Comparison of Nitroglycerin versus Lignocaine Spray to Attenuate Haemodynamic Changes in Elective Surgical Patients Undergoing Direct Laryngoscopy and Endotracheal Intubation: A prospective randomised study

Objectives: This study aimed to compare the effects of nitroglycerin (NTG) versus lignocaine spray in blunting the pressor response during direct laryngoscopy and endotracheal intubation. Methods: This study was conducted between January and June 2018 in the Department of Anesthesiology, Teerthankar Mahaveer Medical College, Moradabad, India. A total of 90 elective surgical patients of American Society of Anesthesiologists physical status grades I or II were divided into three groups, comprising two treatment groups and one control group. Patients in the treatment groups received either one puff (1.5 mg/kg) of lignocaine 10% spray or one puff (400 μg) of NTG spray in the oropharynx one minute prior to the induction of anaesthesia. Haemodynamic variables and mean rate pressure product at baseline and one, two, three, four and five minutes post-induction were compared. Results: There was a significant reduction in mean heart rate at 3–5 minutes in both treatment groups compared to the control group (P <0.050), as well as lower increases in mean arterial pressure at 1–3 minutes (P <0.050). However, at 2–4 minutes, there was a significantly greater decrease in mean systolic blood pressure in the NTG group compared to both the lignocaine and control groups (P <0.050). Moreover, a greater decrease in mean rate pressure product response at 1–5 minutes was observed in the NTG group compared to the lignocaine and control groups (P = 0.001). Conclusion: The NTG spray was more effective than lignocaine in attenuating blood pressure increases and rate pressure product during elective laryngoscopy and intubation.Keywords: Endotracheal Anesthesia; Intubation; Laryngoscopy; Lignocaine; Nitroglycerin; Comparative Effectiveness Research; India

Bug Management Using Machine Learning

Automated tests of software can often independently log different bugs for the same underlying problem (root cause). Manually identifying duplicate bugs is a source of toil for engineers. A related problem of bug management is that of bug routing, e.g., determining the right team or person to route a bug report to for the purposes of debugging. This disclosure describes techniques for bug deduplication and bug routing based on machine learning (ML). Per the techniques, a binary machine classification model is trained to aggregate bugs with a common root cause. Bugs in a class of bugs with a common root cause are deduplicated, e.g., represented by just one of the multiple bugs in the class. Further, a multi-class ML model is trained to predict the right team for handling a new (incoming) bug

Integrating Bug Deduplication in Software Development and Testing

A bug deduplicator identifies independently discovered bugs that have the same underlying cause. Deduplication of bugs reduces toil for the software team by reducing the number of bugs that developers need to examine. However, if a bug deduplicator incorrectly classifies a bug as a duplicate, human developers might ignore the bug, allowing it to escape to production. A tradeoff exists between toil reduction and risk tolerance. This disclosure describes techniques that enable a software team to trade off the effort to remove bugs (e.g., auto-close bugs so that humans save toil and time) against the risk of errors in a bug deduplicator. Custom settings and a confidence level that a bug is a duplicate are used to determine whether to log a particular bug, to log it with comments, etc. The techniques enable the embedding of a bug deduplicator at suitable locations within a software development toolchain. The performance of the bug deduplicator can be fine-tuned in real-time by an analysis of its true negative and false positive metrics

Chandrayaan-3 Alternate Landing Site: Pre-Landing Characterisation

India's third Moon mission Chandrayaan 3 will deploy a lander and a rover at a high latitude location of the Moon enabling us to carry out first ever in-situ science investigations of such a pristine location that will potentially improve our understanding on primary crust formation and subsequent modification processes. The primary landing site (PLS), is situated at 69.367621 degS, 32.348126 degE. As a contingency, an alternate landing site (ALS) was also selected at nearly the same latitude but nearly 450 km west to PLS. In this work, a detailed study of the geomorphology, composition, and temperature characteristics of ALS has been carried out using the best-ever high resolution Chandrayaan 2 OHRC DEMs and Ortho images, datasets obtained from Chandrayaan 1 and on-going Lunar Reconnaissance Orbiter. For understanding the thermophysical behaviour, we used a well-established thermophysical model. We found that the Chandrayaan 3 ALS is characterised by a smooth topography with an elevated central part. The ALS is a scientifically interesting site with a high possibility of sampling ejecta materials from Tycho and Moretus. Based on the spectral and elemental analysis of the site, Fe is found to be near approx. 4.8 wt.%, with Mg approx. 5 wt.%, and Ca approx. 11 wt.%. Compositionally, ALS is similar to PLS with a highland soil composition. Spatial and diurnal variability of around 40 K and 175 K has been observed in the surface temperatures at ALS. Although belonging to similar location like PLS, ALS showed reduced daytime temperatures and enhanced night-time temperatures compared to PLS, indicating a terrain of distinctive thermophysical characteristics. Like PLS, ALS is also seems to be an interesting site for science investigations and Chandrayaan 3 is expected to provide new insights into the understanding of lunar science even if it happens to land in the alternate landing site.Comment: 13 pages, 7 figure

The great mimicker “Burkholderia cepacia”: A case of intra-abdominal abscesses

Burkholderia cepacia infections are underreported and often seen in immunocompromised or cystic fibrosis patients. We describe a case of intra-abdominal abscesses and bacteraemia due to Burkholderia cepacia in a non-cystic fibrosis patient. A middle aged farmer with uncontrolled diabetes presented with 1 month of fever, abdominal pain, anorexia and weight loss. Examination revealed hepatosplenomegaly. Imaging showed multiple abscesses in liver and spleen. Burkholderia cepacia grew in the blood cultures. Patient showed clinical and radiological resolution post treatment with meropenem and subsequently co-trimoxazole. Clinicians' awareness, targeted investigations and early therapeutic intervention are essential for diagnosis and management of Burkholderia cepacia infections

Cholesterol loaded cyclodextrin increases freezability of buffalo bull (Bubalus bubalis) spermatozoa by increasing cholesterol to phospholipid ratio

Aim: The study was conducted to investigate the effect of cholesterol loaded cyclodextrin (CLC) on freezability of buffalo spermatozoa. Materials and Methods: Murrah buffalo bull semen samples with progressive motility of 70% and greater were used. After the evaluation of motility and livability, four equal fractions of semen samples were made. Group I was kept as control and diluted with Tris, whereas Group II, III and IV were treated with CLC solution at the rate of 2.0, 3.0 and 4.0 mg/ml respectively to obtain 120 × 106 sperm/ml as final spermatozoa concentration. The aliquots of all the groups were incubated for action of CLC, followed by dilution and freezing. Evaluation at pre-freeze and post-thaw stage of progressive motility, viability and level of cholesterol and phospholipid was done. Results: The mean cholesterol content (μg/100 × 106 spermatozoa) of Group I, II, III and IV at pre-freeze stage was 21.55±0.63, 49.56±1.38, 55.67±0.45 and 47.79±1.01 and at post-thaw stage were 13.18±0.45, 34.27±0.71, 36.21±0.48 and 33.68±0.56, respectively. At pre-freeze stage, cholesterol content was significantly (p<0.01) higher in Group III in comparison to other groups. The mean cholesterol and phospholipids content of fresh sperm was 24.14±0.58 and 51.13±0.66 μg/100 × 106 sperm cells, respectively, and C/P ratio of spermatozoa at fresh stage was 0.47±0.067. Conclusion: CLC treatment maintains the C/P ratio and plays an important role in maintaining membrane architecture of spermatozoa. Hence, addition of CLC may be helpful in increasing freezability of buffalo spermatozoa by increasing the C/P ratio of spermatozoa

Performance Analysis in Vitro Method of Antimicrobial Activity in Different Commercial Antibiotics

This study was motivated by the fact that certain food poisonings and harmful microorganisms in ethanol and water determine roselle (Hibiscus sabdariffa), rosemary (Rosmarinus officinalis), clove (Syzygium aromaticum), and thyme (Thymus vulgaris). is to exhibit the capacity to eliminate Least inhibitory focuses (MICs) of different plant extricates against Gram-positive microorganisms (Bacillus cereus, Staphylococcus aureus), Gram-negative microscopic organisms (Escherichia coli, Enteritidis, Vibrio parahaemolyticus, Pseudomonas aeruginosa) and parasites (Candida albicans) and antibacterial impacts were explored. It is dissolved and measured using the agar well dispersion technique. The concentrate showed antimicrobial efficacy against the microorganisms and yeast used in the tests. Both pHint reduction and cell layer hyperpolarization indicated that the plant extract had a profound effect on the membranes of Gram-positive and Gram-negative microorganisms. Overall, plant extracts have significant potential as unique regular food additives due to their antibacterial properties

Long-term follow-up after ultrathin vs. conventional 2nd-generation drug-eluting stents: a systematic review and meta-analysis of randomized controlled trials.

AIMS: Contemporary 2nd-generation thin-strut drug-eluting stents (DES) are considered standard of care for revascularization of patients undergoing percutaneous coronary intervention. A previous meta-analysis of 10 randomized controlled trials (RCTs) with 11&nbsp;658 patients demonstrated a 16% reduction in the 1-year risk of target lesion failure (TLF) with ultrathin-strut DES compared with conventional 2nd-generation thin-strut DES. Whether this benefit is sustained longer term is not known, and newer trial data may inform these relative outcomes. We therefore sought to perform an updated systematic review and meta-analysis of RCTs comparing clinical outcomes with ultrathin-strut DES (≤70 µm strut thickness) with conventional 2nd-generation thin-strut DES. METHODS AND RESULTS: We performed a random-effects meta-analysis of all RCTs comparing ultrathin-strut DES to conventional 2nd-generation thin-strut DES. The pre-specified primary endpoint was long-term TLF, a composite of cardiac death, myocardial infarction (MI), or clinically driven target lesion revascularization (CD-TLR). Secondary endpoints included the components of TLF, stent thrombosis (ST), and all-cause death. There were 16 eligible trials in which 20&nbsp;701 patients were randomized. The weighted mean follow-up duration was 2.5 years. Ultrathin-strut DES were associated with a 15% reduction in long-term TLF compared with conventional 2nd-generation thin-strut DES [relative risk (RR) 0.85, 95% confidence interval (CI) 0.76-0.96, P = 0.008] driven by a 25% reduction in CD-TLR (RR 0.75, 95% CI 0.62-0.92, P = 0.005). There were no significant differences between stent types in the risks of MI, ST, cardiac death, or all-cause mortality. CONCLUSIONS: At a mean follow-up of 2.5 years, ultrathin-strut DES reduced the risk of TLF, driven by less CD-TLR compared with conventional 2nd-generation thin-strut DES, with similar risks of MI, ST, cardiac death, and all-cause mortality

Mortality after drug-eluting stents vs. coronary artery bypass grafting for left main coronary artery disease: a meta-analysis of randomized controlled trials.

AIMS: The optimal method of revascularization for patients with left main coronary artery disease (LMCAD) is controversial. Coronary artery bypass graft surgery (CABG) has traditionally been considered the gold standard therapy, and recent randomized trials comparing CABG with percutaneous coronary intervention (PCI) with drug-eluting stents (DES) have reported conflicting outcomes. We, therefore, performed a systematic review and updated meta-analysis comparing CABG to PCI with DES for the treatment of LMCAD. METHODS AND RESULTS: We systematically identified all randomized trials comparing PCI with DES vs. CABG in patients with LMCAD. The primary efficacy endpoint was all-cause mortality. Secondary endpoints included cardiac death, myocardial infarction (MI), stroke, and unplanned revascularization. All analyses were by intention-to-treat. There were five eligible trials in which 4612 patients were randomized. The weighted mean follow-up duration was 67.1 months. There were no significant differences between PCI and CABG for the risk of all-cause mortality [relative risk (RR) 1.03, 95% confidence interval (CI) 0.81-1.32; P = 0.779] or cardiac death (RR 1.03, 95% CI 0.79-1.34; P = 0.817). There were also no significant differences in the risk of stroke (RR 0.74, 95% CI 0.35-1.50; P = 0.400) or MI (RR 1.22, 95% CI 0.96-1.56; P = 0.110). Percutaneous coronary intervention was associated with an increased risk of unplanned revascularization (RR 1.73, 95% CI 1.49-2.02; P &lt; 0.001). CONCLUSION: The totality of randomized clinical trial evidence demonstrated similar long-term mortality after PCI with DES compared with CABG in patients with LMCAD. Nor were there significant differences in cardiac death, stroke, or MI between PCI and CABG. Unplanned revascularization procedures were less common after CABG compared with PCI. These findings may inform clinical decision-making between cardiologists, surgeons, and patients with LMCAD