Study on Perioperative Glycemic Control and Postoperative Infections

OBJECTIVE: To study the effects of perioperative glycemic control and their impact on postoperative infections in various general surgical procedures in patients with diabetes mellitus. BACKGROUND: Patients with diabetes are more likely to undergo various surgical procedures than non-diabetics. Perioperative glycaemic control in diabetics is challenging and leads to lesser postoperative infectious complications. This study helps to establish the significance of strict glycaemic control in these patients. METHODS: A prospective study of 50 diabetic patients undergoing various surgical procedures was done for the association of perioperative glycaemic control and the incidence of postoperative infections for a 30-day period during the period, from 1.1.2014 to 30.06.2014 in Thanjavur Medical College. The stastical significance and the overall incidence of postoperative infections were analysed with the amount of glycaemic control achieved. RESULTS: Of the 50 patients, 28 were males and 22 females. The mean age of the study is 54 years. 35 patients of elective surgery and 15 patients of emergency surgery were included. Mean plasma glucose concentration in the perioperative period calculated and patients were divided into four quartiles (I-120-180 mg/dl; II-181 to 220 mg/dl; III-221 to 260 mg/dl; IV-261 to 350 mg/dl) accordingly. The incidence of SSIs in each quartile (I-IV) was 16.7%, 54.5%, 66.7% & 100% respectively. 13.3%, 18.2% 33.3% & 66.7% incidence of pneumonia and 6.7%, 9.1%, 16.7% & 33.3% incidence of UTI occurred in quartile I to quartile IV respectively. Similarly the rate of occurrence of sepsis is 18.2% in II, 33.3% in III and 66.7% in IV quartile with no sepsis in I quartile patients. The overall incidence of postoperative infectious complications in each quartile from I to IV is 36.7%, 72.7%, 83.3% and 100% respectively. SSI accounted for the most common and sepsis for the least common complication in these patients. Insulin therapy proved to be a better way to achieve glycaemic control in these patients. The optimal glycaemic range desired is between 120 to 180 mg/dl. CONCLUSION: Good perioperative glycaemic control is associated with a decrease in postoperative infectious complications in diabetic patients undergoing various surgical procedures

Profile of abnormal results of conventional coagulation tests in Trauma Patients.

Trauma is a serious global health problem accounting for approximately 1 in 10 deaths worldwide1. Approximately 50% of trauma related deaths occur immediately and these deaths can only be avoided by injury prevention. 30% of the trauma patients die during the initial hours post injury and preventing these deaths is the goal of modern trauma care. The commonest cause for this death is uncontrolled non-surgical hemorrhage. This is potentially preventable. Hence identification of the cause of bleeding and effective control of bleeding is expected to decrease mortality. All of this has to be achieved in the ‘Golden Hour’ i.e. within 1 hour of a severe injury. Life threatening bleeding in trauma patients due to vascular injury often requires surgical intervention. Sometimes arterial embolization may be required in patients with multiple trauma. A review of recent literature shows an acute ‘Coagulopathy of Trauma’ (COT) as a distinct entity and is said to be present in 1 of 4 severely injured trauma patients in the western world when tested within 1 hour of admission. This caused diffuse bleeding [exsanguination] and is more difficult to manage and requires transfusion by fresh frozen plasma, platelets and coagulation factor concentrates instead of the conventional intravenous fluids, plasma expanders and packed cells alone. The diagnosis of this acute coagulopathy can be made by performing basic tests for coagulation such as Prothrombin time (PT), partial thromboplastin time (APTT) and Ddimer. The objective of the study was to observe the occurrence of ‘Coagulopathy of Trauma’ in severely injured trauma patients, by examining the results of the basic screening tests for coagulation, such as Prothrombin Time [PT], Activated Partial Thromboplastin Time [APTT], D-dimer and Platelet count. The study population was 62 patients with severe injuries [i.e. Revised Trauma Score between 4/12 & 11/12], admitted directly to the Emergency Medicine Department of PSGIMSR Hospital. We found that most of these patients were aged between 21 & 40 years and that most of them were males. 23% of the patients had abnormal results of PT, while 4.8% had abnormal results of APPT. However, 76% had abnormal results of Ddimers, thus highlighting that a fibrinolytic activity existed in most patients with severe injuries. 11.3% had thrombocytopenia on admission. 81% of the study population had abnormal results of any 1 of the screening tests for coagulation. Hence we recommend that it is essential to perform these screening tests in all trauma patients with severe injuries to identify the coagulopathy of trauma, so that, the patients are provided with appropriate evidence-based therapy. All the 5 patients who had isolated head injuries had abnormal results of any 1 of the screening tests for coagulation. Of these, 2 patients had abnormal results of all the 4 parameters and died within 24 hours of admission. This substantiates the current practice in neurosurgery, to perform the screening tests for coagulation for all patients with head injury, however trivial it might be on physical examination. Further studies are essential to correlate abnormal results of screening tests for coagulation in severely injured trauma patients, with outcomes such as duration of hospital stay, morbidity and mortality

Effects of irrigation regimes and brown manuring on physiological parameters and yield of direct seeded rice (TRY 3) under sodic soil condition

Direct seeded rice (DSR) production has been recognised as a more efficient way for conserving both labour and water. However, in regards to irrigation and brown manuring (BM), DSR has gotten relatively little attention. Hence, a field study was conducted to findout the effect of irrigation and brown manuring on physiological characters and yield of DSR (TRY 3) under sodic soil condition. The experiment was laid out in a split plot design and each replicated thrice. The main plots consist of irrigation after 10 cm (M1) and 15 cm (M2) depletion of field water tube and irrigation after the disappearance of ponded water (M3). The sub plots consist of sesbania BM at 15 (S1), 20 (S2) and 25 kg ha-1 (S3), PE Pretilachlor at 0.45 kg ha-1 fb PoE Bispyribac sodium at 25 g ha-1 + hand weeding (HW) on 45 DAS (S4), HW (S5) and weedy check (S6). Results revealed that higher SPAD value was recorded under M3 which was on par with M1. Among sub plots maximum SPAD value was recorded with S5 followed by S4 and S2. Treatment M2 recorded maximum proline content. There is no significant difference found in relative water content (RWC). However, higher RWC content was observed in M3. At the same time, higher grain and straw yield were recorded under M3 with S5, followed by M1 with S5. However, due to a large amount of water required and the higher labour costs associated with hand weeding, M1 with S2 was the best choice for increasing DSR productivity

Impact of alternate wetting and drying irrigation and brown manuring on water use, weed control and yield of drum seeded rice

Direct-seeded rice (DSR) is a cost-effective and environmentally friendly method of crop establishment. Weed menaces in DSR considerably reduce the yield potential, which can be addressed by effective irrigation and weed management practices. Information on the impact of various water-saving irrigations and brown manure (BM) on water use, weed studies, and the yield of drum-sown rice is very limited. A field investigation was conducted to determine the effects of alternate wetting and drying irrigation (AWDI) methods (10 cm, 15 cm dropped from FWT and farmers practices) and BM (Sesbania at 15, 20 and 25 kg ha-1, Pretilachlor 0.45 kg ha-1 as PE fbBispyribac Na 25 g ha-1 as PoE + hand weeding (HW) on 45 DAS, HW at 20 and 45 DAS, and weedy check. The results revealed that AWDI at 15 cm depletion of FWT with HW on 20 and 45 DAS increased the water use efficiency (5.3 kg ha mm-1), water productivity (0.53 kg m-3), water saving percentage (35.83%), and reduced the water consumption (770 mm). Continuous submergence with HW at 20 and 45 DAS significantly increased grain (4.4 t ha-1) and straw yield (6.5 t ha-1). At the same time, it reduced the grasses (53.3 and 58.4%) and sedges (76 and 75%), density and dry weight, respectively, over AWDI at 10 cm dropped from FWT. Thus, irrigation at 10 cm below FWT with sesbania BM at 20 kg ha-1 could be recommended for higher productivity of drum-sown rice under sodic soil conditions

Comparative Evaluation of Various Statistical Models and Its Accuracy for Landslide Risk Mapping: A Case Study on Part of Himalayan Region, India

Among other natural hazards, Landslides are the most prominent and frequently occurring natural disaster in the state of Himachal Pradesh with higher socio-economical losses. About 0.42 million sq.kms of area are prone to landslide activities in our country that is excluding the snow covered areas. The current research focuses on estimating the landslide risk zones of the Shimla Tehsil, Himachal Pradesh using various statistical models. Landslide contributing factors as such Landuse Landcover, Elevation, Slope, Lithology, Soil, Geology and Geomorphology has been used to assess the Landslide risk factors. Data obtained from LANDSAT 8 OLI sensors, SRTM DEM, Soil and Land Use Survey of India and SOI Toposheets have been used as sources. Weighted Overlay, Fuzzy logic and Analytical Hierarchical Process models will be used to categorize the Vulnerability and risk Zones of the study area. The causative factors were analyzed and processed in GIS environment. These values will be then being integrated using various studied models to produce individual landslide vulnerability and risk zones. The results reveal that most of the study area falls under Very Low risk category with a total coverage of 67.34%. Low and Moderate area covers about 23% and 9.13% of the study area. Higher risk areas only account for about 0.46%. Higher percent of the study area is mostly covered by settlements. National highways, Metal roads, Slopes and Denser settlements are located along the Moderate and low risk areas. The results retrieved from the WOM model reveals a total of 55% of the area comes under very low category. Low and Moderate category covers about 31.4% and 10.6% of the study area. High and Very High category cover a total of 1.9% together

Serpentine Synergy: Design and Fabrication of a Dual Soft Continuum Manipulator and Soft Snake Robot

This work presents a soft continuum robot (SCR) that can be used as a soft continuum manipulator (SCM) and a soft snake robot (SSR). This is achieved using expanded polyethylene foam (EPE) modules as the soft material. In situations like post-earthquake search operations, these dual-purpose robots could play a vital role. The soft continuum manipulator with a camera attached to the tip can manually search for survivors in the debris. On the other hand, the soft snake robot can be made by attaching an active wheel to the soft continuum manipulator. This mobile robot can reach places humans cannot and gather information about survivors. This work presents the design, fabrication, and experimental validation of the dual soft continuum robot.41 pages, 21 figure

Experimental investigation on no fines concrete by addition of natural fibres

No fines concrete is a type of lightweight concrete that is made without the use of fine aggregates. In this experimental investigation, the effect of adding bamboo and sugarcane fibres on the mechanical properties of no fines concrete was studied. The specimens were prepared by replacing a portion of the coarse aggregates with 1.5% of bamboo and sugarcane fibres by volume. The specimens were tested for compressive strength and splitting tensile strength at 7, 14, and 28 days of curing. The results showed that the addition of bamboo and sugarcane fibres improved the mechanical properties of no fines concrete. The optimal percentage of fibre content was found to be 1.5% by volume, which improved the compressive strength and splitting tensile strength by 23% and 18% respectively, compared to the control specimens. Additionally, the use o natural fibres in no-fine concrete can result in a more sustainable and eco-friendly construction material

Performance assessment on manufacturing of unfired bricks using industrial wastes

This paper presents eco-friendly unburnt bricks made up of fly ash, waste plastic powder, waste glass powder, lime, gypsum and crusher sand as alternatives to conventional burnt clay bricks for sustainable development. The research focuses on the maximum utilization of industrial waste in eco-friendly unburnt brick production. Materials are characterized according to their chemical and geotechnical properties. In this research, we use a milled waste glass powder of size less than 600μm and plastic powder obtained from plastic waste of size less than 600μm are added along with crushed sand, gypsum, lime and fly ash with various mix proportions concerning FaL-G mix concept. All the proportions were taken on a weight basis. Compressive strength, water absorption, and efflorescence are the key parameters chosen for comparing the innovative brick with conventional fly ash brick. There are five different mixes (Type A, B, C, D & E) are made in this research. The plastic and glass powders are replaced by crusher sand at the increased rate of 2% in every mix whereas 2%,4%,6%,8%, and 10%. It was found that the type B bricks have 17.63% strength was increased when compared to base mix. From the test results, type B bricks have enhanced mechanical performance when compared to all other mixes