Prospective study of spontaneous bacterial peritonitis/spontaneous bacterial empyema(SBP/SBE) in a tertiary care center

AIMS AND METHODS: Microbiolgical profile,response to antibiotics and factors affecting outcome were analyzed prospectively in patients with SBP with or without SBE from 2012 to 2014. Infections were categorized based on mode of acquisition into community acquired CA), health care related(HCR) and Nosocomial acquired(NA) groups. Piperacillintazobactum was given for CA and HCR infections. NA type and any infection with multi organ dysfunction was given meropenem and teicoplanin. Antibiotic was escalated in nonresponders(defined as ˂25% reduction in ascitic/pleural fluid neutrophil count after 48 hours). RESULTS: Among 283 episodes (in 255 patients, including 13 episodes of SBE), 51%,35% and 12% were in CA,HCR and NA respectively. Predominant etiology of cirrhosis was ethanol(45%). Ascitic/pleural fluid cultures grew an organism in 34%. Commonest organism was E.Coli in all groups(61%) followed by Enterococcus(14%). Among Gram negative organisms, Extended spectrum beta-lactamase(ESBL) producing isolates were noted in 44%,75% and 86% in CA,HCR and NA respectively. Vancomycin resistant Enterococci were grown in two episodes. Nonresponse was predicted by female sex, NA type of infection and prior exposure to antibiotic. In multivariate analysis, independent predictors of In-hospital mortality were nonresponse to antibiotic(80% vs 25%, p=0.05), presence at admission of organ failure (93% vs 45%, p<0.002),upper GI bleed(24% vs 9%, p=0.03) or hepatic encephalopathy(67% vs 23%, p=0.01). Type of SBP was not significant in multivariate analysis,probably due to different antibiotics used in different groups. CONCLUSIONS: Enterobacteriaceae were the commonest group causing SBP/SBE. There was very high rate of ESBL producing isolates among Gram negative organisms, highest being in NA group. Day 3 response in ascitic/pleural fluid predicts mortality and host factors predict mortality better than microbiological factors or mode of acquisition of SBP/SBE

DEVELOPMENT, OPTIMIZATION AND EVALUATION OF PULSATILE DRUG DELIVERY CAPSULES LOADED WITH CARVEDILOL BY APPLYING QUALITY BY DESIGN

Objective: The purpose of this research is to find the best way for designing carvedilol pulsatile drug delivery system capsules. Methods: The research paves the way to improve the method of preparing carvedilol pulsatile drug delivery by adjusting critical material attributes (CMA) such as coating polymer concentration, critical process parameters (CPP) such as inlet temperature and atomizing air pressure, and their impact on critical quality attributes (CQA) like particle size (PS in nm), entrapment efficiency in percentage (% EE) and amount of drug delivered in percent (%ADR) at 12 h in the carvedilol pulsatile pellets filled capsules by applying the Box-Behnken design. By varying the polymer concentration and process parameters, nearly 15 formulations were created. Results: Based on the influence of CMA, CPP on CQA, the formulation CP13 was determined to be the most optimized formulation among the 15 formulations. The optimized levels of CMA were found to be-1 level of coating polymer concentration and CPP was found to be-1 level of inlet temperature, 0 level of atomizing air pressure and it optimized CQA like PS was found to be 1017.5±8.4 nm, % EE was found to be 96.8±2.8 %, % ADR at 12 h was found to be 88.4±3.4 %. Carvedilol Pulsatile drug delivery system was designed by using optimized fluidized bed coater in order to decrease the usage of attributes, decrease the productivity cost and enhance the usage of specific attributes at fixed concentration for further manufacturing scale. Conclusion: By the current results it was concluded that the optimized CMA and CPP that shown in the results are the suitable attributes for the best formulation of carvedilol pulsatile drug delivery system capsules

A nearest level control technique for an asymmetric source configuration of multi-level inverter topology

In this paper, an asymmetric source configuration of Multilevel Inverter (MLI) topology has been proposed. It consists of eight unidirectional switches, two bidirectional switches and four isolated DC sources. By considering 1:5 and 1:4 source configurations, the inverter produces 25-level and 21-level outputs respectively with the same switching action. For producing negative voltage levels, there is no requirement of separate backend H-bridge and inherently produces both positive and negative voltage levels. The main advantage of this topology is that in every state, only four switches are in ON mode and else are in OFF state. It also gives less per unit Total Standing Voltage (TSV) and thereby cost requirement of semiconductor devices can become decreases. For generating gate pulses, the simple Nearest Level Control (NLC) has been used by considering the round function. This technique is basically a fundamental switching frequency technique thereby switching losses are greatly reduces as compared with high switching frequency Pulse Width Modulation (PWM) techniques and it is particularly suitable for large number of levels. With this control technique, there is no inrush current has been developed at the input of DC sources. Finally, with step change in Modulation Index (MI) values the proposed topology with two different source configurations have been validated through MATLAB/Simulink platform

Advancement in the Materials Used In Aircraft-A Review

This paper describes about the advanced materials used in aircraft, aircraft body, aircraft engines etc. So many researches are going on the advancement of materials for aircraft. For the Aerospace Engineering applications there is huge upgradation in the field of material science structure and engineering with the technical related to progress in advanced materials. This paper gives a clear picture of aircraft materials which were used before and which are in use at present

Effects of temperature and load during hot impression behavior of Cr-Ni stainless steel

Austenitic Stainless steels are majorly used because of their high resistance to aqueous corrosion and high temperature properties. Some major applications of stainless steels at high temperatures include engine and exhaust components in aircrafts, recuperators in steel mills, and pulverized coal injection lances for blast furnaces. In all the above said applications, the components are constantly subjected to loads and high temperatures. This makes the study of their creep behavior very important to decide the life of the component. Cr-Ni stainless steel was used as a starting material, and hot impression creep test was performed on cylindrical samples of 10 mm height and 15 mm diameter for a dwell time of 150 min at two different loads of 84 and 98 MPa and at two different temperatures 450 and 500 °C. The time vs. indentation depth was plotted, and creep rate was calculated in each case. It was observed that with an increase in time, creep rate increased in the primary creep region and remained almost constant in the secondary creep region irrespective of temperature and load. The indentation depth and creep rate increased with an increase in load and temperature

Intelligent Vehicle Black Box System Using IoT

Humans are currently involved in numerous transportation-related accidents on the roads. Numerous accidents and fatalities caused by human error are the result of the rising number of vehicles on Indian roads and a lack of enforcement of traffic laws. They also suffer loss of life and valuable property as a result of those accidents. As a result, accidents involving driver inattention to traffic laws and driver fatigue follow. The field of computer vision is actively researching real-time eye detection and tracking. Face alignment can benefit from eye localization and tracking. The duration of eye closure and percentage of eye closure (PEC) can be used to measure driver fatigue. It is based on a hardware system that uses a camera to capture images of the driver in real time and software to monitor the driver's eye in order to prevent accidents. In the event of an accident, GSM and GPS are utilised to track the location of the automobile, and the local hospital and police are alerted. Thanks to IoT technology, this position may always be found in the cloud platform service. The 24/7 Governance is notified to call for emergency assistance by using the push and panic button

FPGA-Based Portable Ultrasound Scanning System with Automatic Kidney Detection

Bedsides diagnosis using portable ultrasound scanning (PUS) offering comfortable diagnosis with various clinical advantages, in general, ultrasound scanners suffer from a poor signal-to-noise ratio, and physicians who operate the device at point-of-care may not be adequately trained to perform high level diagnosis. Such scenarios can be eradicated by incorporating ambient intelligence in PUS. In this paper, we propose an architecture for a PUS system, whose abilities include automated kidney detection in real time. Automated kidney detection is performed by training the Viola–Jones algorithm with a good set of kidney data consisting of diversified shapes and sizes. It is observed that the kidney detection algorithm delivers very good performance in terms of detection accuracy. The proposed PUS with kidney detection algorithm is implemented on a single Xilinx Kintex-7 FPGA, integrated with a Raspberry Pi ARM processor running at 900 MHz