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Background Pain after anterior cruciate ligament reconstruction (ACLR) can be attributed to both arthroscopic surgery and graft - donor site. Conventionally used techniques of peripheral nerve blockade may not provide complete analgesia to graft - donor site. Moreover, femoral nerve blockade is known to cause quadriceps strength deficit. The purpose of this study was to evaluate whether addition of peri-hamstring infiltration to adductor canal block can lead to better analgesia after surgery than block alone. Methods 60 ASA grade I & II patients scheduled for anterior cruciate ligament reconstruction surgery using ipsilateral hamstring autograft under subarachnoid block were randomly distributed into 2 groups to receive postoperatively either adductor canal block alone (group A) or peri-hamstring infiltration along with adductor canal block (group AH). Adductor canal block was given in both the groups using 15 ml of 0.5% ropivacaine with 1:200000 adrenaline. Patients in Group AH received additional 20 ml 0.5% ropivacaine with 1:200000 adrenaline at hamstring donor site. Postoperative pain on Visual Analogue Score (VAS) at various time intervals, time to first rescue analgesic requirement, cumulative analgesic requirement over 24 h, quadriceps strength, adverse effects and patient satisfaction were recorded. Results Statistically significant difference in mean VAS score (resting & dynamic) was observed in both the groups at 8 and 12 h (p value Conclusion Peri-Hamstring infiltration of local anaesthetic along with adductor canal block is better than adductor canal block alone at allaying postoperative pain due to hamstring autograft.

Background Recently, indirect laryngoscopes have emerged as an important tool in managing a difficult airway but the literature is insufficient on the comparison of C-MAC D-Blade with Macintosh for tracheal intubation during manual-in-line stabilization. We compared the efficacy of C-MAC D-blade with Macintosh laryngoscope for tracheal intubation in patients with manual-in-line stabilization. Methods Eighty adult patients undergoing elective surgery under general anesthesia were intubated after application of MILS using C-MAC D-Blade (n = 40) or Macintosh laryngoscope (n = 40) as per group allocation. Intubation Difficulty Scale was the primary outcome. We also recorded the duration of laryngoscopy, modified Cormack-Lehane grading, time taken for intubation, total intubation time, optimizing maneuvers required, number of attempts, and complications. Result The median intubation difficulty score (inter-quartile range) was significantly lower with C-MAC D-Blade[(0, 0–1) vs (3, 2–3)](P Conclusion C-MAC D-Blade is superior to the Macintosh laryngoscope in terms of lower Intubation Difficulty Score in patients undergoing tracheal intubation with cervical spine immobilization.

Mitigation of Pb(II) ions from water using economic method is an important research area to combat the pollution due to lead ions Pb(II) in water as it have severe toxic effects in human beings. In present work, Pristine Pavo Cristatus feather powder (PCFP) has been employed for removal of Pb(II) ions and the process of adsorption was optimized through four level Box Behnken design (BBD) of response surface methodology (RSM) over a broad range of pH (3.0–9.0), initial lead ion concentration (20–100 mg/L), contact time (20–180 min) and temperature (297 K to 333 K). Different isotherms were applied to confirm the type of adsorption. Langmuir maximum removal efficiency was 121.95 mg/g for lead ions adsorption onto PCPF at optimal values of pH 6; adsorbent dose 20 mg/L; temperature 303 K and contact time 120 minutes obtained from batch studies. Pseudo-second-order reaction model showed good applicability for kinetic studies. Thermodynamic parameters were also evaluated to check feasibility and nature of adsorption. The optimal parameters obtained for maximum Pb(II) ions adsorption were at pH = 6.31, initial Pb(II) ion = 43.79 mg/L, contact time = 119.51 minutes and temperature = 59.67 oC. The experimental and predicted values were found to be in good agreement with each other.

Cadmium is one of the toxic heavy metal that is discharged into the surroundings by various routes such as sedimentary rocks, weathering and erosion of rock, earth’s crust, marine phosphate and phosphorites, forest fires etc. However battery manufacturing industry, plated containers, mining, auto exhaust, smelting of nonferrous metals, cigarettes ore dressing, and galvanized pipes are the main anthropogenic sources of cadmium heavy metal in environment. Ingestion of cadmium in human body increases the risk of many diseases. Many techniques have been applied for the removal of cadmium heavy metal ions from water. The aim of the current work is to propose economical material for effective cadmium ion removal from aqueous phase. A Pavo cristatus feather which is locally available and low-cost is used as an adsorbent for the removal of cadmium ions from water. The adsorption ability of Pavo cristatus feather has been investigated as a function of concentration of cadmium, pH of solution, adsorbate concentration, contact time and temperature. Maximum adsorption of cadmium on Pavo cristatus feather was observed at 5 pH of the solution. Adsorption of cadmium on Pavo cristatus feather was initially found to increase with increase in concentration of cadmium, time of contact and adsorbate concentration. The Langmuir, Freundlich and Temkin adsorption isotherm models were applied to analyse the experimental data. The experimental data was well fitted to Langmuir isotherm model. However, the maximum Langmuir adsorption capacity for cadmium on Pavo cristatus feather at pH 5 was 64.52 mg/g. The kinetics study was examined using the pseudo first order and pseudo second order kinetic models and was best described by the pseudo second order model. Thermodynamic parameters such as the change of Gibbs free energy, entropy and enthalpy of adsorption were also calculated. The study showed that Pavo cristatus feather can be used as a low cost and efficient adsorbent for removal of heavy metal ions from industrial wastewater/water. This material may also be utilized for removal of other toxic heavy mental ions from water.

Background and Aim: Coronavirus disease 2019 (COVID-19) has become a global pandemic with the spectrum of disease from asymptomatic or mild disease to severe cases requiring intensive care unit (ICU) admission. In India, it started with milder presentation affecting younger population. Later on, an increase in disease severity was observed involving older age group as well. However, there is a paucity of published data regarding patients requiring ICU care in India. This case series describes the initial experience of an ICU in India regarding epidemiological profile, clinical course, and outcome of critically ill COVID-19 patients. Methods: This case series included 27 consecutive laboratory-confirmed COVID-19 patients who were admitted in a tertiary care ICU over 14 days period, followed up till their discharge from ICU. Demographic and clinical data, including laboratory and radiological findings, were compiled with special attention to co-morbidities of the patients. The management of these patients was done as per the institutional protocol for critically ill COVID-19 patients. Results: The median age of the patients was 50 years with no difference in gender. Comorbid conditions were seen in 85% of the patients with diabetes (43.7%) and hypertension (37.5%) as the most common conditions. The median duration of symptoms before admission was 6 days with fever as the most common clinical symptom at presentation. Chest roentogram showed bilateral lung infiltrates in 88.8% of the patients. Mild, moderate, and severe hypoxia were observed in 3, 8, and 16 patients, respectively. Ten patients were managed with oxygen therapy. Seventeen patients (62.9%) required ventilatory support. Mortality rate among patients admitted to our ICU was 59.2%. Conclusions: This case series shows middle-aged patients with comorbid diseases present with severe COVID-19 disease and have poor outcome.

Background: Arthroscopic rotator cuff repair surgery may lead to significant postoperative pain. Interscalene block (ISB) is an effective analgesic technique in these surgeries but there is a risk of the phrenic blockade. Subacromial local anesthetic infiltration is a phrenic sparing alternative technique for postoperative analgesia. The primary aim of our study was to compare the ISB with a continuous subacromial infusion (SAC) with regard to postoperative analgesia. Methods: This prospective randomized, interventional parallel arm trial was conducted in 60 ASA grade I and II, adult patients (30 patients in each group) posted for arthroscopic rotator cuff repair surgery. Patients were randomly assigned to receive either ultrasound-guided ISB (Group ISB: 15 ml of 0.75% ropivacaine) or continuous SAC (Group SAC: 15 ml 0.75% ropivacaine as a subacromial injection by ultrasound guidance and infusion of 3 ml/hour of 0.5% ropivacaine through the catheter placed subacromial by the surgeon). Intraoperative hemodynamic parameters, visual analog scores (VAS), and rescue analgesic requirements for 24 hours, patient satisfaction, and complications were recorded. Results: Rescue analgesic requirement was significantly higher in SAC at zero hours (P=0.000), while it was significantly higher in ISB at 12 hours (P=0.02). The VAS scores were comparable at all time points and patient satisfaction at 24 hours was similar. None of the patients had rated satisfaction related to pain relief as poor in any group. Complications like ptosis and motor weakness were seen only with ISB. Conclusion: Both the techniques provided effective analgesia and comparable patient satisfaction with lesser incidence of complications in the SAC group. ISB provided more effective immediate postoperative pain relief while SAC was more effective in delayed analgesia for arthroscopic rotator cuff repair surgeries. SAC can be considered a reasonably safe alternative to ISB in patients with contraindications to the latter.

Punica granatum carpellary membrane (PGCM) has been chemically modified with 2,4 dinitrophenylhydrazine by one step reaction process. Pristine PGCM and modified Punica granatum carpellary membrane (MPGCM) have been employed as adsorbents for removal of cadmium (II) ions from aqueous solution. Modification on the surface of PGCM was characterized by Fourier transform infrared, scanning electron microscope, energy dispersive X-ray spectroscopy and X-ray diffraction techniques. Removal of Cd (II) ions was carried out at various optimized conditions i.e. adsorbent dose (20 mg/l), pH (7), contact time (2 h), and temperature (303 K). The Langmuir isotherm model was the best fit with a high value of regression coefficient (R 2 = 0.991–0.999) compared with the Freundlich and Temkin models. Langmuir maximum adsorption capacity for cadmium was found to be 111.11 mg/g for PGCM and 142.85 mg/g for MPGCM. Kinetics of adsorption of cadmium onto MPGCM was best described by pseudo-second-order kinetics model compared with pseudo-first-order. The negative value of free energy change showed that adsorption was highly spontaneous and favorable. Also the positive value of entropy and enthalpy showed that the process of adsorption was associated with increased randomness and endothermic in nature. Mechanism of removal of cadmium ions from water by MPGCM has also been explicated.

C16-6-16 incorporated mesoporous MCM-41 was investigated as an effective adsorbent for the adsorption of cadmium ions from the aqueous medium. Adsorption process was affected by different physiochemical factors such as pH, initial concentration, temperature and contact time. Optimization of experimental data was done to find out best optimal conditions using response surface methodology. Twenty nine trials were runs according to Box–Behnken design. Quadratic model was found to be best fit with maximum R2 value 0.9954 and gives the suitable relationship between the variables and response. The optimal parameters were obtained for adsorption of cadmium ions on to C16-6-16 incorporated mesoporous MCM 41. The results showed that the adsorption conditions have considerable effects on the removal of cadmium ions.

Punica granatum carpellary membrane powder (PGCM) and its surface modified form (MPGCM) with 2,4-dinitrophenylhydrazine (2,4-DNP) were used as adsorbents for removal of bivalent lead ions from aqueous phase system. Batch mode experiments using various parameters were carried out to assess the adsorption isotherms and dynamics of the process. Langmuir isotherm was well-fitted model for experimental data. Langmuir adsorption capacity using PGCM and MPGCM at pH of 7 was found to be 169.49 and 196.07 mg/g, respectively. Rate constant and thermodynamic parameters were calculated to evaluate the kinetic model and temperature dependence nature of adsorption. Box-Behnken design was applied to optimize the adsorption process of bivalent lead ions for PGCM and MPGCM using pH (3.0-9.0), initial bivalent lead ions concentration (20-100 mg/L), contact time (20-180 min), and temperature (20-60°C) parameters. The optimum conditions for maximum removal of bivalent lead ions on PGCM were found to be at pH of 6.99, initial bivalent lead ions concentration of 98.95, contact time of 176.05, and temperature of 21.20°C and on MPGCM at pH of 6.51, initial bivalent lead ions concentration of 99.99, contact time of 177.89, and temperature of 20.02°C, respectively. PRACTITIONER POINTS: Adsorption of bivalent lead from water using Punica granatum carpellary membrane powder and its modified form MPGCM is discussed. Batch mode experiments using various parameters were carried out to assess the adsorption isotherms and dynamics of the process. Langmuir adsorption capacity using PGCM and MPGCM at pH of 7 was found to be 169.49 and 196.07 mg/g, respectively. Box-Behnken design was applied to optimize the adsorption process of bivalent lead ions.

Adsorption of lead ions by mesoporous material incorporating Gemini surfactant C16-6-16 (G-MCM-41) was investigated using response surface methodology. The effect of pH, initial metal concentration and contact time was studied using Box-Behnken design (BBD). The optimal parameters for maximum adsorption capacity (81.92 mg/g) were obtained at pH 5.85, initial lead ion concentration 99.02 mg/L, and contact time 118.49 min. The effect of different variables and their interactions were assessed by analysis of variance (ANOVA). The surface and contour response plot shows the interaction of different variables and response. The experimental data fits best in the quadratic model with maximum predicted R2 value of 0.9013 and Prob > F is

Schwannomas arising from cervical vagus nerve is an extremely rare benign neoplasm. The majority of patients present with insidiously growing lateral neck mass without neurological deficit. We report a case of symptomatic cervical vagal nerve schwannoma in a 32-year-old female. Complete surgical resection is the treatment of choice. However, anesthetic management of these tumors can be challenging. We describe here the complications experienced during the management of the patient.

Congenital Lobar Emphysema (CLE) is a developmental anomaly, characterized by hyperinflation of one or more pulmonary lobes. It presents in infancy with variable degree of respiratory distress due to compression atelectasis. It is most often associated with mediastinal shift with subsequent hypoxia. CLE poses a diagnostic and therapeutic dilemma. We report a case of five-month-old infant of CLE requiring left lobectomy, who was previously being treated for pneumonia which was unresponsive to medical therapy. Anaesthetic challenges experienced during the case and a brief review of literature is presented.

Brucellosis is one of the leading causes of abortion in domestic animals that imposes costs on both economy and society. The disease is highly zoonotic and poses risk to animal handlers due to its zoonotic nature. It causes stillbirth, loss of kids and abortion in last term of pregnancy. Reproductive damage includes infertility in does and orchitis and epididymitis in breeding bucks, which result in high financial losses to farmers and the agriculture industry as a whole. It requires highly sensitive and specific assays to diagnose the disease at field level. In the current study, a visual loop-mediated isothermal amplification (LAMP) assay and the TaqMan® real-time PCR were developed with high sensitivity and specificity. For the TaqMan® probe, real-time PCR primers were developed using Omp31 gene as target and primers were designed using discontiguous conserved sequences of Omp31 gene. The Omp31 probes were designed by attaching 6-FAM reporter dye at the 5′ end and BHQ-1 quencher at the 3′ end. Published primers were used for visual LAMP assay targeting the Omp25 gene. Sensitivity of the standardized visual LAMP assay and TaqMan® real-time PCR assay was determined by serial dilution of positive Brucella melitensis DNA (102 to 10−4 ng) obtained from standard culture. The TaqMan® probe real-time assay can detect as low as 100 fg of B. melitensis DNA, whereas culture from vaginal swab washings has a limit of detection (LOD) of only 1 cfu/ml. Similarly, the visual LAMP assay can detect as low as 10 fg of B. melitensis DNA as compared to an LOD of 30 cfu/ml from culture of vaginal swab washings. Both assays were compared with serological tests (serum tube agglutination test (STAT) and indirect enzyme-linked immunosorbent assay (iELISA)) for diagnostic sensitivity and specificity. Diagnostic sensitivities and specificities for TaqMan® real-time PCR vs. LAMP assays were 98 and 100% vs. 100 and 97.8%, respectively. Results of visual LAMP assay indicated that LAMP is a fast, specific, sensitive, inexpensive and suitable method for diagnosis of B. melitensis infection under field conditions. On the other hand, Omp31 TaqMan® probe real-time assay can be used in conjunction with the other field-based diagnostic tests due to its high specificity.

Background: This study was conducted to compare the analgesic efficacy of 10 ml versus 20 mL of 0.5% ropivacaine in nerve stimulator guided interscalene brachial plexus block, in patients undergoing arthroscopic shoulder surgery. Methods: A total of 70 American Society of Anesthesiologists physical status classes 1 and 2 patients, aged 18–65 years, undergoing unilateral arthroscopic shoulder surgery, were randomized into two groups. Group A received single shot inter-scalene block with 20 mL of 0.5% ropivacaine whereas Group B received the same with 10 mL. The primary outcome was difference in the total postoperative fentanyl consumption over 24 h. Secondary outcomes were difference in block onset, intra-operative hemodynamic parameters, intra-operative fentanyl consumption, duration of effective analgesia, visual analogue scale (VAS) scores at various time intervals, duration of motor block, and incidence of hemidiaphragmatic (HD) palsy. Results: Total 24 h fentanyl consumption was significantly higher in Group B (558 ± 112 mcg) compared to Group A (296 ± 88 μg). Block onset was slower in Group B than Group A. There was no difference in intra-operative fentanyl consumption. Postoperative VAS scores were significantly higher in Group B compared to Group A, at 6 h and thereafter. Duration of motor block was significantly shorter in Group B (6.25 ± 1.25 h) compared to Group A. HD palsy was seen in all the cases in both the groups. Conclusion: Single shot nerve stimulator guided interscalene block with 10 ml of 0.5% ropivacaine was inferior to 20 mL of 0.5% ropivacaine with respect to postoperative analgesic efficacy.

Sir, Laparoscopic approach to surgery has expanded its horizon tremendously. It is a preferred approach in many general, urological and thoracic procedures. Massive subcutaneous emphysema is a rare complication of laparoscopic surgery. We report here such a complication after laparoscopic nephroureterectomy using carbon dioxide (CO2) as an insufflating gas. A 62 yr old male, weight 65kg, American Society of Anesthesiologists physical status II was scheduled for nephroureterectomy for sarcoma left kidney through transperitoneal approach. The only positive history revealed in preoperative evaluation was hypertension since 2 yrs. In the operating room, intravascular cannulation was established after baseline routine monitoring [electrocardiography, non-invasive blood pressure, pulse oximetric oxygen saturation (SpO2) and end-tidal CO2, (ETCO2)]. Standard general anaesthesia induction and intubation was performed using injection fentanyl, propofol and vecuronium bromide. Patient was maintained on O2:N2O (35:65) and isoflurane. Pneumoperitoneum was created using CO2 insufflation and was maintained for 4 hours. Intraoperatively, cardiovascular parameters, EtCO2 and peak inspiratory pressure remained normal throughout. The intra- abdominal pressure was in the range of 12-13 mm Hg. Maximum EtCO2 noticed during this period was 42mm Hg, which was normalised by increasing minute ventilation. 3 h after creation of pneumo-peritoneum, patient was noted to have developed marked subcutaneous emphysema over face, neck and chest. Skin crepitus was more on lateral aspects of neck bilaterally. It involved both the eyelids. Caudal extent of emphysema could not be demarcated due to patient positioning and surgical drapes. Arterial blood gas analysis (ABG) was obtained and found to be normal. All ventilatory parameters including EtCO2 were within normal limits at this moment. The surgeon was notified about emphysema. Pneumoperitoneum was deflated after nephrectomy. Uretrectomy was done after opening the abdomen. Entire surgery lasted for 6 hrs. Facial swelling and crepitus over neck started resolving gradually after deflation of pneumoperitoneum. At the end of surgery, direct laryngoscopy was done to exclude the presence of pharyngeal emphysema and laryngeal oedema which may accompany subcutaneous emphysema of face and neck and can cause airway obstruction. Arterial blood gas (ABG) values were repeated and found to be normal. The patient was extubated after confirming audible leak on positive pressure ventilation, after deflating the endotracheal tube cuff, ruling out tracheal compression by neck emphysema. Gaseous collection was allowed to be drained by spontaneous absorption and exhalation. Patient was transferred to ICU for further monitoring. Postoperative chest radiograph in intensive care unit (ICU) confirmed the diagnosis of surgical emphysema in the neck and chest and ruled out pneumothorax and pneumomediastinum. Patient remained stable in post operative period and was transferred to ward next day. Massive subcutaneous emphysema is an extremely rare complication.[1,2] On palpation, it produces an unusual crackling sensation as the gas in pushed through the tissues. Severity of emphysema can be compared on a four point scale.[3] (0) No subcutaneous emphysema, (1) Mild emphysema with crepitus at trocar insertion site, (2) Mild emphysema with crepitus extending to the abdomen and thighs. (3) Massive emphysema extending to the chest, neck and face. Prolonged surgery and pneumoperitoneum of >200 minutes, insufflation of CO2 at pressure ≥15 mm Hg, 6 or more ports and old age due to decrease in natural subcutaneous resistance are the factors which predispose to the risk of development of subcutaneous emphysema.[4,5] The patient had massive subcutaneous emphysema probably due to prolonged pneumoperitoneum of 4 hours duration. Age of the patient was another possible factor which may be responsible for such massive emphysema. Absence of rise in EtCO2 was unusual, a finding contrary to most reports where an increase in EtCO2 was found along with massive subcutaneous emphysema. Our findings are consistent with the finding of Giorgakis and Fernandez-Diaz where they found no increase in EtCO2 intraoperatively.[6] In view of the paucity of literature showing massive subcutaneous emphysema in the absence of increased EtCO2, we wished to share our experience. We recommend that the patient should be closely examined under the drapes intraoperatively even if ventilatory parameters are normal on monitor.

A two stage 3.2–6.3 GHz Ultra Wide-Band CMOS Low Noise Amplifier with out-band rejection topology by using modified low noise Active Inductor with 0.18μm CMOS technology is presented in this paper. Due to the Federal communication commission's power limitation on the transmitting signal at transmitter, the receiver signal power of the UWB system is very smaller than interferer narrow-band signals. To avoid this interference and to get the original received signal at receiver side the characteristic of interference rejection must be at receiver. As the low noise amplifier is very first stage of the receiver, here in this paper we proposed a wide-band input network with out-band rejection capability to suppress the out-band properties as its first stage of LNA. Source degenerated cascode Amplifier is used as the amplifier stage of LNA. To attenuate more the out-band rejection characteristic without influencing the input matching, a dual band Notch filter with the low noise Active Inductor is used as the second stage. An Active Inductor circuit has been designed to modify with respect to improve its Quality factor as well as to reduce its noise, as comparatively an Active Inductor has lowered the noise performance than the Passive Inductors. There is maximum 75–85 dB out-band rejection has been measure with the power gain of almost 15dB and 0.9 nV/sqrt(Hz) the minimum power spectral density has been measured while consuming a DC power of 4.7mW.

Airway management of an infant with a giant cervical lump may be a difficult task. The anesthesiologist must be prepared to face associated challenges during securing the airway in such patients. We report our experience with One year old infant who presented with huge cystic hygroma in the cervical region leading to recurrent episodes of respiratory tract infection and distress. Surgical removal was needed as sclerotherapy proved ineffective in reducing its size. Proseal laryngeal mask airway was used as a conduit after inhalational induction since airway could not be maintained with bag and mask. The child was tracheostomized postoperatively and also had a prolonged Intensive Care Unit stay. Difficulties encountered in intubation and postoperative management of this child are discussed in this report.

As the CMOS technology is being scaled down continuously, power dissipation is the major constraint for VLSI designers. In this paper we propose a differential 9T cell SRAM which employs differential read operation of cell as compared to conventional 8T cell SRAM without compromising with performance and stability. Moreover the proposed 9T SRAM uses a gated ground sleep transistor (nmos transistor inserted between ground line and SRAM cell) which reduces the sleep leakage power consumption 10 times as compared to the conventional 8T cell SRAM in the sleep mode. The differential operation of the proposed cell helps in keeping the other peripherals to be simple and consume low power. Results show read and write power of proposed cell is 33% and 35% reduced as compared to 8T cell SRAM. So along with the symmetrical design, differential read operation and gated ground, performance of the proposed design improves with reduced power and minimal area overhead.

Novel oxazolidinones were synthesized containing a number of substituted five-membered heterocycles attached to the 'piperazinyl-phenyl-oxazolidinone' core of eperezolid. Further, the piperazine ring of the core was replaced by other diamino-heterocycles. These modifications led to several compounds with potent activity against a spectrum of resistant and susceptible gram-positive organisms, along with the identification of ranbezolid (RBx 7644) as a clinical candidate.