Utility of Surgical APGAR Score in Predicting Postoperative Morbidity and Mortality in patients Undergoing Laparotomy: A Prospective study

BACKGROUND: Health facilities strive to offer quality surgical care by minimizing postoperative complications. Predicting complications facilitates objective clinical decision making during recovery. Compared to existing morbidity and mortality predictive scores, the Surgical Apgar Score is simple and effective. Morbidity and mortality in patients undergoing laparotomy are high; an effective scoring system can reduce these. OBJECTIVE: To determine the utility of the Surgical Apgar Score in predicting the thirty day major postoperative complications rates for patients undergoing laporotomy. Study Design: Prospective descriptive study. Study Population: 154 patients aged 13 years and above undergoing laparotomy at Madras Medical College & Rajiv Gandhi Govt. General Hospital, Chennai were selected by consecutive sampling until the desired sample size was achieved. Study Duration: March 2016 to September 2016. MATERIAL AND METHODS: Intra operative values of the lowest mean arterial pressure, the lowest heart rate and the blood loss were collected using a questionnaire immediately after surgery and the Surgical Apgar Score was derived for each patient. The occurrence of major complications and the mortality rate was determined during a thirty day period starting immediately after surgery. Data was obtained from the admitting ward, the ICU and surgical outpatient clinic notes. Major complication definitions were according to the one described by Copeland et al. Data collected was entered and analyzed using statistics. P values were generated using t test for means, x2 for comparison of proportions, analysis of variance (ANOVA) and where applicable Fischer’s exact test. Results were presented in graph, tables and charts. RESULTS: 154 patients were recruited of which 2 were lost on follow up. The mean age in this study was 35.18 years. This study had a skewed distribution of gender with 75% of patients being male. The most common reason for laparotomy is penetrating abdominal injury. This is18.4% of the overall cause of laparotomy. It could be seen that emergency laparotomy is the major cause for the development of major postoperative complications when compared to elective laparotomies. Female sex, 40 years or lesser age and surgery time more than 2 hours are other noted factors in our study that was found to be associated with a significantly higher rates of complications. It can be observed in our study that, long duration of surgery and a low mean Surgical Apgar Score is having a strong association. From our study we can interpret that, patients having a SAS 0f 0 – 4 who belong to the high risk group had a higher complication rate of 58.3% when compared with the patients having a score of 8 – 10 who belong to low risk group. This group had a lower complication rate of 16.6%. It was statistically significant too. This clearly demonstrates the efficacy of the Surgical Apgar Score in selecting patients who are at a higher risk of developing major complications from patients who are at an average risk of developing complications. CONCLUSION: Laparotomy surgery is associated with significant morbidity and mortality. The SAS, despite using simple and widely available intra-operative parameters, is useful tool to predict occurrence of 30 day major complications and mortality following laporotomy surgery

Non-axisymmetric Magnetorotational Instabilities in Cylindrical Taylor-Couette Flow

We study the stability of cylindrical Taylor-Couette flow in the presence of azimuthal magnetic fields, and show that one obtains non-axisymmetric magnetorotational instabilities, having azimuthal wavenumber m=1. For Omega_o/Omega_i only slightly greater than the Rayleigh value (r_i/r_o)^2, the critical Reynolds and Hartmann numbers are Re_c ~ 10^3 and Ha_c ~ 10^2, independent of the magnetic Prandtl number Pm. These values are sufficiently small that it should be possible to obtain these instabilities in the PROMISE experimental facility.Comment: final version as accepted by Phys Rev Let

Prospects of tourism through software industries in India

Tourism is an important catalyst emerging as a global phenomenon in the socio-economic development in the modern times. Software industry in India through its business activities promotes tourism as a most profitable industry and also credited with contributing a substantial amount of foreign exchange. Development of Information Technology has transformed the contemporary business environment in the tourism sector. This paper highlights the new dimension of the development of tourism supported by technological progres

Fin Field Effect Transistors Performance in Analog and RF for High-k Dielectrics

The high-k is needed to replace SiO2 as the gate dielectric to reduce the gate leakage current. The impact of a high-k gate dielectric on the device short channel performance and scalability of nanoscale double gate Fin Field Effect Transistors (FinFET) CMOS is examined by 2-D device simulations. DG FinFETs are designed with high-k at the high performance node of the 2008 Semiconductor Industry Association International Technology Roadmap for Semiconductors (ITRS). DG FinFET CMOS can be optimally designed to yield outstanding performance with good trade-offs between speed and power consumption as the gate length is scaled to < 10 nm. Using technology computer aided design (TCAD) tools a 2-D FinFET device is created and the simulations are performed on it. The optimum value of threshold voltage is identified as VT=0.653V with e=23(ZrO2) for the 2-D device structure. For the 2-D device structure, the leakage current has been reduced to 9.47´10-14 A. High-k improves the Ion/Ioff ratio of transistors for future high-speed logic applications and also improves the storage capability.Defence Science Journal, 2011, 61(3), pp.235-240, DOI:http://dx.doi.org/10.14429/dsj.61.69

Dental Prosthetic Status and Prosthetic Need of the Institutionalized Elderly Living in Geriatric Homes in Mangalore: A Pilot Study

Introduction. To promote oral health among the elderly, we need to know their prosthetic status and prosthetic need. Hence, a survey of prosthetic status and need of elderly inmates of old age homes in Mangalore was done. Materials and Methods. A cross-sectional study was undertaken, and 133 subjects aged 60 years and above were examined (54.9% males and 45.1% females). Results. Eighty-eight percent of those examined were fully edentulous, and only 12% had complete dentures; none of the study subjects had partial dentures. Prosthetic status was significantly associated with gender (P = .024), while prosthetic need and gender were not significantly associated (P = .395). Conclusions. A high unmet need for prosthetic care existed among the institutionalized elderly surveyed

Design of Digital Frequency Synthesizer for 5G SDR Systems

The previous frequency synthesizer techniques for scalable SDR are not compatible with high end applications due to its complex computations and the intolerance over increased path interference rate which leads to an unsatisfied performance with improved user rate in real time environment. Designing an efficient frequency synthesizer framework in the SDR system is essential for 5G wireless communication systems with improved Quality of service (QoS). Consequently, this research has been performed based on the merits of fully digitalized frequency synthesizer and its explosion in wide range of frequency band generations. In this paper hardware optimized reconfigurable digital base band processing and frequency synthesizer model is proposed without making any design complexity trade-off to deal with the multiple standards. Here fully digitalized frequency synthesizer is introduced using simplified delay units to reduce the design complexity. Experimental results and comparative analyzes are carried out to validate the performance metrics and exhaustive test bench simulation is also carried out to verify the functionality

Smart Cloud Storage Service in Public Cloud Using Dropbox

Cloud computing is a collection of technologies that have come together with the use of internet, it will serve the customer’s or user’s. While user’s store their data in the cloud it is important that the data should be in a secure manner. For maintaining the data securely we have proposed a scheme which consists of three entities those are users, TPA and the cloud server. Here in the place of cloud server we have used Dropbox. By implementing this concept we will be able to provide security for the data which is stored in the cloud server from the un-authorized access. This concept is applicable for accessing data either in distributed environment or can run the application concurrently by number of cloud users. The main objective is to store the data in the public cloud in an encrypted form rather than in a plain text manner for maintaining data security and confidentiality

Simulation Results of Double Forward Converter

This work aims to find a better forward converter for DC to DC conversion.Simulation of double forward converter in SMPS system is discussed in this paper. Aforward converter with RCD snubber to synchronous rectifier and/or to current doubleris also discussed. The evolution of the forward converter is first reviewed in a tutorialfashion. Performance parameters are discussed including operating principle, voltageconversion ratio, efficiency, device stress, small-signal dynamics, noise and EMI. Itscircuit operation and its performance characteristics of the forward converter with RCDsnubber and double forward converter are described and the simulation results arepresented