Routine versus early nasogastric decompression in gastrointestinal surgeries: a randomized controlled trial

Background: Traditionally nasogastric decompression is carried out in post operatively in patients undergoing gastrointestinal surgery. The purpose of the study is to assess the benefits of nasogastric decompression in the early postoperative period as compared to routine nasogastric decompression in patients undergoing gastrointestinal surgeries. Objectives: To assess the benefits of nasogastric decompression in the early postoperative period as compared to routine nasogastric decompression in patients undergoing gastrointestinal surgeries, to assess the complications associated with nasogastric tube insertion, and to assess the effect of early nasogastric tube removal on the patients’ postoperative morbidity and comfort level.Methods: This was a randomized control trial done in the Shree Sayajirao General Hospital, Vadodara.  According to patient flow and previous study details the estimated sample size was 300 patients. Patient allotment was 150 patients in each group. Patients admitted on odd dates will be followed for routine nasogastric decompression, and patients admitted on even dates will be followed for early nasogastric decompression. Inclusion criteria for the study include laparotomies performed by any abdominal incisions on emergency as well as elective bases. Variables to be studied were patient comfort (according to patient’s opinion), vomiting (episodes, type, amount, content, on which post-operative day), abdominal distension, appearance of normal bowel sounds, passage of flatus and/or stools (according to patient’s history), incidence of aspiration pneumonia and total duration of the hospital stay with wound complications. Data will be processed and analyzed by chi square test and t-test.Results: In the study total 300 patients were included. No significant difference between both the groups in case of postoperative vomiting with p- value of 0.6028 (i.e. p > 0.05) and abdominal distension with p- value of 0.5183 (i.e. p > 0.05). Significant difference seen in the appearance of the bowel sound in post-operative period with p- value of 0.0002 (i.e. p < 0.05) and passage of flatus or stool with p-value of <0.0001. In case of early decompression group mean postoperative day for the suture removal was 11.9 days and for routine decompression group it was 12.3 days, the difference was statistically significant with p- value of 0.0006 (i.e. p < 0.05). The mean for the total hospital stay for early decompressed group was 10.04 days and for routine decompression group it was 10.47 days which was highly statically significant with p- value of 0.0001 (i.e. p < 0.05). Post-operative wound complication which was statically significance with p-value of 0.0394 (i.e. p < 0.05) and respiratory complications was also significant with p-value of 0.0367 (i.e. p < 0.05). In case of early decompression post-operative nausea, vomiting and abdominal distention were higher but not significant statistically.Conclusions: Early removal of Ryle’s tube leads to less incidence of respiratory complications and wound complications ultimately early suture removal and less hospital stay. Early removal of Ryle’s tube leads to early resolution of postoperative paralytic ileus indicated by early appearance of bowel sounds and early passage of flatus and stool.

Cosmogenic effects in Mbale chondrite

This article does not have an abstract

Cosmogenic records in the recently fallen Devgaon (H4) chondrite

A stony meteorite fell in the village Devgaon, Bastar district, Chattisgarh, Central India on 2001 February 12. The meteorite was fully covered with fusion crust and weighed about 12 kg. Chemical composition, cosmogenic nuclear tracks, radionuclides and noble gases have been studied to determine its classification, the preatmospheric size and the irradiation history

Defluoridation of Ground Water Using Activated Carbon of Ber (Indian Jujube) Leaves

The present study deals with defluoridation of ground water using activated carbon of ber (Indian jujube) leaves. In this study, Activated Ber leaves carbon (ABLC) prepared by heating the leaves in electric furnace was found to be useful for the removal of fluoride. Batch experiments were applied on water sample to study the influence of pH, adsorbent dose and contact time on adsorption efficiency. Fluoride removal reached a maximum of 72.5% by particle size 0.3mm of ABLC at pH 6.0. The adsorption of fluoride from aqueous solution with ABLC followed Freundlich equation. The values of adsorption capacity (K) and intensity of adsorption (1/n) indicate greater affinity for fluoride. Thermally activated Ber leaves carbon (ABLC) was good adsorbent

Solar cosmic ray produced noble gases and tracks in lunar fines 10084 and 14163

This article does not have an abstract

Identification of Adult Mouse Neurovirulence Determinants of the Sindbis Virus Strain AR86

Sindbis virus infection of mice has provided valuable insight into viral and host factors that contribute to virus-induced neurologic disease. In an effort to further define the viral genetic elements that contribute to adult mouse neurovirulence, the neurovirulent Sindbis virus strain AR86 was compared to the closely related (22 single amino acid coding changes and the presence or absence of an 18-amino-acid sequence in nsP3 [positions 386 to 403]) but avirulent Girdwood strain. Initial studies using chimeric viruses demonstrated that genetic elements within the nonstructural and structural coding regions contributed to AR86 neurovirulence. Detailed mapping studies identified three major determinants in the nonstructural region, at nsP1 538 (Ile to Thr; avirulent to virulent), an 18-amino-acid deletion in nsP3 (positions 386 to 403), and nsP3 537 (opal to Cys; avirulent to virulent), as well as a single determinant in the structural genes at E2 243 (Leu to Ser; avirulent to virulent), which were essential for AR86 adult mouse neurovirulence. Replacing these codons in AR86 with those found in Girdwood resulted in the attenuation of AR86, while the four corresponding AR86 changes in the Girdwood genetic background increased virulence to the level of wild-type AR86. The attenuating mutations did not adversely affect viral replication in vitro, and the attenuated viruses established infection in the brain and spinal cord as efficiently as the virulent viruses. However, the virus containing the four virulence determinants grew to higher levels in the spinal cord at late times postinfection, suggesting that the virus containing the four attenuating determinants either failed to spread or was cleared more efficiently than the wild-type virus

Pattern recognition receptor MDA5 modulates CD8+ T cell- dependent clearance of west nile virus from the central nervous system

Many viruses induce type I interferon responses by activating cytoplasmic RNA sensors, including the RIG-I-like receptors (RLRs). Although two members of the RLR family, RIG-I and MDA5, have been implicated in host control of virus infection, the relative role of each RLR in restricting pathogenesis in vivo remains unclear. Recent studies have demonstrated that MAVS, the adaptor central to RLR signaling, is required to trigger innate immune defenses and program adaptive immune responses, which together restrict West Nile virus (WNV) infection in vivo. In this study, we examined the specific contribution of MDA5 in controlling WNV in animals. MDA5(−/−) mice exhibited enhanced susceptibility, as characterized by reduced survival and elevated viral burden in the central nervous system (CNS) at late times after infection, even though small effects on systemic type I interferon response or viral replication were observed in peripheral tissues. Intracranial inoculation studies and infection experiments with primary neurons ex vivo revealed that an absence of MDA5 did not impact viral infection in neurons directly. Rather, subtle defects were observed in CNS-specific CD8(+) T cells in MDA5(−/−) mice. Adoptive transfer into recipient MDA5(+/+) mice established that a non-cell-autonomous deficiency of MDA5 was associated with functional defects in CD8(+) T cells, which resulted in a failure to clear WNV efficiently from CNS tissues. Our studies suggest that MDA5 in the immune priming environment shapes optimal CD8(+) T cell activation and subsequent clearance of WNV from the CNS

Sunstein, Statutes, and the Common Law – Reconciling Markets, the Communal Impulse, and the Mammoth State

Professor Cass Sunstein\u27s new book, After the Rights Revolution: Reconceiving the Regulatory State, builds upon, and in important ways seeks to integrate, much of Professor Sunstein\u27s work over the past several years. He has been one of our most prolific and influential writers on issues of governmental structure, approaching the subject both from more or less conventional administrative law perspectives and from the constitutional perspectives of separation of powers. His work has dealt with a tension often addressed in the literature, that between the eighteenth-century Madisonian constitutional engine of limited, internally checked government and the realities of our sprawling contemporary structures. A particular contribution of Sunstein\u27s has been to insist on bringing forward the Madisonian visions, on their accommodation, not their abandonment. This contribution entails rather vigorous disagreement with the economics-driven theorists of public choice, on the right, and those of deconstructionism, on the left. Sunstein wants to build a conceptual framework for contemporary government that embraces the Madisonian ideal of government structured to serve genuinely public ends in face of the risk of faction; that vision entails both reaching agreement on appropriate distinctions between public and private ends, and finding effective contemporary expression of such ideas as checks and balances

Cosmogenic effects in Mbale, L5/6 chondrite

Measurements of particle tracks, cosmogenic radionuclides, and rare gas isotopes in Mbale indicate that the meteoroid had a simple, one-stage exposure for 30.2 Ma in interplanetary space. On the basis of the measured track production rates and 60Co and 26Al activities, the meteoroid is estimated to be a sphere with a radius of &#8776; 36 cm. The activities of several cosmogenic radionuclides (i.e., 57Co, 54Mn, 22Na, 44Ti, and 26Al) in two fragments having different shielding, as estimated by their track density and 60Co activity, provide the depth variation in their production rates. Cobalt-57, 54Mn and 22Na activities agree with the production that is expected around the maximum of the solar cycle 22 as calculated from the Sunspot numbers. The U, Th-4He and K-40Ar ages are measured to be 0.54 Ga indicating a late thermal event which is in agreement with the thermal history of some other L group chondrites. The trapped N has &#948; 15N of -57 &#177; 4%o, which is much lighter than the average L-group chondrite value; this indicates the presence of an isotopically anomalous light N component