Randomised Control Study Comparing the Haemodynamic Changes to Intubation using Levitan Optical Stylet alone Versus Intubation using Levitan Optical Stylet along with Macintosh Laryngoscope

Endotracheal intubation and laryngoscopy are very essential tools in the hands of anaesthesiologist in maintaining airway. Airway management is the fundamental aspect of anaesthetic practice, emergency and critical care medicine. Endotracheal intubation incur haemodynamic responses like increase in heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure. Since the upper airway is highly innervated, airway instrumentation results in significant haemodynamic responses. Anaesthesiologist found a technique of intubation which minimized the stimulation of the upper airway. Levitan optical stylet gained its importance, since its introduction by Dr. Richard Levitan. The shorter length resembles standard stylet making it useful in every laryngoscopy, handling and shaping of the tracheal tubewhile offering a fibreoptic intubation and immediate visual confirmation of intratracheal placement. The primary objective of this study was to compare the haemodynamic responses to intubation using Levitan optical stylet alone versus intubation using levitan optical stylet along with Macintosh laryngoscope. Secondary outcome measures the ease of intubation, intubation time with two techniques, complications and failure rate. We recruited 80 patients in this prospective study, after obtaining ethical committee approval. These patients were aged between 18-60 yrs belonging to ASA I and ASA II with MPC I and MPC II and thyromental distance >6.5 cm. Hypertensive patients, difficult airway and cardiovascular patients were excluded from the study. They were divided into two groups. Group A – intubation carried with Levitan optical stylet, Group B - intubation carried out with Levitan optical stylet along with Macintosh laryngoscope. These patients were evaluated for the haemodynamic responses at preintubation, postintubation (0min), 1min, 3min, 5min and 10 min respectively. The time taken for intubation, ease of intubation in both the groups were also noted down. Postoperatively patients were monitored for complications such as sorethroat, hoarseness of voice and bleeding. These results were tabulated and analysed using SPSS software version 22. The two groups were comparable in terms of age, weight and sex. Other parameters such as ASA, thyromental distance, interincisor gap were also comparable. The stress response associated with endotracheal intubation was more with group B (patients intubated with Macintosh laryngoscope) than with group A (intubation with Levitan alone) at post intubation 0min,1min and 3 min as the p valve was 0.00. The mean time taken for intubation in group A (55 seconds) was longer than group B (20 seconds) and the p value was 0.00 and found to be statistically significant. The success rate of intubation in group B was 100% whereas in group A was 95%. The failure rate of intubation was 5% in group A. No serious complications were encountered in both the groups. Hence we concluded that Levitan optical stylet was more superior than conventional Macintosh laryngoscope in the aspect of haemodynamic responses

WHO OGCT as a Diagnostic Test For Gestational Diabetes Mellitus

INTRODUCTION: Diabetes Mellitus is a clinical syndrome characterized by hyperglycemia due to absolute or relative deficiency of insulin. Lack of insulin whether absolute or relative affects the metabolism of carbohydrate, protein, fat. Pregnancy is characterised by mild fasting hypoglycemia, post prandial hyperglycemia, hyper insulinism and insulin resistance- a diabetogenic stress. Normally pregnant woman elaborates an increased insulin production by 30% above her non pregnant state. A woman who is unable to achieve adequate insulinogenic compensation develops Gestational Diabetes. Pregnancy unmasks the minor intolerance of carbohydrate metabolism in subjects with reduced pancreatic islet cell reserve. Gestational Diabetes was defined as carbohydrate intolerance of variable severity with its onset or first recognition during pregnancy. Use of this term was encouraged in order to communicate the need for increased surveillance and to convince the woman of the need for further testing postpartum. Gestational Diabetes is often asymptomatic and associated with increased fetal and neonatal morbidity and mortality. Good glycemic control reduces the risk of complication. AIM OF THE STUDY: 1. To find out whether 2 hours 75g WHO OG CT is as efficacious as 2 hours 75g WHO OGTT in detecting gestational diabetes mellitus in antenatal population between 16 – 32 weeks. 2. To analyse fetal outcome in GDM patients. MATERIALS AND METHODS: Place of Study : Institute of Obstetrics and Gynaecology, Egmore. Year of Study : 2005 – 2006. Nature of Study : Prospective Study. Selection of Cases : 800 pregnant women between 16 – 32 weeks were randomly Selected irrespective of parity, age Previous obstetric outcome. Inclusion Criteria : 1. All the women with gestational age by history and clinical examination between 16 to 32 weeks were included in this study. 2. Women who were not sure of the last menstrual period and whose clinical examination was inappropriate had an ultrasound examination and when the period of gestation was between 16 – 32 weeks were included in this study. Exclusion Criteria : 1. Women who were not within 16-32 weeks of gestation were excluded from the study. 2. Women who were already pregestational diabetes were excluded. Method : Pregnant women who were selected with the above criteria had urine glucose and albumin estimation done.Complete and careful clinical history was taken with regard to menstrual cycles, previous obstetric history, family history. Complete clinical examination was done. Ultrasound examination was done to ruleout congenital anomalies, to detect hydramnios and macrosomia. Patients were subjected to WHO OGCT .75g glucose was given in 200ml of water. 2 hour later 1 cc of venous blood was drawn in a test tube containing EDTA and immediately sample was taken for plasma glucose analysis. Following the glucose drink patients were prohibited from eating food or drinking except water. Same patients were instructed to come 2 days later after regular diet consumption with over night fasting of 8 hours and 2 hrs 75g WHO OGTT was done. The sensitivity and specificity of WHO OGCT in diagnosing GDM is estimated by statistical analysis of plasma glucose values. SUMMARY: 1) In 800 Randomly selected patients who attended our antenatal clinic prevalence of GDM was found to be 10.89% by WHO criteria. 2) 2 hr 75g WHO OGCT was performed on all 800 patients attending our antenatal clinic between 16-32 weeks since ethnically Indian belong to a high risk group. 3) Out of 100 non GDM patients between 16-20 weeks only 51 reported reassessment at 24-28 weeks and 30 reported for reassessment at 32 weeks. Out of 154 non GDM patients at 21-24 weeks, 100 reported for reassessment at 24 weeks and 57 reported for reassessment at 32 weeks. Out of 196 non GDM patients at 25-28 weeks only 97 came for reassessment at 32 weeks. This demonstrates the phenomenon of no show. 4) In our study it was found that all the patients who were diagnosed as GDM by WHO OGTT gave positive results with WHO OGCT. Thus sensitivity and specificity of WHO OGCT is 100%. WHO OGCT is useful as a diagnostic test for GDM. No show is not possible in first visit. 5) In our study it was found that i) As age increases the prevalence of GDM increases, ii) As number of gravida increases prevalence of GDM increases, iii) As BMI increases prevalence of GDM increases, iv) Positive family history predicts the higher risk of developing GDM, v) Macrosomia was seen in 20.69% of GDM patients. Hydramnios 2.3% in GDM Patients, PIH 16.09% in GDM Patients, Macrosomia 20.69% in GDM Patients Caesarean section rate 49.23% in GDM Patients, Hypoglycemia 29.23% in GDM Patients, Hypocalcemia 20% in GDM Patients, Hyperbilirubinemia 15.38% in GDM Patients, RDS 9.2% in GDM Patients. Among mothers whose babies had macrosomia 13 were on insulin and 5 were on medical nutrition therapy. 6) Hence early detection of gestational diabetes and effective management to maintain optimal blood glucose levels will drastically reduce maternal morbidity due to gestational diabetes and bring about a definite reduction in perinatal mortality rate. CONCLUSION: 1) Screen pregnant women universally for gestational diabetes. 2) 2 hr 75g WHO OGCT can be used to diagnose GDM and is as efficacious as 2 hr 75g WHO OGTT. More studies are needed before clinical application can be made. 3) To detect Gestational Diabetes Mellitus early. 4) Inspite of treatment 20.69% of GDM patients had macrosomic babies. In infants of GDM patients RDS was seen in 9.2%, hypoglycemia was seen in 29.23%,. hyperbilirubinemia was seen in 15.38%. So more stringent treatment of GDM will improve perinatal outcome. Screening universally for GDM improves the perinatal outcome, postpones the onset of diabetes in mother and also has a role in primary prevention of diabetes in offspring

An FPGA based Efficient Fruit Recognition System Using Minimum Distance Classifier

The paper deals with a simple yet effective fruit identification system developed on an FPGA, SPARTAN 3(XC3S200-5PQ208) platform .The fruits under consideration were apple, banana, sapodilla and strawberry. Out of these selected fruits there were four different classes of apples, two different classes of sapodillas and one class each of the other two fruits. A total of 800 color images, 200 images of each fruit of size 64x64 were used for training. The fruit identification success rate mainly depends on the feature vector and the Classifier used. The 3D feature vector incorporates two first order statistical features and the shape feature. Using the 3D feature vector the MATLAB analysis of The Minimum Distance Classifier (MID) fetched a success rate of 85%.The Verilog coded Hardware platform was developed by burning the COE file of a Test image generated by JAVA ECLIPSE IDE onto the IP core. The MATLAB results were verified using the Hardware Platform. Keywords: RGB image, feature vector, MID, Verilog, FPGA, IP core, COE file

Development and validation of integrated pest management modules against spotted pod borer Maruca vitrata Fabricius on garden bean Lablab purpureus var. typicus (L.)

To reduce the detrimental effect of insecticides, an effective Integrated Pest Management (IPM) module is necessary for the eco-friendly management of Maruca vitrata in garden bean ecosystem. Two field trials were carried out to evaluate the efficacy of different insecticides and botanicals against M. vitrata on Lablab purpureus var. typicus. Two seasons field evaluation of insecticides revealed that chlorantraniliprole 18.5 SC  was the most effective treatment to control the pest recorded 0.11 and 0.36 larva/plant in two seasons, respectively after two rounds of spray followed by flubendiamide 20 WG (0.46 and 0.92 larva/ plant) and emamectin benzoate 5 SG (0.50 and 0.95 larva/plant). Among botanicals tested, commercial neem formulation and 5% Ageratina adenophora recorded the least larval count of 1.64 & 1.05 larva/plant and 2.24 & 1.45 larva/plant in two seasons, respectively. IPM modules were developed with three effective insecticides (chlorantraniliprole 18.5 SC, flubendiamide 20 WG and emamectin benzoate 5 SG), two effective botanicals (commercial neem formulation 1500 ppm and 5% A. adenophora) along with the pheromone trap for validation. All the IPM modules were equally effective in managing M. vitrata population on L. purpureus and recorded a significantly (at 5 %) lower larval population than the farmer’s practice. The residues of chlorantraniliprole, flubendiamide and emamectin benzoate reached below the detectable level at the time of harvest. The population reduction of predatory coccinellids and spiders was also lower in IPM modules than in farmer’s practice. An increased benefit cost (1.95 to 1.99) ratio was observed in IPM modules. 

Pole harvesting - A skillful operation in oil palm fresh fruit bunch (FFB) harvest

The study demonstrates the importance of skilled pole harvester (PH). Skill in pole harvesting ultimately reduces the human drudgery, time and cost involved in rope and cutlass harvest (RCH) while harvesting oil palm fresh fruit bunches (FFBs). Comparative cumulative harvesting activities in FFB harvest apparently showed that average number of strokes for frond(s) and FFB harvest by skilled PH (8.6) were less than unskilled PH (22.0). The slashing time required to harvest FFB was less in case of skilled PH (2.1 min) compared with RCH (3.2 min.) and unskilled PH (17.8 min.) which eventually is reflected in total slashing and harvesting time for 1 MT FFBs. The difficulty experienced by unskilled PH was likely to be more than RCH and skilled PH method of harvest

Employee Empowerment

The work done by the human resource in healthcare are the key to bringing about patient healing. As the tasks that each of the different human resource healthcare professionals have to do is quite enormous and varied and differs from patient to patient depending upon their unique needs it is also equally challenging to train the staff. The concept of employee empowerment is therefore extremely critical for staff to do what requires to be done for patients in a timely manner keeping the best interest of the patient in the mind. This article takes a thorough look at this concept as well as how it is measured. Its application is also discussed taking the example of the Aravind Eye Hospital

Clinicians as Secondary Users of Patient-Centered Mobile Technology in Complex Healthcare Settings

This paper describes the preliminary research findings and prototype development of a Personal Health Record mobile application. A pilot study about patient-clinician interaction guided by common ground theory was performed. The goal of the pilot study was to gather requirements to support development of a smartphone application to be used in a future experimental study. Findings from the pilot study suggest that smartphones could be used to manage health information considered important for a successful healthcare consultation