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In this paper, a Particle Swarm Optimization (PSO) method for tuning the parameters of multiscale retinex based color image enhancement is presented. The image enhancement using multiscale retinex scheme heavily depends on parameters such as Gaussian surround space constants, number of scales, gain and offset etc. Due to hard selection of these parameters, PSO has been used in order to investigate the optimal parameters for the best image enhancement. The PSO method of parameter tuning adopted for multiscale retinex with modified color restoration (MSRMCR) algorithm achieves very good quality of reconstructed images, far better than that possible with the other existing methods. The presented algorithm is compared with other promising enhancement schemes such as histogram equalization, NASA's multiscale retinex with color restoration (MSRCR), Improved MSRCR (IMSRCR), and Photoflair software. The quality of the enhanced image is validated iteratively using an efficient objective criterion which is based on entropy and edge information of an image. Finally, the quality of the reconstructed images obtained by the proposed method is evaluated using Wavelet Energy (WE) metric. The experimental results presented shows that color image enhanced by the proposed algorithm are clearer, vivid and efficient.

Face detection in an image is a problem that has gained lots of importance in the last decade. Detecting faces is quite simple for human beings because it comes naturally but it is not so easy to teach a computer to detect faces. We divide the detection problem into three steps. The first step is Integral Image [1] which allows the features used by detector to be computed very quickly. The second step is a learning algorithm, based on AdaBoost, which selects a small number of critical visual features from a larger set and yields extremely efficient classifiers [2]. The third step is combining more complex classifiers in a cascade [3] which allows background regions of the image to be quickly discarded while spending more computation on promising face like regions. We conduct extensive experiments on publicly available databases to verify the efficacy of the proposed algorithm. In real time the detector runs at 15 frames per second without resorting to image difference or skin color detection.

Unmanned Air Vehicles (UAVs) have become an intelligent asset for surveillance, target tracking and reconnaissance in both urban and battlefield settings. This paper gives a framework for scale weight selection during feature extraction in aerial images from UAV. Dual-Tree Complex Waveform technique is used to extract rich feature descriptors of keypoints in images so that full phase and amplitude information can be retained at each scale. The scale weights are dependent on image characteristics such as the illumination and the contrast levels. The outcome of the framework shows promising results in terms of less redundancy of salient features from the images and hence improving the computational speed.

Background: It is currently presumed that spinal anaesthesia can compromise respiratory muscle function during carbon dioxide (CO2) pneumoperitoneum. This observational study was designed to delineate the respiratory effects of CO2 pneumoperitoneum under spinal anaesthesia. Patients & Methods: Forty one patients undergoing elective gynecological laparoscopy were administered spinal anaesthesia with 15 mg heavy bupivacaine and 50 mcg of fentanyl. Heart rare, blood pressure, tidal volume, respiratory rate and end tidal CO2 were serially recorded before, during and after the pneumoperitoneum. Arterial blood gas analysis was done before and 20 min after initiation of pneumoperitoneum. Results: The mean heart rate and blood pressure decreased by less than 20% of the preoperative value. The mean tidal volume decreased from 353 ± 81(Standard Deviation) to 299±95 ml, p = 0.032, over the first 9 min after the pneumoperitoneum with a complete recovery towards the base line, 340 ± 72 ml, within 30 min during the surgery. The maximal inspiratory capacity declined from 1308±324 ml to 1067±296 ml at 20 min and recovered to 1187±267 ml, 5min after decompression. There was no observed change in the respiratory rate. Similarly, increase in the end tidal CO2 from 31.68±4.13 to 37.62±4.21 mmHg, p = 0.000, reached a plateau around 15 min and declined after decompression. Arterial carbon dioxide showed a corresponding increase at 20 min without change in arterial to end tidal CO2 difference. All observed changes were within the physiological limits. Conclusion: In a conscious patient undergoing laparoscopy with pneumoperitoneum, under spinal anaesthesia, the preserved inspiratory diaphragmatic activity maintains ventilation and, the gas exchange within physiological limits. Hence it is a safe alternative to general anaesthesia.

In this paper, a new algorithm and a novel architecture suitable for Field Programmable Gate Array (FPGA) implementation of adaptive color image enhancement based on Hue-Saturation-Value (HSV) color space is presented. The contrast and luminance of the color image is enhanced by using saturation feedback. The saturation component is enhanced by stretching its dynamic range to get rich color display. Hue is preserved in order to avoid color distortion. The adaptive luminance enhancement is achieved by using a simple geometric mean filter since traditional arithmetic mean filter tends to lose image detail such as edges and sharpness when compared to geometric mean filter. An efficient architecture for histogram equalization is also developed in order to evaluate the performance of proposed algorithm. The algorithm is implemented on Xilinx Vertex II XC2V2000–4ff896 FPGA device. The pipelining and parallel processing techniques have been adapted in order to speed up the enhancement process. The experimental results show that the color images enhanced by the proposed algorithm are clearer, vivid and efficient.

Face detection is one of the challenging problems in image processing. This paper proposes a novel technique for detecting faces in color images using skin color model algorithm combined with skin likely-hood, skin Segmentation, Morphological operation and Template matching. Color images with skin color in the chromatic and pure color space YCrCb, which separates luminance and chrominance components. A Gaussian probability density is estimated from skin samples, collected from different ethnic groups, via the maximum-likelihood criterion. Adaptive thresholding for segmentation to localize the faces within the detected skin regions. Then, mathematical morphological operators are used to remove noisy regions and fill holes in the skin-color region, so we can extract candidate human face regions. These system is achieve high detection accuracy, high detection speed and reduce the false detecting rate.

Autonomous video surveillance and monitoring has a rich history. A new method for detecting multiple moving objects based on improved background subtraction model and for tracking is based on feature based approach has proposed. Then identified moving objects are also counted, by indexing individually. The proposed algorithm is automatic and efficient in intelligent surveillance applications like vehicles monitoring, event recognition, and crime prevention, etc. The proposed model has proved to be robust in various environments (including indoor and outdoor scenes) and different types of background scenes. Experiments on real scenes show that the algorithm is effective for object detection and tracking.

In this paper, a new technique for the enhancement of color image using multiscale retinex with modified color restoration has been proposed. The basic steps of multiscale retinex algorithm have been analyzed, modified and various operations are performed in an orderly manner. The enhancement effects are visually effective. In addition, it adds true color constancy to an image. The experimental results show that multiscale retinex method based on color restoration technique is an efficient and computationally inexpensive. The proposed method not only provides true color fidelity for poor quality images but also averages the color components to gray value for balancing colors.

In this paper, an adaptive color image enhancement based on geometric mean filter is proposed. The contrast of the color image is enhanced by using saturation feedback from saturation components and incorporating spatial information into luminance components. Hue is preserved in order to avoid color distortion. The adaptive luminance enhancement is achieved by using a geometric mean filter in place of arithmetic mean filter since arithmetic mean filter tends to lose image detail such as edges and sharpness when compared to geometric mean filter. The traditional algorithm uses the arithmetic mean filter which smoothes local variations of luminance and saturation. The reconstructed quality of image using this scheme is generally not satisfactory. In the proposed method, geometric mean filter has been adopted that achieves very good quality reconstructed images, far better than that possible with the arithmetic mean filter. It not only enhances poor quality images but also solves the problem of gray world violation. The experimental results show that color images enhanced by this algorithm are clearer, vivid and efficient.

In this paper, a novel architecture suitable for Field Programmable Gate Array (FPGA) implementation of an adaptive color image enhancement based on Hue-Saturation-Value (HSV) color space is presented. The saturation feedback is used in order to enhance contrast and luminance of the color image. The saturation component is enhanced by stretching its dynamic range. Hue is preserved in order to avoid color distortion. The adaptive luminance enhancement is achieved by using a simple arithmetic mean filter. An efficient architecture for histogram equalization is also developed in order to evaluate the performance of proposed algorithm. The algorithm is implemented on Xilinx Vertex II XC2V2000-4ff896 FPGA device. The pipelining and parallel processing techniques have been adapted in order to speed up the enhancement process. The experimental results show that the color images enhanced by the proposed algorithm are clearer, vivid and efficient.

Recognition of degraded characters is a challenging problem in the field of document image analysis. Two main reasons for degradation of characters are due to noise scanning and intrinsic degradation caused by font variations. The degradation of characters is mostly in the form of characters being broken at several places which hinders their recognition of OCR systems. Many OCRs have been designed which correctly identify fine printed characters without any anomalies. However, very few research works has been reported on the recognition of the degraded character recognition due to its complexity. The efficiency of the OCRs system decreases if the input image is degraded and the characters are broken at several places, which frequently occur in old documents. In this paper, a novel approach based on slope pattern and its spatial relationship is used for recognizing broken characters. The proposed method is based on the computation of slope pattern of the individual characters in eight view-directions and generating image code for each character. The algorithm has been applied on the broken characters with successful results.

Degraded character recognition is a challenging problem in the field of Optical Character Recognition (OCR). The performance of an optical character recognition depends upon printed quality of the input documents. Many OCRs have been designed which correctly identifies the fine printed documents. But, very few reported work has been found on the recognition of the degraded documents. The efficiency of the OCRs system decreases if the input image is degraded. In this paper, a novel approach based on gradient pattern for recognizing degraded printed character is proposed. The approach makes use of gradient pattern of an individual character for recognition. Experiments were conducted on character image that is either digitally written or a degraded character extracted from historical documents and the results are found to be satisfactory.

Mutations in the BRCA1 and BRCA2 genes profoundly increase the risk of developing breast and/or ovarian cancer among women. To explore the contribution of BRCA1 and BRCA2 mutations in the development of hereditary breast cancer among Indian women, we carried out mutation analysis of the BRCA1 and BRCA2 genes in 61 breast or ovarian cancer patients from south India with a positive family history of breast and/or ovarian cancer. Mutation analysis was carried out using conformation-sensitive gel electrophoresis (CSGE) followed by sequencing. Mutations were identified in 17 patients (28.0%); 15 (24.6%) had BRCA1 mutations and two (3.28%) had BRCA2 mutations. While no specific association between BRCA1 or BRCA2 mutations with cancer type was seen, mutations were more often seen in families with ovarian cancer. While 40% (4/10) and 30.8% (4/12) of families with ovarian or breast and ovarian cancer had mutations, only 23.1% (9/39) of families with breast cancer carried mutations in the BRCA1 and BRCA2 genes. In addition, while BRCA1 mutations were found in all age groups, BRCA2 mutations were found only in the age group of A; 5267T -> G) G) and three mutations that have been reported earlier. Interestingly, 185delAG, a BRCA1 mutation which occurs at a very high frequency in Ashkenazi Jews, was found at a frequency of 16.4% (10/61). There was one novel mutation (4866insT) and one reported mutation in BRCA2. Thus, our study emphasizes the importance of mutation screening in familial breast and/or ovarian cancers, and the potential implications of these findings in genetic counselling and preventive therapy.

Background: Although there are many methods for postoperative pain management, implementation may be limited in some settings due to practical or financial constraints. Simple, inexpensive and easily implemented analgesic methods may improve access to effective pain relief. Methods: Fifty patients undergoing truncal vagotomy and gastrojejunostomy for pyloric stenosis secondary to chronic duodenal ulceration were studied in this prospective randomized trial. Subjects were assigned to receive either wound perfusion with 8 mL of 0.25% bupivacaine every 5 hours through a catheter placed subcutaneously or intravenous pethidine 0.2 mg/kg on demand for postoperative pain relief. Postoperative pain scores at rest were measured by visual analog scale and the opioid requirement at 0–12 hours, at 12–24 hours and at 24–36 hours were compared. Changes in respiratory parameters were also compared between the two groups. Results: Pain scores at 0–12 hours were significantly lower in the wound perfusion group compared with the intravenous pethidine group (5.7 ± 1.3 vs. 4.3 ± 1.2, mean ± SD; P

In digital signal processing applications, the convolution with a very long sequence is often required. In order to compute convolution of long sequence, overlap-add method (OLA) and overlap-save method (OLS) can be considered. The OLA and OLS are well known efficient schemes for high-order filtering. The most commonly used implementation for digital filtering algorithms are digital signal processors, special purpose digital filtering chips and application specific integrated circuits (ASICs) for large volumes. In this paper, a high performance, high throughput and area efficient architecture for the field programmable gate array (FPGAs) implementation of block convolution process is proposed. The most significant aspect of the proposed method is the development of a multiplier architecture based on vertical and crosswise structure of ancient Indian Vedic mathematics and embedding it in OLA and OLS methods for improved efficiency. The coding is done in VHDL (very high speed integrated circuits hardware description language) and the FPGA synthesis is done using Xilinx Spartan library. The results shows that OLA and OLS method of block convolution implemented using Vedic multiplication is efficient in terms of area/speed compared to its implementation using conventional multiplier architectures.

Ninety ASA 1 and 2 pregnant women with term singleton pregnancies and no maternal and fetal complications, scheduled for elective or emergency Caesarean section, were randomly allocated to group LT (15 degrees left lateral table tilt, n = 45) and group MD (leftward manual displacement, n = 45). Subarachnoid block was established with a 25-gauge spinal needle at the L3-L4 interspace using 1.5 ml of 0.5% hyperbaric bupivacaine. A median sensory level of T6 was observed in both groups but the incidence of hypotension was markedly lower in group MD when compared to group LT (4.4% vs 40%; p0.001) with a significant reduction in mean (SD) ephedrine requirement (6 (0) vs 11.3 (4.9) mg; p0.001). The mean (SD) fall in systolic blood pressure was 28.8 (7.3) mmHg in group LT and 20 (12.7) mmHg in group MD. The time to maximum fall in systolic blood pressure was similar in both groups (4.5 min). We conclude that manual displacement of the uterus effectively reduces the incidence of hypotension and ephedrine requirements when compared to 15 degrees left lateral table tilt in parturients undergoing Caesarean section.

Background: Procedural discomfort is experienced by patients during the establishment of subarachnoid block even after good preoperative counseling and adequate premedication. To enhance comfort, procedural sedation that would provide good analgesia, faster recovery, and amnesia is necessary. Materials and Methods: Patients with American Society of Anesthesiologists Status I and II posted for elective surgeries under subarachnoid block were premedicated with injection midazolam 0.05 mg/kg and preloaded with 10 ml/kg ringer lactate solution. They were randomized into three groups of 30 each. Group K0.3 received ketamine 0.3 mg/kg, Group K0.4 received ketamine 0.4 mg/kg and Group K0.5 received ketamine 0.5 mg/kg intravenously. University of Michigan sedation score, ease of positioning, prick response, verbal response, hallucinations, recall of procedure, and patient satisfaction were evaluated. Results: There was statistically significant difference in sedation among the three groups. Increased dose necessitated help of two persons to position the patient, which showed statistically significant difference. Verbal response was seen early in Group K0.3 (4.67 ± 2.84 min). There was no recall of experience of subarachnoid block procedure in any of the groups in spite of back muscle contraction or patient movement. Hence, all patients in all three groups were satisfied and were willing to undergo subarachnoid block, if the situation arises. Conclusion: Ketamine in the dose of 0.3 mg/kg provided sufficient sedation for allaying procedural discomfort due to less sedation, less positional difficulty, early verbal response, no hallucinations, no recall of performance of procedure, and good patient satisfaction.

Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis are two forms of a life-threatening skin condition, in which cell death causes the epidermis to separate from the dermis. The syndrome is thought to be a hypersensitivity complex that affects the skin and the mucous membranes. The most well-known causes are certain medications, but it can also be due to infections, or more rarely, cancers. SJS usually begins with fever, sore throat, and fatigue, which is commonly misdiagnosed and therefore treated with antimicrobials. Ulcers and other lesions begin to appear in the mucous membranes, almost always in the mouth and lips, but also in the genital and anal regions. Conjunctivitis of the eyes occurs in about 30% of children who develop SJS. A rash of round lesions about an inch across arises on the face, trunk, arms and legs, and soles of the feet, but usually not the scalp. SJS is a medical emergency that usually requires hospitalization. Treatment focuses on eliminating the underlying cause, controlling symptoms and minimizing complications. Recovery after SJS can take weeks to months, depending on the severity of the condition. If it was caused by a medication, then the medication and others closely related to it has to be avoided permanently.An 18-month-old male child was admitted to a private health setup in Kolar with the complaints of peeling and discoloration of the skin, ulcerations in the oral cavity, eyelids, and genitalia. The parents gave the history of cefotaxime injection being administered to the child for treating typhoid 20 days back. Seven days after the administration of cefotaxime, the child had developed maculo-papular lesions all over the body. Later on there was peeling and discoloration of the skin. Itching was present. Ulcerations in the oral cavity, eyelids and genitalia were also noticed by the parents, who then brought the child to the health care center. According to the Naranjo’s adverse drug reaction probability scale, there is a possible relation between this adverse drug reaction (SJS) and cefotaxime.

In the era of fiberoptics, securing of the airway under general anesthesia in small children with temporomandibular joint ankylosis without a flexible pediatric fiberoptic endoscope requires considerable skill. We describe the use of an adult flexible fiberoptic laryngoscope with a video camera system to visualize the glottis from one nostril while the tracheal tube was passed from the other nostril.

Airway obstruction during general anesthesia is fairly common. Foreign body causing obstruction of the laryngeal mask airway is uncommon but can confuse the anesthesiologist trying to troubleshoot the cause of inability to ventilate. We present a case of complete airway obstruction with a nematode caught in the vertical bars of the laryngeal mask airway after its insertion.

Juvenile myoclonic epilepsy (JME; OMIM 606904) is a subtype of common idiopathic generalised epilepsy (IGE) and affects up to 26% of all individuals with IGE.1–3 JME is characterised by the onset in adolescence of bilateral myoclonic jerks usually affecting the upper limbs.1,4 Patients also have generalised tonic-clonic seizures and about one third experience absence seizures. Genetic factors are known to play an important role in the etiology of JME.3,4 While identification of genes underlying predisposition to JME has been relatively slow due to clinical and genetic heterogeneity,5,6 progress made so far in the isolation and characterisation of genes associated with other monogenic subtypes of IGE, provides evidence that most idiopathic epilepsy syndromes are caused by mutations in genes encoding ion channels.7 The implications of these findings in monogenic subtypes of the disorder for the complex polygenic subset are now being increasingly appreciated.8 Two types of voltage gated potassium channels have been associated with seizure disorders, the KCNQ channels and the Kv channels. Loss of function mutations for the potassium channels KCNQ2 and KCNQ3 have been identified in families with a rare autosomal dominant subtype of IGE called benign familial neonatal convulsions (BFNC).9,10 Allelic association of JME with KCNQ3 has been suggested in a South Indian cohort of JME patients.11 Mutation in human KCN1A predisposes to episodic ataxia and partial epilepsy.12 These findings emphasise the importance of potassium channels in controlling neuronal excitability and thus make potassium channel genes potentially interesting candidates for idiopathic epilepsy syndromes. The calcium activated potassium channels are an interesting class of potassium channels that regulate neuronal excitability.13,14 These are gated by intracellular calcium ions and their activity is responsible in part for the afterpolarisation that follows a single action …

An Ala322Asp mutation in the GABRA1 gene was recently reported to be responsible for causing the autosomal dominant (AD) form of juvenile myoclonic epilepsy (JME) in a French-Canadian family. To study if JME families from India exhibiting the AD mode of inheritance carry the Ala322Asp mutation, we examined 35 unrelated JME-affected individuals from such families for the Ala322Asp mutation in GABRA1. Ala322Asp mutation was not observed in any of these JME-affected individuals, suggesting that this mutation is unlikely to be a predominant mutation involved in causation of epilepsy. To evaluate the possibility of other mutation(s) in and around GABRA1 that may predispose to JME, we compared the allele frequencies at two marker loci, D5S2118 and D5S422, flanking GABRA1, in probands and 100 matched population controls. One of the allele frequencies at D5S422 shows a significant difference between the cases and controls (chi-square = 11.44, d.f. = 1, P = 0.0007), suggesting genetic association between JME and genes located in the proximity of the DNA marker.

Fifty children were randomized for induction with 0.3 mg kg(-1) midazolam or 5 mg kg(-1) thiopentone. Efficacy, safety, recovery time, amnesic effect, tolerability and recovery characteristics were compared. Midazolam required longer for induction and recovery from anaesthesia. The safety profile was similar with both drugs.Midazolam is efficacious and safe for the induction of anaesthesia in children. Its action is comparable with thiopentone and may be an alternative to it.

Summary Background: Various techniques of laryngeal mask airway (LMATM) insertion have been described in adults but only limited clinical trials have been conducted in children despite a varying range in success rate by the recommended method. Method: The study was conducted in 62 ASA 1 and 2 children who were randomly allocated for the evaluation of LMA insertion by the midline approach with the cuff completely deflated (group MD, control group, n = 31) or laterally with the cuff partially inflated (group LP, study group, n = 31). Propofol was used as the sole induction agent in all children. Ease of insertion, position of the LMA with fibreoptic laryngoscope and incidence of stomach insufflation were assessed. Results: Fewer attempts and a significant reduction in the time for insertion was noted in group LP (14.4 ± 4.2 s) compared with group MD (23.1 ± 2.1 s), P

Juvenile myoclonic epilepsy (JME) is a common subtype of idiopathic generalized epilepsy that shows a complex pattern of inheritance. We have tested the association between JME phenotype and an intragenic marker in KCNQ3 by using the transmission disequilibrium test in 119 probands and their parents. Mutations in KCNQ3 are known to cause benign familial neonatal convulsions and are involved in the physiologically important M current in neurons. Our results provide suggestive evidence of allelic association between JME and KCNQ3 ( P-value=0.008) and raise an interesting possibility of a genetic contribution to JME, viz., of a gene that causes a monogenic form of human epilepsy.

We present a case of a 40-year-old male patient who presented to us with radicular pain in arm for anterior cervical discectomy with fusion. The preanesthetic checkup including indirect laryngoscopy was normal with routine investigations within normal limits. The patient was induced and intubated with the established routine technique without any obvious airway problems. Prophylactic dexamethasone was administered, and the intraoperative course was uneventful. Immediately after extubation, it was noticed that the patient had inspiratory stridor and whispered voice on the operation theater table itself. Assessment by Bonfils retromolar fiberscope under fentanyl sedation revealed bilateral vocal cord edema. The patient was re intubated and put on T piece with humidified O 2 . After 72-h, patient was extubated after confirming normal vocal cord movement under flexible fiberscope guidance. This case is presented to alert anesthesiologist about the possibility of vocal cord edema even though other potential airway complications are possible. We would also highlight the importance of Bonfils retromolar fiberscope in awake vocal cord examination and flexible fiberscope use in managing patients presenting with airway problems during extubation.

Background: Truview PCD laryngoscope is specially designed to aid positioning of the endotracheal tube as well as to record entry of the tube into glottis. Aim of the study is to compare the view of glottic opening and ease of intubation between Truview PCD laryngoscope and Macintosh laryngoscope in patients undergoing general anesthesia (GA). Methodology: Two hundred patients undergoing elective surgery, under GA were randomized into two groups, Group TV and Group ML. In Group TV, Trueview PCD laryngoscope was used initially to visualize the vocal cords for Cormack and Lehane grading (CLG) and to spray the vocal cords with 10% lignocaine. Then the patient was ventilated for 1 min and Macintosh laryngoscope was used to visualize the vocal cords for CLG and proceed with intubation. In Group ML, Macintosh laryngoscope was used initially and later Truview PCD laryngoscope. Time to intubation, CLG, number of attempts and hemodynamic parameters were recorded. Results: Ninety-six and 89 patients had CLG1 visualization when Truview PCD laryngoscope was used as 1 st and 2 nd device respectively compared to 41 and 68 with Macintosh laryngoscope ( P = 0.00). Four patients had CLG 4 visualization with Macintosh laryngoscope that turned out to be grade II visualization with Truview PCD laryngoscope ( P = 0.00). Mean time taken for intubation with Truview PCD and Macintosh laryngoscope was 21.10 ± 5.64 s and 15.79 ± 2.76 s respectively ( P = 0.00). Conclusion: Better visualization with lesser CLG was found with Truview PCD laryngoscope but it took longer time for intubation than Macintosh laryngoscope. The hemodynamic response to intubation was significantly less with the use of Truview PCD laryngoscope when compared to that of Macintosh laryngoscope.

A new approach for tuning the parameters of MultiScale Retinex (MSR) based color image enhancement algorithm using a popular optimization method, namely, Particle Swarm Optimization (PSO) is presented in this paper. The image enhancement using MSR scheme heavily depends on parameters such as Gaussian surround space constant, number of scales, gain and offset etc. Selection of these parameters, empirically and its application to MSR scheme to produce inevitable results are the major blemishes. The method presented here results in huge savings of computation time as well as improvement in the visual quality of an image, since the PSO exploited maximizes the MSR parameters. The objective of PSO is to validate the visual quality of the enhanced image iteratively using an effective objective criterion based on entropy and edge information of an image. The PSO method of parameter optimization of MSR scheme achieves a very good quality of reconstructed images, far better than that possible with the other existing methods. Finally, the quality of the enhanced color images obtained by the proposed method are evaluated using novel metric, namely, Wavelet Energy (WE). The experimental results presented show that color images enhanced using the proposed scheme are clearer, more vivid and efficient., Comment: 24 pages, 12 figures

Fixed drug eruption (FDE) is a clinical entity occurring in the same site or sites each time the drug is administered. Acute lesions appear as sharply marginated erythematous plaques, which are usually found on lips, genitalia, abdomen, and legs. The eruptions usually occur within hours of administration of the offending agent and resolves spontaneously without scarring after few weeks of onset. Most common drugs causing FDE are sulfonamides, tetracyclines, salicylates, barbiturates, doxycycline, fluconazole, clarithromycin, etc. Ciprofloxacin, a widely used fluoroquinolone antimicrobial, induces cutaneous adverse drug reactions (ADRs) in about 1-2% of treated patients. Urticaria, angioedema, maculopapular exanthems, and photosensitivity are the most frequently documented cutaneous adverse reactions. In this case report, the patient soon after taking ciprofloxacin tablets, developed itching in the lips, palms and in scrotal region. On continuing the treatment, the next day he developed fluid filled lesions over palm, knuckle, and hyperpigmentation. He gives a history of severe itching and rashes in scrotal region. He gives a history of similar complaints in the previous month after taking ciprofloxacin medication. There was no history of intake of any other medication. On examination, bullous lesions and pustules in finger webs, hyperpigmentation on knuckles, and scrotal erosions were seen. In the present case report, the patient presented with FDE immediately after oral administration of ciprofloxacin and got completely cured after stopping the drug and taking adequate treatment. According to the Naranjo’s ADR probability scale (score=8), this ADR is categorized as a “probable” reaction to the drug.

Acne is the chronic inflammatory disease of the pilosebaceous unit, characterized by the formation of comedones, erythematous papules and pustules. Steroid induced acne is an acneiform eruption characterized by sudden onset of follicular papules and pustules shortly after starting topical or oral corticosteroid. Here, we report a case of a 25-year-old female patient who presented herself to the Dermatology out-patient department with the complaints of acne all over the face after the application of mometasone furoate ointment.

The operation theatre complex of a hospital represents an area of considerable expenditure in a hospital budget and requires maximal utilization to ensure optimum cost-benefit. There is paucity of data in India on the use of available operating time and the reasons for less-than-optimal utilization have not been studied.This audit was done prospectively over a period of 12 months in the department of general surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry. Operation theatre utilization was studied with respect to the starting and closing of the operation theatre, interval between surgical procedures, cancellation of surgical procedures and reasons thereof.The operation theatre was functional for 279 days during the year of the study, and 1773 cases were operated (6.3 cases per day). The total operating time utilized was 91.5%. The major reasons for cancellation of a total of 310 cases were lack of operating time (65.2%), emergency surgery during the elective list (13.9%), and preoperative lack of fitness (11.3%). Among all the lists, 43.6% started late and 63.6% of lists finished well before the scheduled closing time. Absence of monitoring equipment and non-availability of additional qualified anaesthetists necessitated induction of anaesthesia in the main operating room and accounted for 11% of the total operating time.Delay in starting lists, under-scheduling, interruption due to emergency surgeries, administrative reasons, induction of anaesthesia and recovery policies are the main factors that account for inefficient use of operating facilities. The correction of these factors would increase the available operating time by nearly 20%.

Nineteen previously trained resident anaesthetists were instructed to perform adult single-rescuer basic life support for 5 min on a manikin, in a double-blind crossover design, changing the hand of contact with the sternum from right to left while performing external cardiac compression (ECC). Total, correct and incorrect ECCs comprising of inadequate depth, wrong hand placement, incomplete relaxation and too much compression were recorded and grouped according to the dominant hand (group DH) or non-dominant hand (group NH) in contact with the sternum. The number of correct ECCs was significantly greater in group DH, median 141 compared to group NH, median 97; P0.005. More ECCs were of inadequate depth in group NH, median 34 as compared to a median of 8 in group DH; P0.005. Similarly, the incidence of wrong hand placement was significantly higher in group NH; median of 4 versus median of 0 in group DH, P0.05. The incidence of incomplete relaxation and too much ECC was not significantly different between the two groups (P0.05). We conclude that ECC is performed with fewer errors when the dominant hand of the rescuer is placed in contact with the sternum.

Awake fibreoptic nasotracheal intubation (FNI) is performed in potentially difficult airways under local anaesthesia. This observer-blinded study was designed to evaluate the efficacy of upper airway anaesthesia produced by nebulized lignocaine against combined regional block (CRB) for awake FNI.Forty-eight ASA 1 adults were randomly allocated to receive 4 ml of 4%-nebulized lignocaine (nebulization group) or translaryngeal block, bilateral superior laryngeal nerve block and three 4% lignocaine-soaked cotton swabs in the nose (CRB group). Facial grimace and patient comfort were assessed by grimace and airway reactivity scores. Patients reported their discomfort on a 4-point score.All patients underwent successful FNI without significant discomfort; 79% in the nebulization group and 83% of the patients in the CRB group reported the procedure to be comfortable. A higher grimace score was recorded on insertion of the endotracheal tube (ETT) through the nostril in the nebulization group when compared to the CRB group, P0.005. Similarly, patients in the CRB group were more comfortable during passage of the ETT into the glottis, as compared to the nebulization group. A progressive increase in heart rate was observed in all patients from the beginning of the procedure, but the rise in the nebulization group was greater, (P0.05) and also lasted longer than in the CRB group (P0.05). Mean arterial pressure was higher in the nebulization group when compared to the CRB group (P0.05), with patients belonging to the CRB group demonstrating considerable haemodynamic stability.Both nebulization and CRB produced satisfactory anaesthesia of the upper airway, but CRB provided better patient comfort and haemodynamic stability.

We designed this double-blind study to evaluate the efficacy of preemptive epidural bupivacaine and small-dose morphine for postoperative analgesia in children after herniorraphy. Sixty children, ASA physical status I or II, who were undergoing elective hernia repair under general anesthesia were randomly allocated into two groups. Group I (preemptive group) received 0.66 mL/kg 0.25% bupivacaine with morphine 0.02 mg/kg caudally after the induction of anesthesia but 15 min before surgery. Group II (postincisional group) received the same drug mixture after surgery. Pain was assessed using an objective pain scale (OPS). Time to first postoperative analgesics (TFA), the number of supplementary analgesic used, and the amount of morphine consumed over the ensuing 24-h period were noted. The OPS score was significantly less in Group I at 0.5, 4, and 8 h (P0.05) than in Group II after surgery. The median OPS score recorded over 24 h was 0 for Group I and 2 for Group II, which was significantly different (P0.05). The TFA in Group I (12.55 +/- 3.06 h) was significantly (P0.05) prolonged compared with Group II (10.62 +/- 3.18 h). The total postoperative morphine consumption in Group I (2.24 +/- 1.4 mg) was significantly (P0.05) less than that in Group II (3.34 +/- 2.29 mg). Nevertheless, the incidence of nausea and vomiting was not significantly different between the groups. In this study, we demonstrated that preemptive epidural bupivacaine and small-dose morphine administration is superior to the same mixture given at the conclusion of surgery for pain relief.This study was performed on two groups of 30 children undergoing hernia repair. Group I received a bupivacaine-morphine mixture caudally before surgery, and Group II received the same drugs caudally at the completion of surgery. Postoperative assessment demonstrated longer and better pain relief in Group I.

Preoperative over-ordering of blood is very common and leads to holding up of the blood bank reserve, ageing of the blood unit and wastage of blood bank resources. We evaluated the preoperative blood-ordering and transfusion practices for common elective general surgical procedures at a major Indian hospital. The principal aim of this study was to identify the surgical procedures where type and screen can be introduced and to formulate a maximum surgical blood-order schedule for those procedures where a complete cross-match appears mandatory.Six hundred and eighty patients undergoing 21 different surgical procedures between April 1993 and March 1995 were studied. Blood-ordering and transfusion details were noted and the data used to calculate cross-matched to transfused ratio (C/T ratio), transfusion probability (%T) and transfusion index (Ti). The maximum surgical blood-order schedule was calculated using Mead's criterion.There was gross over-ordering of blood in 10 out of the 21 procedures studied. Three hundred and seventy (40%) of the cross-matches performed were unnecessary. Sixty per cent of the patients studied had blood loss of less than 10% of the total blood volume and 90% of the cross-matches performed for this group were unnecessary. Based on these data, the maximum surgical blood-order schedule was calculated for 11 common surgical procedures.This study shows that blood was over-ordered in 10 out of the 21 procedures studied. Implementation of the recommended maximum surgical blood-order schedule and introduction of type and screen for eligible surgical procedures is a safe, effective and economic solution to preoperative over-ordering of blood.

The interpleural block (IPB) is a relatively safe procedure and is commonly practised to provide analgesia. A local anaesthetic injected into the interpleural space spreads widely to block various neural structures. The IPB can initiate bronchospasm by interrupting the sympathetic outflow but sparing the parasympathetic outflow to the lungs. In addition, unilateral reduction of intercostal muscle tone with consequential selective reduction of the functional residual capacity of that lung may also mimic airflow obstruction. We report a case of unilateral bronchospasm encountered following IPB.

Eclampsia is one of the most common emergencies encountered by anesthesiologists which involve a safe journey of two lives. The definition, etiology, pathophysiology, treatment guidelines along with a special reference to management of labour pain and caesarean section are discussed. Eclampsia is commonly faced challenging case in our day to day anaesthesia practice,but less is discussed in our anaesthesia text books. Lot of controversies with regard to fluid management and monitoring still remain unanswered.

Ranitidine, a widely used drug, is known to be well tolerated. This case report illustrates a severe anaphylactic reaction after a single intravenous dose of 50 mg ranitidine during the emergency cesarean section under spinal anesthesia. Anaphylaxis was successfully managed with Inj. adrenaline, Inj. hydrocortisone, ventilatory, and inotropic support following which she had a full recovery. Awareness of this rare but fatal adverse reaction to this commonly used drug could help in early recognition of the event if faced suddenly.