Intra-spinal epidural leakage of bone cement during vertebroplasty of an osteoporotic vertebral fracture: case report and review of literature

Vertebral fractures are one of the most common complications of osteoporosis. Prolonged and intractable pain leads to immobilization and significant morbidity. Vertebroplasty is designed primarily to relieve pain, and the procedure is considered when osteoporotic vertebral fracture does not respond to a reasonable period of conservative care. Vertebroplasty has a low complication rate with most common complication being adjacent vertebral body fracture and rare complication due to extra-vertebral cement leakage causing nerve root compression or pulmonary embolism. We report a case of 55 year old lady with osteoporotic D12 wedge compression fracture subjected to vertebroplasty resulting in intraspinal cement leakage noticed intra-operatively. Patient underwent immediate decompression, cement extraction and posterior instrumentation. Postoperative course was uneventful

Study of potential drug interactions between prescribed drugs in geriatric patients attending outpatient department in a government tertiary care hospital in Maharashtra

Background: A drug interaction is defined as a modification of the effect of a drug when it is administered with other drugs. Geriatric population is exposed to multiple drugs and consequently suffers many drug interactions (DIs). The objective of this study was to assess the potential drug interactions (PDI) in the geriatric population attending out-patient department (OPD) in a tertiary care hospital.Methods: A cross sectional observational study was carried out from July to September 2015. Patients of either gender, age 60 years or more, attending OPD in tertiary care hospital and prescribed two or more drugs, were included in the study. Prescriptions of medical officers were screened for PDIs with Medscape drug interaction software available on the website www.medscape.com.Results: In the present study, out of 600 prescriptions, 48.50% were identified having at least one drug interaction. Total 584 PDIs were found in 111 drug pairs. 29.62% PDIs were pharmacodynamic, 42.80% pharmacokinetic type and 10.78% PDIs were found affecting serum potassium level. Majority of PDIs (61.81%) were found significant followed by minor (36.98%) and severe (1.19%). Ranitidine and cyanocobalamin was the most common pair showing PDI (105) followed by aspirin and enalapril (44). Aspirin was found to be the most common single drug amongst pairs to cause PDI in the present study.Conclusions: In the present study, PDIs were studied in geriatric population. Knowledge of the prevalence and predictors of clinically important PDIs will help physicians and pharmacists identify patients at higher risk of adverse drug interactions requiring more cautious pharmacotherapy

DRUG UTILIZATION PATTERN IN GERIATRIC PATIENTS ATTENDING OUT PATIENT DEPARTMENT AT RURAL TERTIARY CARE HOSPITAL IN MAHARASHTRA.

Objective: To observe a prescription pattern in elderly patients attending outpatient department (OPD) and evaluating prescriptions according to theWorld Health Organization (WHO) prescription indicators.Methods: A cross-sectional observational study was conducted from July to September 2015. Patients of either gender, age 60 years or more, attending OPD in tertiary care hospital were included in the study. Prescriptions of medical practitioners were collected and evaluated for demographic data and the WHO drug prescribing indicators.Results: A total of 600 patients were enrolled in the study. The majority of the patients were in the age group 60-69 years (66.33%) with male preponderance (61%). The average number of drugs per prescription was 3.41. Out of 2045 drugs prescribed, 1261 drugs (61.66%) were prescribed by their generic name and 784 drugs (38.33%) were prescribed by their brand name. 1700 drugs (83.12%) prescribed were from the WHOs essential medicines list 2015. Total encounters involving injectable usage were 0.15%. Drugs acting on the cardiovascular system (21.12%) were the most frequently prescribed, followed by nonsteroidal anti-inflammatory drugs (NSAIDs) (20%). Ranitidine (16.62%) is the most frequently prescribed drug. Conclusions: In this study, drug prescription pattern was rational as per the WHO drug prescribing indicators. However, issues such as polypharmacy and inaccuracies of dose and duration were seen.Keywords: Drug utilization study, Geriatric, Outpatient department, Rational use of medicines

A study of maternal mortality due to non-obstetric causes

Background: Pregnancy, although being considered a physiological state, carries the risk of serious maternal morbidity and at times mortality, due to various complications that may arise during pregnancy, labour or thereafter. The existing medical condition, infection, and surgical condition which is collectively called as non- obstetric cause pre disposes a women for more complication than a non-pregnant women, so much so that it can lead to maternal mortality. Thus, Pregnancy is more vulnerable state and present study was carried out to study, analyse and review various non-obstetrics causes of death of women during pregnancy or within 42 days of termination of pregnancy in Tertiary care centre.Methods: This was an Observational study, conducted in the department of obstetrics and gynaecology, at a tertiary care hospital attached with medical college, from October 2016 to October 2018. The details of maternal deaths were collected from various departments with non- obstetric causes and analyzed.Results: The total number of deliveries in my study period was 15,208. There were 197 maternal mortality in our study period, of which 51 women died of non-obstetric causes. The most common cause of maternal mortality in our study was hepatic cause i.e. 33.33% amongst which viral hepatitis was the most common cause followed by respiratory (19.60%), infectious (15.18%), heamoglobinopathy (13.72%), cardiac (5.88%), neurological (5.88%), surgical (5.88%) causes.Conclusions: Looking into our study, maternal mortality can be reduced by identifying various different indirect medical causes which are preventable by proper pre-pregnancy evaluation for pre-existing comorbid conditions

Agarose processing in protic and mixed protic–aprotic ionic liquids : dissolution, regeneration and high conductivity, high strength ionogels

We have shown that low viscosity alkyl or hydroxyalkyl ammonium formate (ILs) can dissolve agarose, and higher dissolution can be achieved in the mixed, alkyl or hydroxyalkyl ammonium + imidazolium or pyridinium ILs. The polarity parameters α, β, π*, ET(30) and ETN of these IL systems were measured to explain their dissolution ability for agarose. Dissolved agarose was either regenerated using methanol as a precipitating solvent or ionogels were formed by cooling the agarose–IL solutions to ambient temperature. Exceptionally high strength ionogels were obtained from the agarose solutions in N-(2-hydroxyethyl)-ammonium formate or its mixture with 1-butyl-3-methylimidazolium chloride. Regenerated material and ionogels are characterized for their possible degradation/conformational changes and gel properties (thermal hysteresis, strength, viscoelasticity and conductivity) respectively. A high strength, high conducting ionogel was demonstrated to be able to build an electrochromic window. Such ionogels can also be utilized for other soft matter electronic devices and biomedical applications

Management of Renewable Energy for a Shared Facility Controller in Smart Grid

© 2016 IEEE. This paper proposes an energy management scheme to maximize the use of solar energy in the smart grid. In this context, a shared facility controller (SFC) with a number of solar photovoltaic panels in a smart community is considered that has the capability to schedule the generated energy for consumption and trade to other entities. In particular, a mechanism is designed for the SFC to decide on the energy surplus, if there is any, that it can use to charge its battery and sell to the households and the grid based on the offered prices. In this regard, a hierarchical energy management scheme is proposed with a view to reduce the total operational cost to the SFC. The concept of a virtual cost is introduced that aids the SFC to estimate its future operational cost based on some available current information. The energy management is conducted for three different cases, and the optimal cost to the SFC is determined for each case by the theory of maxima and minima. A real-time algorithm is proposed to reach the optimal cost for all cases, and some numerical examples are provided to demonstrate the beneficial properties of the proposed scheme

Selection of online Features and its Application

Selection of Online Feature is significant important concept in data mining. Batch learning is the mostly used learning algorithm in feature selection. Instead of Batch learning, online learning is most efficient and scalable machine learning method. Most existing system studies of online learning should access the data related to features. But accessing all data becomes a problem when we deal with high dimensional data. To avoid this limitation we proposed system in this online learner allowed to operate a classifier having fixed and small number of features related data. But the significant challenge Selection of online features (SOF) is how to construct accurate prediction for a data using a small number of operative features. To develop novel Selection of Online Feature algorithms to perform a various tasks of Selection of Online Feature by using semi supervised and supervised with unlabeled and label data for full input and partial input. Hence it provides integrity and scalability to the data storage system efficiently and users will be accessing the data through online

How long does treated supracondylar humerus fracture in children take to recover elbow range?

Background: Our goal was to address requirement of physiotherapy after treatment of supracondylar humerus fractures in children and evaluate result of casting on elbow without injury using control group of distal forearm fractures.Methods: 57 cases of supracondylar fractures were included in this retrospective study and compared with group of 54 children with distal forearm fractures treated with long arm casting for 28 days. Passive elbow ROM was checked with goniometer on day of cast removal, 2 weeks later, and then every month until the elbow ROM returned to 95% ROM (ROM-95) of uninjured side. No physiotherapy was given.Results: Average time in cast for supracondylar fracture group was 31.8 days and distal forearm fracture group was 32.4 days. The elbow total flexion angle reached a plateau of 139 degrees at 1month after cast removal whereas forearm group required less than 2 weeks. Total rotation ROM required half the time to reach 139 degrees in forearm group. From the paired t test it took more time for pronation to recover than supination in supracondylar fractures. In supracondylar group there was positive correlation between casting period and recovery period of ROM-95 elbow extension (p=0.021) and days of casting (p=0.021) and ROM-95 flexion recovery period. There was no statistically significant impact between casting and recovery period in other directions and recovery of ROM-95 & F-ROM and the subclassification and type of treatment of individual fractures.Conclusions: Lessons learned: thorough assessment of elbow function post cast removal, lack of need of physiotherapy in management protocol and elbow stiffness is related to initial injury and associated treatment not merely immobilisation