Effect of Forgetting Factor on Gray Box Auto Regressive Exogenous Algorithm for Short Term Diurnal Temperature Forecast in Remote Area Regions

Abstract: Remote arid areas are devoid of weather data which may be called fairly accurate. They have to rely upon predictions in nearby cities, sometimes more than 300 kms away and that too in completely different demographic and physical structure. It is important to establish alternative method of weather prediction. Model based weather prediction is presented in this paper for such application. It is based upon the principle of dynamic modelling and parameter estimation. These parameters have no physical meaning but a change in their behaviour predicts the change in climatic condition. The selection of model based upon forgetting factor is preferred after evaluating Akaike information criterion, Bayesian information criterion and, Deviance information criterion. It can be interpreted accordingly to predict the climate at local scale. The methodology is based upon smaller data accumulation but provides fairly accurate results

Sphincter saving anorectoplasty (SSARP) for the reconstruction of Anorectal malformations

<p>Abstract</p> <p>Background</p> <p>This report describes a new technique of sphincter saving anorectoplasty (SSARP) for the repair of anorectal malformations (ARM).</p> <p>Methods</p> <p>Twenty six males with high ARM were treated with SSARP. Preoperative localization of the center of the muscle complex is facilitated using real time sonography and computed tomography. A soft guide wire is inserted under image control which serves as the route for final pull through of bowel. The operative technique consists of a subcoccygeal approach to dissect the blind rectal pouch. The separation of the rectum from the fistulous communication followed by pull through of the bowel is performed through the same incision. The skin or the levators in the midline posteriorly are not divided. Postoperative anorectal function as assessed by clinical Wingspread scoring was judged as excellent, good, fair and poor. Older patients were examined for sensations of touch, pain, heat and cold in the circumanal skin and the perineum. Electromyography (EMG) was done to assess preoperative and postoperative integrity of external anal sphincter (EAS).</p> <p>Results</p> <p>The patients were separated in 2 groups. The first group, Group I (n = 10), were newborns in whom SSARP was performed as a primary procedure. The second group, Group II (n = 16), were children who underwent an initial colostomy followed by delayed SSARP. There were no operative complications. The follow up ranged from 4 months to 18 months. Group I patients have symmetric anal contraction to stimulation and strong squeeze on digital rectal examination with an average number of bowel movements per day was 3–5. In group II the rate of excellent and good scores was 81% (13/16). All patients have an appropriate size anus and regular bowel actions. There has been no rectal prolapse, or anal stricture. EAS activity and perineal proprioception were preserved postoperatively. Follow up computed tomogram showed central placement the pull through bowel in between the muscle complex.</p> <p>Conclusion</p> <p>The technique of SSARP allows safe and anatomical reconstruction in a significant proportion of patients with ARM's without the need to divide the levator plate and muscle complex. It preserves all the components contributing to superior faecal continence, and avoids the potential complications associated with the open posterior sagittal approach.</p

Effect of Dexmedetomidine on Intraoperative Haemodynamics and Postoperative Analgesia in Laparoscopic Cholecystectomy

Background and objectives:Dexmedetomidine is an α2 agonist with sympatholytic, anxiolytic, sedative and analgesic effect used as adjunct during surgeries for its haemodynamic stabilizing effect and analgesic effect. Primary aims of the study were to evaluate the haemodynamic effect of intravenous dexmedetomidine and the duration and quality of analgesia in laparoscopic cholecystectomy. Secondary aims were sedation levels and occurrence of side effects.Materials and methods:Eighty four patients, American society of Anaesthesiologists physical status I and II, aged 18-60 years of either gender undergoing laparoscopic cholecystectomy in general anaesthesia were randomly allocated into two equal groups. Group C patient received Normal Saline and Group S patient received dexmedetomidine loading dose infusion of 1µg/kg over 10 minutes before induction and maintained with 0.4µg/kg/hr till the removal of gall bladder. Induction with propofol and fentanyl was done. Standard monitoring including Heart Rate, Mean arterial pressure, oxygen saturation were monitored perioperatively. Postoperative analgesia requirement and sedation score were assessed.Results: In Group S, the haemodynamic responses were significantly attenuated. During postoperative period, 24 hours analgesic requirement of diclofenac sodium was 141.43mg in group S as compared to 217.50mg in group C(p&lt;0.001). Side effects were treatable. Sedation was better in Group S.Conclusion:Dexmedetomidine effectively attenuates haemodynamic stress response during laparoscopic surgery with reduction in postoperative analgesic requirements.</p

Study of Bacteriological Profile of Post Operative Wound Infection in A Tertiary Care Hospital in North India

  Surgical site infections (SSIs) are known to be one of the most common worldwide causes of nosocomial infections account for nearly 20% to 25% of all healthcare associated infections. Aims and objectives to isolate the different organisms from post-operative wound infections, to determine the antibiotic sensitivity pattern of these isolates and to determine the rate of SSI. The post-operative specimen received in Department of Microbiology from the various surgical wards of our hospital  and were processed according to standard bacteriological techniques. Antibiotic susceptibility testing was performed by Kirby-Bauer disk diffusion technique. All the staphylococcal isolates were subjected to determination of methicillin resistance by cefoxitin disc diffusion method. Antimicrobial susceptibility testing was carried out for all 278 isolates and the results are depicted Staphylococcus aureus strains showed a high degree of resistance for ampicillin (85.7%). Methicillin resistance was seen in 15.7% of all the S.aureus isolates. Gram negative isolates showed even higher rate of resistance and commonly prescribed agents like gentamicin, cotrimoxazole and ciprofloxacin were found resistant for most of the gram negative isolates. Meropenem showed good activity against most of the gram negative isolates, including for P. aeruginosa and Acenetobacter spp, strains which showed high resistance for meropenem also. The present microbiological study has determined the com­monest bacteria responsible for the post-operative wound infectons. There was predominance of commonly isolated bacterial species were S. aureus, E. coli , P. aeruginosa and. To establish the most suitable empirical treatment for each patient, it is very important to know the microbial epidemiology of each institution. Using the results of this study, an initiative for establishing improved hospital antimicrobial policy and antimicrobial prescribing guidelines should be undertaken

Evaluation of the prevalence of dermatophytes infection and its etiological agents – A clinico-microbiological study

Background: Skin infections are common diseases in developing countries, Skin infections due to Dermatophytes has become a significant health problem affecting children, adolescents and adults of which Dermatophytosis are of particular concern in the tropics. Dermatophytosis constitutes a group of superficial fungal infections of the epidermis, hair and nails. Aim: To study the prevalence of dermatophytes infection in different patients and to find the etiological agents of dermatophytes. Methods: The study was conducted at the Department of Microbiology, Patna Medical College and Hospital, Patna. All samples in the form of skin and nails were collected randomly in batches under aseptically condition from both out patients &amp; in-patients. KOH mount was done for direct exam. Culture was also done. Results: A total of 354 samples were collected of which majority were skin 341 (96.3%). Majority of the patients belonged to the age group of 21-30 (33.9%) and were males (81.4%). Groin lesion was the most common lesion (58.5%). KOH, culture and both tests positive was found in 78%, 79.7% and 66.7% samples respectively. The sensitivity and specificity of KOH was 88.7% and 44.4 % respectively with positive predictive and negative predictive value of 85.5% and 41% respectively. Conclusion: In the present study, Dermatophytosis is a major problem in North Indian population &amp; prevalence of dermatophytic infection is alarming in both rural as well as urban community

A study to evaluate the bacteriological profile of Chronic Suppurative Otitis Media and its antibiotic susceptibility pattern in subjects attending OPD of Tertiary Care Institution

Background: Chronic suppurative otitis media (CSOM) is defined as persistent or intermittent infection of ear for more than three months duration where the infected discharge occurs through the perforated tympanic membrane caused by bacteria , fungi and virus resulting in inflammation of mucosal lining that results in partial or total loss of the tympanic membrane and ossicles. Aim: To evaluate the bacteriological profile of Chronic Suppurative Otitis Media and to evaluate their antibiotic susceptibility pattern.Methods: A total of 66 patients with symptoms of CSOM were enrolled in the study. Out of 66 patients, 54 were unilateral cases and 12 were bilateral cases. Thus the total 78 samples were available for culture. Samples from 78 discharging ears were collected with the help of aural speculum by swabbing the discharging ears with two sterile cotton swabs.Results: Antimicrobial susceptibility testing was carried out for all the isolates. Imipenem resistance was not seen to any of the isolate. Amikacin was the most effective antibiotic in the present study. It was effective against maximum number of strains 74 (94.9%) followed by levofloxacin 72 (92.3%), Gentamicin 70 (89.7%), Ofloxacin 68 (87.2%) and Ciprofloxacin 62 (79.5%).Conclusion:The chronic suppurative otitis media has become public health importance in the present days in developing countries like India. It is well known disease of multiple etiology and its recurrence and persistence. Irregular, haphazard and indiscriminate use of antibiotics has precipitated the emergence of multi resistant bacteria. The most common the bacteriological agent associated with CSOM in our area was Pseudomonas aeruginosa with a gradual decline in their sensitivity pattern to a number of fluoroquinolones. Amikacin and levofloxacin has proven to be the drug of choice

Prevalence of hepatitis-B surface antigen in subjects attending OPD of Tertiary care institution

Background: Hepatitis B virus is a partially double-stranded circular DNA virus and is a member of the Hepadnaviridae family. The virus consists of a core capsid which contains viral DNA and this is surrounded by an envelope containing surface antigen (HBsAg). Both whole and incomplete virus particles, consisting entirely of HBsAg, are produced during replication of HBV. The HBsAg particles vary greatly in morphology and are found in high concentrations in early acute infection and continue to be produced in chronic disease.Aim: Diagnostic potential of Hepatitis-B surface antigen (HBsAg) positivity and its prevalence was evaluated among OPD Patients. Methodology: The prevalence of hepatitis B surface antigen (HBsAg) was studied among 767 subjects (male 470 and female 297), aged 05-55 years volunteers, who required medical check-ups. Blood samples, collected were tested for HBsAg using a third-generation ELISA kit. Results: Of the 767 subjects, male 1.82% and female 1.17% were positive for HBsAg. The results revealed that hepatitis B infection in the target group was below the intermediate endemicity. Conclusion: This study demonstrates that proper training of new entrants in the medical field can be pivotal in preventing HBsAg and it is advocated that a programme for education, vaccination and prophylaxis must be implemented in all healthcare set ups

Giant retroperitoneal fetus-in-fetu: An unusual cause of respiratory distress

Fetus-in-fetu (FIF) is a rare congenital condition in which a vertebrate fetus is incorporated within its host, a newborn or an infant. We report an interesting case of FIF presenting as an abdominal mass with respiratory distress in a 4-month-old girl, and review the existing literature. An ultrasound abdomen showed a right sided cystic mass containing multiple calcifications. Laparotomy revealed a well-encapsulated right retroperitoneal mass above the right kidney with two rudimentary limbs attached to an amniotic bag by an umbilical cord. Excision of the capsule revealed a yellowish fluid and an incompletely developed fetus covered by vernix caseosa. Pathologic examination showed an irregular fetiforme mass, weighing 1200 gm, with two rudimentary limbs, encephalus, stomach, duodenum, bowel, bone, cartilage, bone marrow, upper and lower respiratory tissue, and spleen. Complete excision of the FIF was performed. The postoperative period was uneventful and the patient was discharged on the seventh postoperative day

Complete separation of the rectum (black arrow) from the fistula (white arrow) continues until the fistula is completely free

<p><b>Copyright information:</b></p><p>Taken from "Sphincter saving anorectoplasty (SSARP) for the reconstruction of Anorectal malformations"</p><p>http://www.biomedcentral.com/1471-2482/7/20</p><p>BMC Surgery 2007;7():20-20.</p><p>Published online 24 Sep 2007</p><p>PMCID:PMC2093923.</p><p></p