Clinical Attachment

YANAMALA VIJAY RAJ
CLINICAL ROTATION REPORT
BY
YANAMALA VIJAY RAJ
Mtech in Clinical Engineeri

YANAMALA VIJAY RAJ
LIST OF DEPARTMENTS VISITED IN CMC VELLORE AS PART OF CLINICAL ROTATION:
1. Cardiology
2. Child Health
3. Clinical Immunology and Rheumatology
4. Community Health and Development (CHAD)
5. Developmental Pediatrics
6. Endocrinology, Diabetes and Metabolism
7. ENT
8. General Surgery & Colorectal Surgery
9. Low Cost Effective Care Unit
10. Neonatology
11. Nuclear Medicine
12. Orthopaedics
13. Physical Medicine and Rehabilitation
14. Pulmonary medicine
15. Radiation Therapy
16. Neurosciences
17. Transfusion Medicine & Immunohematology – Clinical Pathology

YANAMALA VIJAY RAJ
1) Cardiology:
Cardiology is a branch of medicine dealing with disorders of the heart be it human or animal.
The field includes medical diagnosis and treatment of congenital heart defects, coronary artery
disease, heart failure, valvular heart disease and electrophysiology.
The following Equipments functioning and its role in diagnosis of patients are studied.
 Cardiac Monitors
 Cardiac Ultrasound Machines
 Vascular Ultrasound Machines
 EKG Machines
 Defibrillators
 Intra-Aortic Ballon Pumps
 Heart-Lung Bypass Machines
 Stress Test System
 Infusion Pump
 Vascular Doppler
 AED-Automated External Defibrillators
 Vascular Stunts
 Pacemakers
 Electrocardiogram (ECG)
 Echocardiogram
 Exercise stress test (EST)
 Holter Monitor
Problems Identified in Cardiology Department:
A) Optiminal functional Stents:
Solution:
i) Usage of bio-degradable stunts, for reduction of immunogenic reactions at long term usage.
ii) Usage of drug delivery polymer stunt, that can deliver certain doses of drug at regular
interval of times,
B) Mobile application that creates a easy interface between patient and doctor.

YANAMALA VIJAY RAJ
Solution: Mobile based database system, where data saved from mobile, and viewed or accessed
by doctor at hospital. By this way the patient need not visit hospital regularly to report his
health parameters.
2) Child Health:
The Child Health Department of CMC has 3 units. A separate Pediatric Casualty is under Child
Health. This gives emergency services to children.
Child Health Unit I:
Apart from giving general medical care to children, the Child Health Unit I looks after children
with:
• Haemato-oncology (eg leukaemia & cancers)
• Endocrine problems ( hormone problem, short stature,obesity, hypothyroidism and
diabetes mellitus)
• Infectious diseases(HIV/AIDS)
Child Health Unit II:
Apart from giving general medical care to children, the Child Health Unit II looks after
children with:
• Kidney problems( complicated nephrotic syndrome, Nephritis, Chronic renal failure
and other renal problems.)
• Rheumatic conditions ( joint diseases)
Child Health Unit III:
Child Health Unit III is mainly general Pediatric (children's) Care and specializes in children
with Asthma
(Wheeze, cough and short of breath)
PROBLEMS:
A) Squeeze machine

YANAMALA VIJAY RAJ
Solution: Squeeze Machine is a hug machine, also known as a hug box, a squeeze machine, or a
squeeze box, designed to calm hypersensitive persons, usually individuals with autism
spectrum disorders.
B) Flow rate controller setup for Dialysis machine in PICU
Solution:
In general Dialysis setup, flow rate of filtered blood entering back into body is not present. This
hampers the flexibility of doctors to control the fluid entering body. As different patients (both
old and young) need different flow rate, a dire need devolved to design and implement flow
rate controller system.
By placing flow rate sensor at the junction between the dialyzer and the tube that delivers fluid
to body, and flow rate is automated by connecting value that regulates the flow rate to
microcontroller.

YANAMALA VIJAY RAJ
3) Clinical Immunology and Rheumatology:
Rheumatology department cares for people with arthritis (painful joints) and other problems
caused when the body “attacks itself” - Systemic Autoimmune Connective Tissue Diseases.
The following Equipments are observed in the department.
 FACSAria II
 LSRII
 FACScan
 Flow Cytometer
 TreeStar
 ELISA
General Work flow in immunology department:
Rheumatology looks after:
 Rheumatoid Arthritis
 Systemic Lupus Erythematosus (SLE)
 Scleroderma (Systemic sclerosis)
 Polymyositis / Dermatomyositis
 Crystal arthropathies

YANAMALA VIJAY RAJ
PROBLEMS:
A) Reynolds phenomenon:
In medicine, Raynaud phenomenon is excessively reduced blood flow in response to cold or
emotional stress, causing discoloration of the fingers, toes, and occasionally other areas. Blood
capillaries at the fingertip are damaged, and based on this several diagnostic methods are
devised.
Solution:
i) Small Equipments that work on the principle of Doppler Effect can be devised.
ii) Thermal sensing imaging based techniques can be made utilized in designing equipment.

YANAMALA VIJAY RAJ
4) Community Health and Development (CHAD):
CMC’s Community Health Department and its Community Health and Development program,
popularly known as CHAD, is a true example of the fine balance between training and service
to the community. It is the manifestation of CMC’s philosophy of maintaining and expanding
its focus on tertiary care while augmenting community health work. Over half a century, the
department has grown manifold and attracted people all over the world.

YANAMALA VIJAY RAJ
PROBLEMS:
1) Digitalize the work flow, thereby reducing the communication gap between cadres
associated with CHAD
Solution:
Windows based form application
5). Endocrine:
Endocrine department treats patients diagnosed with diabetes, The department of
Endocrinology looks after patients with hormone problems and abnormal metabolism.
Common Endocrine Problems treated are:
 Diabetes (sugar in the blood)
 Thyroid disorders ( thyroid swelling, thyroid cancer, hyperthyroidism, hypothyroidism)
 Irregular menstruation (oligomenorrhoea & Amenorrhoea)
 Obesity (overweight)
 Short stature (being too short)
 Tall stature (being too tall)
 Young hypertension (age less than 30years)
 Menopausal symptoms
PROBLEMS:

YANAMALA VIJAY RAJ
A) Diabetics OPD Database Management:
 Department of Endocrinology, Diabetes and Metabolism have specific
requirements to be included in OPD form which is not always needed.
 New columns that meet the need of department has to added to present OPD
form, and unnecessary column deleted.
 Need to digitalize patient’s medical records in specific format.
 Need to have a sorting software that can sort patients based on their diagnostic
condition mentioned in OPD form.
 Save, retrieve, sorting of data for diabetes I form, Mody genetic testing form
SOLUTION:
 A windows form based application, which is used as a platform to display the digital
version of OPD Form.
 Application connected to MYSQL Database, which stores the entry values in application.
 Separate tables created under the same Schema (database name).
 Data-grid view that displayed the stored values.
 Print (Save as PDF) option for the displayed data on data-grid view.
 Give remote access to different PC in department to database, so that all doctors in the
respective department can save data.
 Sorting out the data saved based on how it needs to be sorted out.
 Login ID & Password for restricted access to everyone.
 Provision to copy the data /sorted out data in excel.
 Make form more flexible by adding radio buttons, checkboxes.
 IP address tracker for IP address tracking for the required PC.
 Windows player, picture viewer, pdf reader included in application.
 Search option for listing out required patient from the stored data.

YANAMALA VIJAY RAJ
B) OPD Diseaseswise Database Mgnt
SOLUTION: Windows database management application using C# and MySQL database.

YANAMALA VIJAY RAJ
C) Continues Glucose Monitoring Systems
SOLUTION: Biomedical equipment for monitoring insulin levels daily + 7 days + monthly
report systems
and connect the equipment with alarm system or sms alerts to doctors/nurses, so that
immediate actions can be taken.
Target Before food After food
Normal 4.0 to 5.9 mmol/L under 7.8 mmol/L
Type 2 diabetes 4 to 7 mmol/L under 8.5 mmol/L
Type 1 diabetes 4 to 8 mmol/L under 10 mmol/L
Glucose Biosensors:
Couple glucose downstream metabolic pathway, with electrochemical sensor.

YANAMALA VIJAY RAJ
ATP-> ADP + Pi
Pi can be detected by the following enzymes ( chemiluminescent ) :
ATP sulfurylase, luciferase and apyrase, and with the substrates adenosine 5´ phosphosulfate
(APS) and luciferin.

YANAMALA VIJAY RAJ
Solution 2: Detection of glucose by laser:
D) Bio informatics analysis of mutated proteins in mody diabetes:
Pdx1, neuroD1 and mafa genes mutation are found be responsible for the mody diabetes onset
in younger population. The tertiary structures of proteins are not available on PDB. Hence the
models of proteins are predicted using online servers. And the proteins are docked and the
docking score of mutated protein docked pdb is compared with the wild protein docked protein
pdb and results are inferred.

YANAMALA VIJAY RAJ
6) Developmental Pediatrics:
The Developmental Paediatrics department works with children who are different to most
other children. For example they may not walk the same, or speak the same or have some
abnormality.
About one in every 10 children born have something that makes them different. Some people
call this a disability, here it is seen as a neuro-developmental need. The unit wants to show the
children that they are loved as they are. The unit tries not to make children feel like “patients”.
So it is called a unit and has a hall of residence (not a ward).
The department does outpatient assessment and then outpatient treatment. The Hall of
Residence (ward) lets children stay with their family for “inpatient” treatment.
Development Pediatrics looks after children with:
 Dysembryogenic state – problems when the baby was growing in the mother’s womb.
 Feto-placental insufficiency – the baby did not get enough oxygen, food etc from the
placenta.
 Antenatal complications – problems before baby is born.
 Peri and neonatal insults - problems during childbirth or soon afterwards.
 Neurodegenerative illnesses – illnesses of the nerves and brain, usually genetic (in the
genes).
 Neuro-developmental delays and behavior dysfunctions – children who are slow doing
the things other normal children do. Others have behavioral problems or are very noisy
etc.
The following activities in the department are noted,
 Early learning center
 Sleep monitoring
 Terrace therapy outside
 Playroom
 Nutrition Education

YANAMALA VIJAY RAJ
 Sleep Hygiene Practices
 Sensory motor observatory room
PROBLEMS:
A) Learning app for AUTISTIC KIDS
Solution:
To design an android app using android studio and MIT app inventor.
B) Communication device (hardware)
Solution:
To design a hardware kit with some buttons and audio in different languages.
7) ENT:
Department of ENT at CMC Vellore are mainly focused on the treatment of ear, nose and throat
conditions in adults and children. This will include problems in hearing and deafness, ringing
in the ears, vertigo (dizziness), noses that are very stuffy or runny all the time, tonsil problems,
cancers of the ENT areas etc.
The following Equipments functions and its working principles are analyzed.
 Endoscopy
 Stroboscope
 Voice clinics
 Audio-vestibular clinics
Further the following instruments are seen
 Pure tone audiometry
 Auditory brainstem response (ABR) audiometry
 Auditory Steady-State Response (ASSR
 Oto-acoustic emission testing (OAE)
 Electrocochleography & Videonystagmography

YANAMALA VIJAY RAJ
 Hearing Aid trial
 Neonatal screening
 Speech assessment
 Voice analysis and therapy
PROBLEMS:
A) Low cost ABR Testing Machine
B) Low cost OAE Testing Machine
Solutions:
Cost effective designing of equipment can bring down the cost.
8. Surgery
The following problems are reported by doctors when we visited surgery department as part of
clinical rotation.
PROBLEMS:
A) Detection of Intestinal Anastomosis leakage.
 Anastomotic leakage (AL) is defined as intestinal content leaking into the peritoneal
cavity through an anastomotic defect.
 Consequently colonic bacteria like Escherichia coli and Enterococcus faecalis spread
throughout the peritoneal cavity possibly leading to peritonitis.
 This, in turn, may lead to sepsis and mortality.
SOLUTION:

YANAMALA VIJAY RAJ
i) Bio-medical equipment can be designed based on the following physiological factors.Analysis
of peritoneal drain fluid after colorectal surgery.
 E.coli present in drain,
 Cytokines present in drain due to inflammation,
 Acute phase protein present in drain,
 IR spectrum comparison between control and subject drain,
ii) Ecoli based detection techniques:
• PCR techniques
• Florescent techniques
• Flow cytometer
• Monoclonal targeting
iii) Dye based techniques: Nonyl Acridine Orange for ecoli detection
iv) Visualization of Phospholipid Domains in Escherichia coli by Using the Cardiolipin-Specific
Fluorescent Dye 10-N-Nonyl Acridine Orange.

YANAMALA VIJAY RAJ
Mono-clonal based Ecoli detection:
 Target Ecoli by mono-clonal antibodies
 Immuno-Complex precipitation detection
 Several biomarkers of infection, namely C-reactive protein (CRP) and procalcitonin
(PCT), have been shown to be useful in the diagnosis of infection.
 C-reactive protein (CRP) detection by immune-turbidimetric method.

YANAMALA VIJAY RAJ
9) Low Cost Effective Care Unit
CMC’s holistic understanding of health and healing calls for accessible, quality primary care
backed up by strong tertiary care services. Decades of experience serving a region with
endemic poverty and barriers to well-being (i.e. lack of education, unemployment, poor water
quality and hygiene systems, drought-plagued agricultural areas) are reflected in CMC’s
leadership in community health.
Working with the urban poor in Vellore, LCECU staff come face-to-face with unthinkable
living conditions, heartbreaking and complex illness, injury, loss, poverty—all exposing the
grave disparities in healthcare that exist in India. LCECU staff approach their work with a
distinct philosophy of empowerment, respect, dignity and compassion. They immerse
themselves in the very personal aspects of individual care. Staff work to ensure that each
person is empowered with enough knowledge and skill to understand his or her condition and
make informed decisions. In the context of extreme poverty, where the extraordinary
interventions common in the U.S. are not practical or necessarily appropriate, the individual in
the LCECU’s care is given unexpected control and dignity.
Established in 1983, the LCECU works from a small outpatient clinic and 46-bed general
practice facility attached to the Schell Eye Hospital in Vellore City. Most LCECU staff are Family
Physicians, specialists within the community health field who focus is on the individual in the
context of the family and community. The Family Physician is actually a highly trained
generalist who has a unique level of knowledge in primary and secondary care and refers out
for tertiary care. The delivery of individualized primary care takes into account the socio-
economic circumstances in an area, and does not go outside of an efficient, low-cost approach.
Medical tests are only ordered if they have the potential to change a diagnosis. Medication is
prescribed based only on its effectiveness and affordability.
PROBLEMS:
A) Digitalize the communication gap:
GPS based mobile app to save location of the visits, by social workers.
B) Database for saving and sorting visits based on location and patient diagnostic condition.
Mobile based application, using MySQL Lite Database.

YANAMALA VIJAY RAJ
10) Neonatology:
The department treats newborn babies that are born early and small or that get sick shortly
after being born.
According to department 9000 babies are born in CMC each year. Some will need to be
ventilated, others may need antibiotics. Most babies then grow up to be fit and well. After
discharge from the nursery, these babies are followed up in the High Risk Infant Clinic (HRIC).
These babies have a multi-disciplinary assessment by a team of physicians, occupational
therapists, physiotherapists and developmental pediatricians. An eye and hearing are also
assessed.
Assessment and counseling for high-risk mothers and their families in the Perinatal Clinic is an
important service. Often, they can take fluid from around the baby in the womb and look at the
baby's chromosomes. This will say if the baby is OK or if there is a problem.
The following equipments are seen in department and its importance in department are
learned from supervisor allocated to us for clinical visit.
 Bililights
 Blood pressure monitor
 Cardiopulmonary monitor
 Central line
 C-PAP (continuous positive airway pressure)
 Endotracheal tube
 Incubator

YANAMALA VIJAY RAJ
 Intravenous line
 Nasal cannula or nasal prongs
 Oxygen hood
 Pulse oximeter
 Radiant warmer
 Respirator
 Umbilical catheter
 Ventilator
PROBLEMS:
A) Low cost incubator:
SOLUTION: With heating coil and automated control of temperature using microcontroller via
thermistor.
11) Nuclear Medicine:
Nuclear medicine is a medical specialty involving the application of radioactive substances in
the diagnosis and treatment of disease.
The list of equipments seen in department are categorized as follows
Camera/Computer Systems
 Camera, planar only
 Camera, with SPECT
 Camera, dual head, planar
 Camera, dual head, SPECT
 Camera, multi-head (3-4 heads)
 CT imaging system
 Attenuation correction for SPECT
 Nuclear medicine-specific computer
 PET system

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Display Media
 Formatter, multi-imager
 Laser printer
 Dry film
 Video system
 Teleradiology (modem)
 PACS image storage
Quality Control Equipment
 Flat-field flood source (fillable)
 Co57 sheet source
 Planar spatial resolution phantom
 3-dimensional SPECT phantom
 Sealed sources, including check sources and transmission sources
 CT quality control phantom
Non-Imaging Equipment
 Dose calibrator
 Ionization chamber (Cutie Pie)
 G-M meter (Geiger counter)
 Gas ventilation delivery system
 Gas ventilation trap
 Aerosol delivery system
 Thyroid probe
 Well counter
 Mo99/Tc99m generator

YANAMALA VIJAY RAJ
Laboratory Equipment
 Centrifuge
 Pipettes
 Fume hood
 Laminar flow hood
 Microscope
Patient Care Equipment
 Intravenous infusion pump
 ECG monitor
 Treadmill
 O2 saturation monitor (pulse oximeter)
 Defibrillator
 Glucose meter
 IV contrast delivery system
 Sphygmomanometer
PROBLEMS:
A) Automated dose dispenser:
Radio-active Iodine is generally used in nuclear medicine department. Small doses are given to
patient diagnosed. Till date manual methods are utilized. An automated method of dispensing
the dose of radioactive Iodine, reduces the effective dose of radioactivity on technicians.
SOLUTION:
Pressure system is employed for dispensing fluid from fluid reservoir, and flow rate sensor are
employed for control dispensing of fluid.

YANAMALA VIJAY RAJ
12) Orthopaedics:
Orthopaedics look after problems of the bones including the spine, arms and legs, the ligaments,
joints like the hands and knees, and the muscles
There are 3 units under orthopaedics,
Orthopaedics unit 1, 2 & 3 - Treat General Adult Orthopaedics problems.
Spinal Disorder Surgery Unit - Takes care of Spinal disorders surgery and back surgery.
Pediatric Orthopaedics unit takes care of children with Orthopaedics and Club foot (children
born with a twisted foot).

YANAMALA VIJAY RAJ
PROBLEMS:
A) Design 3D model for Knee joints before surgery to predict the load, movements and other
parameters form CT/X-rays Images.
Solution:
To design a 3d model (dummy) using the knee navigation software and some materials like
ceramics so that we can assess joints before surgery.

YANAMALA VIJAY RAJ
13) Physical Medicine and Rehabilitation
The department of Physical Medicine and Rehabilitation is a large interdisciplinary team of
doctors, nurses, occupational therapists, physiotherapists, speech therapists, social workers,
psychologist, prosthetists and orthotists. This team works together in maximizing the health
and functional abilities of people with disabilities. The department provides outpatient and
inpatient services for persons with physical/neurological impairments due to conditions such
as
 Spinal Cord Injury
 Brain Injury due to trauma and other causes
 Stroke
 Developmental disorders such as cerebral palsy, spinal dysraphism
 Amputations of the extremities
 Rheumatological conditions
 Haemophilia
 Neuromuscular disorders
 Chronic pain
PROBLEM:
Exoskeleton for Rehab
SOLUTION:
A robotic suit that helps the survivors of stroke, spinal cord injury and other forms of lower
extremity weakness to walk again. The robotic exoskeleton will change the course of recovery
in gait training and neuro rehabilitation by augmenting not only the individual’s strength, but
the therapist’s ability to work with their patients.

YANAMALA VIJAY RAJ
14) PULMONARY MEDICINE:
A pulmonologist, or pulmonary disease specialist, is a physician who possesses specialized
knowledge and skill in the diagnosis and treatment of pulmonary (lung) conditions and
diseases.
As part of rotation the following are observed in the department.
 Spirometry
 Lung volume measurements by Nitrogen wash out & Helium dilution
 Body plethysmography
 Diffusing capacity measurements, by CO diffusion
 Bronchoprovocation testing
 Respiratory muscle strength testing
 Impulse oscillometry
 Rhinomanometry
 Fibreoptic, video & rigid bronchoscopy
 Therapeutic bronchoscopy – Argon plasma coagulation and Electro surgery
 Thoracoscopy using flexi-rigid/rigid thoracoscope
 Airway stenting
 Balloon bronchosplasty
 Endobronchial ultrasound (EBUS)
 Chest sonography & guided procedures.
PROBLEMS: not reported.
15) Radiation Therapy:
The department is leading cancer center in the country with facilities available for delivery of
radiotherapy using state of the art high precision radiotherapy techniques such as Stereotactic
irradiation(Stereotactic Radiosurgery / Stereotactic Radiotherapy), 3Dimensional Conformal
Radiotherapy (3DCRT), Intensity modulated therapy (IMRT) and Image Guided Radiotherapy
(IGRT). The patients are treated either as inpatient or as an outpatient based on necessity.
The following are observed in the department.

YANAMALA VIJAY RAJ
 Theratron 780C
 PRIMUS Linear Accelerator
 Clinac 2100C/D Linear Accelerator
 HDR Brachytherapy
 3D PLATO Treatment Planning System
 Varian Radiotherapy Simulator
 Eclipse Planning System
 BrainLAB Stereotactic system
PROBLEMS: Not reported.
16) NEUROLOGY:
The Neurology unit handles all kinds of neurological problems, both acute and chronic.
Patients with acute stroke, Guillain Barre Syndrome and myasthenic crisis and cerebral
hypoxia (hanging) are some of the acute cases admitted for treatment. We have experience in
treatment of immune mediated diseases of the nervous system and we get referrals from all
over India. Plasma exchange is being done for patients with Guillain Barre Syndrome, acute
disseminated encephalomyelitis and myasthenia gravis. Our unit does conventional machine
plasma exchange and also manual plasma exchange. Manual plasme exchange is a very cost
effective modality of treatment for patients with Guillain Barre Syndrome.
NEUROSURGERY
The Section of Neurosurgery is divided into units, Neurosurgery Unit-1 and Neurosurgery
Unit-2 for the purpose of efficient delivery of patient care. All brain and spine disorders are
managed by both units.
1. NEUROSURGERY UNIT I
2. NEUROSURGERY UNIT II
Brain:
Brain tumors form the commonest disorder treated including gliomas, meningiomas, pituitary
adenomas, craniopharyngiomas, vestibular schwannomas and intraventricular tumors. Other

YANAMALA VIJAY RAJ
disorders treated include hydrocephalus, intractable epilepsy, movement disorders, infections
such as pyogenic abscesses, tuberculosis, fungal infections and cysticercosis.
Spine:
Degenerative spine disorders, cervical and lumbar are managed by both units with modern
instrumentation techniques. Spinal dysraphism and congenital craniovertebral junction
anomalies are commonly treated. We also manage spine infections and trauma. Of particular
note is the management of spine and spinal cord tumors, both intramedullary and
extramedullary.
Equipment:
The operation theaters are well equipped with microscopes, high speed drill systems, Ultrasonic
surgical aspirators, endoscopic equipment for pituitary and intraventricular surgeries and
stereotactic systems. Also available are intraoperative ultrasound for imaging and
intraoperative neurophysiological monitoring. We also perform stereotactic radiosurgery for
brain tumors and AVMs.
Although conventional stereotactic surgery was initiated in the Department in 1960 with a
Bertrand stereotactic frame, the modern era of image guided stereotactic surgery using the
Brown Robert Wells (BRW) system was introduced in 1987. Since then over 1800 stereotactic
surgeries have been performed in the Department. There are 2 stereotactic frames (BRW and
CRW) and an MR compatible frame (CRW) and lesion generator (Radionics RFG 3B).
We introduced Stereotactic Radiosurgery (SRS) and Stereotactic Radiotherapy (SRT) for the first
time in India in June 1995 using the X Knife, LINAC based system, Since then over 500 SRS and
SRT procedures have been done. This program offers the most economical package for these
procedures.
INTRAOPERATIVE MONITORING
The Neurophysiology laboratory handles Intraoperative monitoring procedures. Full-fledged
Intraoperative monitoring (IOM) procedures were started in the year 1991. At present facilities
and expertise are available to monitor patients who are considered to be at risk during
neurosurgical procedures. Several techniques have been standardized to suit our requirements.

YANAMALA VIJAY RAJ
At present it is feasible to monitor patients undergoing neurosurgical procedures for spinal
cord, brain stem and cortex. The following techniques are employed -
a. Spinal cord surgeries such as intramedullary tumours, Scoliosis correction,
arteriovenous malformations and tethered cord cases we use motor evoked potentials (MEP)
and direct nerve stimulation techniques.
b. For intrinsic brain stem mass, cerebello-pontine angle tumours, we localize motor
nuclei, monitor facial nerve. For brachial plexus nerve injuries we identify branches and assess
their functional status. For microvascular decompression cases brain stem auditory evoked
responses (BAER) can be done.
c. Central sulcus localization is done using SSEP monitoring. Direct cortical stimulation is
done under general anaesthesia for localization of primary motor areas, and in awake
craniotomies to localize the speech areas. Aneurysm surgeries are also done under SSEP
monitoring.
d. In epilepsy surgeries we do corticograms using grid electrodes and depth electrodes to
localize epileptic areas.
PROBLEMS:
App to measure the falls
Solution:
Android based app to measure the number of falls in patients affected by epilepsy.

YANAMALA VIJAY RAJ
17. Transfusion Medicine & Immunohematology – Clinical Pathology:
PROBLEMS:
a. Malaria detection kit (cost effective) using pressure transducer
b. Automated blood group testing using od detection system
18. Cell culture lab:
a. Continuous monitoring of cell culture growth using strain gauges
19. Biochemistry lab:
a. Low cost spectrophotometry using light sensors
b. Low cost microscope using lasers
c. Low cost flow cytometer using lasers
d automated ELISA analyzers using photo diodes

Clinical Attachment

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