Bilateral Transversus Abdominis plane block using ropivacaine and bupivacaine for lower segment caesarean section under spinal anaesthesia: A prospective, randomized, single blinded, placebo controlled study for evaluating the analgesic efficacy of 0.5% ropivacaine vs 0.25% bupivacaine

BACKGROUND: Transversus abdominis plane block is a regional anaesthetic technique which provides analgesia after lower abdominal surgeries particularly where the somatic pain forms the main component of pain, from the incision of the anterior abdominal wall. TAP block provides sensory blockade of the skin over the lower abdominal wall by deposition of local anaesthetic drugs in the neurovascular plane between Internal oblique aponeurosis and transversus abdominis muscle. We evaluated the efficacy of bilateral TAP block using Ropivacaine & Bupivacaine for lower segment caesarean section done under spinal anaesthesia in a prospective, randomized, single blinded, placebo controlled study. METHOD: 75 pregnant women undergoing lower segment caesarean section (elective or emergency) were randomized to undergo USG guided bilateral TAP block with 0.5% Ropivacaine (n = 25) or 0.25% Bupivacaine (n = 25) or Normal saline (n = 25). At end of the surgery performed under spinal anaesthesia bilateral TAP block was performed under ultrasound guidance using 20 ml of 0.5 % Ropivacaine or 0.25 % Bupivacaine or saline on each side. Each patient was assessed postoperatively for Heart rate, Blood pressure, VAS scores, the time for initiation of analgesia and complications in postoperative ward every 15 minutes for first one hour, then at 2, 4, 6, 12, 24, 48 hours postoperatively in ward. The results were the mean duration of analgesia in the control group (normal saline) was 1.49 hours, ranging from 0.5 to 0.25 hours and in the intervention group who received 0.25% Bupivacaine was 6.22 hours, ranging from 4 to 8 hours and in the group which received 0.5% Ropivacaine was 20.6 hours, ranging between 17.65 to 23.54 hours which was found to be statistically significant and there was no difference in the haemodynamic parameters of the intervention groups(Bupivacaine and Ropivacaine) . There were no complications attributable to TAP block or the drugs under study except a few cases of failure due to displacement of the needle while giving drugs. CONCLUSION: Hence we conclude that 0.5% Ropivacaine provided longer duration of analgesia than 0.25 % Bupivacaine when used in TAP block in women undergoing lower segment caesarean section

Correlation of Ocular Perfusion Pressure and Intraocular Pressure Changes during Hemodialysis in End-Stage Renal Disease: An Observational study

OBJECTIVE: To assess correlation of IOP and OPP changes during Hemodialysis. METHODS: CKD patients-receiving hemodialysis for ≥ 1month were included. At 3 time points, IOP and BP measurement were done.15 minutes before initiation of HD (T1), 2 hours after initiation of HD (T2), and 15 minutes after ending HD (T3). Mean arterial pressure (MAP) and OPP (systolic, diastolic, and mean OPP) were calculated. Patients with MOPP, DOPP, SOPP below baseline and variation in IOP were reviewed every 3 months. RESULTS: From T1 to T3, IOP significantly increased by 2.7 mm Hg (both eyes, P=0.000), MAP significantly decreased by 10.13 mm Hg (P = 0.000), and all OPP measures significantly decreased from baseline (all P < 0 .001). Using previously reported thresholds of increased glaucoma development and progression risk, in both eyes 58% of had a SOPP of ≤101 mm Hg, 58% had a DOPP of ≤55 mm Hg, and 48% had a MOPP of ≤42 mm Hg. At the end of our study period, 6 of 58 patients(below baseline OPP) were found to develop early glaucomatous field defects and early optic nerve head changes in both eyes at follow-up visits. CONCLUSIONS: Significantly increased IOP and decreased OPP occur during HD, bringing both to levels that increase the risk of glaucoma development and progression. Hence our study reveals the importance of screening and monitoring of IOP and characteristic early optic nerve head changes and early visual field changes of glaucoma in end-stage renal disease patients who are on hemodialysis

Analysis of Datura stramonium Linn. biodiesel by gas chromatography - mass spectrometry (gc-ms) and influence of fatty acid composition on the fuel related characteristics

Biodiesel is a mixture of fatty acid alkyl esters obtained by the reaction of triglycerides of vegetable or animal origin with alcohol in the presence of a catalyst. The fatty acid profile influences the overall properties of the biodiesel. The properties of individual fatty acid depend on the occurrence of double bonds, fatty acid chain length and branching. Better understanding of the fatty acid composition and correlating the fuel properties is of utmost importance in improving the optimal performance. In the present study, Datura stramonium biodiesel is analyzed for its fatty composition using Gas chromatography assisted with mass spectrometry. The influence of fatty acids of the fuel related properties is discussed.Â

Production and Utilization of Vermicompost in Agro Industry

SUMMARYVermicompost was prepared by using the earthworms, Eudrilus eugeniae collected from the Sathyamangalam, Erode district and it is maintained under normal laboratory conditions. The compost was prepared in large amount and the rate of compost was noted for eight months from the months of October 2005 to May 2006. After production of the compost, required amount of compost was taken for the growth of vegetables like Solanum melongena (Brinjal), Capsicum minimum (Chilli), Alysicarpus spinosus (Mullakeerai) and Amaranthus viridis (Pachathandukeerai) were observed using 2kgs of garden soil along with 1kgs of vermicompost (in the ratio 2:1). The results showed higher percentage of biomass production in the vermicompost medium (Experiment) when compared to the garden soil (Control). Due to their short life span some plants in the experimental medium showed high growth rate in short period. Key words: Eudrilus eugeniae, Vermicompost, Solanum melongena, Capsicum minimum, Alysicarpus spinosus, Amaranthus viridis G. Nithya and M. Lekeshmanaswamy. Production and Utilization of Vermicompost in Agro Industry.  J Phytol 2/2 (2010) 68-72

Puerperal Group A Streptococcal sepsis: a case report

Group A Streptococcal (GAS) sepsis in puerperium is one of the recognised causes of maternal mortality. Though the onset is often insidious, it can progress rapidly to a life-threatening invasive infection, toxin-mediated shock, and end-organ failure, even before clinical signs become apparent. We report a case of puerperal GAS sepsis that was successfully managed. 24-years-old para 1 was readmitted to the intensive care unit requiring non-invasive ventilation on postnatal day 6 with clinical and biochemical features of sepsis. Blood culture, episiotomy wound swab, and high vaginal swab grew GAS. Broad-spectrum antibiotics initiated. She developed ascites that progressively increased and needed therapeutic paracentesis. She was discharged after four weeks of hospitalization. Early identification and prompt treatment are the keys to prevent severe morbidity and maternal mortality

(R1984) Analysis of M^[X1], M^[X2]/G1, G_2^(a,b)/1 Queue with Priority Services, Server Breakdown, Repair, Modified Bernoulli Vacation, Immediate Feedback

In this investigation, the steady state analysis of two individualistic batch arrival queues with immediate feedback, modified Bernoulli vacation and server breakdown are introduced. Two different categories of customers like priority and ordinary are to be considered. This model propose nonpreemptive priority discipline. Ordinary and priority customers arrive as per Poisson processes. The server consistently afford single service for priority customers and the general bulk service for the ordinary customers and the service follows general distribution. The ordinary customers to be served only if the batch size should be greater than or equal to a , else the server should not start service until a customers have accumulated. Meanwhile priority queue is empty; the server becomes idle or go for vacation. If server gets breakdown while the priority customers are being served, they may wait in the head of the queue and get fresh service after repair completion, but in case of ordinary customers they may leave the system. After completion of each priority service, customer may rejoin the system as a feedback customer for receiving regular service because of inappropriate quality of service. Supplementary variable technique and probability generating function are generally used to solve the Laplace transforms of time-dependent probabilities of system states. Finally, some performance measures are evaluated and express the numerical results

Polymorphic behavior of an organic compound

Objective: Polymorphic crystals were exhibited in many organic compounds. The frequency changes, relative intensities, band contours, and numberof bands were observed in the spectra of different polymorphism which may be due to molecule-molecule interactions in the crystal unit cells. Theshape of a molecule at its site in the unit cell is distorted by molecular interactions.Methods: The identification of a pure crystal form and to quantify a mixture of two forms infrared and Raman spectra of different crystalline formsof the same organic compound can be used. 2'-chloro-4-methoxy-3-nitro benzil (1) was synthesized and its two polymorphic forms were obtainedby recrystallization from the solvents acetone/chloroform and ethanol. The polymorphism present in the compound was confirmed by single crystalX-ray crystallography and differential scanning calorimetry.Results: The polymorph 1.1 crystallizes as triclinic P-1 space group in the solvent acetone – chloroform and the polymorph 1.2 crystallizes asmonoclinic P21/c space group in the solvent ethanol.Discussion: The intermolecular lattice energy and the interplay of molecular conformation in the crystallization and stability of polymorphs areidentified by X-ray crystal structures of conformational polymorphs.Keywords: Conformational polymorphism, Organic compounds, Single crystal growth, X-ray diffraction

Study of Calcium to Creatinine Ratio in a Spot Sample of Urine for Early Prediction of Pre Eclampsia

INTRODUCTION: Despite so much research and changes in management pre eclampsia is still a leading cause of maternal morbidity and mortality in India and worldwide. About 5-7% of the pregnancy are affected by pre eclampsia and hypertensive disorders. pre eclampsia is a multi system disorder pathology behind is reduced perfusion of organs due to vasospasm. It is usually associated with proteinuria or edema or both. This is the disorder of widespread vascular endothelial malfunction and vasospasm which occurs after 20 weeks of gestation and presents till 4-6 weeks postpartum. AIMS AND OBJECTIVES: To evaluate calcium to creatinine ratio for the early diagnosis of pre eclampsia and thus identify population at greater risk to be included in primary prevention programme. Study Design: Prospective study. Study Population: Women of gestatioal age < 20 weeks attending AN clinic in the Obstetrics and Gynaecology Department, Coimbatore Medical College Hospital, Coimbatore. Study Period: January 2018 to January 2019. Sample Size: 200. Selection Criteria: INCLUSION CRITERIA: Antenatal women of any age, Singleton pregnancy, Gestational age less than 20 weeks, Any parity, Normotensive patients, Without proteinuria. EXCLUSION CRITERIA: • Blood pressure 140/90mmhg or more. • Proteinuria –tested with dipstick >1+ in random urine sample • History of PIH in past pregnancy • History of chronic hypertension • Diabetes mellitus • Renal disease • Vascular disease • Immunological disease METHODOLOGY: All antenatal women who attended the outpatient department at the department of obstetrics and gynaecology Coimbatore medical college hospital based on selection criteria will be enrolled in this study. 1. Informed written consent will be obtained from all patients. 2. Participation in the study was voluntary. 3. All subjects were informed about the aims and objectives of the study, the test to be done and the nature of their population. 4. A detailed history, a complete physical general examination and obstetric examination was performed. 5. A spot urine sample was collected for estimation of calcium and creatinine. 6. Urinary Calcium was determined by orthocresophthalein method and urinary creatinine by jaffes method. 7. CCR was calculated those with ratio <0.04 were considered positive those with a ratio of >0.04 were considered as test negative. 8. Cutoff for CCR is taken as < 0.04. 9. Patients are then followed to predict how many of them developed pre eclampsia. STATISTICAL ANALYSIS: The results obtained were further analysed for SD, t test, SEM, and p value. The p value <0.001 was consider significant. comparative study was done by using chi square test. RESULTS: All 200 low risk antenatal patients were then followed till delivery once in four weeks to predict how many of them developed pre eclampsia. And the results obtained were analysed for statistical significance and if pre eclampsia developed managed as per local protocol. Out of 200 samples, 19 women had positive calcium creatinine ratio while 181 had negative calcium creatinine ratio. Among the 19 positive CCR ratio- • 15 developed hypertension i,e 6 developed severe pre eclampsia, 5 developed non severe pre eclampsia and 4 developed gestational induced hypertension, while the remaining 4 women remains normotensive and No one developed eclampsia. While among 181 negative CCR ratio ,one women developed gestational induced hypertension. The incidence of preterm birth is more common than term birth in hypertension of pregnancy and it is about more than 40%. In our study also when comparing the association of gestational age at delivery with CCR, premature deliveries is more than term deliveries in women those who developed hypertension during pregnancy and it showed p value of 0.000* and it is statistically significant. In our study we compared the association of gestational age of collection with CCR, • First trimester (14 weeks)-69 had negative CCR and 3 of them had positive CCR. • Second trimester(14-20 weeks)-112 had negative CCR and 16 had positive CCR. While comparing the association of gestational age of collection with CCR had p value of 0.046 and it is statistically significant. And the second trimester CCR (84%) is more ideal than first trimester(15%) CCR. The association of PIH with CCR in primigravida and multigravida is also statistically significant with significant p value of 0.000*. The incidence of positive CCR in primi and multi in our study is about 11% and 5% respectively, which is as similar as incidence of PIH in primi and multi and its about 10-15% and 5% respectively. CONCLUSION: The estimation of Calcium Creatinine Ratio in a spot sample of urine for prediction of pre eclampsia had p value of < 0.001 and it is statistically significant and it can be used as a screening test for low risk asymptomatic antenatal women with less than 20 weeks of gestation for prediction of pre eclampsia. Also the association of gestational age of collection less than 20 weeks with CCR, has a significance p value and it is also statistically significant and while comparing second trimester CCR is more ideal than first trimester. The association of PIH with CCR in primigravida and multigravida is also statistically significant with significant p value of 0.000*. It can therefore be suggested as a screening test for low risk antenatal women with less than 20 weeks of gestation for prediction of pre eclampsia, especially when the government encourages in booking visit. As PICME (Pregnancy and Infant Cohort Monitoring and Evaluation) entry should be made before 12 weeks as per government norms, so we can have the opportunity to screen the mother with this CCR ratio at earlier period to predict pre-eclampsia during this booking visit. And also PMSMA-The Pradhan Mantri Surakshit Matritva Abhiyan under ministry of health and family welfare guarantees an antenatal care free of cost universally to all pregnant women in their second and third trimesters of pregnancy on the 9th of every month. We can also screen the mother with this CCR ratio to predict the pre eclampsia as a part of this government schemes. Pre eclampsia is a chief cause for maternal morbidity and mortality in worldwide, especially in developing countries. Many research work are going on for a better predictor for pre eclampsia and therefore to prevent the maternal mortality and mortality associated with that. An accessibility of a good screening test would pledge and encourage more exploration work in the direction of secondary prevention of early diagnosis and treatment