normal diet, Post operative hospital stay, Return to normal activity, Cosmesis. CONCLUSION: In our study the laparoscopic cholecystectomy surpasses the open cholecystectomy by the followings: Better visualization and magnification of surgical anatomy. • Decreased post operative morbidity. • Shorter duration of analgesic requirements. • Shorter duration of antibiotic requirements. • Decreased wound infection. • Quicker ambulance, better compliance and rapid return to normal activity. • Rapid resumption of normal diet. • Shorter post operative hospital stay. • Best cosmesis. The only disadvantage is the prolonged operative time, which can be minimized in due course of time as the learning curve progresses. We have also found that the conversion to open cholecystectomy should be done in proper time with out any hesitation in case of complications that could not be managed by laparoscopic surgery and conversion in such case reflects sound judgment and should not be considered as a complication

Analysis of kinetics parameters on T cell recognition to viral infection

T cell plays an important role in clearance of viral infections and development of memory population for a rapid immune response in the case of secondary infections. T cells utilize T cell receptor (TCR) to recognize viral antigens in the form of peptide major histocompatibility complex (pMHC) as its ligand. When viral mutations occur, TCR recognition is impaired for its ligand and in result, lowers immune cell lytic response. Conventionally, TCR binding kinetics to its ligands is linked to TCR binding propensity stemming from 3D assays, providing numerical values in relation to its strength. However, characterizing the interaction of viral variant peptides to TCR is poorly understood and providing a unique perspective in understanding the interaction provides potential solutions to vaccine development, especially for chronic viral infections. In this study, we characterize Cytomegalovirus (CMV)-specific T cell 2D effective binding affinity to both WT and viral variants. Additionally, we characterized to elucidate the importance of specific amino acids found on the peptide influences recognition, thereby potentially bridging gap to understand the mechanics of how specific recognition motifs influence functionality. As T cell gets activated following peptide recognition, multiple signaling pathways take place in order to invoke an effective functional output. To invoke such a response, T cells first translate from naïve to activated state and then returning to homeostasis over the course of an immune response. Although the entire process takes several days, how recognition dynamics is influenced in the context of viral clearance and how that leads into developing memory population has not been fully elucidated. To understand these phenomenon, we primarily evaluated a single transgenic T cell population over the course of an acute lymphocytic choriomeningitis virus (LCMV) viral infection to characterize and understand the dynamics of the T cell function and development that is influenced by organ compartmentalization. Our results highlight an important aspect on how TCR propensity is influenced by the microenvironments during viral clearance and in the occurrence of viral mutation, how characterizing TCR recognition provides new insights on impaired binding kinetic and functional profile.Ph.D

Resumption of virtual machines after adaptive deduplication of virtual machine images in live migration

In cloud computing, load balancing, energy utilization are the critical problems solved by virtual machine (VM) migration. Live migration is the live movement of VMs from an overloaded/underloaded physical machine to a suitable one. During this process, transferring large disk image files take more time, hence more migration and down time. In the proposed adaptive deduplication, based on the image file size, the file undergoes both fixed, variable length deduplication processes. The significance of this paper is resumption of VMs with reunited deduplicated disk image files. The performance measured by calculating the percentage reduction of VM image size after deduplication, the time taken to migrate the deduplicated file and the time taken for each VM to resume after the migration. The results show that 83%, 89.76% reduction overall image size and migration time respectively. For a deduplication ratio of 92%, it takes an overall time of 3.52 minutes, 7% reduction in resumption time, compared with the time taken for the total QCOW2 files with original size. For VMDK files the resumption time reduced by a maximum 17% (7.63 mins) compared with that of for original files

Effects of Anchor Structure and Glycosylation of Fcγ Receptor III on Ligand Binding Affinity

Isoforms of the Fcγ receptor III (FcγRIII or CD16) are cell surface receptors for the Fc portion of IgG and important regulators of humoral immune responses. Different ligand binding kinetics of FcγRIII isoforms are obtained in three dimensions by surface plasmon resonance and in two dimensions by a micropipette adhesion frequency assay. We show that the anchor structure of CD16 isoforms isolated from the cell membrane affects their binding affinities in a ligand-specific manner. Changing the receptor anchor structure from full to partial to none decreases the ligand binding affinity for human IgG1 (hIgG1) but increases it for murine IgG2a (mIgG2a). Removing N-glycosylation from the CD16 protein core by tunicamycin also increases the ligand binding affinity. Molecular dynamics simulations indicate that deglycosylation at Asn-163 of CD16 removes the steric hindrance for the CD16-hIgG1 Fc binding and thus increases the binding affinity. These results highlight an unexpected sensitivity of ligand binding to the receptor anchor structure and glycosylation and suggest their respective roles in controlling allosterically the conformation of the ligand binding pocket of CD16

Rapid real-time PCR detection of Listeria monocytogenes in enriched food samples based on the ssrA gene, a novel diagnostic target

A real-time PCR assay was designed to detect a 162-bp fragment of the ssrA gene in Listeria monocytogenes. The specificity of the assay for L. monocytogenes was confirmed against a panel of 6 Listeria species and 26 other bacterial species. A detection limit of 1-10 genome equivalents was determined for the assay. Application of the assay in natural and artificially contaminated culture enriched foods, including soft cheese, meat, milk, vegetables and fish, enabled detection of 1-5 CFU L. monocytogenes per 25g/ml of food sample in 30h. The performance of the assay was compared with the Roche Diagnostics 'LightCycler foodproof Listeria monocytogenes Detection Kit'. Both methods detected L. monocytogenes in all artificially contaminated retail samples (n=27) and L. monocytogenes was not detected by either system in 27 natural retail food samples. The method developed in this study has the potential to enable the specific detection of L. monocytogenes in a variety of food types in a time-frame considerably faster than current standard methods. The potential of the ssrA gene as a nucleic acid diagnostic (NAD) target has been demonstrated in L. monocytogenes. We are currently developing NAD tests based on the ssrA gene for a range of common foodborne and clinically relevant bacterial pathogens

Nanolitre real-time PCR detection of bacterial, parasitic, and viral agents from patients with diarrhoea in Nunavut, Canada

Background. Little is known about the microbiology of diarrhoeal disease in Canada's Arctic regions. There are a number of limitations of conventional microbiology testing techniques for diarrhoeal pathogens, and these may be further compromised in the Arctic, given the often long distances for specimen transport. Objective. To develop a novel multiple-target nanolitre real-time reverse transcriptase (RT)-PCR platform to simultaneously test diarrhoeal specimens collected from residents of the Qikiqtani (Baffin Island) Region of Nunavut, Canada, for a wide range of bacterial, parasitic and viral agents. Study design/methods. Diarrhoeal stool samples submitted for bacterial culture to Qikiqtani General Hospital in Nunavut over an 18-month period were tested with a multiple-target nanolitre real-time PCR panel for major diarrhoeal pathogens including 8 bacterial, 6 viral and 2 parasitic targets. Results. Among 86 stool specimens tested by PCR, a total of 50 pathogens were detected with 1 or more pathogens found in 40 (46.5%) stool specimens. The organisms detected comprised 17 Cryptosporidium spp., 5 Clostridium difficile with toxin B, 6 Campylobacter spp., 6 Salmonella spp., 4 astroviruses, 3 noroviruses, 1 rotavirus, 1 Shigella spp. and 1 Giardia spp. The frequency of detection by PCR and bacterial culture was similar for Salmonella spp., but discrepant for Campylobacter spp., as Campylobacter was detected by culture from only 1/86 specimens. Similarly, Cryptosporidium spp. was detected in multiple samples by PCR but was not detected by microscopy or enzyme immunoassay. Conclusions. Cryptosporidium spp., Campylobacter spp. and Clostridium difficile may be relatively common but possibly under-recognised pathogens in this region. Further study is needed to determine the regional epidemiology and clinical significance of these organisms. This method appears to be a useful tool for gastrointestinal pathogen research and may also be helpful for clinical diagnostics and outbreak investigation in remote regions where the yield of routine testing may be compromised