A2L Refrigerants Leaks and Ignitions Testing under Whole Room Scale

Environmental concerns raised by high global warming potential (GWP) refrigerants have triggered a series of activities around the world to curtail the use of hydrofluorocarbons (HFCs). Many of the promising alternative refrigerants being investigated are mildly flammable and fall under the A2L safety classification of ASHRAE 34. In an effort to properly address A2L refrigerants in safety standards, the Air-Conditioning, Heating, and Refrigeration Technology Institute (AHRTI) undertook a research project to investigate refrigerant leaks and ignition testing under whole scale room conditions. This paper summarizes refrigerant leak and ignition tests for A2L refrigerants R-32, R-452B, R-455A and R-457A. The work included two main tasks. The first involved testing R-32 and R-452B under a controlled environment to explore factors affecting the refrigerants’ ignition. These factors include refrigerant leak rates, leak locations, leak opening size and oil effect. In the second task, tests were conducted under whole room scale for typical air-conditioning and refrigeration configurations. The whole room testing simulated large refrigerant leaks with ignition sources present from a packaged terminal unit, a residential split AC, a rooftop unit, a reach-in cooler and a walk-in cooler under various scenarios. Key observations will be summarized and future research work will be discussed

Comparative study of chlorhexidine dressings versus simple gauze dressings in midline laparotomy wound

Background: Wound infections are the most common complication of surgery that adds significantly to the morbidity of the patient and the cost of the treatment. Most of the surgical site infections are preventable. Dressing is an active element of wound management, designed to control infection and promote healing. This study was done to compare clinical efficacy of normal gauze dressings versus chlorhexidine dressings in midline laparotomy wounds.Methods: Patients with midline laparotomy incision were randomized to receive either gauze or chlorhexidine dressings. Bacterial colonization, post- operative fever, frequency of infection, change of dressings, hospital stay and postoperative pain were assessed at the start of treatment and at weekly intervals until full healing occurred.Results: A total of 128 patients were enrolled in the study and divided into 2 groups viz chlorhexidine group (Group A) and Simple gauze group (Group B) with 64 patients each. Wound cultures, change of antibiotics, post-operative soakage, median hospital stay duration, postoperative pain, post- operative wound infection, and follow up visits for wound healing were compared between two groups A and B and statistical significance established.Conclusions: The analysis of wound culture, fever incidence and frequency of infection on Chlorhexidine dressings showed decreasing trends compared to traditional dressings

To assess the role of multisite instillation of bupivacaine-xylocaine combination for reducing post-operative pain after elective laparoscopic cholecystectomy

Background: Pain following laparoscopic surgery is multifactorial, arising from trocar sites (somatic pain), operative site (visceral pain) and shoulder pain (referred from diaphragmatic irritation because of pneumo-peritoneum). Currently no standard of care exists to reduce post-operative pain by use of local analgesia in laparoscopic cholecystectomy. Despite many studies, there are contradictory results. Aim of the study was to assess whether instillation of local anaesthetics at trocar sites and intraperitoneally, reduces the amount of pain experienced in the immediate postoperative period after laparoscopic cholecystectomy.Methods: This prospective study was carried out in the Department of General Surgery in a tertiary medical Centre in Mumbai. 75 subjects were randomized into 2 groups. Group A consisting of 38 patients were subjected to multisite instillation of LA combination (bupivacaine+xylocaine) at trocar site, gall bladder fossa, sub diaphragmatic space. Group B, (control group) consisting of 37 patients was given no such LA. Post operatively, pain was assessed by VAS scale (0-100) at 1,4,24 hours. Both the groups were compared and analysed.Results: Group A showed significantly reduced pain scores at 1, 4 and 24 hours post operatively as compared to group B.Conclusions: Our results indicate that multisite infiltration of local anesthetic combination (bupivacaine+xylocaine) after laparoscopic cholecystectomy surgery significantly reduces pain at 1, 4 and 24 hours postoperatively

DROWSINESS DETECTION AND MONITORING SYSTEM

Wakefulness of a driver is an extremely important factor that needs to be continuously monitored.. A drowsy driver can be a cause of several mishaps and accidents on highways which could lead to loss of money, physical injuries, and the most important, loss of human life. Drowsiness detection system is a car safety technology that helps to prevent and thus reduce accidents caused by the driver getting drowsy. The system is designed for four-wheeler vehicles (or more) wherein the driver’s fatigue or drowsiness is detected and alerts are generated. The proposed method will use a USB camera that captures the driver’s face and eyes and processes the images to detect the driver’s fatigue. On the detection of drowsiness, the programmed system cautions the driver through an alarm to ensure vigilance. The proposed method consists of various stages to determine the wakefulness of the driver

Dziesięć przykazań zabiegów hernioplastyki z uwolnieniem mięśnia poprzecznego brzucha – szczegóły techniczne i wnioski

Wprowadzenie: Separacja komponentów tylnych (PCS) metodą uwolnienia mięśnia poprzecznego brzucha (TAR) pozwala na przezwyciężenie wad tradycyjnych podejść naprawczych opisywanych w literaturze. Cel: W niniejszej pracy dokonujemy oceny bezpieczeństwa i skuteczności przedmiotowego podejścia, prezentując wnioski z własnego doświadczenia zdobytego w leczeniu dużej serii złożonych przepuklin brzusznych. Ponadto oceniamy rolę optymalizacji przedoperacyjnej i znaczenie dedykowanego zespołu rekonstrukcji powłok brzusznych (AWR) dla poprawy wyników leczenia operacyjnego. Materiał i metody: Dokonano retrospektywnej oceny wszystkich pacjentów poddawanych zabiegowi TAR w specjalistycznym ośrodku leczenia przepuklin w latach 2016–2019. Gromadzone dane obejmowały: dane demograficzne, szczegółowe informacje o przebiegu leczenia w okresie okołooperacyjnym oraz informacje o powikłaniach pooperacyjnych. Pierwszorzędowymi zmiennymi wynikowymi były zdarzenia w miejscu operowanym (SSO) i nawroty przepukliny. W celu określenia znaczących czynników prognostycznych wystąpienia SSO opracowano model regresji wielorakiej. Wyniki: W grupie 92 kolejnych pacjentów średnia wieku wyniosła 52 lata, zaś średni wskaźnik masy ciała – 27,9. Do głównych chorób współistniejących należały: cukrzyca (41%), nadciśnienie tętnicze (23%) i przewlekła obturacyjna choroba płuc (15%). Średni rozmiar defektu przepuklinowego wyniósł 13,2 cm, zaś średni czas pracy 232 minuty. Całkowite zamknięcie tylnej pochewki mięśnia prostego osiągnięto w 95,6% przypadków. Stwierdzono 18 (19,5%) przypadków SSO, w których zastosowano postępowanie zachowawcze; żadnym z przypadków nie była konieczna eksplantacja siatki. Doszło do 2 (2,1%) nawrotów przepukliny, wymagających operacji rewizyjnej. W przypadku analizy wieloczynnikowej istotnym predyktorem SSO był czas operacji (wartość p = 0,047). Wnioski: AWR z wykorzystaniem podejścia TAR pozwala na uzyskanie trwałej naprawy przepukliny przy niskim wskaźniku chorobowości ogólnej. Zastosowanie holistycznego podejścia ma na celu optymalizację przygotowania przedoperacyjnego oraz utworzenie dedykowanego zespołu AWR w celu dalszej poprawy wyników leczenia chirurgicznego

Decalogue of transversus abdominis release repair – technical details and lessons learnt

Background Posterior component separation (PCS) via transversus abdominis release (TAR) technique overcomes the pitfalls of traditionally described repairs. We evaluate the safety and efficacy of this approach and present the lessons we have learnt in our experience with a large series of complex ventral hernias. We also evaluate the importance of pre-operative optimisation and the value of a dedicated abdominal wall reconstruction (AWR) team in improving the surgical outcomes. Study Design A retrospective review of all patients undergoing TAR at a specialised hernia centre in the 2016-2019 period was performed. Pertinent data collected included patient demographics, peri-operative details and post-operative complications. Primary outcome variables were surgical site occurrences (SSO) and hernia recurrence. A multivariate regression model was developed to determine significant predictors of SSO. Results In 92 consecutive patients, the mean age was 52 years with a mean body mass index of 27.9%. Major comorbidities included diabetes (41%), hypertension (23%), and chronic obstructive pulmonary disease (15%). The mean hernia defect was 13.2 cm and the average operative time was 232 minutes. Complete posterior sheath closure was achieved in 95.6% cases. There were 18 (19.5%) cases of SSO which were managed conservatively and no cases required mesh explanation. There were 2 (2.1%) recurrences which required a redo surgery. On multivariate analysis operative time (p value 0.047) was a significant predictor of SSO. Conclusions AWR using the TAR approach offers a robust repair with low overall morbidity. A holistic pre-operative optimisation strategy and a dedicated AWR team can further improve surgical outcomes

Drug Repurposing of Approved Drugs Elbasvir, Ledipasvir, Paritaprevir, Velpatasvir, Antrafenine and Ergotamine for Combating COVID19

Pneumonia of unknown cause detected in Wuhan, China was first reported to the WHO Country Office in China on 31 December 2019. The outbreak was declared a Public Health Emergency of International Concern on 30 January 2020. Currently, there is no Vaccine against COVID-19 pandemic and infection is spreading worldwide vary rapidly there is an exigent requirement of practicable drug treatment. Drug repurposing is one of the most promising approaches for that. Many reports are available with in silico drug repurposing but the majority of them engrossed on a single target. The present study aimed at screening the approved against Covid19 protein and extract the combination of operational comprehensively. A total of 1735 drug molecules against all COVID19 protein structures and sequential screening recognize the better potential of anti-HCV drugs over anti-HIV drugs. The study designated Elbasvir, Ledipasvir, Paritaprevir, Velpatasvir, Antrafenine Ergotamin as promising drug candidates for covid19 treatment. The computational analysis also reveled the better potential of proposed drugs over the currently used drug combination for COVID19 drugs. </p

Endoscopic Retrograde Cholangiopancreatography Scope‑induced Duodenojejunal Flexure Perforation: The World’s First Case

Duodenojejunal (DJ) flexure perforation is very rare. DJ flexure perforation following endoscopic retrograde cholangiopancreatography (ERCP) has not be documented till date. They are associated with significant morbidity and mortality. We present an ERCP‑induced DJ flexure perforation which has been treated with primary closure in two layers at our institution. To the best of our knowledge, this is the world’s first case. Such site of ERCP‑induced perforation has not been reported in literature till date. A 75‑year‑old female patient underwent repeated ERCP for obstructive jaundice. There was perforation during the third ERCP while removing the larger stone. Emergency laparotomy was performed with primary closure of perforation in two layers. ERCP‑induced DJ flexure perforation has not yet been documented. It is potentially life‑threatening. Early recognition may lead to a better prognosis through earlier intervention

Comparative study of chlorhexidine dressings versus simple gauze dressings in midline laparotomy wound

Background: Wound infections are the most common complication of surgery that adds significantly to the morbidity of the patient and the cost of the treatment. Most of the surgical site infections are preventable. Dressing is an active element of wound management, designed to control infection and promote healing. This study was done to compare clinical efficacy of normal gauze dressings versus chlorhexidine dressings in midline laparotomy wounds.Methods: Patients with midline laparotomy incision were randomized to receive either gauze or chlorhexidine dressings. Bacterial colonization, post- operative fever, frequency of infection, change of dressings, hospital stay and postoperative pain were assessed at the start of treatment and at weekly intervals until full healing occurred.Results: A total of 128 patients were enrolled in the study and divided into 2 groups viz chlorhexidine group (Group A) and Simple gauze group (Group B) with 64 patients each. Wound cultures, change of antibiotics, post-operative soakage, median hospital stay duration, postoperative pain, post- operative wound infection, and follow up visits for wound healing were compared between two groups A and B and statistical significance established.Conclusions: The analysis of wound culture, fever incidence and frequency of infection on Chlorhexidine dressings showed decreasing trends compared to traditional dressings