Effects of bupivacaine infiltration on postoperative tramadol consumption in elective day care unilateral inguinal hernia repair

Objective: To determine the difference in analgesic requirement in terms of mean postoperative narcotic consumption and mean postoperative pain score in patients undergoing unilateral inguinal hernia repair with or without bupivacaine infiltration as day-care patients.Methods: The randomised controlled trial was conducted at Aga Khan University Hospital, Karachi, from June to December 2011, and comprised patients who were randomly divided into groups A and B. Tramadol 1.5 mgkg-1 was used as intraoperative analgesia. At the time of closure of surgical incision, 20ml of bupivacaine 0.25% plain was infiltrated in the subcutaneous tissue sub-facially and in the deeper layers along the incision line in patients of group A. In group B, which was the control group, the surgical wound was closed without infiltrating bupivacaine. On arrival in post-anaesthesia care unit, the patient\u27s pain scores was assessed using Visual Analogue Scale every 15 minutes for the first hour, every 30 minutes for next one hour, and hourly for the next two hours by a blinded observer. Postoperative narcotic consumption was also noted.Results: There were 80 patients in the study; 40(50%) in each of the two groups. Mean postoperative narcotic consumption and mean pain scores were high in group B in all follow-ups (up to 4 hours) compared to group A patients (p \u3c 0.05).CONCLUSIONS: Wound infiltration with 0.25% bupivacaine diminished post-operative pain and decreased narcotic analgesic consumption for the first four hours after unilateral inguinal hernia repair

Sedation-analgesia in non operative locations: practice trends of anaesthetists

Sedation/analgesia is a mode of anaesthesia which facilitates an uncomfortable or painful procedure, such as gastrointestinal endoscopy, in a rousable and cooperative patient. The objective of the study was to assess the practice trends for administering sedation analgesia in non operative locations in Aga Khan Hospital, Karachi by anaesthetists. It was a descriptive study which retrospective reviewed anaesthesia records. A total of 41 ASA I-IV cases were reviewed. Non invasive cardiorespiratory monitoring and clinical sedation monitoring were applied. Intravenous Propofol infusion and midazolam boluses were used, singly or in combination with fentanyl boluses. All our patients recovered uneventfully within 5 minutes of the end of procedure. The practice trends for drug regimens are similar to those reported in recent literature. However we need to provide BIS monitoring, target controlled and patient maintained sedation to enhance patient and operator comfort

Urinary tract infection presenting as jaundice in neonates

Neonatal Hyperbilirubinaemia is a common finding during the first postnatal week. Physiological jaundice occurs in first week of life in 60% of term and 80% of premature neonates. Non physiologic or pathologic jaundice occurs in 5-10% of newborns which require intervention. According to AAP guidelines laboratory investigation for jaundice include total serum bilirubin, blood Type and coombs test and if the baby has an elevation of direct reacting or conjugated bilirubin, there should be a urine analysis and urine culture. Here we are presenting 5 cases that developed indirect hyperbilirubinaemia and routine workup done according to AAP guidelines were normal. On extensive investigation all cases found to have urinary tract infection despite of having indirect bilirubin and they needed course of antibiotics according to sensitivities and follow up ultrasound. From our experience we suggest that UTI should be considered as a cause of neonatal jaundice especially when indirect bilirubin peaks after one week of life at mean age of 10.8 +/- 2.38 days

Optimizing multi-objective task scheduling in fog computing with GA-PSO algorithm for big data application

As the volume and velocity of Big Data continue to grow, traditional cloud computing approaches struggle to meet the demands of real-time processing and low latency. Fog computing, with its distributed network of edge devices, emerges as a compelling solution. However, efficient task scheduling in fog computing remains a challenge due to its inherently multi-objective nature, balancing factors like execution time, response time, and resource utilization. This paper proposes a hybrid Genetic Algorithm (GA)-Particle Swarm Optimization (PSO) algorithm to optimize multi-objective task scheduling in fog computing environments. The hybrid approach combines the strengths of GA and PSO, achieving effective exploration and exploitation of the search space, leading to improved performance compared to traditional single-algorithm approaches. The proposed hybrid algorithm results improved the execution time by 85.68% when compared with GA algorithm, by 84% when compared with Hybrid PWOA and by 51.03% when compared with PSO algorithm as well as it improved the response time by 67.28% when compared with GA algorithm, by 54.24% when compared with Hybrid PWOA and by 75.40% when compared with PSO algorithm as well as it improved the completion time by 68.69% when compared with GA algorithm, by 98.91% when compared with Hybrid PWOA and by 75.90% when compared with PSO algorithm when various tasks inputs are given. The proposed hybrid algorithm results also improved the execution time by 84.87% when compared with GA algorithm, by 88.64% when compared with Hybrid PWOA and by 85.07% when compared with PSO algorithm it improved the response time by 65.92% when compared with GA algorithm, by 80.51% when compared with Hybrid PWOA and by 85.26% when compared with PSO algorithm as well as it improved the completion time by 67.60% when compared with GA algorithm, by 81.34% when compared with Hybrid PWOA and by 85.23% when compared with PSO algorithm when various fog nodes are given

Design, synthesis, characterization and computational docking studies of novel sulfonamide derivatives

This study reports three novel sulfonamide derivatives 4-Chloro-N-[(4-methylphenyl) sulphonyl]-N-propyl ben- zamide (1A), N-(2-hydroxyphenyl)-4-methyl benzene sulfonamide (1B) and 4-methyl-N-(2-nitrophenyl) ben- zene sulfonamide (1C). The compounds were synthesised from starting material 4-methylbenzenesulfonyl chlo- ride and their structure was studied through 1H-NMR and 13C-NMR spectra. Computational docking was per- formed to estimate their binding energy against bacterial p-amino benzoic acid (PABA) receptor, the dihydrop- teroate synthase (DHPS). The derivatives were tested in vitro for their antimicrobial activity against Gram+ and Gram- bacteria including E. coli, B. subtilis, B. licheniformis and B. linen. 1A was found active only against B. linen; 1B was effective against E. coli, B. subtilis and B. linen whereas 1C showed activity against E. coli, B. li- cheniformis and B. linen. 1C showed maximum activity with minimum inhibitory concentration (MIC) of 50, 100 and 150 µg/mL against E. coli, B. licheniformis and B. linen respectively. 1C exhibited maximum affinity to DHPS with binding free energy of -8.1 kcal/mol. It enriched in the top 0.5 % of a library of 7663 compounds, ranked in order of their binding affinity against DHPS. 1C was followed by 1B which showed a moderate to low level MIC of 100, 250 and 150 µg/mL against E. coli, B. subtilis and B. linen respectively, whereas 1A showed a moderate level MIC of 100 µg/mL but only agai st B. linen. These derivatives may thus serve as potential anti-bacterial alternatives against resistant pathogens

Bioinoculants in Technological Alleviation of Climatic Stress in Plants

Global climate change is leading to a series of frequent onset of environmental stresses such as prolonged drought periods, dynamic precipitation patterns, heat stress, and cold stress on plants and commercial crops. The increasing severity of such stresses is not only making agriculture and related economic sector vulnerable but also negatively influences plant diversity patterns. The global temperature of planet Earth has risen to 1.1°C since the last 19th century. An increase in surface temperature leads to an increase in soil temperature which ultimately reduces water content in the soil, thereby, reducing crop growth and yield. Moreover, this situation is becoming more intense for agricultural practices in arid and semi-arid regions. To overcome climatically induced stresses, acclimatization of plant species via bioinoculation with Plant Growth Promoting Rhizobacteria (PGPR) is becoming an effective approach. The PGPR are capable of colonizing rhizosphere (exophytes) as well as plant organs (endophytes), where they trigger an accumulation of osmolytes for osmoregulation or improving gene expression of heat or cold stress proteins, or by signaling the synthesis of phytohormones, metabolites, proteins, and antioxidants to scavenge reactive oxygen species. Thus, PGPR exhibiting multiple plant growth-promoting traits can be employed via bioinoculants to improve the plant’s tolerance against unfavorable stress conditions

Seroprevalence of hepatitis C in type 2 diabetes: evidence for a positive association

<p>Abstract</p> <p>Background</p> <p>There is a growing body of literature on the relationship of Hepatitis C virus infection (HCV) and type 2 diabetes mellitus (T2DM). However, there are certain gaps in literature and the data is inconclusive. This study was, therefore, carried out to determine the prevalence of HCV infection in diabetic patients and to elucidate the presence of any possible relationship between HCV and T2DM in this region.</p> <p>Methods</p> <p>Serologic testing for anti-HCV antibody was done on a sample of 3000 individuals with T2DM visiting Diabetes Clinic of Nishtar Medical College Hospital, Multan and 10,000 volunteer blood donors visiting blood bank of the same hospital during the study period using Accurate rapid immunochromatographic kits which was later confirmed by using Chemelex S.A third generation ELISA kit for positive cases. Data about various variables was collected from diabetic patients using a structured questionnaire after taking informed consent.</p> <p>Results</p> <p>Prevalence rate of 13.7% for HCV infection was recorded among subjects having T2DM with seropositivity rate of 4.9% among the control group of volunteer blood donors without diabetes. The patients with T2DM were more likely to have HCV infection as compared to the control group (OR = 3.03, 95%CI = 2.64-3.48, p = 0.001). Diabetic patients with age above 55 years had higher prevalence rate as compared to younger individuals. Male patients had significantly high seropositivity as compared to female patients (15.3% vs. 12.4%, p = 0.02). Those with duration of diabetes 11 years and above and the ones with good glycemic control had higher seroprevalence rates of 18.2% and 18.7% respectively. There was no statistically significant difference among subjects when the distribution of HCV was studied on the basis of marital status, locality, or family history of diabetes.</p> <p>Conclusions</p> <p>The results show that there is a strong association between HCV and T2DM in the region as evident from significantly higher prevalence of HCV infection in diabetics as compared to the control group in the present study.</p

Outcomes following small bowel obstruction due to malignancy in the national audit of small bowel obstruction

Introduction Patients with cancer who develop small bowel obstruction are at high risk of malnutrition and morbidity following compromise of gastrointestinal tract continuity. This study aimed to characterise current management and outcomes following malignant small bowel obstruction. Methods A prospective, multicentre cohort study of patients with small bowel obstruction who presented to UK hospitals between 16th January and 13th March 2017. Patients who presented with small bowel obstruction due to primary tumours of the intestine (excluding left-sided colonic tumours) or disseminated intra-abdominal malignancy were included. Outcomes included 30-day mortality and in-hospital complications. Cox-proportional hazards models were used to generate adjusted effects estimates, which are presented as hazard ratios (HR) alongside the corresponding 95% confidence interval (95% CI). The threshold for statistical significance was set at the level of P ≤ 0.05 a-priori. Results 205 patients with malignant small bowel obstruction presented to emergency surgery services during the study period. Of these patients, 50 had obstruction due to right sided colon cancer, 143 due to disseminated intraabdominal malignancy, 10 had primary tumours of the small bowel and 2 patients had gastrointestinal stromal tumours. In total 100 out of 205 patients underwent a surgical intervention for obstruction. 30-day in-hospital mortality rate was 11.3% for those with primary tumours and 19.6% for those with disseminated malignancy. Severe risk of malnutrition was an independent predictor for poor mortality in this cohort (adjusted HR 16.18, 95% CI 1.86 to 140.84, p = 0.012). Patients with right-sided colon cancer had high rates of morbidity. Conclusions Mortality rates were high in patients with disseminated malignancy and in those with right sided colon cancer. Further research should identify optimal management strategy to reduce morbidity for these patient groups