3,310 research outputs found
CHARACTERIZATION OF CARBAPENEM RESISTANT ACINETOBACTER BAUMANNII ISOLATED IN A TERTIARY CARE HOSPITAL: EPIDEMIOLOGY AND TREATMENT OUTCOME
Objective: Carbapenem resistant Acinetobacter baumannii (CR-Ab) has emerged as a major nosocomial pathogen, but optimal treatment regimens are unknown. Our objectives were to determine the epidemiology and outcome of CR-Ab infections at a tertiary care hospital.Methods: CR-Ab isolates were collected from January to April 2013. MICs were determined and isolates were subjected to screening for carbapenemase production by Modified Hodge test (MHT), metallo-β-lactamase (MBLs) by EDTA disk synergy test and AmpC β-lactamase by AmpC disk test. 15 isolates were subjected to PCR for detection of resistant genes, blaOXA-23, blaVIM and blaNDM. Treatment outcomes of infections were evaluated.Results: 51 CR-Ab isolates from tracheal aspirate (21), blood (15); tissue/wound/drainage (13) and urine samples (2) were collected. Colistin appeared to be the most effective agent with 98% in vitro activity. MHT showed 98% positivity, MBLs production was detected in 94.1% isolates and 64.7% were positive for AmpC β-lactamase production. All 15 isolates carried blaOXA-23 and blaVIM, of these 3 also carried blaNDM gene. Colistin containing combinations were more commonly used (68.3%). Colistin-noncarbapenem combination showed improved clinical response compared to colistin-carbapenem combination against Acinetobacter isolates carrying blaOXA-23 and blaVIM.Conclusion: A stringent infection control practice along with antimicrobial stewardship is needed to prevent emergence of Acinetobacter carrying multiple carbapenemase genes along with blaNDM. Various colistin combinations are preferentially used to treat CR-Ab infections. Identification of antimicrobial combinations with proven in vitro activity that encompass local susceptibility patterns as well as molecular mechanisms of resistance is needed to provide better outcome.Keywords: Acinetobacter baumannii, Carbapenem resistance, Carbapenemases, Colistin combination, metallo-β-lactamase, NDMÂ
Study of Behaviour of Square and Rectangular Footings Resting on Cohesive Soils Based on Model Tests
The estimation of a reliable value of bearing Capacity of soil is the most important step in the foundation design work. Number of theoretical approaches and in-situ tests for the estimation of bearing capacity of footing are available. The reliability of any theory can be demonstrated by comparing the experimental test results on field footings with theoretical predictions. One of the reliable methods is the load test on full sized footing. However, this test as covered under IS 1888-1982 is too expensive and time consuming. Model tests can be conducted on footings of various sizes. The surface characteristics for different loading conditions can provide information on qualitative and quantitative contribution of such parameters on bearing of footings in absence of field test results. It is revealed that research work (Sawant et al (2000), Rajgopal et al (2000), Sawaf et al (2005), Mohmoud et al (1989), Harikrishna et al(2000), Sahu et al (1970) etc.)has been carried out for load tests on model footings resting on sand as foundation medium. However no work has been reported so far on c – Φ soil. In this present study a laboratory model with loading frame has been developed in Geotechnical Engineering Laboratory of College of Engineering, Pune to conduct small scale load tests, to determine Bearing capacity characteristics of footings resting on c-Φ soil. Load tests were conducted on two square, two circular and five rectangular footings resting on c – Φ soil in the laboratory model. The bearing capacity, time – settlement relationship, pressure settlement relationship of footing resting on c – Φ soil and effect of various parameters such as L/B ratio, shape and size of footing on bearing capacity of footing were studied. Comparison is made between bearing capacity of footings estimated by the conventional methods such as Vesic’s, Tezaghi’s method and that estimated by Model Test Results. The model tests provide qualitative information on parameters influencing bearing capacity of footings. These tests can be used to check the bearing capacity estimated by analytical method
Non-descent vaginal hysterectomy in previous cesarean section: a retrospective study of 30 cases
Background: Non-Descent Vaginal Hysterectomy (NDVH) is removal of uterus through vagina in non-prolapsed uterus. Objective of present study was to assess safety, feasibility of NDVH in patients with previous cesarean section.Methods: Retrospective study was conducted in department of Obstetrics and Gynecology of Shree Dharmasthala Manjunatheshwara (SDM) College of Medical Sciences, Dharwad, India from April 2008 to June 2016. Effort was made to perform hysterectomies vaginally in women with benign conditions with history of one, two or three caesarean sections. Information regarding age, parity, number of previous LSCS, uterine size, blood loss, duration of operation, difficulties in separating bladder, intra -operative, post-operative complications were recorded.Results: Total thirty cases were selected for NDVH with history of one, two and three cesarean sections. All successfully underwent NDVH, except one in which bladder injury occurred which was repaired at same time vaginally. Thirteen patients had previous one Lower Segment Cesarean Section (LSCS), sixteen had two LSCS and one had three LSCS. Commonest indication was abnormal uterine bleeding followed by leiomyoma of uterus. Mean duration of surgery was 97 min. Mean blood loss was 150 ml. Post-operative complications were minimal. Patient mobility, resumption of daily activities was fast. Mean hospital stay was 4-5 days.Conclusions: Vaginal hysterectomy is safe, cost effective method of hysterectomy in women with previous cesarean section scar requiring hysterectomy for benign conditions with fewer complications, shorter hospital stay and less morbidity
Modified purandare’s cervicopexy-a conservative surgery for genital prolapse: a retrospective study
Background: Purandare described a technique for the surgical treatment of genital prolapse in young women in 1965. This technique of cervicopexy is easy to perform and provides dynamic support to the uterus. The objective of study is to evaluate the role of modified Purandare’s cervicopexy in the treatment of genital prolapse in reproductive age group and to study the pregnancy outcome and fertility in patients who have undergone modified Purandare’s sling surgery.Methods: Between January 2007 and December 2015, 20 women in the reproductive age (mean age 30.5 years, range 24 to 37 years) underwent modified Purandare’s cervicopexy at Shree Dharmasthala Manjunatheshwara (SDM) College of Medical Sciences, Dharwad, India. Of these, 2 (10%) patients were nulligravida, 7 (35%) were primipara and 11 (55%) were multigravida. Four (20%) women had associated infertility. Additional surgeries like tubectomy were performed in 4 (20%) women, tubal patency test in 3 (15%), ovarian drilling in 2 (10%) and myomectomy in 2 (22.2%) women, and cystocele repair was done in 4 women (20%).Results: All 20 patients were analysed for intraoperative and postoperative complications. All were followed up for mean duration of 12 months. There were no reported intra or post-operative complications. Out of 4 infertile women, 2 conceived spontaneously 6 months after the surgery. Of these, one delivered successfully at term by lower segment caesarean section and other by normal vaginal delivery. One woman conceived 8 months after the surgery spontaneously, antenatally followed for 3 months and then later was lost to follow-up. There was no recurrence of prolapse.Conclusions: Nulliparous prolapse can be treated by various surgical procedures, each having their own merits and de-merits. Our modification of Purandare’s cervicopexy is simple, effective and is less technically demanding
Online Library Package to Boost the Functionality and Usability of the Existing Libraries
The current computational era has given rise to the idea of the digital library. The essential purpose of digital libraries is to enable readers to more easily explore books for reading. The library is a fast-growing process. The prehistoric system of maintaining it is no longer efficient. Library staff handles tedious tasks which involve sorting, lending, returning, classification of books etc. In addition, library users encounter problems for searching, borrowing, renewing the book, queuing, and so on. To overcome these barriers, this paper proposes a smart E-library Application based on Android technology. It mainly focuses on the central operations in a Library like analyzing total books, calculating available books, updating information, searching books and a facility to request and return books. This Software package is an Android Application developed for android O.S based phones, intended to help users to maintain and organize Library Services. This software package is user-friendly. It will allow quick transactions and will make easy to handle the issue and return of books from the Library without much involvement of manual bookkeeping. This software has been developed to maintain all the daily work of the library. It has many features which are generally not available in normal library systems like facility of reader login and a facility of admin login. The admin can monitor the whole system
Surgical management of chronic fourth degree perineal tear: a single center experience
Background: The aim of this article is to present the ridge about the recognition, preoperative management, surgical technique and long term follow up of patients with chronic fourth degree perineal tear.Methods: Authors conducted a prospective study in the department of obstetrics and gynecology in SDM hospital of medical sciences from 2008 January to 2016 December. Data on age, parity, incontinence to flatus, solid or liquids stools, duration of symptoms, history of previous repair, duration of repair, post-operative stay, complications and recovery were collected and analyzed. A total of thirty cases of chronic perineal tear were studied.Results: A total of 30 patients underwent CPT repair. Average duration of surgery was 90 minutes. 27 out of 30 patients were discharged on post-operative day 10. Three patients were non-compliant to treatment. Of the total 30 patients, two patients were lost for follow up. Overall success rate was 93% including patients who underwent re-surgery for failed repair.Conclusions: The significant finding of the present study was that a secondary repair of an anal sphincter injury was not associated with an unfavorable subjective outcome in relation to symptoms of anal incontinence. A good insight of perineal and anal sphincter anatomy and adherence to the sound principles is essential. The success rate in this study is 93.3% highlighting that a diligently performed operation by a surgeon of adequate expertise likely results in satisfactory outcome
Effect of V-shaped Ribs on Internal Cooling of Gas Turbine Blades
Thermal efficiency and power output of gas turbines increase with increasing turbine rotor inlet temperature. The rotor inlet temperatures in most gas turbines are far higher than the melting point of the blade material. Hence the turbine blades need to be cooled. In this work, simulations were carried out with the leading edge of gas turbine blade being internally cooled by coolant passages with V-shaped ribs at angles of 30°, 45° or 60° and at three aspect ratios (1:1, 1:2 and 2:3). The trailing edge of the blade was cooled by cylindrical and triangular pin-fin perforations in staggered and inline arrangements. Numerical analyses were carried out for each configuration of the cooling passages. The best cooling passages for leading edge and trailing edge were deduced by comparing the results of these analyses. It was found that using V-shaped ribs and fins induces a swirling flow, which in turn increases the velocity gradient and hence produces an improvement in heat transfer. The results show that under real time flow conditions, the application of V-shaped ribs and pin-fin perforations is a very promising technique for improving blade life
Diabat method for polymorph free energies: Extension to molecular crystals
Lattice-switch Monte Carlo and the related diabat methods have emerged as efficient and accurate ways to compute free energy differences
between polymorphs. In this work, we introduce a one-to-one mapping from the reference positions and displacements in one molecular
crystal to the positions and displacements in another. Two features of the mapping facilitate lattice-switch Monte Carlo and related diabat
methods for computing polymorph free energy differences. First, the mapping is unitary so that its Jacobian does not complicate the free
energy calculations. Second, the mapping is easily implemented for molecular crystals of arbitrary complexity. We demonstrate the mapping
by computing free energy differences between polymorphs of benzene and carbamazepine. Free energy calculations for thermodynamic cycles,
each involving three independently computed polymorph free energy differences, all return to the starting free energy with a high degree of
precision. The calculations thus provide a force field independent validation of the method and allow us to estimate the precision of the
individual free energy differences
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