Mean Fall Research Articles

Assessment of cardiac risk in chronic asymptomatic alcoholics using blood pressure and electrocardiogram, and the relation with duration of drinking.

Background The Global Status Report 2017 reveals that 11% of Indians indulge in binge drinking. Chronic alcohol intake may lead to cardiac problems and hypertension. The aim of this study was to evaluate cardiovascular risk among asymptomatic chronic alcoholics. Methods A total of 80 asymptomatic chronic alcoholics of South Indian origin, from the psychiatry ward of Sri Ramachandra Institute of Higher Education and Research, India were diagnosed with alcohol dependence syndrome(ADS). Group I includes alcoholics for 10 years or less and group II includes alcoholics for more than 10 years. Alcohol consumption was measured using the DSM IV criteria. Blood pressure (BP) and electrocardiographic (ECG) data were measured on admission and 2 weeks later. The paired t-test compared a significant outcome of the two sets of data at p ≤ 0.05 level of significance. Results Forty percent of the patients were found to be hypertensive and only 2.5% were found to be pre-hypertensive on admission. The mean age of the hypertensives was 46.9 and nonhypertensives was 42.1 The difference in the BP evaluated after 2 weeks was staggering - systolic BP had a mean fall of 6.1 mm Hg (p < 0.001) and diastolic BP 2.25 mm Hg (p = 0.001). The electrocardiogram results showed significant changes like left ventricular hypertrophy, abnormal T waves, and QT prolongation. Conclusions Chronic alcoholism is a major criterion for heart abnormalities such as elevated BP and left ventricular enlargement, and our study supports this as we see that alcohol consumption for more than 10 years shows significant deterioration. Further clinical observations and long-term prospective studies are needed to confirm these observations.

Vitamin D rise enhances blood perfusion in patients with multiple sclerosis.

The chemical structure of vitamin D resembles steroids and anabolics. Following activation by enzymatic hydroxylation, vitamin D enhances numerous body functions. We determined 25-hydroxy-vitamin D, number of erythrocytes, haematocrit, mean corpuscular haemoglobin and mean corpuscular volume in 97 patients with multiple sclerosis initially and 6 months later. Patients with deficient levels of 25-hydroxyvitamin D (< 30ng/mL) were advised to perform vitamin D supplementation and received a prescription of a vitamin D formulation. Six months later we observed a rise of 25-OH-vitamin D, as to be expected, and a modified constellation of blood parameters such as elevation of mean corpuscular haemoglobin concentration and fall of mean corpuscular volume. Mean corpuscular haemoglobin and number of erythrocytes remained stable. The haematocrit went down. We suggest that vitamin D elevation may be beneficial in disorders characterised by chronic neuroinflammation and neurodegeneration, since changes of blood perfusion parameters may enhance cellular tissue oxygenation.

Hematological Parameters Throughout the First Month of Direct-Acting Antivirus (DAA) Plus Ribavirin for HCV

Abstract Introduction Hematological complications such as neutropenia, thrombocytopenia, and anemia of DAAs/ribavirin in HCV can result in suboptimal outcomes. This study was aimed to investigate the frequency of hematological variations and their impact on the response to DAA therapy. Patients were defined as having hematological abnormalities if they had the presence of either/or a combination of the following hematological parameters at least once during the first month of treatment: drop in (Hb) level, TLC, and PLT count. Pretreatment, Hb, WBC count, and PLT count were not statistically related to the treatment response. However, lower count of all parameters was associated with moderate or advanced hepatic fibrosis stages according to the METAVIR scoring (P &lt; .001). Static analysis showed that drop in Hb, TLC, and PLT count was significantly associated with response to treatment; P &lt; .001, .21, and .41, respectively. Methods Fifty-eight patients for treatment of chronic hepatitis were studied. Their hematological parameters including TLC, Hb, and platelet counts were recorded before starting antiviral therapy and then at 3 monthly intervals. All the patients were given DAAS/ribavirin as antiviral therapy. Data were collected over a period of 3 months. Results Fifty-eight patients with mean (SD) age of 54.38 (12.67) years were studied. There was a mean hemoglobin (Hb) fall of 1.5 g/dL at the first 4 weeks of antiviral therapy. Mean TLC fell to 1.03 × 10⁹/L in the first month. A similar downward trend was noted in platelet values with a mean fall of 12.3 × 10⁹/mm in the first month of the antiviral therapy. Of the cases, 41.4% developed clinically significant anemia as evidenced by hemoglobin 11 g/dL after 4 weeks of antiviral therapy; this fall was noted only in first 4 weeks of treatment. Conclusion Significant hematological abnormalities occurred within the first 4 weeks of antiretroviral therapy. There was significant decrease in hemoglobin level.

The relationship between atmospheric blocking and temperature anomalies in Turkey between 1977 and 2016

AbstractThe relationship between the character of atmospheric blocking and surface temperature has not been studied in depth for Turkey. Here, these relationships are investigated for the period 1977–2016. The seasonal mean temperature anomalies for all stations during blocked days varies between −2.1 and 0.8°C. There are four main patterns representing the mean seasonal temperature anomalies for all stations during blocked and non‐blocked days. The annual cycle for each group is nearly opposite, and this indicates the impact of blocking on observed temperature, as blocked days comprised 30% of the study period. When focusing on the spatial distribution of mean seasonal anomalies, the winter and fall seasons show that, almost all stations have negative temperature anomalies although anomalies are close to zero during warm seasons (spring and summer). The composite analysis shows that the western part of the country is strongly affected by cold air advection during upstream blocking events and the eastern part of the country is affected by warm temperature advection for downstream blocking events. There is a statistically significant (95% confidence level) negative correlation between blocking intensity and temperature anomalies in all seasons except spring. There is no relationship between both blocking duration and longitudinal extent and the seasonal mean temperature anomaly except during winter, which has a significant negative correlation. The temperature anomaly distribution stratified by season shows that strong positive anomalies are rarely observed in all seasons. Only winter and spring were associated with very strong positive anomalies and only at a few stations. Rex‐type atmospheric blocking events are observed during the period of not only the maximum temperature anomaly but also for minimum anomalies. However, the location of the blocking event differed from the typical situation above, with the cold and warm events being located downstream and upstream of Turkey, respectively.

Investigating the Stellar Mass Growth Histories of Satellite Galaxies as a Function of Infall Time Using Phase-space

Abstract We compile a large sample of nearby galaxies that are satellites of hosts using a well-known Sloan Digital Sky Survey (SDSS) group catalog. From this sample, we create an “ancient infallers” and “recent infallers” subsample, based on the mean infall time predicted from cosmological simulations for galaxies with their location in phase-space. We compare the stellar mass growth histories of the galaxies in these two subsamples, as determined from multiwavelength spectral energy distribution fitting that uses a comprehensive library of star formation history shapes derived from cosmological simulations. By simultaneously controlling for satellite stellar mass and host halo mass, we can clearly see the impact of time spent in their hosts. As we might predict, the ancient infaller population shows clear signs of earlier quenching, especially for lower mass satellites in more massive hosts. More importantly, we find that the effects are not limited to massive hosts. We find that hosts that might be considered low-mass groups (halo masses ∼1013 M ⊙) can significantly alter their satellites, even for massive satellites (stellar masses ∼1010 M ⊙). Intriguingly, we see changes in the mass growth history of the satellites of clusters as early as 8 or 9 Gyr ago, when they had not yet entered the virial radius of their current host. We propose that this could be the result of galaxies being preprocessed in low-mass substructures in the protocluster outskirts, prior to infall.

Clinical efficacy of Professional Continuous Glucose Monitoring in improving glycemic control among children with Type 1 Diabetes Mellitus: An Open-label Randomized Control Trial

Frequent self-monitoring of blood glucose (SMBG) is the only accurate method available for insulin dose titration in patients with T1DM. Professional continuous glucose monitoring (p-CGM) is blinded recording of glucose trends over 5–7 days and helps physicians to guide insulin titration to patient. This study was planned to assess efficacy of insulin dose adjustments, based on p-CGM plus SMBG in improving glycemic control compared to SMBG alone. We did an open-label, parallel design, randomized control trial among children (2–10 years) having T1DM for at least 6 months. Subjects in the intervention group were placed on p-CGM (iPRO 2™ Professional CGM, Medtronic, USA) for 3–5 days along with regular SMBG. Data from p-CGM was analyzed by physician and used to guide insulin titration along with SMBG over following 3 months. Control group had only SMBG records for titrating insulin doses. Primary outcome was change in HbA1c 3 months after intervention. A total of 68 eligible children were randomized, 34 each to either arms. Thirty children in intervention group and 33 in control group completed the study and were analyzed. It was found that there was more decreased unit change in HbA1c, percentage of low sugar records and total insulin requirement per day, after 3 months follow-up, in intervention group. However, difference was not significant except for total insulin Units/kg/day (p = 0.014). In sub-group analysis of children with baseline HbA1c >7.5%, there was a significant mean fall of HbA1c by 1.27% (p = 0.045). There were no major adverse events associated with p-CGM. We conclude that addition of p-CGM along with SMBG may help in adjusting insulin dose more effectively especially in children with higher baseline HbA1c.

Posturographic examination of body balance in patients with Chiari type I malformation and correlation with the presence of syringomyelia and degree of cerebellar ectopia.

We aimed to evaluate balance using the Tetrax Interactive Balance System (TIBS) in patients with Chiari type I malformation (CM-I) and to assess their fall risk with other clinical parameters. This cross-sectional, prospective study was conducted at physical medicine and rehabilitation outpatient clinics and neurosurgery department of a university hospital between December 2013 and December 2014. The study included a total of 36 patients (31 females, 5 males; mean age 40.6±10.0 years; range, 18 to 60 years) with CM-I. Dynamic balance was assessed using the Berg Balance Scale (BBS), and posturographic examinations were performed using the TIBS. The mean Fall Risk Index (FI) value was 42.4±29.8 and the mean BBS score was 55.5±1.5. The most common complaints were neck pain (94.4%), headache (88.9%), paresthesia (86.1%), fatigue (83.3%), and vertigo (80.6%). The mean tonsillar herniation below the foramen magnum was 8.7±3.8 (mm). Of the patients, 15 (42.85%) had syringomyelia. The degree of tonsillar ectopia was statistically significantly lower in patients with syringomyelia (p<0.05). The BBS scores were near identical among the patients with or without syringomyelia, although the FI values were lower in the patients with syringomyelia. Comparing cerebellar ectopia ≤9 mm versus >10 mm, the FI values were slightly higher in the patients with ectopia >10 mm, although there was no statistically significant difference in the FI or BBS values. Our study results suggest that CM-I can decrease the body balance stability and, thus, increase the fall risk. Evaluation of balance in patients with CM using TIBS static posturography is a simple and effective technique.

Cover Crop Species and Cultivars for Drill‐Interseeding in Mid‐Atlantic Corn and Soybean

Core Ideas Annual ryegrass and orchardgrass performed similarly in field corn. Medium red clover was the most consistent legume species in field corn. No effect of annual ryegrass cultivar was observed in field corn. Annual ryegrass was the most consistent species in soybean. ABSTRACTDrill‐interseeding is becoming a viable method for integrating cover crops in no‐till corn (Zea mays L.) production in the Mid‐Atlantic region. Development of best management practices for drill‐interseeding cover crops into no‐till grain crops requires greater understanding of cover crop performance at the species and cultivar level. Experiments were conducted at multiple Mid‐Atlantic locations (Maryland, Pennsylvania, New York) in two consecutive growing seasons (2013–2014, 2014–2015) to evaluate establishment and performance of drill‐interseeded: (i) grass and legume cover crop species (n = 8) and annual ryegrass [Lolium perenne L. spp. multiflorum (Lam.) Husnot] cultivars (n = 10) in field corn, and (ii) grass and legume cover crop species (n = 6) in soybean [Glycine max (L.) Merr]. Fall biomass production of drill‐interseeded cover crops was higher and less variable among locations in field corn than soybean. Annual ryegrass, orchardgrass (Dactylis glomerata L.), medium red clover (Trifolium pratense L.), and crimson clover (Trifolium incarntum L.) produced greater mean fall biomass than other species in field corn, but variable winter hardiness of crimson clover resulted in less spring biomass than alternative species. No differences were observed among annual ryegrass cultivars. Annual ryegrass, medium red clover, and crimson clover produced greater mean fall biomass than other species in soybean across locations. Our results highlight the viability of a narrow suite of cover crop species for interseeding in Mid‐Atlantic no‐till grain systems and point to the need for development of agronomic practices that facilitate greater niche complementarity between cover and cash crops.

Comparing Paleomagnetic Study Means With Apparent Wander Paths: A Case Study and Paleomagnetic Test of the Greater India Versus Greater Indian Basin Hypotheses

AbstractThis paper discusses the framework for comparing independent study means (SMs) with averages of aggregated study mean paleomagnetic poles, hereafter referred to as reference poles, contributing to continental or global apparent polar wander paths (GAPWP). Paleomagnetists typically compare individual SMs to these population means to compute latitudinal displacements or rotations with uncertainties estimated by comparing A95's. Using this comparison statistic, more than half of the population of reference SMs contributing to a GAPWP fall at an angular distance that is greater than their combined uncertainties. Two approaches are presented that yield similar results based on different rationales and comparison statistics. Common to both approaches is K95,GAPWP, the angular distance within which 95% of poles contributing to an APWP mean fall. One approach combines K95,GAPWP and the A95,SM of the independent study mean that can only be judged to be significantly displaced if the angular difference with the GAPWP mean exceeds their combined uncertainty. The second approach uses K95,GAPWP as the best estimate of total error of each study mean, which when combined with uncertainty of the GAPWP mean, A95,GAPWP, defines the angular difference that the independent study mean needs to exceed to be judged to be significantly displaced from a GAPWP mean. These comparison statistics are used to assess paleomagnetic support for Greater Indian Basin hypothesis for the paleogeographic evolution of the northern margin of India prior to collision with Asia. The Greater Indian Basin hypothesis is not supported based on these more rigorous criteria.

Physical properties of SDSS satellite galaxies in projected phase space

We investigate how environment affects satellite galaxies using their location within the projected phase-space of their host haloes from the Wang et al.'s group catalogue. Using the Yonsei Zoom in Cluster Simulations, we derive zones of constant mean infall time T_inf in projected phase-space, and catalogue in which zone each observed galaxy falls. Within each zone we compute the mean observed galaxy properties including specific star formation rate, luminosity-weighted age, stellar metallicity and [alpha/Fe] abundance ratio. By comparing galaxies in different zones, we inspect how shifting the mean infall time from recent infallers (mean T_inf < 3 Gyr) to ancient infallers (mean T_inf > 5 Gyr) impacts galaxy properties at fixed stellar and halo mass. Ancient infallers are more quenched, and the impact of environmental quenching is visible down to low host masses (< group masses). Meanwhile, the quenching of recent infallers is weakly dependent on host mass, indicating they have yet to respond strongly to their current environment. [alpha/Fe] and especially metallicity are less dependent on host mass, but show a dependence on mean T_inf. We discuss these results in the context of longer exposure times for ancient infallers to environmental effects, which grow more efficient in hosts with a deeper potential well and a denser intracluster medium. We also compare our satellites with a control field sample, and find that even the most recent infallers (mean T_inf < 2 Gyr) are more quenched than field galaxies, in particular for cluster mass hosts. This supports the role of pre-processing and/or faster quenching in satellites.

Falls in nursing homes: challenges from a nursing perspective.

Falls are very common among older people. Previous literature has reported a mean fall rate of 1.7 falls per person-year (range, 0.6–3.6) for those who live in nursing homes (Rubenstein et al, 1994) and a rate of 0.65 (range, 0.3–1.6) for those living in the community (Rubenstein, 2006). A more recent study of 70,000 falls in Bavarian nursing homes has reported a similar fall rate (1.6 per person-year), with the rate being higher among men (Rapp et al, 2012). The higher fall rate among older people in nursing homes compared to the rest of the community is expected, and falls are a major reason for admission into nursing homes. One non-injurious fall carries a 3.1 times relative risk of admission into a nursing home, while a fall accompanied by serious injuries is associated with a 10.2 times higher relative risk (Tinetti and Williams, 1997). Even though the majority of falls in nursing homes do not result in serious injury, 10–25% result in hospital admission and/or fractures (Vu et al, 2004). With such a high prevalence, falls, unsurprisingly, result in 81.5% of external (defined as premature, usually injury related and potentially preventable) causes of deaths among nursing home residents (Ibrahim et al, 2017).

STUDY ON EFFECTS OF REPEATED SALBUTAMOL NEBULIZATIONS ON SERUM POTASSIUM LEVELS AND QTC ON ELECTROCARDIOGRAM IN CHILDREN WITH ACUTE WHEEZE

Objective: Acute wheeze is a common problem in young children with respiratory disorders. This study emphasizes on whether there are any significant changes in serum potassium levels and QTc interval during repeated salbutamol nebulizations. Methods: A cross-sectional observational study was conducted at a tertiary care teaching hospital. The study group comprised of 41 children in the age group of 6 months–12 years. Pediatric asthma score and vital parameters (heart rate, respiratory rate, and SpO2) were recorded at the onset and end of salbutamol nebulizations. Baseline serum potassium levels were taken at the onset and then at the end. An electrocardiogram (ECG) was taken at 1 h and another at 3 h, for those who continued to require repeated nebulizations until then. Results: The mean fall in serum potassium levels after repeated salbutamol nebulizations was 0.3±0.4 (p<0.05). The mean fall after 3, 4, 5, and 6 salbutamol nebulizations was 0.06, 0.44, 0.66, and 0.43 mEq/L, respectively. There were no significant changes in ECG patterns in these children. The mean QTc at 1 h of repeated salbutamol nebulizations was 0.41±0.02 (s) and that after 3 h (for children requiring repeated nebulizations until then) was 0.43±0.01 (s). The mean rise in QTc at 3 h was 0.004 s, which was not statistically significant (p=0.137). Conclusion: We conclude that serum potassium levels should be monitored in children receiving repeated salbutamol nebulizations for acute wheeze.

A12359 The Effect of Thyroid Hormone Replacement on the Level of Blood Pressure in the Cases of Subclinical Hypothyroidism

Objectives: Background: Hypothyroidism (both subclinical and overt) is associated with increased cardiovascular morbidity. About 3% hypertensive patients found to have hypothyroidism during the routine investigations. Objectives: To assess the effect of thyroid hormone replacement on the level of blood pressure in the cases of newly diagnosed subclinical hypothyroidism. Methods: Patients above the age of 15 years admitted to various wards (Indoor) or attending Endocrinology OPD at teriatary care health centre of north India were enrolled during the period of one year. The cases were divided into two groups, normotensive and hypertensive. Cases with subclinical hypothyroidism after evaluation were prescribed thyroxine replacement therapy to achieve euthyroid function. Each group followed periodically at 1 ½, 03 and 06 month with measurement of blood pressure and serum TSH, T3 and T4 level. Results: The prevalence of hypertension in cases of subclinical hypothyroidism in this study was 33.4 per 100 populations. There was no correlation between serum TSH level and blood pressure level in hypertensive group (p > 0.05). In hypertensive group mean fall in blood pressure after thyroxine replacement therapy was systolic blood pressure 20.10 ± 11.2 diastolic blood pressure 13.16 ± 3.8 and in mean arterial pressure 15.2 ± 4.7. With replacement of thyroxine hormone, the blood pressure was normalized in 47.4% (45 out of 95 cases) cases with elevated blood pressure. Conclusion: The effect of thyroxine replacement therapy in cases of hypertension with subclinical hypothyroidism on blood pressure was significant reduction in blood pressure after achieving normal thyroid function.

Initial orthostatic hypotension among patients with unexplained syncope: An overlooked diagnosis?

BackgroundInitial orthostatic hypotension (IOH) is a clinical syndrome of transient orthostatic hypotension that is defined as a drop in blood pressure of >40 mm Hg systolic and/or >20 mm Hg diastolic within 15 s after standing, accompanied by symptoms of cerebral hypoperfusion, but without sustained orthostatic hypotension (blood pressure decrease >20/10 mm Hg after 1–3 min of standing). As the etiology of syncope remains unknown in a large proportion of patients, we hypothesized that IOH is highly prevalent among patients with unexplained syncope. MethodsWe studied 250 consecutive outpatients with unexplained syncope that were evaluated in the syncope-unit of our tertiary referral hospital. We measured hemodynamic changes in response to active standing using a beat-to-beat blood pressure measurement device, first after lying supine for >5 min and then after squatting for 30 s. Results11.2% of the patients were diagnosed with syncope due to IOH, with a mean fall in blood pressure of 47.4 ± 12.5/29.0 ± 10.7 mm Hg within 15 s after standing up. Therefore, IOH was the second commonest cause of syncope in our cohort. 46.2% of the patients diagnosed with syncope due to IOH used antihypertensive drugs, mostly betablockers (41.6%) and/or tamsulosin (24.9%). The squatting-to-standing-test in addition to the lying-to-standing-test resulted in only 3 additional patients diagnosed with syncope due to IOH. ConclusionsIOH is highly prevalent among patients with previously unexplained syncope. Therefore, beat-to-beat blood pressure measurement should be considered in patients with unexplained syncope.

On the forward modeling of radar Doppler spectrum width from LES: Implications for model evaluation.

Large-eddy simulations of an observed single-layer Arctic mixed-phase cloud are analyzed to study the value of forward modeling of profiling millimeter-wave cloud radar Doppler spectral width for model evaluation. Individual broadening terms and their uncertainties are quantified for the observed spectral width and compared to modeled broadening terms. Modeled turbulent broadening is narrower than the observed values when the turbulent kinetic energy dissipation rate from the subgrid-scale model is used in the forward model. The total dissipation rates, estimated with the subgrid-scale dissipation rates and the numerical dissipation rates, agree much better with both the retrieved dissipation rates and those inferred from the power spectra of the simulated vertical air velocity. The comparison of the microphysical broadening provides another evaluative measure of the ice properties in the simulation. To accurately retrieve dissipation rates as well as each broadening term from the observations, we suggest a few modifications to previously presented techniques. First, we show that the inertial subrange spectra filtered with the radar sampling volume is a better underlying model than the unfiltered -5/3 law for the retrieval of the dissipation rate from the power spectra of the mean Doppler velocity. Second, we demonstrate that it is important to filter out turbulence and remove the layer-mean reflectivity-weighted mean fall speed from the observed mean Doppler velocity to avoid overestimation of shear broadening. Finally, we provide a method to quantify the uncertainty in the retrieved dissipation rates, which eventually propagates to the uncertainty in the microphysical broadening.

A double-blind, randomised trial of a polyphenolic-rich nail bed balm for chemotherapy-induced onycholysis: the UK polybalm study

PurposeNail damage is common amongst patients receiving chemotherapy causing disfigurement and pain. This investigation evaluated whether a topical balm containing steam-extracted, bioactive polyphenolic-rich herbal oils blended with organic waxes could protect the nails via their reported anti-inflammatory, analgesic, anti-oxidant and anti-microbial properties.Methods60 patients (23M, 37F) were randomised to apply (2–3/day) either the plant balm (PB) or a petroleum control (PC) to their nail beds. Demographics, type and number of chemotherapy cycles did not differ between the two groups, recruited between Sept 2015 and Sept 2016. An unpaired t test was used to test the differences in symptoms and physical nail damage between the two groups.ResultsSymptom scores recorded with the dermatology life quality questionnaire (DLQQ) were significantly better, between the start and end of chemotherapy, in the group applying the PB versus PC. Likewise, the mean fall in nail damage, scored with the Nail Psoriasis Index by the supervising physician, was also significantly different.ConclusionThe polyphenolic-rich essential oils and plant-based waxes in this nail bed balm profoundly reduced chemotherapy-related nail damage and improved nail-related quality of life, compared to a control. A further analysis is planned combining this balm with nail bed cooling.

The Effect of Thyroid Hormone Replacement on the Level of Blood Pressure in the Cases of Subclinical Hypothyroidism

International Journal of Medicine and Public Health,2018,8,1,24-28.DOI:10.5530/ijmedph.2018.1.5Published:March 2018Type:Original ArticleThe Effect of Thyroid Hormone Replacement on the Level of Blood Pressure in the Cases of Subclinical HypothyroidismSukriti Kumar, Sumit Rungta, Manish Gutch, Annesh Bhattacharya, Syed Mohd Razi, and Agarwal Avinash Sukriti Kumar1, Sumit Rungta2, Manish Gutch*3, Annesh Bhattacharya4 , Syed Mohd Razi5, Agarwal Avinash6 1Assistant Professor, Department of Radiodiagnosis, King George’s Medical College, Lucknow, Uttar Pradesh, INDIA. 2MD (Medicine), Department of Medicine, King George’s Medical College, Lucknow, Uttar Pradesh, INDIA. 3MD (Medicine), DM (Endocrinology), Assistant Professor, Department of Medicine, King George’s Medical College, Lucknow, Uttar Pradesh, INDIA. 4MD Medicine, Senior Resident, Department of Medicine, King George’s Medical College, Lucknow, Uttar Pradesh, INDIA. 5MD (Medicine), DM (Endocrinology), Senior Resident, Department of Endocrinology, LLRM Medical College, Meerut, Uttar Pradesh, INDIA. 6MD, Associate Prof, Department of Medicine, KGMU, Lucknow, Uttar Pradesh, INDIA. Abstract:Background: Hypothyroidism (both subclinical and overt) is associated with increased cardiovascular morbidity. About 3% hypertensive patients found to have hypothyroidism during the routine investigations. Objectives: To assess the effect of thyroid hormone replacement on the level of blood pressure in the cases of newly diagnosed subclinical hypothyroidism. Methods: Patients above the age of 15 years admitted to various wards (Indoor) or attending Endocrinology OPD at teriatary care health centre of north India were enrolled during the period of one year. The cases were divided into two groups, normotensive and hypertensive. Cases with subclinical hypothyroidism after evaluation were prescribed thyroxine replacement therapy to achieve euthyroid function. Each group followed periodically at 1 ½, 03 and 06 month with measurement of blood pressure and serum TSH, T3 and T4 level. Results: The prevalence of hypertension in cases of subclinical hypothyroidism in this study was 33.4 per 100 populations. There was no correlation between serum TSH level and blood pressure level in hypertensive group (p>0.05). In hypertensive group mean fall in blood pressure after thyroxine replacement therapy was systolic blood pressure 20.10±11.2 diastolic blood pressure 13.16±3.8 and in mean arterial pressure 15.2±4.7. With replacement of thyroxine hormone, the blood pressure was normalized in 47.4% (45 out of 95 cases) cases with elevated blood pressure. Conclusion: The effect of thyroxine replacement therapy in cases of hypertension with subclinical hypothyroidism on blood pressure was significant reduction in blood pressure after achieving normal thyroid function. Keywords:Hypertension, Subclinical hypothyroidism, Thyroxine replacementView:PDF (467.15 KB)

Raindrop fall velocities from an optical array probe and 2-D video disdrometer

Abstract. We report on fall speed measurements of raindrops in light-to-heavy rain events from two climatically different regimes (Greeley, Colorado, and Huntsville, Alabama) using the high-resolution (50 µm) Meteorological Particle Spectrometer (MPS) and a third-generation (170 µm resolution) 2-D video disdrometer (2DVD). To mitigate wind effects, especially for the small drops, both instruments were installed within a 2∕3-scale Double Fence Intercomparison Reference (DFIR) enclosure. Two cases involved light-to-moderate wind speeds/gusts while the third case was a tornadic supercell and several squall lines that passed over the site with high wind speeds/gusts. As a proxy for turbulent intensity, maximum wind speeds from 10 m height at the instrumented site recorded every 3 s were differenced with the 5 min average wind speeds and then squared. The fall speeds vs. size from 0.1 to 2 and &gt;0.7 mm were derived from the MPS and the 2DVD, respectively. Consistency of fall speeds from the two instruments in the overlap region (0.7–2 mm) gave confidence in the data quality and processing methodologies. Our results indicate that under low turbulence, the mean fall speeds agree well with fits to the terminal velocity measured in the laboratory by Gunn and Kinzer from 100 µm up to precipitation sizes. The histograms of fall speeds for 0.5, 0.7, 1 and 1.5 mm sizes were examined in detail under the same conditions. The histogram shapes for the 1 and 1.5 mm sizes were symmetric and in good agreement between the two instruments with no evidence of skewness or of sub- or super-terminal fall speeds. The histograms of the smaller 0.5 and 0.7 mm drops from MPS, while generally symmetric, showed that occasional occurrences of sub- and super-terminal fall speeds could not be ruled out. In the supercell case, the very strong gusts and inferred high turbulence intensity caused a significant broadening of the fall speed distributions with negative skewness (for drops of 1.3, 2 and 3 mm). The mean fall speeds were also found to decrease nearly linearly with increasing turbulent intensity attaining values about 25–30 % less than the terminal velocity of Gunn–Kinzer, i.e., sub-terminal fall speeds.

3:09 PM Abstract No. 152 Safety and efficacy of angioplasty and/or stenting for transplant renal artery stenosis

Transplant renal artery stenosis (TRAS) is a complication that becomes evident within 3 months to 2 years of transplant. The most common location is the anastomotic site, which can lead to allograft failure, refractory hypertension and fluid retention. Percutaneous transluminal angioplasty is the mainstay of treatment. The aim of this study is to assess the safety, technical factors and efficacy of angioplasty and/or stenting in TRAS. This is a single-center retrospective study of all cases of transplant renal artery angioplasty/stenting from 2015-17. Using CPT codes, 81 cases were retrieved, of which 21 cases were selected for the study. Data was retrieved from electronic medical records and PACS. Paired sample t-tests were used for statistical analyses. CO2 contrast was used for all angiography except for the final measurement angiogram prior to and during stent placement. Iodinated contrast volume was restricted to less than 10 mL in all cases. One case was done with CO2 alone. Out of 21 patients, 12 were females and the mean age was 58.9 years (SD 8). Angioplasty alone was done in 9 patients and stenting was done in 12 patients. Mean angioplasty balloon diameter was 4 mm. Mean stent diameter was 4.7 mm. The mean peak systolic velocity (PSV) in the renal artery prior to intervention was 443.7cm/s (SD 104.0) which decreased to 252.0 cm/s (SD 134.4) at a follow-up duration within one month (p<0.001). The mean creatinine prior to intervention was 2.83 mg/dL (SD 1.2) which decreased to 1.81 mg/dL (SD 1.04) at a follow-up duration within 6 weeks (p<0.001). The mean decrease in PSV was 43% (SD 24.5) and the mean fall in creatinine was 35.2% (SD 18.3). The mean improvement in stenosis post intervention was 130% (SD 95). There was no significant correlation between the improvement in stenosis and the improvement in creatinine or PSV (p = 0.38 and p = 0.47 respectively). There were no complications experienced with any of the 21 patient interventions. Angioplasty and stenting is a safe and effective treatment for transplant renal arterial anastomotic stenosis, which significantly improves blood flow and renal function with minimal use of iodinated contrast agents.

Study Comparing Phenylephrine Bolus and Infusion for Maternal Hypotension and Neonatal Outcome during Cesarean Section under Spinal Anesthesia.

Background:Phenylephrine(PE) bolus and infusion have been compared for post spinal hypotension and neonatal effects during cesarean section(CS) under spinal anesthesia(SA).Aim:The primary aim of this study was to compare bolus doses of 50μg of PE with a fixed infusion rate of 50 μg/min of the same drug given prophylactically. The secondary aim was to study the neonatal outcome and side effects with the two regimes.Settings and Design:This prospective,randomized,comparative study was conducted in the department of Anesthesia in a tertiary care teaching hospital.Materials and Methods:This study was conducted on 100 normotensive women undergoing CS under SA. The patients were randomized into two groups of 50 each. Group A received bolus of 50 μg PE after the systolic BP(SBP) fell by 20% from the baseline and Group B received a prophylactic infusion of 50 μg/min PE. The changes in heart rate (HR), BP and side effects were compared till delivery. The neonatal APGAR scores were compared at 1 and 5 minutes and an umbilical artery sample was sent for blood gas analysis.Statistical Analysis:Categorical variables were shown in number and percentage. Normally distributed continuous variables were presented as mean ± SD and compared using unpaired t-test. Non normally distributed continuous variables were displayed as median and were compared using Mann-Whitney test. A P value of <0.05 was considered significant.Results:In group A, the HR was higher than in group B throughout the monitoring period. (P < 0.001). In group A, SBP trend showed a fall of more than 20% from the base line in 44 patients. The mean fall in SBP was -28.06 ± 5.3 mmHg% in Group A while in group B the mean fall in SBP was only -0.44 ± 4.3mmHg%. Nausea and vomiting was less in group B. There was no difference in APGAR or neonatal acidosis on ABG.Conclusion:There was a tighter control of BP in the infusion group vs. the bolus group while the neonatal outcome was similar in both the groups.