Minimizing Stimulus Current in a Wearable Pudendal Nerve Stimulator Using Computational Models.

After spinal cord injury, functions of the lower urinary tract may be disrupted. A wearable device with surface electrodes which can effectively control the bladder functions would be highly beneficial to the patients. A trans-rectal pudendal nerve stimulator may provide such a solution. However, the major limiting factor in such a stimulator is the high level of current it requires to recruit the nerve fibers. Also, the variability of the trajectory of the nerve in different individuals should be considered. Using computational models and an approximate trajectory of the nerve derived from an MRI study, it is demonstrated in this paper that it may be possible to considerably reduce the required current levels for trans-rectal stimulation of the pudendal nerve compared to the values previously reported in the literature. This was corroborated by considering an ensemble of possible and probable variations of the trajectory. The outcome of this study suggests that trans-rectal stimulation of the pudendal nerve is a plausible long term solution for treating lower urinary tract dysfunctions after spinal cord injury

To study the prescription pattern of antibiotics in medicine intensive care unit at tertiary care hospital

Background: Drug utilization studies are crucial and create a positive awareness about proper use of drugs. Analysing the pattern of prescriptions is important in the settings of intensive care units where patients receive multiple antibiotics. The objective of this study was to analyse the use of antibiotics in a Medicine Intensive Care Unit (MICU) of Government Medical College and Hospital, Aurangabad, Maharashtra, India, a tertiary health care centre.Methods: Total 988 number of patients admitted in MICU from January 2017 to June 2018 were enrolled in the study and fulfilling inclusion criteria. Demographic details, disease state and prescription of antibiotic was recorded.Results: Out of 988, n=700 patients received antibiotics. Most common diseases for which patients were admitted in MICU included OP poisoning (24.86%), snake bite (15.14%), bilateral pneumonitis (12.71%), HELLP syndrome (12.14%), and the least common conditions were chronic obstructive pulmonary disease (COPD), meningitis, sepsis with multiple organ dysfunction syndrome (MODS), Guillen barre syndrome (GBS), lung abscess etc., Most common single antibiotic used in the studied cases was ceftriaxone (21.42%) followed by either alone or in combination piperacillin and tazobactam (12.04%), metronidazole (11.85%) etc.Conclusions: Total 700 patients received systemic antibiotics in present study bringing the incidence of systemic antibiotics use in MICU to be 70.85%. Ceftriaxone and combination of piperacillin and tazobactam are most commonly used antibiotics in MICU of the hospital. All patients admitted in this MICU received antibiotics as per the standard protocols of the hospital

Prescription pattern of antibiotics in neonatal intensive care unit of tertiary care hospital

Background: Recurrent and prolonged courses of antibiotics exposure have resulted in an increase in the prevalence of hospital acquired infections and antibiotic resistant profile. The objective of this study was to quantify the use of antibiotics in a neonatal intensive care unit (NICU) of Govt. Medical College and Hospital, Aurangabad, Maharashtra, a tertiary health care centre.Methods: A total of 260 neonates admitted in NICU from August 2017 to February 2018 were enrolled in the study and fulfilling inclusion criteria of the study. Demographic details, data on antibiotic prescriptions (name, dose, frequency, route of administration) was recorded on pre-tested structured Performa.Results: A total of 248 neonates received the antibiotics. EOS pneumonia was most common i.e. 29.8% followed by LOS pneumonia (20.6%). Sepsis, pneumonia Meningitis, NEC, were common indications for admission in NICU. Among the antibiotic combinations amoxicillin + clavulanate (38.99%), was most commonly prescribed followed by gentamicin (37.89%) and piperacillin (11.01%) respectively. Other antibiotics like, linezolide (0.94%), fluconazole (5.97%), meropenem (4.42%), vancomycine (0.77%) were also used less commonly in NICU. About fifty of the medicine prescribed were in compliance with the national list of essential medicines 2011.Conclusions: In tertiary care setup of NICU amoxicillin + clavulanate and gentamicin are most commonly used antibiotics in NICU. The study concludes that the antibiotic prescription pattern at NICU of our tertiary care hospital was found rational

Repair of ascending aortic pseudoaneurysm eroding through the sternum

In reoperation for an ascending aortic pseudoaneurysm eroding through the sternum, a left ventricular vent allows careful unhurried sternal division under deep hypothermic circulatory arrest. We repaired ascending aortic pseudoaneurysms in 2 patients who had undergone aortic valve implantation 6 and 21 months earlier. A minithoracotomy was made in the left 5th intercostal space, and a vent was placed in the left ventricular apex. Repair was accomplished with a bovine pericardial patch reinforced with a Teflon felt strip. Both patients made an uneventful recovery with good functional status at discharge at the 8- and 18-month follow-up

Detecting colorectal cancer using electrical impedance spectroscopy: an ex vivo feasibility study

Objective: Colorectal cancer is the fourth most common cancer worldwide, with a lifetime risk of around 20%. Current solutions do not allow clinicians to objectively assess tissue abnormality during endoscopy and perioperatively. A solution capable of objectively assessing samples in real time could greatly improve the treatment process. A solution that can be integrated in minimally invasive diagnostics and management strategies to provide real-time point-of-care information would be greatly transformative. Electrical impedance spectroscopy (EIS) may provide such a solution. In this paper, we present a feasibility study on using EIS in assessing colorectal tissue. Approach: We performed tetrapolar EIS using ZedScan on excised human colorectal tumour tissue and the matched normal colonic mucosa in 22 freshly resected specimens following elective surgery for colorectal cancer. Histopathological examination was used to confirm the final diagnosis. Statistical significance was assessed with Wilcoxon signed rank test. Main results: Tetrapolar EIS could discriminate cancer with statistically significant results when applying frequencies between 305 Hz – 625 kHz (p < 0.05). 300 Ω was set as the transfer impedance threshold to detect cancer. Thus, the area under the corresponding receiver operating characteristic curve for this threshold was 0.7105. Significance: This feasibility study demonstrates that impedance spectra changes in colorectal cancer tissue are detectable and may be statistically significant, suggesting that EIS has the potential to be the core technology in a novel non-invasive point of care test for detecting colorectal cancer. These results warrant further development and increasing the size of the study with a device specificity designed for colorectal cancer

Penetrating cardiac trauma: A retrospective case series from Karachi.

Penetrating cardiac trauma is a medical emergency that commonly affects young men throughout the world. A retrospective review of the records of all patients presenting with cardiac injury was done from January 2000 to December 2015 at our institute. There were 10 cases of such trauma, all of whom were males, 17 to 48 years of age. The most common mechanism of injury was gunshot wounds followed by stab wounds. The Mean Revised Trauma Score was 7.23±0.855. Only 2 out of the total 10 patients died (20% mortality). The Right Ventricle followed by the Left Ventricle was the most common site of injury. Median Sternotomy was the surgical procedure of choice in managing these patients. Pericardial tamponade and Haemothorax were common intra-operative findings. Patients having penetrating cardiac injury presenting with detectable signs of life on arrival to the hospital can be rescued by early surgical interventio

Cervical mediastinoscopy in the diagnosis of lymphadenopathy in South Asia.

Abstract We planned to determine the clinical utility and safety of mediastinoscopy in the pathologic diagnosis of mediastinal lymphadenopathy and to determine disease patterns in a tertiary care setting in Karachi. The retrospective review comprised record of patients who underwent mediastinoscopy over 25 years between July, 1990 and August, 2015. Of the 122 patients, records were complete for 88(72%). Mean age was 42.5±12.9 years and 55(62.5%) were male. Overall, 60(68.2%) patients had benign inflammatory diseases; 25 (28.4%) had lymphoma or lung cancer which was accurately staged; 26(29.5%) had tuberculosis; 13(14.8%) sarcoidosis; and 11 (12.5%) had concomitant tuberculosis and sarcoidosis. No mortality or significant morbidity was recorded. Mediastinoscopy was useful in staging bronchogenic carcinoma and influenced the management in this series. It was found to be accurate in the diagnosis of other malignant as well as benign mediastinal pathologies, all of which were treatable

An Index for 4 dimensional Super Conformal Theories

We present a trace formula for an index over the spectrum of four dimensional superconformal field theories on $S^3 \times$ time. Our index receives contributions from states invariant under at least one supercharge and captures all information -- that may be obtained purely from group theory -- about protected short representations in 4 dimensional superconformal field theories. In the case of the $\mathcal{N}=4$ theory our index is a function of four continuous variables. We compute it at weak coupling using gauge theory and at strong coupling by summing over the spectrum of free massless particles in $AdS_5\times S^5$ and find perfect agreement at large $N$ and small charges. Our index does not reproduce the entropy of supersymmetric black holes in $AdS_5$, but this is not a contradiction, as it differs qualitatively from the partition function over supersymmetric states of the ${\cal N}=4$ theory. We note that entropy for some small supersymmetric $AdS_5$ black holes may be reproduced via a D-brane counting involving giant gravitons. For big black holes we find a qualitative (but not exact) agreement with the naive counting of BPS states in the free Yang Mills theory. In this paper we also evaluate and study the partition function over the chiral ring in the $\mathcal{N}=4$ Yang Mills theory.Comment: harvmac 40+16 pages, v3: references and table of contents added, typos fixe

Local Fluid Dynamical Entropy from Gravity

Spacetime geometries dual to arbitrary fluid flows in strongly coupled = 4 super Yang Mills theory have recently been constructed perturbatively in the long wavelength limit. We demonstrate that these geometries all have regular event horizons, and determine the location of the horizon order by order in a boundary derivative expansion. Intriguingly, the derivative expansion allows us to determine the location of the event horizon in the bulk as a local function of the fluid dynamical variables. We define a natural map from the boundary to the horizon using ingoing null geodesics. The area-form on spatial sections of the horizon can then be pulled back to the boundary to define a local entropy current for the dual field theory in the hydrodynamic limit. The area theorem of general relativity guarantees the positivity of the divergence of the entropy current thus constructed

Design of sEMG assembly to detect external anal sphincter activity: a proof of concept

Objective: Conditional trans-rectal stimulation of the pudendal nerve could provide a viable solution to treat hyperreflexive bladder in spinal cord injury. A set threshold of the amplitude estimate of the external anal sphincter surface electromyography (sEMG) may be used as the trigger signal. The efficacy of such a device should be tested in a large scale clinical trial. As such a probe should remain in situ for several hours while patients attend to their daily routine, the recording electrodes should be designed to be large enough to maintain good contact while observing design constraints. The objective of this study was to arrive at a design for intra-anal sEMG recording electrodes for the subsequent clinical trials while deriving the possible recording and processing parameters. &#13; Approach: Having in mind existing solutions and based on theoretical and anatomical considerations, a set of four multi-electrode probes were designed and developed. These were tested in a healthy subject and the measured sEMG traces were recorded and appropriately processed.&#13; Main results: It was shown that while comparatively large electrodes record sEMG traces that are not sufficiently correlated with the external anal sphincter contractions, smaller electrodes may not maintain a stable electrode tissue contact. It was shown that 3 mm wide and 1 cm long electrodes with 5 mm inter-electrode spacing, in agreement with Nyquist sampling, placed 1 cm from the orifice may intra-anally record a sEMG trace sufficiently correlated with external anal sphincter activity.&#13; Significance: The outcome of this study can be used in any biofeedback, treatment or diagnostic application where the activity of the external anal sphincter sEMG should be detected for an extended period of time