A study of the outcome of post operative patients on ventilators

BACKGROUND AND OBJECTIVES: Management of mechanical ventilated post-surgical patients in Intensive Surgical Care Unit needs an interdepartmental disciplinary approach by surgeon, anesthetist and paramedical team. Various factors like respiratory, surgical and other hemodynamic factors play an important role in the outcome of mechanically ventilated patients (ISCU). There are various complications of mechanical ventilation. Post-operative wound infection, sepsis and post-operative respiratory complications are the most common complications in the peri and post-operative period. Post-operative respiratory complications is the second commonest cause for patients mortality, wound sepsis being the primary cause. Respiratory failure after general anesthesia and tracheal intubation has been shown to be one of the most meaningful factors associated with poor patient outcomes leading to longer hospital stay, increased expenses and increased thirty day mortality. Presently the need of the study is to reduce the use of ventilator in the post-operative period and timely assessment and management of mechanical ventilated patients and to identify the effects of surgical factors in determining the outcome of mechanical ventilated patients, which will in turn help in the planning of proper management. Our study aims to assess the patient factors leading to mechanical ventilation in emergency and elective procedures, to study about the modes of mechanical ventilation needed and to assess the incidence of complication and mortality of patients on mechanical ventilation TYPE OF STUDY: Observational (prospective) study. METHODOLOGY: This will be a hospital based time bound study. All those cases which satisfy the inclusion criteria will be included in this study.All patients will be taken into the study after obtaining written informed consent.all the patients who fit into the criteria will be done routine blood investigations like hemoglobin, hematocrit, liver function test, renal function test, serum electrolytes and ABG. Serial bedside Chest X ray and ecg will be done and all the necessary parameters were serially recorded. RESULTS: A total of fifty patients were studied which included in our study with age distribution ranging from 21 to 78 years, with 5(10%) of age group 21 – 30 years, 5(10.1%) of age group 31 – 40 years, 6(12%) of age group 41 – 50 years, 17(34%) of age group 51 – 60 years, 14(28) of age group 61-70 and 3(6%) of age group 71-80 with a mean ± S.D of 49.5 ± 14 years . The sex distribution pattern in our study included 36(72%) males and 14 (28%) females. The different factors that correlated with increased risk of mortality include Patient’s age >50 years (P=0.04), conditions that cause septicemia such as hollow viscus perforation and bowel gangrene (P=0.03), emergency surgery (P=0.04 vs P=0.21 in elective surgery), risk factors such as smoking and alcohol combined when compared with individual risk factors (P=0.04 vs P=0.07), co morbid illness such as diabetes mellitus, systemic hypertension, coronary artery disease and chronic kidney disease combined when compared with those patients with nil comorbid illness(P=0.031 vs P=0.124), prolonged intra operative course, i.e. more than 4 hours when compared with surgery less than 2 hrs (P=0.47 vs P=0.087), increased duration of patients on ventilator upto the time of weaning, i.e. more than 36 hours (P=0.043 vs P=0.097), metabolic acidosis and hypotension requiring inotropic support (P=0.039), new onset post-op complications like acute kidney injury, pulmonary embolism and diabetic ketoacidosis (P=0.039). The factors which did not have a bearing on the mortality of the patient include, mode of ventilation such as ACMV and SIMV(P=0.054 and 0.089), compartmental classification of surgical procedure such as abdomen, head and neck, soft tissue of lower limbs,etc (P=0.061, 0.092, 0.094). The various cause of death include septicemia (24%), septic shock (4%), Pneumonic consolidation and acute pulmonary embolism (2%), acute exacerbation of chronic kidney disease (2%), metabolic acidosis (4%), persistent hypotension (2%), combined acute kidney injury with persistent hypotension(2%). CONCLUSION: Septicemia, being the major cause of death, this factor needs extra attention ranging from optimum pre-operative stabilisation, prophylactic pre-op or post-operative antibiotic coverage. Early identification of complications such as ventilator associated pneumonia, adult respiratory distress syndrome, metabolic acidosis and its appropriate management play a vital role in reducing the case fatality. This study also stresses the need to reduce the use of ventilator in the post-operative period and timely assessment and management of mechanical ventilated patients and to identify the effects of surgical factors in determining the outcome of mechanical ventilated patients, which will in turn help in the planning of proper management

Reveiw of effective data encryption and decryption technique

The requirements of information security within an organization have undergone two major changes in the last several decades. Before the wide spread use of data processing equipment, the security of information  felt to be valuable to an organization was provided primarily by physical and administrative means. The collection of tools designed to protect data and to thwart hacker is computer security. Network security measures are needed to protect data during their transmission. This technique for encryption and decryption process to combine two methods ceaser cipher and transposition cipher, ceaser cipher is one of the substitution techniques. A substitution technique is one in which the letters of plain text are replaced by other letter or by numbers or symbols. if the plaintext is viewed as a sequence of bits, then substitution involves replacing plaintext bit patterns with cipher text bit patterns. The encryption process is two stages first, to convert the given plaintext into cipher text using ceaser cipher text technique, second stage the cipher converted using transposition technique, the final output is cipher text, The Decryption is the reverse process of the Encryption

Recoganisation and security guidance of data integrity in cloud storage

Cloud computing has been envisioned as the de-facto solution to the rising storage costs of IT Enterprises. With the high costs of data storage devices as well as the rapid rate at which data is being generated it proves costly for enterprises or individual users to frequently update their hardware. Storage outsourcing of data to cloud storage helps such firms by reducing the costs of storage, maintenance and personnel. It can also assure a reliable storage of important data by keeping multiple copies of the data thereby reducing the chance of losing data by hardware failures. The study deal with the problem of implementing a protocol for obtaining a proof of data possession in the cloud sometimes referred to as Proof of irretrievability (POR). The problem tries to obtain and verify a proof that the data that is stored by a user at remote data storage in the cloud (called cloud storage archives or simply archives) is not modified by the archive and thereby the integrity of the data is assured. The verification systems prevent the cloud storage archives from misrepresenting or modifying the data stored at it without the consent of the data owner by using frequent checks on the storage archives.&nbsp

Frey’s procedure: short term follow up results in terms of pain, endocrine and exocrine status, a tertiary care centre experience

Background: Chronic pancreatitis, a debilitating disease which affects the patient to an extent to render him bedridden sometimes and often make him/her unable to perform daily work, leading to poor quality of life, severe emotional stress and financial burden. Frey’s procedure one of the most commonly performed surgery in patient of chronic pancreatitis with stones in pancreatic duct and small inflammatory head mass. This procedure had shown promising results in terms of pain control with unclear outcome with respect to exocrine and endocrine status.Methods: Study was conducted in Government Kilpauk Medical College, Chennai during March 2016 to December 2019. Total 21 patients were followed up for 18 months and Post-operative pain was analysed using pain scoring system used by Bloechle et al. Exocrine status in terms of diarrhea, bloating sensation and Fecal Elastase level(preoperative and postoperative) were analysed. Patient glycaemic status were also analysed and compared. Patient Nutritional status was analysed in terms of weight gain.Results: In this study there was significant improvement in pain after surgery in terms of VAS pain Score (Preop Mean-82.14, Post-op Mean- 9.76, p<0.001) , frequency of pain (Preop Mean-78.57, Post-op Mean- 14.29, p<0.001), analgesia required (Preop Mean-15, Post-op Mean- 3.10, p<0.001), and inability to work due to pain (Preop Mean-80.95, Post-op Mean- 11.90, p<0.001). Overall total Pain score was significantly improved after surgery (Preop Mean-256.67, Post-op Mean- 39.05, p<0.001). There was significant weight gain and significant improvement in Fecal Elastase level in patients following surgery, however there was no significant difference in pancreatic exocrine status on the basis of symptoms.Conclusions: Frey’s procedure is very effective in pain control in properly selected patients of chronic calcific pancreatitis, and it also improves nutritional status of patient. Frey’s procedure might improve patient exocrine and endocrine status but further  multicentre studies are needed to come to a conclusion.

5-[1-(4-Meth­oxy­phen­yl)-2-nitro­but­yl]-4-phenyl-1,2,3-selenadiazole

In the title compound, C19H19N3O3Se, the selenadiazole ring is essentially planar (r.m.s. deviation = 0.001 Å). The heterocyclic ring makes dihedral angles of 50.2 (2) and 76.3 (9)°, respectively, with the meth­oxy­phenyl and phenyl rings

5-(2-Nitro-1-phenyl­but­yl)-4-phenyl-1,2,3-selenadiazole

In the title compound, C18H17N3O2Se, the selenadiazole ring is planar [maximum deviation = 0.012 (2) Å for the ring C atom bearing the phenyl substituent]. The dihedral angle between the selenadiazole ring and the attached benzene ring is 46.5 (1)°. There is one short intra­molecular C—H⋯Se contact

Survey of incidence of various surface defects in goat and sheep skin in Madras

23,429 goat skins and 37,026 sheep skins were examined to find out the incidence of various surface defects in them. 33.44 percent of goat skins and 14.6 per cent of sheep skins were found to be affected in quality. Major defects common to both goat and sheep skins were abscess, fire-mark and psoroptosis. In addition to the above common defects demodecosis and sheep pox appreciably deteriorated the quality of goat and sheep skins respectively. Seasonal variation in the incidence of the major defects were also studied

PRODUCTION OF BIOGAS USING FOOD WASTE FROM SRIT HOSTEL

Biogas is typically a gas produced by the anaerobic digestion of biodegradable materials. One of the most promising processes for the energetic transformation of waste is the anaerobic digestion of waste to produce biogas. Food waste, which has become one of global concerns because of its massive amount, contains high organic content, which is used by the microbes as nutrients. The present project aims at production of biogas using food waste generated from SRIT hostel. Our institution has three hostels and two messes, cooking food for more than 1000 students, and there is large quantity of food waste generated daily. The option available for the management of this huge waste is animal feed. So this large quantity of food waste generated should be utilized for better purposes. A survey is carried out and it was found that average food waste generated per person is 243g. The set up consists of a digester which is of 2.75 litres capacity and it was filled with 2/3rd of its capacity with mixed food waste and cow dung in 1: 1 proportion. The initial and final characteristics of the feedstock, such as pH, total solids, volatile solids, C/N ratio and COD are analyzed. The volumetric yield of biogas is noted at regular intervals using water displacement method. The cumulative quantity of biogas produced for 31 days is 565 cm3 per 900 gram of feedstock

Ethyl 2-[N-(2-formyl­phen­yl)benzene­sulfonamido]acetate

In the mol­ecule of the title compound, C17H17NO5S, the two aromatic rings are oriented at an angle of 30.13 (10)°. The ethyl acetate group assumes an extended conformation. Mol­ecules are linked into C(7) chains running along the a axis by inter­molecular C—H⋯O hydrogen bonds, and the chains are crosslinked via C—H⋯π inter­actions, with the sulfonyl-bound phenyl ring acting as an acceptor

Probing the Surfaces of Interstellar Dust Grains: The Adsorption of CO at Bare Grain Surfaces

A solid-state feature was detected at around 2175 cm-1 towards 30 embedded young stellar objects in spectra obtained using the ESO VLT-ISAAC. We present results from laboratory studies of CO adsorbed at the surface of Zeolite wafers, where absorption bands were detected at 2177 and 2168 cm-1 (corresponding to CO chemisorbed at the Zeolite surface), and 2130 cm-1 (corresponding to CO physisorbed at the Zeolite surface), providing an excellent match to the observational data. We propose that the main carrier of the 2175-band is CO chemisorbed at bare surfaces of dust grains in the interstellar medium. This result provides the first direct evidence that gas-surface interactions do not have to result in the formation of ice mantles on interstellar dust. The strength of the 2175-band is estimated to be ~ 4 x 10-19 cm molecule-1. The abundance of CO adsorbed at bare grain surfaces ranges from 0.06 to 0.16 relative to H2O ice, which is, at most, half of the abundance (relative to H2O ice) of CO residing in H2O-dominated ice environments. These findings imply that interstellar grains have a large (catalytically-active) surface area, providing a refuge for interstellar species. Consequently the potential exists for heterogeneous chemistry to occur involving CO molecules in unique surface chemistry pathways not currently considered in gas-grain models of the interstellar medium.Comment: 19 pages inc. 3 figures 2 tables, accepted for publication in MNRA