A Hospital Based Cross-sectional study on the Incidence of Micro-albuminurea and Left Ventricular Hypertrophy among Hypertensive Patients

INTRODUCTION : Hypertension provides both despair and hope. Despair because it is quantitatively the largest risk factor for cardiovascular diseases, is growing in prevalence, and is poorly controlled virtually everywhere. Hope because prevention is possible and because treatment can control hypertension in all most all patients with consequent marked reduction in stroke and heart attack. It should be noted that cardiovascular diseases are the leading cause of death worldwide, not only in economically developed countries but also in the developing world. In turn, hypertension is overall the major contributor to the risks for cardiovascular diseases. The over all world wide prevalence of hypertension is approximately 26% of the adult population, with marked differences between countries. The increasing prevalence of hypertension is primarily a consequence of the population becoming older and obese. Despite overwhelming evidence that effective treatment of hypertension is associated with a significant reduction of cardiovascular events, the number of patients who are aware of their condition and who achieve adequate BP control remains unacceptably low. Albumin excretion and microalbuminuria are currently drawing a great deal of attention in the medical literature. Much of this attention derives from the fact that albumin excretion is a risk factor for kidney failure, stroke, and cardiovascular and all cause mortality, particularly for persons with diabetes and/or hypertension. Based on the data from the Heart Outcomes Prevention and Evaluation Study (HOPE STUDY), it is clear that the presence of microalbuminuria is an signal from kidney that cardiovascular risk is increased and that vascular responses are altered. Microalbuminuria is a highly specific predictor of the simultaneous occurrence of both cardiac and vascular abnormalities. Data from the LIFE study show that the ECG strain pattern of ST-segment depression and T-wave inversion in the lateral precordial leads is a predictor of heart failure. This strain pattern has been associated with increased left ventricular mass and depressed left ventricular function. This study focuses on the incidence of microalbuminuria and left ventricular hypertrophy among hypertensive patients along with demographic analysis. AIMS AND OBJECTIVES : To find out the incidence of Micro-albuminuria and Left Ventricular Hypertrophy among hypertensive patients without associated conditions like Diabetes Mellitus, Stroke, Ischaemic Heart Disease and Renal Diseases. MATERIAL AND METHODS : A hospital based cross-sectional study was conducted among hypertensive patients who attend the out-patient department of cardiology in Chengalpattu Medical College Hospital, Chengalpattu from march 2009 to December 2009 to find out the incidence of microalbuminuria and left ventricular hypertrophy Among hypertensive patients. All patients between the age of 35 and 65 who attend the hypertensive clinic were screened for the following diseases and excluded from the study. 1. Diabetes mellitus. 2. Cerebro-vascular accident. 3. Coronary artery disease. 4. Kidney diseases (creatinine above 2 mg/dl). 5. Urinary tract infection. Diabetes mellitus was ruled out by fasting and post prandial blood sugar. Coronary artery disease and stroke was ruled out by history, physical examination and appropriate investigation. Urinary tract infection was ruled out by urine culture and kidney diseases by blood urea and serum creatinine. Patients who were on ACE/ARB drugs were excluded from the study. Study subjects who were anemic and who had fever were excluded from the study. Only patients with raised blood pressure without the above conditions were the study subjects. BLOOD PRESSURE MEASUREMENT : Once the patient was selected by the above criteria the BP has been recorded in the following manner. Several steps have been taken to minimize the variability. 1. Having the subjects rest silently and comfortably (with back and arm support if seated) for about 5min before measurement. 2. Abstaining from drinking caffeine or alcohol containing beverages or tobacco use within 30 min before a BP measurement. 3. Questioning the subject regarding the most recent meal or evacuation of bowl or bladder. 4. Centering the bladder of cuff over the brachial artery with its lower edge within 2.5 cm of the antecubital fossa. 5. Assuring that the arm was supported at the level of the heart. 6. Listening over the brachial artery by using the bell of stethoscope with minimal pressure exerted over the skin. 7. BP measurements, the cuff typically should be inflated 20mm hg higher than the pressure at which the palpable pulse at the radial artery disappears. 8. Attempting to avoid “terminal digit preference,” there should be an equal number of readings ending in 0,2,4,6, or 8 mmhg. 9. Measurement of BP in both arm typically are obtained at the initial visit, and the arm with higher BP was used thereafter if the difference was greater than 10/5 mmhg. 10.On each occasion at least two readings were taken with as much as time as it was practicable separateable. If reading more than 5mmhg additional readings were taken until they where close. 11.For diagnosis at least three sets of readings at one week apart. CONCLUSION : In our study 22.7 % of the study subjects had microalbuminuria and 20.6 % had left ventricular hypertrophy. There was a strong statistical association between microalbuminuria and age, sex and diastolic blood pressure. Similarly the statistical association between left ventricular hypertrophy and diastolic blood pressure was strong. Both microalbuminuria and left ventricular hypertrophy were not statistically associated with body mass index and systolic blood pressure

Branch and Price Solution Approach for Order Acceptance and Capacity Planning in Make-to-Order Operations

The increasing emphasis on mass customization, shortened product lifecycles, synchronized supply chains, when coupled with advances in information system, is driving most firms towards make-to-order (MTO) operations. Increasing global competition, lower profit margins, and higher customer expectations force the MTO firms to plan its capacity by managing the effective demand. The goal of this research was to maximize the operational profits of a make-to-order operation by selectively accepting incoming customer orders and simultaneously allocating capacity for them at the sales stage. For integrating the two decisions, a Mixed-Integer Linear Program (MILP) was formulated which can aid an operations manager in an MTO environment to select a set of potential customer orders such that all the selected orders are fulfilled by their deadline. The proposed model combines order acceptance/rejection decision with detailed scheduling. Experiments with the formulation indicate that for larger problem sizes, the computational time required to determine an optimal solution is prohibitive. This formulation inherits a block diagonal structure, and can be decomposed into one or more sub-problems (i.e. one sub-problem for each customer order) and a master problem by applying Dantzig-Wolfe’s decomposition principles. To efficiently solve the original MILP, an exact Branch-and-Price algorithm was successfully developed. Various approximation algorithms were developed to further improve the runtime. Experiments conducted unequivocally show the efficiency of these algorithms compared to a commercial optimization solver. The existing literature addresses the static order acceptance problem for a single machine environment having regular capacity with an objective to maximize profits and a penalty for tardiness. This dissertation has solved the order acceptance and capacity planning problem for a job shop environment with multiple resources. Both regular and overtime resources is considered. The Branch-and-Price algorithms developed in this dissertation are faster and can be incorporated in a decision support system which can be used on a daily basis to help make intelligent decisions in a MTO operation

Temperature Driven Structural Phase Transition in Tetragonal-Like BiFeO3

Highly-strained BiFeO3 exhibits a "tetragonal-like, monoclinic" crystal structure found only in epitaxial films (with an out-of-plane lattice parameter exceeding the in-plane value by >20%). Previous work has shown that this phase is properly described as a M$_{C}$ monoclinic structure at room temperature [with a (010)$_{pc}$ symmetry plane, which contains the ferroelectric polarization]. Here we show detailed temperature-dependent x-ray diffraction data that evidence a structural phase transition at ~100C to a high-temperature M$_{A}$ phase ["tetragonal-like" but with a (1-10)$_{pc}$ symmetry plane]. These results indicate that the ferroelectric properties and domain structures of strained BiFeO$_3$ will be strongly temperature dependent.Comment: 10 pages, 3 figure

Land, Caste, and Class in rural West Bengal

By mapping the trajectories of changing dynamics in land relations in both colonial and postcolonial periods in rural West Bengal, this chapter tries to understand the way the land has been determining the issues of the rural economy in the rural hinterland. Based on field-survey data, this chapter argues, first, that the issues of land are shaped through a complex process of dynamic interaction between class, caste and capital. Second, the way the state and its policies do intervene in this complex process in order to shape the issues of land in rural areas has been complicating the matter further by way of privileging the capital and the landed class belonging to higher castes at the expense of the labouring class belonging to subordinate caste groups.Peer reviewe

Spectrophotometric determination of trace amounts of cadmium with iodide and methyl violet

445-446A selective spectrophotometric method based on the interaction of an anionic iodo complex of cadmium with methyl violet has been described for the determination of trace amounts of cadmium. The developed method is precise, accurate and has been applied to determination of cadmium at trace levels (25 ppb) in sea water and high purity samples of indium and zinc materials

Effect of time of pruning and peeling on the bark yield of cinnamon (Cinnamomum verum J. Pres.) in Andaman and Nicobar Islands

An experiment was conducted at Port Blair, Andaman and Nicobar Islands, to study theeffect of time of pruning and peeling on the yield of cinnamon (Cinnamomum verum)intercropped in an arecanut (Areca catechu) garden. Pruning and peeling was carried out at20 days interval from first week of June to August during both the years. The number ofbranches (31) and girth (19.98 cm) were significantly higher in 10th July pruning. Bark yieldtree-1 (both fresh and dry weight) was also significantly higher during 10th July (4.03 kgfresh and 1.22 kg dry weight) pruning indicating that this period is ideal for pruning andpeeling cinnamon in Andaman and Nicobar Islands. &nbsp

Agro-materials : a bibliographic review

Facing the problems of plastic recycling and fossil resources exhaustion, the use of biomass to conceive new materials appears like a reasonable solution. Two axes of research are nowadays developed : on the one hand the synthesis of biodegradable plastics, whichever the methods may be, on the other hand the utilization of raw biopolymers, which is the object of this paper. From this perspective, the “plastic” properties of natural polymers, the caracteristics of the different classes of polymers, the use of charge in vegetable matrix and the possible means of improving the durability of these agro-materials are reviewed

Direct Measurement of Pyroelectric and Electrocaloric Effects in Thin Films

An understanding of polarization-heat interactions in pyroelectric and electrocaloric thin-film materials requires that the electrothermal response is reliably characterized. While most work, particularly in electrocalorics, has relied on indirect measurement protocols, here we report a direct technique for measuring both pyroelectric and electrocaloric effects in epitaxial ferroelectric thin films. We demonstrate an electrothermal test platform where localized high-frequency (approximately 1 kHz) periodic heating and highly sensitive thin-film resistance thermometry allow the direct measurement of pyrocurrents (<10 pA) and electrocaloric temperature changes (<2 mK) using the “2-omega” and an adapted “3-omega” technique, respectively. Frequency-domain, phase-sensitive detection permits the extraction of the pyrocurrent from the total current, which is often convoluted by thermally-stimulated currents. The wide-frequency-range measurements employed in this study further show the effect of secondary contributions to pyroelectricity due to the mechanical constraints of the substrate. Similarly, measurement of the electrocaloric effect on the same device in the frequency domain (at approximately 100 kHz) allows for the decoupling of Joule heating from the electrocaloric effect. Using one-dimensional, analytical heat-transport models, the transient temperature profile of the heterostructure is characterized to extract pyroelectric and electrocaloric coefficients

Calculation of the Phase Behavior of Lipids

The self-assembly of monoacyl lipids in solution is studied employing a model in which the lipid's hydrocarbon tail is described within the Rotational Isomeric State framework and is attached to a simple hydrophilic head. Mean-field theory is employed, and the necessary partition function of a single lipid is obtained via a partial enumeration over a large sample of molecular conformations. The influence of the lipid architecture on the transition between the lamellar and inverted-hexagonal phases is calculated, and qualitative agreement with experiment is found.Comment: to appear in Phys.Rev.