Prospective Randomised Comparison of LMA - Supreme and Endotracheal Tube in Elective Laparoscopic Gynaecological Surgeries

INTRODUCTION: Supraglottic airway devices have become a standard fixture in airway management filling a niche between the face mask and tracheal tube in terms of both anatomical position and degree of invasiveness. These devices sit outside the trachea but provide a hands free means of achieving a gas tight airway. Originally created as hands free replacement for the face mask, the LMA has gone on to replace endotracheal tubes as the preferred airway in millions of cases each year. This remarkable shift has occurred for number of reasons including ease of placement, lower drug requirement, reduced hemodynamic response, smoother emergence and lower incidence of sore throat. Though LMA provided all the above advantages, the risk of gastric distension, pulmonary aspiration of gastric contents and fear of inadequate ventilation acted as a deterrent to the widespread use of LMA. To overcome the above complications Dr. Archie Brain designed the new airway device, LMA – Supreme in 2007, with the modifications to separate the respiratory and gastro intestinal tract. It represents the most advanced laryngeal airway yet developed by Archie Brain, the inventor of original LMA airway, the LMA Classic. Laparoscopic surgery or more appropriately minimal access surgery is well established since last two decades. General anaesthesia with controlled ventilation remains the gold standard technique for laparoscopic surgeries. The ETT has been proved to be a reliable method of securing the airway and is considered the standard of care for protecting the airway from aspiration. They carry an inherent risk of patient trauma, from vocal cord injury to pharyngeal soft tissue injury and also produces hemodynamic responses to rigid laryngoscopy. Because of ease on insertion and reduced trauma, LMA airways have replaced ETT in many procedures. With its integrated gastric tube and verifiable placement, the LMA Supreme is an even more effective alternative. LMA Supreme is a new airway device that combines the different features of its predecessors. It is curved like the LMA-Fastrach, it offers gastric access like LMA- Proseal and it is of single use like LMA- Unique. The LMA-Supreme forms two seals: an effective first seal with the oropharynx (oropharyngeal seal) and an innovative second seal with the upper oesophageal sphincter (the oesophageal seal). The optimised distal tip with gastric access functionally separates the digestive and respiratory tracts thus effectively protecting against regurgitation and gastric distension. With this background this study was conceptualized to compare the performance of LMA- Supreme and Endotracheal tube in elective laparoscopic gynaecological surgeries. AIM OF THE STUDY: To evaluate the advantages and disadvantages of LMA- Supreme (LMA-S) over Endotracheal tube (ETT) for general anaesthesia in women coming for laparoscopic gynaecological surgeries in terms of the following parameters. 1. Ease of insertion of airway device. 2. No. of attempts for insertion of airway device. 3. Time taken for insertion of airway device. 4. Ease of insertion of gastric tube. 5. No. of attempts for insertion of gastric tube. 6. Gastric distension. 7. Haemodynamic responses. 8. Capnography. 9. Blood staining of devices. 10. Incidence of complications. MATERIALS AND METHODS: It was a prospective, randomised, single - blinded, case - controlled study conducted in the Department of Anaesthesiology, Kasturba Gandhi Hospital, Chennai. 60 adult patients satisfying the inclusion criteria were enrolled in the study. INCLUSION CRITERIA: 1. Age : 18 years and above. 2. Weight : BMI < 30 kg/m2. 3. ASA : I & II. 4. Surgery : Elective. 5. Mallampatti scores : I & II. 6. Who have given valid informed consent. EXCLUSION CRITERIA: 1. Not satisfying inclusion criteria. 2. Patients posted for emergency surgery. 3. Patients with difficult airway. 4. Lack of written informed consent. 5. Pregnant female. MATERIALS: 1. LMA Supreme size 3 & 4. 2. Endotracheal tubes- 7 & 7.5 mm CETT. 3. Macintosh laryngoscope with blade size 3. 4. 20 ml syringe. 5. Lubricant jelly, 14 Fr orogastric tube. 6. Drugs: glycopyrolate, fentanyl, midazolam, ondansetron, propofol, atracurium, sevoflurane, neostigmine. 7. Monitors: ECG, Pulse oximetry, Capnography, NIBP. 8. Weighing machine calibrated to 1 kg. OBSERVATION AND RESULTS: This prospective, randomized, comparative, single blinded case control study compares LMA-Supreme insertion with Endotracheal tube in 60 adult females undergoing elective laparoscopic gynaecological surgery. Results are expressed as mean and standard deviation. All statistical analyses were carried out using SPSS for Windows version 15.0. The t-test was used for comparison of quantitative variants. Qualitative variants were compared using the chi-squared test. A P value of less than 0.05 was considered statistically significant. SUMMARY: From this Prospective, Randomised, Comparative single blinded case control study which evaluated the effectiveness of LMA-S and ETT, it is found that, 1. Both LMA-S and ETT were intubated with similar ease (P = 0.314). 2. Number of attempts required for successful insertion of LMA-S was more than that of ETT but not statistically significant. 3. Time taken for insertion of LMA-S was lesser than ETT, which is statistically significant (P <0.001). 4. Ease of insertion of Gastric tube with LMA-S was better than that of ETT, which is statistically significant (P = 0.005). 5. Number of attempts required for successful insertion of gastric tube was lesser with LMA-S than with ETT but not statistically significant. 6. No significant gastric distension occurred intra operatively with both LMA-S and ETT. So, LMA-S provides good oropharyngeal seal and pulmonary ventilation. 7. Both the techniques had no significant differences in SpO2 and EtCO2 before inflation, after inflation and after deflation. Thus LMA-S is also a good airway device for laparoscopic surgeries. 8. Haemodynamically there was a significant difference between two groups with regard to heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure after insertion. LMA-S was found to be a better device in this aspect. 9. Blood staining on LMA-S and ETT were comparable and was not statistically significant. 10. Incidence of post operative sore throat and hoarseness of voice was less with LMA-S than with ETT and was statistically significant. CONCLUSION: LMA-Supreme is an equally effective airway device to ETT in laparoscopic gynaecological surgeries. It has potential advantages like rapid placement, less haemodynamic response, less airway trauma, less pharyngolaryngeal morbidity and better oesophageal seal resulting in reduced risk of gastric distension and aspiration

In situ measurement and management of soil, air, noise and water pollution in and around the Limestone mining area of Yerraguntla, YSR kadapa, Andhra Pradesh, India for the sustainable development

For emerging countries, mining has been a vital factor in employment, economic development, infrastructure, and supply of essential raw materials for Nation’s Gross domestic product (GDP) growth. The Limestone mine industry is serving as a viable route for economic transformation in India.  Limestone exploration causes major damage to the environment at Yerraguntla industrial zone, YSR Kadapa district, Andhra Pradesh, India. The main objective of this study is to evaluate the environmental Pollution parameter that causes Air, Water, Noise, and Soil pollution in and around limestone quarries started in the early 1984. The present study estimated Air Quality Index (AQI) as 76 based on the air quality sub-index approach using four pollutants (PM10, PM2.5, SO2, NOx) for a period of 24 hrs by taking one sample per hour during the post monsoon. Water Quality Index (WQI) obtained as 303.91 from fourteen physicochemical parameters (pH, EC, fluoride, Total alkalinity etc.) measured from water samples. Soil quality was determined using four physicochemical parameters (pH, EC, WHC, Calcium and Magnesium) from the soil samples collected from ten sampling stations. The obtained pH range was (7.6 to 9.4), EC of the soil was determined as 4,140 µs/cm, the water retention capacity of the soil, ranges from (17.68 to 97.68) %, and the Calcium (Ca2+) and Magnesium (Mg2+) ranged from 74.5 to 272.75 mEq/L. Noise levels were determined as 76.64 dB in the mine’s, 58.16 dB in the cement industry, and 52.285 dB in the mine surrounding villages. This study can help mining sector management’s in developing a sustainable Environmental Management frame work to meet the world sustainable development goals  (SDGs)

Find Intruder Application for Smartphone

The Smartphones usage has increased a lot with the advancement in technology coupled withincrease in their computing power. Smart phones are used by many people to store personal datasuch as images, files, contacts, videos and official data like confidential documents. They are also used maintain accounts like Gmail, Facebook, Twitter etc. So the security of smart phones is very important in order to restrict unauthorized access. This application mainly helps to enhance the security of smartphones. It provides real time acknowledgement to the user by sending an SMS and email for the registered mobile number and email id, when someone tries to unlock the mobile.It also provides the image of the persontrying to access the mobile along with the location details

DNA sequence variation and haplotype structure of the ICAM1 and TNF genes in 12 ethnic groups of India reveal patterns of importance in designing association studies

We have examined the patterns of DNA sequence variation in and around the genes coding for ICAM1 and TNF, which play functional and correlated roles in inflammatory processes and immune cell responses, in 12 diverse ethnic groups of India. We aimed to (a) quantify the nature and extent of the variation, and (b) analyse the observed patterns of variation in relation to population history and ethnic background. At the ICAM1 and TNF loci, respectively, the total numbers of SNPs that were detected were 28 and 12. Many of these SNPs are not shared across ethnic groups and are unreported in the dbSNP or TSC databases, including two fairly common non-synonymous SNPs at positions 13487 and 13542 in the ICAM1 gene. Conversely, the TNF-376A SNP that is reported to be associated with susceptibility to malaria was not found in our study populations, even though some of the populations inhabit malaria endemic areas. Wide between-population variation in the frequencies of shared SNPs and coefficients of linkage disequilibrium have been observed. These findings have profound implications in case-control association studies

Histopathological alterations in Senegal sole, Solea Senegalensis, from a polluted Huelva estuary (SW, Spain)

As a component of a large research project to evaluate the effects of contaminants on fish health in the field, histopathological studies have been conducted to help establish causal relationship between pollutants (heavy metals and aromatic polycyclic hydrocarbons—PAHs) and histopathological responses in Senegal sole, Solea senegalensis, from an estuary of SW Spain. Heavy metals (As, Zn, Cd, Pb, Cu and Fe) and 16 PAHs (proprietary USEPA) concentrations in water, sediment and tissues (liver and gills) and histopathological alterations in S. senegalensis from three sampling sites of Ria de Huelva estuary during 2004–2006 years have been analysed. The histopathological studies revealed seasonal and spatial differences in the lesion grade of alterations observing the highest lesion grades in fish from Odiel River and autumn season. No significant differences were observed in the alterations prevalence between sampling sites, but significant differences were observed between seasons observing the highest prevalence in autumn season. However, calculated IPAT demonstrated a low–moderate impact of pollutants on health fish. Correlations between histopathological alterations and pollutants analysed were observed being heavy metals the group that presented a major number of correlations with alterations in several organs of S. senegalensis. In evaluating the general health of fish, the use of histopathological studies in recommended for making more reliable assessment of biochemical responses in fish exposed to a variety of environmental stressors. Statistical analysis using semiquantitative data on pathological lesions can help to establish correlation between cause (stressor) and effect (biomarker)

Silencing COI1 in Rice Increases Susceptibility to Chewing Insects and Impairs Inducible Defense

The jasmonic acid (JA) pathway plays a key role in plant defense responses against herbivorous insects. CORONATINE INSENSITIVE1 (COI1) is an F-box protein essential for all jasmonate responses. However, the precise defense function of COI1 in monocotyledonous plants, especially in rice (Oryza sativa L.) is largely unknown. We silenced OsCOI1 in rice plants via RNA interference (RNAi) to determine the role of OsCOI1 in rice defense against rice leaf folder (LF) Cnaphalocrocis medinalis, a chewing insect, and brown planthopper (BPH) Nilaparvata lugens, a phloem-feeding insect. In wild-type rice plants (WT), the transcripts of OsCOI1 were strongly and continuously up-regulated by LF infestation and methyl jasmonate (MeJA) treatment, but not by BPH infestation. The abundance of trypsin protease inhibitor (TrypPI), and the enzymatic activities of polyphenol oxidase (PPO) and peroxidase (POD) were enhanced in response to both LF and BPH infestation, but the activity of lipoxygenase (LOX) was only induced by LF. The RNAi lines with repressed expression of OsCOI1 showed reduced resistance against LF, but no change against BPH. Silencing OsCOI1 did not alter LF-induced LOX activity and JA content, but it led to a reduction in the TrypPI content, POD and PPO activity by 62.3%, 48.5% and 27.2%, respectively. In addition, MeJA-induced TrypPI and POD activity were reduced by 57.2% and 48.2% in OsCOI1 RNAi plants. These results suggest that OsCOI1 is an indispensable signaling component, controlling JA-regulated defense against chewing insect (LF) in rice plants, and COI1 is also required for induction of TrypPI, POD and PPO in rice defense response to LF infestation

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk–outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk–outcome pairs, and new data on risk exposure levels and risk–outcome associations. Methods We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk–outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. Findings In 2017, 34·1 million (95% uncertainty interval [UI] 33·3–35·0) deaths and 1·21 billion (1·14–1·28) DALYs were attributable to GBD risk factors. Globally, 61·0% (59·6–62·4) of deaths and 48·3% (46·3–50·2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10·4 million (9·39–11·5) deaths and 218 million (198–237) DALYs, followed by smoking (7·10 million [6·83–7·37] deaths and 182 million [173–193] DALYs), high fasting plasma glucose (6·53 million [5·23–8·23] deaths and 171 million [144–201] DALYs), high body-mass index (BMI; 4·72 million [2·99–6·70] deaths and 148 million [98·6–202] DALYs), and short gestation for birthweight (1·43 million [1·36–1·51] deaths and 139 million [131–147] DALYs). In total, risk-attributable DALYs declined by 4·9% (3·3–6·5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23·5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18·6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. Interpretation By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning