DEXMEDETOMIDINE PREMEDICATION WITH KETAMINE AND PROPOFOL DURING BURNS DEBRIDEMENT AND DRESSINGS

Background: Burn patients undergo frequent extensive burn debridement and painful dressing changes. Ketamine and Propofol are the most common anesthetic used along with Opioids and Benzodiazepines in burns dressings. Studies have shown that concomitant use of Dexmedetomidine with Propofol and Ketamine. Objectives: To study the effects of Dexmedetomidine as premedication with Ketamine and Propofol as sole anesthetic agents during burns debridement and dressing. Materials and methods: Total 60 Patients of scheduled for elective burn debridement and dressings at P.R.H. Loni admitted in the wards were enrolled for the study. Patients satisfying the following eligibility criteria were selected and grouped those who received Ketamine and Propofol (Group B) with and without Dexmedetomidine (Group A) and both the groups were assessed to find out difference in the dose requirement, haemodynamic variables and recovery time (using Ramsay Sedation scale). Results: The haemodynamic parameters like heart rate, systolic and diastolic Blood pressure was significantly higher in Group A as compared to Group B. The recovery time in Group A was 12.9 mins as compared to 9.5 mins in Group B. It was observed that dose requirement of Ketamine (228.8±21.9) and Propofol (263.2 ± 22.5) was significantly more in Group A as compared to Group B (101.1±20.3 and 120.8±22.4 respectively).Conclusion: Dexmedetomidine (1μg/kg IM dose) is a good anaesthetic adjuvant that decreases the requirement of Propofol and Ketamine during burns debridement and dressings, maintains stable intraoperative haemodynamics and also has an excellent recovery profile. Key words: Dexmedetomidine; Haemodynamic Changes; Ketamine; Propofol; Recovery Time

Improving safety in care homes:protocol for evaluation of the Walsall and Wolverhampton care home improvement programme

Abstract Background Improving safety in care homes is becoming increasingly important. Care home residents typically have multiple physical and/or cognitive impairments, and adverse events like falls often lead to hospital attendance or admission. Developing a safety culture is associated with beneficial impacts on safety outcomes, but the complex needs of care home residents, coupled with staffing pressures in the sector, pose challenges for positive safety practices to become embedded at the individual and organisational levels. Staff training and education can positively enforce safety culture and reduce the incidence of harms, but improvement initiatives are often short lived and thorough evaluation is uncommon. This protocol outlines an evaluation of a large-scale care home improvement programme in the West Midlands. Methods The programme will run in 35 care homes across Walsall and Wolverhampton over 24\ua0months, and we anticipate that 30 care homes will participate in the evaluation ( n \u2009=\u20091500 staff). The programme will train staff and managers in service improvement techniques, with the aim of strengthening safety culture and reducing adverse safety event rates. The evaluation will use a pre-post design with mixed methods. Quantitative data will focus on: care home manager and staff surveys administered at several time points and analysis of adverse event rates. Data on hospital activity by residents at participating care homes will be compared to matched controls. Qualitative data on experience of training and the application of learning to practice will be collected via semi-structured interviews with staff ( n \u2009=\u200948 to 64) and programme facilitators ( n \u2009=\u20096), and staff focus groups ( n \u2009=\u200936 to 48 staff). The primary outcome measure is the change in mean score on the safety climate domain of the Safety Attitudes Questionnaire between baseline and programme end. Discussion This mixed methods evaluation of a large-scale care home improvement programme will allow a substantial amount of qualitative and quantitative data to be collected. This will enable an assessment of the extent to which care home staff training can effectively improve safety culture, lower the incidence of adverse safety events such as falls and pressure ulcers, and potentially reduce care home resident\u2019s use of acute services

DEXMEDETOMIDINE PREMEDICATION WITH KETAMINE AND PROPOFOL DURING BURNS DEBRIDEMENT AND DRESSINGS

Background: Burn patients undergo frequent extensive burn debridement and painful dressing changes. Ketamine and Propofol are the most common anesthetic used along with Opioids and Benzodiazepines in burns dressings. Studies have shown that concomitant use of Dexmedetomidine with Propofol and Ketamine. Objectives: To study the effects of Dexmedetomidine as premedication with Ketamine and Propofol as sole anesthetic agents during burns debridement and dressing. Materials and methods: Total 60 Patients of scheduled for elective burn debridement and dressings at P.R.H. Loni admitted in the wards were enrolled for the study. Patients satisfying the following eligibility criteria were selected and grouped those who received Ketamine and Propofol (Group B) with and without Dexmedetomidine (Group A) and both the groups were assessed to find out difference in the dose requirement, haemodynamic variables and recovery time (using Ramsay Sedation scale). Results: The haemodynamic parameters like heart rate, systolic and diastolic Blood pressure was significantly higher in Group A as compared to Group B. The recovery time in Group A was 12.9 mins as compared to 9.5 mins in Group B. It was observed that dose requirement of Ketamine (228.8±21.9) and Propofol (263.2 ± 22.5) was significantly more in Group A as compared to Group B (101.1±20.3 and 120.8±22.4 respectively).Conclusion: Dexmedetomidine (1μg/kg IM dose) is a good anaesthetic adjuvant that decreases the requirement of Propofol and Ketamine during burns debridement and dressings, maintains stable intraoperative haemodynamics and also has an excellent recovery profile. Key words: Dexmedetomidine; Haemodynamic Changes; Ketamine; Propofol; Recovery Time

Traditional uses of multi-cob bearing Murlimakai primitive maize landrace from Sikkim state, India

186-190Sikkim is one of the most beautiful tourist hill states and land of traditional landraces of many crops and with incredible agro-biodiversity treasure. Multi-cob baring murlimakai is used for various purposes such as mouthwatering delicious foods preparation such as popcorn, chapati, roti, chyakdung. Makkaiko chamal, makkaiko pitho, makkaiko laddu and makkaiko dalla. Attractive artifacts mats, baskets, fruits and vegetable container baskets, bags and hats are prepared from ears and local beverage jhand and rakshi is prepared from the grans. Immediate conservation of this unique multi-cob bearing landrace either ex situ or in situ is necessary for future needs

Biological and Spectral Studies of Newly Synthesized Triazole Schiff Bases and Their Si(IV), Sn(IV) Complexes

The Schiff bases HL1-3 have been prepared by the reaction of 5-bromothiophene-2-carboxaldehyde with 4-amino-5-mercapto-3-methyl/propyl/isopropyl-s-triazole, respectively. Organosilicon(IV) and organotin(IV) complexes of formulae (CH3)2MCl(L1-3), (CH3)2M(L1-3)2 were synthesized from the reaction of (CH3)2MCl2 and the Schiff bases in 1 : 1 and 1 : 2 molar ratio, where M = Si and Sn. The synthesized Schiff bases and their metal complexes have been characterized with the aid of various physicochemical techniques like elemental analyses, molar conductance, UV, IR, 1H, 13C, 29Si, and 119Sn NMR spectroscopy. Based on these studies, the trigonal bipyramidal and octahedral geometries have been proposed for these complexes. The ligands and their metal complexes have been screened in vitro against some bacteria and fungi

Metal-Based Biologically Active Compounds: Synthesis, Spectral, and Antimicrobial Studies of Cobalt, Nickel, Copper, and Zinc Complexes of Triazole-Derived Schiff Bases

A series of cobalt, nickel, copper, and zinc complexes of bidentate Schiff bases derived from the condensation reaction of 4-amino-5-mercapto-3-methyl/ethyl-1,2,4-triazole with 2,4-dichlorobenzaldehyde were synthesized and tested as antimicrobial agents. The synthesized Schiff bases and their metal complexes were characterized with the aid of elemental analyses, magnetic moment measurements, spectroscopic and thermogravimetric techniques. The presence of coordinated water in metal complexes was supported by infrared and thermal gravimetric studies. A square planar geometry was suggested for Cu(II) and octahedral geometry proposed for Co(II), Ni(II), and Zn(II) complexes. The Schiff bases and their metal complexes have been screened for antibacterial (Pseudomonas aeruginosa, Bacillus subtilis) and antifungal activities (Aspergillus niger, A. flavus). The metal complexes exhibited significantly enhanced antibacterial and antifungal activity as compared to their simple Schiff bases

A CLINICAL STUDY TO EVALUATE THE EFFECT OF SARVANGA UDVARTANA FOLLOWED BY VIRECHANA KARMA AS ROOKSHA POORVAKA SHODHANA IN AMAVATA W.S.R TO RHEUMATOID ARTHRITIS

The change in the classification of Rheumatoid Arthritis under various headings over the past few decades gives an insight to the pathology that requires a deeper understanding.  Considering the role of immune mediating cells, progressive involvement of multiple joints & other systems, reduction in functional capacity, no other group of diseases is responsible for greater loss of earnings. The incidence of Rheumatoid Arthritis increases between 25 and 55years of age, after which it plateaus until the age of 75 and then decreases.Ayurveda understands this disease on the lines of Ama formation, Agni mandhya in rasa vaha srotas primarily, which over time dysfunctions all the 3 Agni (Jatharagni, Dhatwagni, Bhootagni) resulting in Sthabdham kurute gatram. The mainstay of treatment in Rheumatoid Arthritis comprises the early use of Disease Modifying Anti Rheumatic Drugs & Corticosteroids for induction of remission. As Amavata is an Abhishyandha pradhana vyadhi, adopting any snigdha modality of treatment will cause complications, hence identifying the degree of Sama - Nirama avastha in Amavata, Rookshana is to be done prior to any Snigdha chikitsa. Hence, the aim of this study was to evaluate the effect of Rookshana before Virechana Karma in the management of Amavata / Rheumatoid Arthritis. In this present clinical trial conducted in Varsha rtu, 10 diagnosed patients of Amavata / Rheumatoid Arthritis were selected. Statistical analysis showed highly significant improvement p <0.001 in almost all subjective & objective parameters of Amavata

Traditional artifacts from dried leaves of Cymbidium species (orchidaceae) in Indian state of Sikkim

390-394Sikkim is one of the most beautiful tourist hill states with tremendous biodiversity wealth. Cymbidium orchid dominates the states for hobby gardeners and commercial cultivating farmers. Handicraft is a part of hobbies and livelihood of the indigenous communities of the region. The Lepcha tribe craftsmen based on dried leaves of Cymbidium orchid is becoming promising apart from their handloom, cane and bamboo products. Attractive, simple products of dried Cymbidium leaves such as fruit and vegetable baskets, containers, sitting mats, hanging pots, trash bins, and plant growing pots is gaining popularity. Due to no noticeable researches and development in this sector, the traditional artifact craftsmen are unable to establish as a source of livelihood. With strategic approaches and intervention, these unique traditional craftsmen would be a reliable economic venture for the rural youth

DIGITAL FINANCE MARKETING BUSINESS STRATEGY AND MANAGEMENT

The job of this research is to identify the process of digital finance marketing strategies and management systems. The objective in this study has been made on the basis of the goal and the questions have been prepared accordingly. Literature review: The aforementioned advantages of digital marketing for financial services firms enable them to focus on individuals who have a higher probability of becoming clients. When compared to other marketing channels like print and television, the return on investment is extremely high in the case of digital marketing. Handling money matters is a tough job and attracting people in this process is also quite tough, however, the rise of digital marketing systems has helped increase awareness among people to help them connect with the best finance service providers. Methodology: This study has collected secondary data and for that journals, articles and research papers have been a great help. It can be seen that the collection of secondary data is able to help in highlighting historical information Findings and analysis: This section included a thematic analysis of the collected data. Themes have been created to appropriately justify all of the material. This has aided in providing a solution to the research issue. Discussion Digital marketing in the finance field has helped banking, insurance and other financial services providing companies in raising concern for proper and better investments to get financial independence after a certain age. Insurance coverage has become attractive to people and the aggressive marketing strategy has increased the sales of many companies effectively. Market research and analysis are highly important in the case of digital financing where it is a must to rectify the target audience. Conclusion This section contains a description of the way this study has been carried out and completed the research. A thorough overview of the subject in this study can assist everyone in understanding the way digital financial marketing needs to be handle