Hip fractures: mortality and correlation with preoperative comorbidities in Indian elderly population

Background: Hip fractures are an emerging health care problem due to increase in the elderly population all over the world and the associated complications, morbidity and mortality. The objective of this study is to find out the mortality rates in Indian elderly population with hip fractures and to establish an association between various related complications pre and post operatively for a better risk stratification.Methods: A prospective observational cohort study, was carried out at a high-volume orthopaedic centre from 2009 to 2018. And all patients managed for hip fractures were followed up till death or 05 years.Results: The age adjusted first-year mortality was found to be 33% with statistically significant increase in the mortality in individuals with three or more pre-op comorbidities. The significantly associated co-morbidities were chronic renal failure (Hazard ratio 2.32 with CI 1.65- 3.24) and diabetes mellitus (Hazard ratio 1.66 with CI 1.25 – 2.21). There has been a significant dip in the cumulative survival rates of these individuals irrespective of age, sex, preop anaemia.Conclusions: A knowledge about the comorbidities/ risk factors and the extent to which they influence the long-term survival in the geriatric hip fracture patients can help treating physician to effectively prioritise and plan management in coordination with allied specialities.

A simplified predictive framework for cost evaluation to fault assessment using machine learning

Software engineering is an integral part of any software development scheme which frequently encounters bugs, errors, and faults. Predictive evaluation of software fault contributes towards mitigating this challenge to a large extent; however, there is no benchmarked framework being reported in this case yet. Therefore, this paper introduces a computational framework of the cost evaluation method to facilitate a better form of predictive assessment of software faults. Based on lines of code, the proposed scheme deploys adopts a machine-learning approach to address the perform predictive analysis of faults. The proposed scheme presents an analytical framework of the correlation-based cost model integrated with multiple standards machine learning (ML) models, e.g., linear regression, support vector regression, and artificial neural networks (ANN). These learning models are executed and trained to predict software faults with higher accuracy. The study considers assessing the outcomes based on error-based performance metrics in detail to determine how well each learning model performs and how accurate it is at learning. It also looked at the factors contributing to the training loss of neural networks. The validation result demonstrates that, compared to logistic regression and support vector regression, neural network achieves a significantly lower error score for software fault prediction

STREPTOCOCCUS PNEUMONIAE-INDUCED HOST RESPONSES & DISEASE

Ph.DDOCTOR OF PHILOSOPH

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

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

Does Education Leads to Contraceptive Use? A Study of Sexually Experienced Unmarried Men in India

The consequences of pre-marital sex have been the subject of common concern for the public health professionals and policy makers. In India, despite strict societal sanctions, the prevalence of pre-marital sex has been repeatedly documented across literatures. It is believed that existing education system could afford the responsibility to develop protective sexual behavior among unmarried youths. Using National Family Health Survey (2005-06) data, this study examines the effect of education on contraceptive and condom use among sexually experienced unmarried men. Results indicate that education has a positive effect on contraceptive as well as condom use. However the interaction effect of education and awareness on contraceptive and condom use provides the key explanations for safe sexual practices. The findings could help policy makers to focus on both education and awareness which might lead to improvement in safe sexual practices in India where introducing sex education is still a controversial issue. Keywords: Education, awareness, unmarried men, contraceptive and condom use, Indi

EFFECTS OF INTRATHECAL MIDAZOLAM IN SPINAL ANAESTHESIA: A PROSPECTIVE DOUBLE BLINDED CASE CONTROL STUDY

Background: Increasing the duration of action and maximizing postoperative analgesia has always been a domain of interest in spinal blocks. Many adjuvants have been tried along with local anaesthetic agent to achieve the same. The following study was conducted to compare sensory and motor characteristics with 2mg midazolam in subarachnoid block. Aim: To evaluate the efficacy and analgesic effect of the mixture of 2 mg midazolam and 15 mg (3 ml) hyperbaric bupivacaine as compared to bupivacaine alone in patients undergoing infra-umbilical surgery under spinal block. Material and Methods: In this observational prospective case control study 100 patients (ASA class I and II), aged 18 to 55 years, undergoing elective infra-umbilical surgeries under spinal block were randomly divided into Group I- patients were administered 0.5% hyperbaric Bupivacaine (3 ml) + 0.9% Normal saline (0.4 ml) intrathecally and Group 2- patients were administered 0.5% hyperbaric Bupivacaine (3 ml) + 2mg preservative free Midazolam (0.4 ml) intrathecally. The onset and duration of sensory and motor block, hemodynamic variables, and side effects during the surgery and recovery were compared among the groups. Results: 2mg of preservative free midazolam used as an adjuvant to bupivacaine intrathecally reduces onset time of sensory and motor blockade, also time taken to reach T-10. It also increases time taken for two segmental recession and mean duration of analgesia. Conclusion: It can be inferred that Inj. Midazolam 2 mg in combination with Inj. bupivacaine  0.5% hyperbaric can be safely administered  intrathecally for better postoperative analgesia. KEYWORDS: Intrathecal Midazolam; Post-operative Analgesia; Bupivacaine; Spinal Anesthesia