Neglected obstetric haemorrhage leading to acute kidney injury

Pregnancy related acute kidney injury takes substantial share of acute kidney injury (AKI) in India, with obstetrical haemorrhage having high morbidity and mortality. A young female had neglected obstetric haemorrhage (unrecognized intrauterine and massive intraperitoneal bleeding post caesarean, due to uterine trauma and atony) and dangerous intra-abdominal hypertension with exsanguination eventually leading to shock, multifactorial AKI, metabolic acidosis, and hyperkalemia. Intensive and aggressive management with subtotal hysterectomy, inotropes, fluid management, mechanical ventilation, tracheostomy, and hemodialysis changed the outcome. Despite odds against, neglected obstetric haemorrhage with complicated AKI, was managed successfully by emergency hysterectomy, aggressive intervention for AKI with intensive fluid, ventilatory management and daily hemodialysis. Timely identification and aggressive management of this condition and complications is pivotal in preventing complications, morbidity, and maternal mortality.

TPM- A KEY STRATEGY FOR PRODUCTIVITY IMPROVEMENT

During high growth era companies are making technical progress in automation and centralization of the plants, which needs large amount of manual work to maintain the automation systems. The strategy of maintaining the equipment of a plant is crucial for the effectiveness of manufacturing. Total productive maintenance (TPM) is a maintenance program, which involves concepts for maintaining plant and equipments effectively. In this paper detailed implementation of TPM in the cold rolling plant is discussed. Results achieved are quite encouraging in terms of motivated employees, improvement in overall equipment effectiveness (OEE) and reduction in no. of accidents on shop floor

Short-course metronidazole-induced reversible acute neurotoxicity in a renal transplant recipient

Neurotoxic manifestations due to chronic metronidazole intake are well known, but neurotoxicity due to short-term use of metronidazole is very rare. We present a case of acute neurotoxicity due to short course of injectable metronidazole given in usual doses to a renal allograft recipient for persistent diarrhea. It responded to withdrawal of the offending drug. Tacrolimus trough concentration did not increase during neurotoxicity, thereby ruling out any metronidazole-tacrolimus interaction. Magnetic resonance imaging of the brain showed widespread osmotic demyelination and its recovery after drug withdrawal. This is the first reported case of a renal transplant recipient developing acute neurotoxicity due to short-term use of metronidazole, without any increase in tacrolimus trough concentrations

Tranexamic acid overdosage-induced generalized seizure in renal failure

We report a 45-year-old lady with chronic kidney disease stage 4 due to chronic tubulointerstial disease. She was admitted to our center for severe anemia due to menorrhagia and deterioration of renal function. She was infused three units of packed cells during a session of hemodialysis. Tranexamic acid (TNA) 1 g 8-hourly was administered to her to control bleeding per vaginum. Two hours after the sixth dose of TNA, she had an episode of generalized tonic clonic convulsions. TNA was discontinued. Investigations of the patient revealed no biochemical or structural central nervous system abnormalities that could have provoked the convulsions. She did not require any further dialytic support. She had no further episodes of convulsion till dis-charge and during the two months of follow-up. Thus, the precipitating cause of convulsions was believed to be an overdose of TNA

State of the art review on the sustainable dry machining of advanced materials for multifaceted engineering applications: progressive advancements and directions for future prospects

In this article, the comprehensive review on the application, and indeed, a comparative analysis on dry machining of different types of materials (Inconel, steel, aluminum, cast iron, magnesium and advanced materials) used in machining (turning, drilling and milling operations) were carried out in the light of utmost works published in the literature. The work describes the scientific findings of the past twenty years, including sustainable methods (surface texture, solid lubricants, vibration-assisted machining, laser-assisted machining), tool coatings, and geometry of tools. Vibration-assisted machining is another direction that researchers have investigated without the use of cutting coolants, where the complete disposal of coolants is not possible. Various researchers have carried out rigorous experimental work on milling, drilling, and turning operations under dry conditions to machine numerous materials. A significant proportion of experimental data about tool wear, tool wear machining, surface quality, surface integrity, etc, has been analyzed under dry conditions. However, the critical analysis of dry machining for different conventional machining operations for a variety of industrial materials is still lacking for establishing dry machining as a sustainable process for industrial applications. Thus, the critical analysis of various machining parameters and their consequences on tool wear and the surface quality of machined work was carried out in this work. Finally, scientific recommendations based on critical findings were proposed for industrial implementation of dry machining

Peritoneal dialysis catheter insertion by nephrologist using minilaparotomy: Do survival and complications vary in obese?

Introduction: Peritoneal dialysis catheter (PDC) placement for chronic kidney disease (CKD) amongst overweight and obese patients is difficult owing to deeper operating field. Literature being discordant on survival and complications in this patient subset, we attempted to analyse this research question in Indian population. Materials and Methods: We retrospectively analysed PDC inserted by nephrologist using surgical minilaparotomy for survivals and complications amongst 'overweight and obese' cohort ('O') at two tertiary care government hospitals in India, and compared results with normo-weight cohort ('N'), with 12−36 months follow-up. Results: 245 PDCs were inserted by surgical minilaparotomy and 'N' to 'O' ratio was 169:76. 'O' group were more rural residing (P = 0.003) and post-abdominal surgery (P = 0.008) patients. The 1, 2, and 3-year death censored catheter survival rate was 98.6%, 95.8%, and 88.2% respectively in 'O' group, and 97.6%, 94.5% and 91.8% in 'N' group respectively (P = 0.52). Patient survival (P = 0.63), mechanical complications (P = 0.09) and infective complications (P = 0.93) were comparable despite technically challenging surgery in 'O' group. Refractory peritonitis related PDC removal was comparable (P = 0.54). Prior haemodialysis or catheter related blood stream infections or diabetes were non-contributory to results. Conclusions: Catheter survival and patient survival amongst obese and overweight CAPD patients was non-inferior to normal weight patients. Mechanical, and infective complications were comparable despite technically challenging abdominal terrain in 'O' group. The overall CAPD performance was good amongst obese and overweight

Effect of Ranque-Hilsch Vortex Tube Cooling to Enhance the Surface-Topography and Tool-Wear in Sustainable Turning of Al-5.6Zn-2.5Mg-1.6Cu-0.23Cr-T6 Aerospace Alloy

The aerospace metal cutting industry’s search for environmentally friendly practices that do not compromise machining performance is well known. One of the major objectives is the reduction in use of cutting fluids, which play a major role in containing the harsh effects of severe heat generated during machining. Machining performance and product quality can be improved by controlling heat during machining. The purpose of this study was to determine the effectiveness of various environmentally friendly metalworking fluid (MF) strategies for the sustainable turning of aerospace aluminum alloy (Al-5.6Zn-2.5Mg-1.6Cu-0.23Cr-T6) for automotive, marine, and aerospace industrial applications. The SEM images were analyzed for worn tool surfaces and machined surfaces. Under dry conditions, heat does not dissipate well, and will enter the workpiece due to the absence of coolant. This causes extreme damage beneath a turned workpiece. Thus, at 10 µm, a drop in microhardness of approximately 20% can be observed. A similar observation was made in a Ranque-Hilsch vortex tube (RHVT) and in compressed air; however, the drop in hardness was relatively low compared to dry conditions. This evaluation of microhardness indicated a heat-based attention in the turned workpiece, and thus, the heat-based effect was found to be lowest in RHVT and compressed air compared to dry conditions. Results showed that RHVT reduces temperature up to 10%, surface roughness 13%, and tool wear 20% compared to dry turning. Overall, RHVT was identified as more effective environmentally friendly cooling strategy than dry and compressed air for the turning of aluminum alloy 7075-T6