Apert syndrome (Acrocephalosyndactyly): a case report

Apert syndrome is named for the French physician. Eugene Apert in 1906 described the syndrome acrocephalosyndactylia. It is a rare autosomal dominant disorder characterized by craniosynostosis, craniofacial anomalies, and severe symmetrical syndactyly of the hands and feet (i.e. cutaneous and bony fusion refers to webbing of fingers and toes). Apert syndrome is characterized by the premature fusion of certain skull bones (craniosynostosis). This early fusion prevents the skull from growing normally and affects the shape of the head and face. In addition, a varied number of fingers and toes are fused together (syndactyly). Most cases of Apert syndrome are sporadic, may result from new mutations in the gene. The purpose of this paper is to report a case of Apert syndrome in a female fetus of 30 weeks with asymmetrical skull confirmed by prenatal ultrasonography. Pregnancy was terminated and fetus was submitted for detailed autopsy in anatomy dissection hall. The findings and review of literature were presented in this article

A prospective observational study of drug usage in the management of snake bite patients and their outcome in a tertiary care teaching hospital

Background: The objectives of the study were to assess the pattern of management of snakebite especially with respect to use of anti- snake venom and other supportive treatment given and to assess the effect of anti-snake venom on different types of snakebite and to assess their outcome.Methods: A prospective observational study was conducted over a period of 6 months, after getting approval from Institutional Ethics committee. Total of 144 snake bite patients were analysed for six months duration for use of anti-snake venom and other supportive treatment in their management and were assessed for their outcome like recovery, morbidity and mortality.Results: Out of 144 snake bite patients analysed, 71.5% had poisonous type and 28.4% had non- poisonous type of snake bite. Among the total number of snakebites, 47.2% were unknown type and among the known type 25% were viper, 13.2% cobra, 7.6% krait, 6.3% sea snake and 0.7% green snake. Anti-snake venom (ASV) was given to 62 patients depending on severity, of which, 22 patients developed reaction to ASV. Patient with reaction to ASV were treated with corticosteroid and antihistamine injection. Morbidity was seen in 29.1% of patients who developed either cellulitis or gangrene of bitten area, which was more commonly seen among viper bite patients (54.7%).Conclusions: Snakebite is one of the commonest tropical diseases leading to envenomation and poisoning especially in rural areas of tropical countries which has to be treated as early as possible to prevent complications. Majority of the cases in our study were of viper bite and most of them have recovered after treatment

Cadaveric study of accessory renal arteries and its surgical correlation

A thorough knowledge of the accessory renal arteries has grown in importance with the increasing number of renal transplants and other uroradiological procedures. The literature indicates that multiple renal arteries are found in 9-75% cases. Normal anatomy describes each kidney receives irrigation from single renal artery which arises from abdominal aorta at the level L1-L2 vertebrae just below the superior mesenteric artery. Renal artery variations include their origin, number and course. The most common is the presence of additional vessels (accessory arteries) arising above the usual trunk is more frequent than one arising below. The accessory renal arteries are always end arteries. The kidneys may receive a single artery although each organ may equally be supplied by as many as six end arteries. The right and left renal arteries may arise from the aorta by a common stem or arise at lower point than usual in which case the kidneys lie below their usual position. There may be several renal arteries on each side or the renal artery may divide close to its origin into several branches. Current literature reports great variability in renal blood supply, the number of renal arteries mentioned being the most frequently found variation. Normal renal arterial information is useful not only for planning and performing of endovascular, laparoscopic uroradiological procedures and renal transplants. In order to facilitate the clinical approaches, we studied renal arterial pattern in 25 formalin fixed cadavers, on 50 kidneys during the period of one year. The purpose of this present study was to establish the incidence of accessory (aberrant) renal arteries in human cadavers and also discuss its surgical correlation during uroradiological procedures and angiographic interventions.

Enhancement of Indian Software Quality Management Using Multi Criteria Objects and Six Sigma Methodology

The objective of this article is to classify the software serious success factors of six sigma execution, as well as the lean six sigma tools methods that it uses in all the phases of the DMAIC structured methodology.A literature survey of six sigma software serious success factor has been realized and also an attempt to connect them with the enablers of Indian software quality management. A literature survey of the lean six sigma tools and methods used to follows and a classify them according to the phase of the DMAIC.This article has to collect a list of 6 software serious factors which were classified according to the five Indian software quality management enablers and the IMF,EMF,ESF,ISF differentiation. A list of various methods utilized in the different phases of sixsigma and the ISO suggestions has also been referred.Finally the classification of software serious success factors and methods of six sigma technology could be a valuable lean six sigma tools for academics and professionals to understand and execute the methodology in the appropriate way

Analysis of medication errors in medicine ward of medical college teaching hospital, Mandya

Background: Medication errors are one of the most common types of medical error that is seen in hospitalised patients. Since medication error is one of the growing concerns of healthcare issue and have implications on patient safety, the purpose of this study was to identify medication error and in turn would help to create awareness among healthcare professionals and provide safety to the patients.Methods: Study was initiated after obtaining approval from the Institutional Ethics Committee. The study was done for a period of 1 year between June 2016 and May 2017. Clinical data and data regarding the medication that was prescribed, transcribed, dispensed, administered was collected and was analysed for various types of medication errors during the different stages of medication use process.Results: A total of 351 subjects were recruited in the study for assessing medication error. About 2,283 drugs were prescribed among 351 patients. Maximum number of drugs was administered through parenteral route (50.3%). Medication error was most common during the prescribing stage (51.4%) followed by transcribing stage (39.1%), administration stage (6.9%), and dispensing stage (2.6%). On an average 6 drugs were prescribed per patient. Total of about 5411 errors have occurred out of which 98.8% of errors were preventable, 1.2% of errors were non-preventable. Cardiovascular system (21.9%) and endocrine and renal system (21.9%) was commonly affected due to the medication errors.Conclusions: Medication errors are one of the commonest problems of the healthcare system should be identified and documented and their causes should be studied in order to develop systems that minimize the recurrence

Inheritance of powdery mildew resistance in sunflower (Helianthus annuss L.)

Powdery mildew caused by Golovinomyces cichoracearum is the most important disease on sunflower worldwide. The investigation was undertaken to determine the mode of genetic inheritance of powdery mildew resistance in five F1 and F2 populations of sunflower. The four hybrids were derived by crossing resistant with susceptible genotype and one hybrid between resistant and highly susceptible genotype. Out of 23 hybrids, five crosses viz., PM-22x PM-36, PM-14xPM-36, PM-16xPM-38, PM-17xPM-35 and PM-34x PM-23 were resistant under natural as well as artificial epiphytotic screening conditions and the same five resistant hybrids segregated in 9R:7S ratio in F2 population indicating involvement of two independent loci controlling powdery mildew resistance in sunflower

A prospective observational study of prescription appropriateness of elderly hypertensive patients using Beers criteria in a tertiary care teaching hospital

Background: The prevalence of hypertension has been increased among the urban population especially among the elderly. Use of inappropriate medication is one of the major problems seen among elderly age group above 60 years who take more medication when compared to that of younger population. Inappropriate prescriptions can be avoided by identifying safer pharmacological alternatives and also utilizing non-pharmacological therapy. Quality and safety of prescribing in elderly patients is one of the global healthcare concern and efforts should be made to improve appropriateness of medication among this group of population. This study was done to assess the relationship between inappropriate medication use and its health outcomes in elderly hypertensive population.Methods: A prospective observational study was conducted over a period of 3 months, after getting approval from Institutional Ethics Committee. Total of 117 elderly hypertensive patients aged >60 years were analysed for three months duration for the rationality of medication prescribed using Beer’s criteria and the health outcome due to inappropriate medication use.Results: Out of 117 elderly hypertensive patients analysed, 49 (41.9%) were males and 68 (58.1%) were females. Most of the patients had associated co morbid illness like diabetes mellitus (48.7%), respiratory diseases (24.8%), cerebrovascular accident (30.8%), cardiovascular diseases (19.7%), fever (13.7%), anaemia (9.4%), etc. Out of 117 patients 10 drugs were used in 3.4% of cases. Antihypertensive drugs that were commonly used in our study was calcium channel blocker (52.1%), diuretics (42.7%), Angiotensin converting enzyme inhibitors (36.8%), β-blockers (17.1%) and Angiotensin receptor blockers (11.1%). Adverse health effects like drug induced gastritis, electrolyte imbalance, metabolic dysfunction and renal impairment was seen in few patients because of inappropriate medication.Conclusions: Use of inappropriate medication is one of the major problems seen among elderly, because of the co morbid illness associated with the primary disease which leads to polypharmacy. Prescription inappropriateness was seen among 86.3% of elderly hypertensive patients as per Beers criteria which may be because of comorbid illness that was seen among these patients. It is necessary to implement certain policies in geriatric healthcare to prevent the poor outcome due to drug therapy.

Investigation of the crystal structures of n-(4-fluorobenzoyl) benzenesulfonamide and n-(4-fluoro-benzoyl)-4-methylbenzenesulfonamide

The title compound, C26H26N2O7, is a thia­midine derivative. Geometric parameters are in the usual ranges. The crystal packing is stabilized by a classical N—H⋯O hydrogen bond, several weak C—H⋯O hydrogen bonds and a π–π stacking inter­action

Nonequilibrium Phase Transitions in Models of Aggregation, Adsorption, and Dissociation

We study nonequilibrium phase transitions in a mass-aggregation model which allows for diffusion, aggregation on contact, dissociation, adsorption and desorption of unit masses. We analyse two limits explicitly. In the first case mass is locally conserved whereas in the second case local conservation is violated. In both cases the system undergoes a dynamical phase transition in all dimensions. In the first case, the steady state mass distribution decays exponentially for large mass in one phase, and develops an infinite aggregate in addition to a power-law mass decay in the other phase. In the second case, the transition is similar except that the infinite aggregate is missing.Comment: Major revision of tex