A comparative randomized controlled parallel group study of efficacy and tolerability of labetalol versus methyldopa in the treatment of mild preeclampsia

Background: The objective of the current study was to compare the efficacy and tolerability of labetalol versus methyldopa in the treatment of mild preeclampsia.Methods: We carried out a prospective randomized controlled parallel group study on 100 outpatients of Obstetrics and Gynaecology Department of Government Medical College, Patiala, a tertiary care teaching hospital. Pregnant patients (20-40 weeks gestational age) newly diagnosed with blood pressure (BP) of ≥140/90 mm Hg were included in the study. All patients with systolic BP (SBP) ≥160 mm Hg and diastolic BP (DBP) ≥110 mm Hg after 20 weeks of gestation, history of hypertension, renal diseases, diabetes mellitus, epilepsy, and thyroid diseases were excluded from the study. After taking the informed consent, 50 patients each were randomized to either of the two treatment arm-oral labetalol or oral methyldopa. Difference in the BP measurements at the time of admission and at the time of delivery were analyzed by applying paired t-test. For intergroup analysis, we applied independent t-test using SPSS version 16. A p<0.05 was regarded as significant.Results: Both methyldopa and labetalol cause significant fall in SBP, DBP and mean arterial pressure (MAP) in their groups (p<0.001). However, when we compared both groups it was labetalol, which causes significant fall in MAP as compared to methyldopa (p<0.001). The incidence of adverse effects like hypotension, headache, and sedation were also less in labetalol group.Conclusion: Labetalol has an upper edge over methyldopa in control of BP during pregnancy with minimal adverse effects

Open Loop Control of The Z Source Resonant Converter for the Electric Vehicle Wireless Battery Charger

Wireless charger for Electric Vehicles (EVs) is an off-line application and it needs power factor correction (PFC) function, which usually consists of a front-end boost PFC and a cascaded DC/DC converter. Recently, Z-source resonant converter (ZSRC), a single-stage solution with low cost and high efficiency, was proposed for EV wireless charger. Combining with the Z-source network, the control scheme is more challenged and sophisticated. The experimental setup is done for the open loop control of the z source resonant converter. The pic microcontroller is used for the generating the pulse gate for the MOSFET and the conductor coils are used for the wireless power transmission, The experiment is done for the 33v input dc and the 88v dc output voltage prototype

Ovarian Malignancies in Children: A Five Year Review.

INTRODUCTION : Ovarian tumors are rare accounting for 1% of childhood malignancies. Unlike adult tumors, two thirds of the pediatric ovarian malignancies are of germ cell origin. Tumors of epithelial and stromal origin occur less frequently. As with testicular tumors, the incidence of germ cell ovarian tumors parallel gonadotrophin release implicating hormonal factors in the aetiology. The prognosis and the treatment strategies for malignant pediatric tumors have also changed drastically over the last few years. The outlook was dismal in the prechemotherapy era. But with the advent of platinum based chemotherapy in the 1980s, the prognosis for these tumors has altered dramatically. It has also facilitated the redefinition of risk groups. Since then, chemotherapy regimes have been sequentially modified to reduce the toxicity while maintaining survival rates. Surgical approach has also evolved to a more tailored approach. As we move into the future, with higher success rates in the overall survival, the highlight is now on reducing the toxicity of the chemotherapy regimes. Ongoing studies are now evaluating conservative surgeries in the hope of reducing the overall morbidity. An attempt is being made to redefine surgical principles in the hope of improving the quality of life without compromising the overall survival. With more survivors of childhood cancer, interest is now being focused on the delayed effects on treatment and its impact on potential fertility patterns. More stress is now being laid on maintaining the reproductive abilities of these patients and a number of studies are ongoing in this direction. AIMS & OBJECTIVES : To review the presentation, treatment and histology of ovarian tumors in children. To note the accuracy of diagnostic imaging and operative staging. To calculate the survival rates. To assess the effect of chemotherapy on the attainment of menarche in those surviving in the peripubertal age group. MATERIALS AND METHODS : A retrospective review of all ovarian malignancies treated at the Institute of Child Health between January 2001 and January 2006 was done. 48 patients with ovarian malignancies were identified. Defective case records of 5 patients owing to lack of essential data were excluded from the study. A structured proforma was prepared(vide infra). The age at presentation, symptoms and nature of presentation were noted. The efficacy of imaging in pointing at the malignant nature of the lesion was also assessed. The tumor marker elevations vis-à-vis the histopathology was correlated. Intraoperative features of the tumor, capsular integrity and associated anomalies were recorded. Pathological reports on gross and microscopic features of the tumor were compared with the intraoperative findings. CONCLUSIONS : Review of ovarian tumors at our institute showed that germ cell tumors are highly treatable solid malignancies in the prepubertal age group. Most of these tumors present early making local control easy. This is further boosted by effective platinum based chemotherapy. As seen in our study,epithelial ovarian malignancies are rare in children. Ultrasonogram has a fairly good degree of reliability as an indicator of potentially malignant lesions. Nevertheless, it should be used only as an adjunct and not as the primary modality for diagnosis. In the acute setting, to prevent loss of significant information which might affect staging and treatment, it is better to treat all suspicious lesions as potentially malignant, until proved otherwise. The onset of puberty following chemotherapy is comparable with that of age matched controls. With the advent of newer agents and less toxic regimes, further trials are required to assess their impact on fertility. Their effects on the reproductive potential is a critical issue that needs to be addressed in the long run. Till such time that more light is thrown on this ,caution has to be exercised. To quote Larsen et al.,“ though there may exist unknown repair mechanisms after anticancer treatment, the biological age of the ovaries is 10 years ahead of the chronological age.” This important factor is to be stressed in the counseling of these patients

Opportunities for children of migrant labour

In its broad and philosophical sense, the greater purpose of education is undoubtedly that of enabling every child to reach his or her full potential. The conviction that every child can learn seeks to capture this sensibility, even while keeping in mind that learning processes may vary with the individual child’s developmental stage, pace and motivation to learn. Another dimension to be factored in is the external environment within which learning is experienced and transacted, namely the socio-economic background of the child that quite often dominates and thereby, critically affects the development of learning

Prevalence of HIV ocular manifestations in relation to CD4 count at ART Centre, SMCH, Chennai

INTRODUCTION: HIV;bane of new era has been a serious health issue since its discovery in the early 70’s. Although with the current fall in the incidence globally and India; as per UN 2012 reports ;India is still the third largest nation with HIV population. HIV manifests indirectly and it does so by decreasing the immunity especially CD4 cells,thereby leading to secondary infections. It affects all systems alike ;eye and its adnexa is no exception. HIV ocular complications include minor opportunistic infection,tumor, inflammation, vasculopathy and retinopathy. It is important that these manifestations are detected irrespective of symptoms or history and treated at the earliest possible. This study is done in order to find the prevalence of the various ocular manifestation of HIV, its correlation to CD4 count and the role of HAART. AIM: To evaluate the prevalence of ocular manifestations in HIV seropositive patients, attending the ART centre, Stanley Medical College and Hospital. To evaluate how the manifestations correlate to the CD4 count. To evaluate the impact of HAART on ocular HIV manifestations. METHODS AND MATERIALS: STUDY DESIGN: Cross sectional study was undertaken on 100 HIV seropositive patient attending the ART centre with known CD4 count was included in the study.The study period was from February 2013 till completion of hundred patients. INCLUSION CRITERIA HIV seropositve consented patients attending ART centre irrespective of ocular complaints, irrespective of treatment status. Any age group CD4 count obtained at the time of examination. EXCLUSION CRITERIA Severely ill patients. CD4 count could not be obtained. Pre-existing systemic illnesses. The importance of ocular examination in them was thoroughly explained in patients own language.Consent in patients own language was obtained from all those who were willing to take part in study.Any photographic records of the lesions were taken only if the patient consented for the same.Upon completion of data collection, statistical analysis was applied. STATISTICAL ANALYSIS: Chi square test was done for statistical analysis of the obtained data. ROUTINE OCULAR EXAMINATION WAS DONE AS FOLLOWS: • Ocular history. • Ocular examination included: • Best corrected visual acuity. ( Snellen’s chart ) • Slit lamp evaluation – Adnexa and Anterior segment • Dilated fundus evaluation (0.8 % tropicamide with 5% phenylephirine) – 90 D and 20 D • Neuro ophthalmological examination • Orbit • Tonometry for IOP evaluation • Schirmer’s for dry eye evaluation • Patient with suspected lesions were referred for complete systemic and laboratory work up. • Serological investigations included TORCH titre, PCR assay for HZV, VZ. • Other investigations were done as per clinical indication included CT brain/ MRI brain. OBSERVATION AND DISCUSSION: The mean age of patients in our study was 38.14 +/- 11.84 which fell in line with mean age of the comparative studies.Majority of the patient prevalence in our study fell under the reproductive age group of 20-40 years. This pattern was similarly noticed in Biswas et al , Gururaj et al and Lamichhane G et al study. However our prevalence rate of 58 % was closely comparable to the Gururaj et al study which had 54 %.Also comparable with the Gururaj et al study was the decrease in prevalence with increase in age.Of special mention is the similarity in the prevalence of patients in the age group < 20 years. Our study shows a higher male prevalence in comparison to females. The age gender distribution in our study was not significant, p= 0.3. This was also the finding in Lamichhane G et all study. Sexual route was the most common mode of disease transmission, and this was observed in study by Biswas et al and Gururaj et al. Gururaj et al had 1 homosexual route of exposure.P value of 0.1274 signifies that the route of exposure has no impact the prevalence of the ocular manifestations.Majority of the patients in our study were observed in clinical stage I and II. The findings were similar in the Gururaj et al and Amare et al study. It was observed in our study that all patients those who fell under the Clinical category III /IV had ocular HIV manifestation, and mostly of the opportunistic type. This was equally observed in the studies to which we compared to in the above table.With p value of 0.003 we can conclude that prevalence of ocular manifestation increases with the clinical staging of disease. And this is probably due to the increase in the opportunistic infection in these stages. This was observed both in Gururaj et al and the Amare et al study as well.We observed an increased prevalence of ocular manifestations in the CD4 range of 200 – 500 cells/mm3. This was comparable to the Ethiopian study by Amare et al.P value in our study was 0.0235, which was significant. This significance was observed in all the above mentioned studies.Hence ocular manifestations is seen to increase significantly with decrease in CD4 count, especially in levels < 200 cells/mm3. Blepharitis and conjunctival microvasculopathy was the commonest anterior segment findings observed in this study. The prevalence of both of which were significantly higher in comparison to the studies mentioned above.Kaposi sarcoma and conjunctival squamous cell carcinoma were nil, and were comparable to the two Indian studies mentioned above. These findings were present in the African studies. And this has been implicated due to the homosexual practises.we see differences in most of the anterior segment presentations in comparison to other Indian studies. This can be attributed to the geographical change in location of the study.The prevalence of HIV retinopathy, toxoplasmosis acute retinal necrosis and uveitis in our study was comparable to the prevalence in Biswas et al study.The same finding was not so with CMV retinitis. This limitation was observed probably due to the sample size in our study. Ocular TB and syphilis were not recorded in our study. CONCLUSION: HIV infection is a problematic communicable disease present in our population, affecting commonly the reproductive age group. HIV manifests in the eye either directly in the form of viral load or causes low immunity thereby increasing chances for opportunistic infections.With the introduction of HAART, the life expectancy of the patients have significantly increased. However the ocular manifestations continue to present in innumerable forms.Not all patients with early HIV opportunistic infection present to us with ocular symptoms until unless the manifestation is severely blinding and irreversible.Most of the symptomatic patients are the ones with blepharitis and conjunctivitis, a non-blinding yet troublesome form of disease manifestations.The ART centres in India at present practice just the referral of patients for ophthalmological examination only when the patient develops ocular complaints.With the number of ocular findings observed, our study highlights the need for a routine ophthalmological screening of all HIV seropositive patients. We recommend a routine screening of HIV seropositive patients upon diagnosis, prior to starting ART therapy to obtain a baseline ocular status. Once the patient is started on HAART , he/she must undergo at-least a half yearly ocular examination. This is important for two reasons; one to look out for immune reconstitution syndromes, two to identify the ocular side effects of HAART.CD4 counts have to be strictly considered while monitoring these patients. It serves both as a risk factor as well as an indicator of opportunistic manifestations.A very important observation we made was the patients non-consenting to any detailed examination outside of the ART centre. This was due to the stigma attached to the disease and the fear of being publically recognised as HIV seropositive.All this indicates a need for provision of ophthalmic setup in the ART centre.This can be made possible with adequate resources and trained ophthalmic personnel

Enabling environment in schools for children of migrant labour

Millions of unskilled and semiskilled labourers have left their native villages to escape extreme rural poverty and to find a job in big cities. These migrant workers travel from one area of work to another along with their families. They live in small sheds, sometimes provided by the construction company for the duration of the construction project and then move to another site. Most of the time the construction companies do not provide electricity or sanitation facilities

DABCO promoted one-pot synthesis of dihydropyrano(c)chromene and pyrano[2,3-d]pyrimidine derivatives and their biological activities

AbstractA simple and efficient one-pot synthesis of heteroaryl substititued dihydropyrano(c)chromenes and pyrano[2,3-d]pyrimidines has been developed via initial Knoevenagel, subsequent Micheal and final heterocyclization reactions of heteroaryl aldehyde, malononitrile and barbituric acid/ dimedone. 1,4-Diazabicyclo [2.2.2] octane (DABCO) has been used as a catalyst. Short reaction time, environment friendly procedure and excellent yields are the main advantages of this procedure. All synthesized compounds have shown good antimicrobial activity against different microbial stains

A stochastic model for prediction of Erosion-oxidation interaction on boiler grade steel Surfaces

Fly ash particles entrained in the flue gas from boiler furnaces in coal-fired power stations can cause serious erosive wear on steel surfaces along the flow path. Such erosion can reduce significantly the operational life of the boiler components. A fundamentally-derived mathematical model embodying the mechanisms of erosion involving cutting wear, plastic deformation wear and effect of temperature on erosion behaviour, has been developed to predict erosion rates on the coal fired boiler components such as boiler tubes, economizer and airpreheater assemblies at room and elevated temperature. Various grades of steels, commonly used in the fabrication of boiler components and published data pertaining boiler fly ash has been used for modelling the process. The model incorporates the tensile properties of the target metal surface at room and elevated temperatures, as well as the characteristics of the ash particle dynamics in the form of impingement angle, impingement velocity and composition of the ash particle in terms of the silica content. The mathematical model has been implemented in an userinteractive in-house computer code, (EROSIM–1 ) to predict the erosion rates at room and elevated temperature for various grades of steel normally used in boiler components. The model predictions have been found to be in good agreement with the published data. The model will be calibrated in future with the plant and experimental data generated from a high temperature air-jet erosion testing facility. It is hoped that the calibrated model will be useful to the power plant industry for erosion analysis of boiler components

A mathematical model to characterize effect of silica content in the boiler fly ash on erosion behaviour of boiler grade steel

Fly ash particles entrained in the flue gas of coal-fired boilers can cause serious erosion on the critical components along the flow path. Such erosion can significantly jeopardise operational life of the boiler. A first principle based theoretical model has been developed embodying the mechanisms of erosion involving cuttingwear, plastic deformationwear and effect of temperature on erosion behaviour, to predict erosion rates of pertinent boiler grade steels. Various grades of steels commonly used in the fabrication of boiler components and published data pertaining to boiler fly ash has been used in modelling the phenomena. The model also provides a quantitative predictive framework to study the effect of percentage of silica content in the ash particles on the erosion potential. The erosion sensitivity of particle impact velocity, angle of impingement and variation of surface temperature of the substrate (steel) have also been studied as a function of silica content in the ash. The model has been implemented in a computer code to predict the erosion rates at room and elevated temperature for various grades of steels under different particle impact conditions. The model predictions have been found to be in good agreement with the published data. This investigation illustrated that any minor increase in silica level in the ash can considerably aggravate the erosion rates, signifying the fact that silica content in the ash plays a critical role in characterising erosion potential of fly ash