Studies on Heterocyclic Compounds

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Study of importance of medial cortex in distal femur comminuted fracture

Background: Distal femur fractures require high energy trauma by means of road traffic accidents. There are various modalities of fixation, involving plating, external fixator and intramedullary nailing. cause of nonunion like smoking, osteoporosis, early weight bearing, improper construction of fixation, improper reduction.Methods: The study was conducted on 20 patients having distal femur fractures operated previously by using a different modality of implant goes in failure like bending of implant, broken of implant, peri implant fracture after second episode of trauma. Patient was preoperatively assessing for rule out occult low grade infection by blood investigation like ESR and CRP. Previous X-ray review to find cause of nonunion.Results: All patients showed a complete union at the fracture site with an average duration of 4-6 months. There was no complaint of infection, joint stiffness or difficulty in weight bearing after treatment with revision fixation and bone grafting. Patients were able to walk without affecting their daily activity of living.  Conclusions: Comminuted medial cortex left unfixed or maligned will go into varus collapse and leads to failure of fixation

Seasonal changes in microbial community structure and nutrients content in rhizospheric soil of Aegle marmelos tree

A preliminary investigation was carried out on dominance of different types of microbial communities at different monsoon seasons in rhizospheric soils of Aegle marmelos tree. Nutrients content of soil were also determined simultaneously to correlate with the microbial population. Results show that the rhizosphere of Aegle marmelos contains gram-negative bacteria, Rhizobium, Azotobacter,Actinomycetes and Yeast and major plant nutrients and their count as well as dominance changes with moisture content in rhizosphere.Except actinomycetes all the microorganisms were found highest duringmonsoon season whereas in post-monsoon season Actinomycetes were dominant. Amount of water in rhizosphere soil also affects soil chemical properties. Soil pH, organic carbon, C:N ratio, available nitrogen and available phosphorus were recorded maximum in monsoon, whereas electrical conductivity and total nitrogen content were found maximum in post-monsoon

Placental laterality and uterine artery resistance as predictor of preeclampsia: a prospective study at GMERS Medical College, Dharpur-Patan, North Gujarat, India

Background: Placental abnormality is one of the initial events seen in patients who are destined to develop preeclampsia. The objective was to study whether ultrasonically identified; placental laterality and uterine artery resistance can be used as a predictor for development of preeclampsia.Methods:This prospective observational study was conducted at GMERS Medical College, Dharpur-Patan tertiary care teaching institute in North Gujarat from January 2013 to December 2014. A total 400 non high risk primigravida with singleton pregnancy were included, all patients with diabetes, hypertension, renal disease, and history of smoking were excluded. In all these patients, location of placenta was determined by ultrasonography at 18 to 22 weeks of gestation. Patients who had lateral placenta were subjected for colour Doppler study for determining uterine artery resistance index. All 400 patients were followed till delivery for occurrence of preeclampsia as per ACOG guidelines. All data was analyzed and statistical significance was determined by x2 test and value of p<0.05 is considered significant.Results:Out of 400 cases, 80 (20%) cases had laterally located placenta on ultra sound examination done at 18-24 weeks of gestation. Out of the 80 women with laterally located placenta, 28 (35%) developed preeclampsia. This relationship was statistically significant. All 80 patients who had lateral placenta, 26 patients had raised uterine artery resistance and out of those 26 patients, 22 developed preeclampsia and 54 had no change in uterine artery resistance. Out of those 54 only 6 had preeclampsia (p<0. 001). The sensitivity of determining uterine artery resistance as a predictive test was 84.6%, the specificity 88.8 %, positive predictive value 78.5 % and negative predictive value 92.3%.Conclusion: A chance of preeclampsia is more in patients with lateral placenta but its sensitivity and specificity increases significantly when it is combined with uterine artery velocimetric waveform study, and we can predict preeclampsia in patient who is having lateral placenta and raised uterine artery resistance.

Clinical profile and management of ectopic pregnancy in patients with ectopic pregnancy at GMERS medical college and hospital Dharpur-Patan, North Gujarat region, India

Background: Ectopic pregnancy is assuming greater importance because of its increasing incidence and its impact on woman’s fertility. Objective: To study the clinical profile and management of ectopic pregnancies.  Methods: This prospective  study was conducted over one year from 1st January 2013 to 31st December 2013 for risk factors, mode of presentation, status at admission, diagnostic and treatment modalities and management of patients with ectopic pregnancy.Results: Over all mean rate of ectopic pregnancy has been found 11.41/1000 births. Out of total 52 cases 32 (64%) were referred while 20 (36%) were emergency cases. Out of 52 patients, 23 (44.23%) were from urban areas and 29 (55.77%) were from rural areas. Majority of the patients (51.97%) were in 26-30 years age groups. Gravida 3 had highest incidence (30.76%) of ectopic pregnancy. Maximum (50%) ectopic pregnancies were found in women with active married life of 5-10yrs. Out of total 52 cases, 44 (84.62%) were ruptured ectopic pregnancy cases. Ampulla was the most common site for tubal ectopic pregnancy (51.92%). Abdominal pain was the most common presenting symptoms (92.30%) followed by amenorrhoea in 84.61% cases. Majority of patients had history of infertility (42.30%) as a major risk factor. Laparoscopic management was done in 13 (25%) patients out of them lap. salpingectomy was done 9 (17.31% of total) and lap. Salpingostomy was done in 4 (7.69% of total) patients.Conclusion: Although ectopic pregnancy will never be completely prevented, but incidence can be reduced and much of the morbidity and mortalities can be minimised by prevention and efficacious diagnostic and interventional strategies aimed primarily at those women who are at high risk for the condition and taking precaution that woman who likely to become high risk are handled in such a way that the number of these high risk women are reduced.

Association between convalescent plasma treatment and mortality in COVID-19: a collaborative systematic review and meta-analysis of randomized clinical trials.

Funder: laura and john arnold foundationBACKGROUND: Convalescent plasma has been widely used to treat COVID-19 and is under investigation in numerous randomized clinical trials, but results are publicly available only for a small number of trials. The objective of this study was to assess the benefits of convalescent plasma treatment compared to placebo or no treatment and all-cause mortality in patients with COVID-19, using data from all available randomized clinical trials, including unpublished and ongoing trials (Open Science Framework, https://doi.org/10.17605/OSF.IO/GEHFX ). METHODS: In this collaborative systematic review and meta-analysis, clinical trial registries (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform), the Cochrane COVID-19 register, the LOVE database, and PubMed were searched until April 8, 2021. Investigators of trials registered by March 1, 2021, without published results were contacted via email. Eligible were ongoing, discontinued and completed randomized clinical trials that compared convalescent plasma with placebo or no treatment in COVID-19 patients, regardless of setting or treatment schedule. Aggregated mortality data were extracted from publications or provided by investigators of unpublished trials and combined using the Hartung-Knapp-Sidik-Jonkman random effects model. We investigated the contribution of unpublished trials to the overall evidence. RESULTS: A total of 16,477 patients were included in 33 trials (20 unpublished with 3190 patients, 13 published with 13,287 patients). 32 trials enrolled only hospitalized patients (including 3 with only intensive care unit patients). Risk of bias was low for 29/33 trials. Of 8495 patients who received convalescent plasma, 1997 died (23%), and of 7982 control patients, 1952 died (24%). The combined risk ratio for all-cause mortality was 0.97 (95% confidence interval: 0.92; 1.02) with between-study heterogeneity not beyond chance (I2 = 0%). The RECOVERY trial had 69.8% and the unpublished evidence 25.3% of the weight in the meta-analysis. CONCLUSIONS: Convalescent plasma treatment of patients with COVID-19 did not reduce all-cause mortality. These results provide strong evidence that convalescent plasma treatment for patients with COVID-19 should not be used outside of randomized trials. Evidence synthesis from collaborations among trial investigators can inform both evidence generation and evidence application in patient care

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Simulation of the flow induced by positive pressure ventilation fan under wind driven conditions

Positive Pressure Ventilation (PPV) is a tactical forced ventilation technique used by many fire departments to remove smoke, heat and contaminants from a burning building. PPV usage as a post fire strategy is generally proven and widely accepted as an effective ventilation tool. However, its success as a pre-attack strategy in controlling the spread of fire and smoke is only ensured when it is used correctly and with caution. The efficiency of PPV depends mainly upon net air flow rate through the fire structure. The amount of fresh air blown into the building during a PPV attack is affected by various factors such as fan capacity, distance between the fan and inlet door, inlet dimensions, exhaust opening area, wind and fire conditions etc. Computational Fluid Dynamics (CFD) is a useful and costeffective tool in improving our understanding on various factors affecting the effectiveness of PPV and could be used to improve both the fire fighter and fire victim’s safety. In the present investigation, the SMARTFIRE CFD fire field model is validated using two full-scale experiments characterising a PPV fan. This work is extended by investigating the relationship between the exhaust/inlet area ratio and the net air flow rate into the room geometry under wind and no wind conditions. Finally, results from the simulations of a complex multi-storey structure involving wind driven fire and PPV fan are also presented. Suggestions have been made on the choice of vent locations for better fan performance

Oleic acid based polymeric flow improvers for Langhnaj (North Gujarat, India) crude oil

AbstractThis research article investigates the effect of polymeric flow improvers (FI) as pour point depressants (PPD) and rheological property improvers of waxy crude oil in Langhnaj, North Gujarat (India), since application of FI is a more economically viable option for crude oil transportation. Three new comb-shaped copolymers of maleic anhydride and n-alkyl oleate were synthesized by free radical solution polymerization, which were consequently reacted with hexadecyl amine to get poly (hexyl oleate-co-hexadecyl maleimide-co-n-alkyl oleate). Synthesized polymers were characterized by Fourier Transform Infrared Spectroscopy (FTIR) and Gel Permeation Chromatography (GPC). These FIs were further evaluated for their pour point depression property and rheology modifier with and without additive using Fann Viscometer. The prepared FIs act as effective pour point depressants as well as viscosity index improvers