MHD Flow with Slip Effects and Temperature-dependent Heat Source in a Viscous Incompressible Fluid Confined between a Long Vertical Wavy Wall and a Parallel Flat Wall

This study examines the problem of an MHD free convection flow in the presence of a temperaturedependent heat source in a viscous incompressible fluid between a long vertical wavy wall and a parallel flat wall with constant heatflux and slip flow boundary condition. A uniform magnetic field is assumed to be applied perpendicular to the walls. It is assumed that the flow consists of two parts; amean part and aperturbedpart. Expressions for the zeroth-order and first-order velocity, temperature, skin friction, and Nusselt number at the wal lr ;ire obtained. The effects of different parameters entering into the problem, viz., free convection parameter, magnetic parameter, and heat source parameter on the zeroth-order and first-order velocity fields, temperature field, skin friction, and Nusselt number at the walls are shown graphically and discussed numerically

Seasonal variation of ambient air quality at selected sites in Agra city

127-133The seasonal variation in the ambient air concentration of SO2, NO2 and suspended particulate matter (SPM) in the urban atmosphere of Agra, India, during the year 1998-99, has been reported. The city was hypothetically divided into six monitoring zones. The maximum concentrations of SO2, NO2 and SPM were observed at Foundry Nagar and St. John's crossing. However, the minimum concentrations of SO2 and NO2 were observed at Dayalbagh, while the SPM concentration were minimum at Tajganj region. The value of SPM was always found higher than the prescribed limit of 100 μgm-3, while the values of SO2 and NO2 were found within the permissible limits, except sometimes in winter seasons, which may be due to thermal inversion. The value of monthly average pollutant standard index (PSI) has also been reported. The value varies from 127 to 497 in Agra

Comparative study to assess the quality of analgesia of bupivacaine and bupivacaine with dexmedetomidine in ultrasound-guided pectoral nerve block type I and II in breast surgeries

Background and Aims: Dexmedetomidine has been demonstrated to be safe and efficacious in prolonging the duration of peripheral nerve blocks. This study was designed to compare the duration, quality of postoperative analgesia, hemodynamic stability, and patient's satisfaction with addition of dexmedetomidine to bupivacaine versus plain bupivacaine in pectoral nerve block (Pecs) type I and II in breast surgeries. Material and Methods: This prospective randomized double-blind study was carried out in 60 American Society of Anesthesiologists grade I–III female patients, aged 18–70 years randomly allocated into two equal groups. Group A received 10 ml 0.25% bupivacaine for pecs I block and 20 ml 0.25% bupivacaine for pecs II block. Group B received 10 ml 0.25% bupivacaine with dexmedetomidine for pecs I block and 20 ml 0.25% bupivacaine with dexmedetomidine in pecs II block, keeping a total dose of dexmedetomidine of 1 μg/kg body weight and the volume constant in both the groups. Results: Numerical rating scores at rest and on abduction of arm were significantly lower in Group B. There was a 40% increase in duration of complete analgesia in dexmedetomidine group (1024.0 ± 124.9 min) compared to plain bupivacaine (726.4 ± 155.3 min; P < 0.001). Total consumption of injection diclofenac sodium in 24 h was 23% less in Group B (77.5 ± 13.6 mg) compared to Group A (100.0 ± 35.9 mg, P = 0.003). Patient satisfaction score was significantly better in dexmedetomidine group. No adverse effects were noted in either group. Conclusion: Dexmedetomidine as an adjunct to bupivacaine helps prolong the duration and improves the quality of postoperative analgesia in pecs I and II block without serious side effects

Expression of p53 and bcl2 in squamous cell carcinoma of head and neck

Background: Head and neck squamous cell carcinoma (HNSCC) is the sixth-most common malignancy worldwide. Despite advances in radiotherapy and surgical treatment, survival rates have not changed significantly in the last 40 years. Molecular markers are currently being identified that can determine prognosis preoperatively by routine tumor biopsy, lead- ing to improved management of HNSCC patients. Aim: The aim of the present study was to demonstrate the expression of p53 and bcl2 proteins in squamous cell carcinoma of head and neck (HNSCC) and to correlate the expression of p53 and bcl2 with clinical staging (AJCC) and WHO histological grading of SCC. Materials and methods: The study population comprised 50 cases of HNSCC. Tissue sections from these cases were subjected to hematoxylin and eosin (H and E) and immunohistochemical (IHC) staining using p53 and bcl2, and a comparative analysis of the results was performed. Cases of colon carcinoma and benign lymphoid hyperplasia were used as positive controls for p53 and bcl2, respectively. Results: Positivity for p53 was recorded in 30 cases (30/50), while positivity for bcl2 was recorded in 44 cases (44/50). Positivity for p53+/bcl2+ coexpression was seen in 28 cases (28/50). The frequency of p53 expression was associated with tumor histologic grade (p=0.02), increasing lymph node involvement (p=0.01), and clinical stage (p=0.038). The frequency of bcl2 expression was associated with histological grade (p=0.02) and increasing lymph node involvement (p=0.028), but not with clinical stage (p=0.242). Moreover, the combined p53+/bcl2+ expression was significantly associated with histo- logical grade (p=0.02) and lymph node involvement (p=0.01). Conclusion: Study of p53 and bcl2 expression may provide clinicians with more exact information in order to evaluate tumor aggressiveness and survival rates. [Arch Clin Exp Surg 2016; 5(3.000): 160-168

Assessment of In-Vitro Synergy of Fosfomycin with Meropenem, Amikacin and Tigecycline in Whole Genome Sequenced Extended and Pan Drug Resistant <i>Klebsiella Pneumoniae</i>: Exploring A Colistin Sparing Protocol

Fosfomycin has emerged as a very useful antimicrobial in management of extremely drug resistant (XDR) and pan drug resistant (PDR) Klebsiella pneumoniae. In this study, we assessed in-vitro synergy of colistin sparing combinations of fosfomycin (FOS) with meropenem (MEM), tigecycline (TGC) and amikacin (AK) against XDR and PDR Klebsiella pneumoniae. Method: Non-replicate fully characterised 18 clinical isolates of K. pneumoniae (15 XDR and 3 PDR strains) were subjected to in-vitro synergy testing by checkerboard and time kill assay. Combinations tested were FOS-MEM, FOS-TGC and FOS-AK with glucose-6-phosphate being incorporated in all runs.WGS was carried out on the Illumina next-generation sequencing platform. Results: FOS-MEM and FOS-AK both demonstrated excellent synergy against all PDRs and all but one XDR. Synergy led to lowering of MICs to susceptible breakpoints. FOS-TGC demonstrated antagonism. MLST-231 K. pneumoniae predominated (14), followed by ST-395 (3) and ST147 (1). Majority harboured OXA-232 (n = 15), while n = 2 carried NDM-1 type and n = 1 co-carried NDM-5 + OXA-232. Mortality was high in both ST-231 (57.1%) and ST-395 (66.6%). Synergy was observed despite widespread presence of resistance markers against aminoglycosides [aph(3′)-Ic, aacA4, and rmtf], beta-lactams [blaSHV-11, blaTEM-1b, blaCTX-M-15, and blaOXA-232], fosfomycin [fosA6 and fosA5] and presence of porin proteins OmpK37, OmpA and K. pneumoniae antibiotic efflux pumps Kpn F, H, G, and E. Conclusion: FOS + MEM and FOS + AK are excellent colistin sparing combinations against ST 231, ST-395 and ST-147 XDR and PDR K. pneumoniae. FOS with fewer side effects than colistin, excellent tissue distribution and minimal side effects may be recommended in combination with meropenem

Implementation of community based advance distribution of misoprostol in Himachal Pradesh (India): lessons and way forward

Abstract Background Postpartum Hemorrhage remains the leading cause of maternal mortality. To prevent PPH, Misoprostol tablet in a dose of 600 micrograms is recommended for use immediately after childbirth in home deliveries wherein the use of oxytocin is difficult. The current article describes an implementation of “community based advance distribution of Misoprostol program” in India which aimed to design an operational framework for implementing this program. Methods The intervention was carried out in Janjheli block in Mandi district of the state of Himachal Pradesh which is a mountainous terrain with limited geographical access and reported 90% home deliveries in the year 2014–15. An operational framework to implement program activities was designed which was based on WHO HSS building blocks. Key implementing steps included- Ensuring local ownership through program leadership, forecasting and procurement of 600 mcg misoprostol tablets, training, branding and communication, community engagement and counselling, recording and reporting, monitoring, supportive supervision and feedback mechanisms. Results Over the one year of implementation, 512 home deliveries were reported, out of which 89% received the tablets and 84% consumed the tablet within one minute of delivery. No incidence of PPH in tablet consuming mothers was reported. On account of periodic counselling and effective community engagement the intervention also contributed to better tracking of pregnancies till delivery and institutional delivery rates which increased to 93% from 45% and 57% from 11% respectively as compared to the preceding year. Conclusions The model has successfully shown the use of single misoprostol tablets of 600 mcg, first time in this program. We also demonstrated a HSS based operational framework, based on which the program is being scaled to additional blocks in Himachal Pradesh as well as to other states of India