ADVANCED METALLISATION METHODS FOR MONOCRYSTALLINE SILICON WAFER SOLAR CELLS

Ph.DDOCTOR OF PHILOSOPH

Our Experience in Comparing Laparoscopic and Open Herniotomy For Pediatric Inguinal Hernia Repair: Revisiting the Debate

Introduction: Traditionally, open groin exploration has been done for congenital inguinal hernia and hydrocele, but recently, laparoscopic herniotomy has gained popularity and has become a successful alternative to open herniotomy. This study compares Laparoscopic herniotomy [LH] and Open herniotomy [OH] regarding operative time, patency of contralateral internal ring, post-op complications, recurrence rates, and parental satisfaction. Materials and Methods: A multicentric randomized prospective comparative study was done at two tertiary care centers in North India. A total of 180 patients (newborn to 12 years) with congenital inguinal hernia and congenital hydrocele were included based on the inclusion criteria and were randomized using computer-generated numbers to assign to open and laparoscopic herniotomy surgery groups. Various parameters were evaluated during the pre-op, intra-op, and post-op periods. Results: The study was carried out from Nov 2014 to April 2019. The majority of the patients operated on had a right inguinal hernia in both groups (50% in each group). For bilateral inguinal hernia or hydrocele mean time taken by open technique was 41.16 minutes, and by laparoscopy was 37.75 minutes. In the case of unilateral hernia/hydrocele, it was 20.24 minutes by open technique compared to 24.3 minutes by laparoscopy. But the difference in operative time was statistically not significant. Conclusion: Based on our observation and results, we conclude that both laparoscopic and open techniques are equally effective and comparable in managing inguinal hernia and hydrocele, with advantages and disadvantages. Claims of one procedure being better than the other and counterclaims of one being more complicated than the other are ill-founded, and the efficacy of each procedure must be viewed with an unbiased approach

A Pilot Study Evaluating the Role of Ivabradine for Rate Control in Patients With Rheumatic Atrial Fibrillation

OBJECTIVES: Ivabradine may have a role in rate control of atrial fibrillation (AF) due to effects on HCN channels in AV node. We studied role of Ivabradine in rate control of rheumatic AF. METHODS: 80 patients, rheumatic AF, HR \u3e 100 bpm (age 47 ± 11 yrs, AF duration 6.8 ± 2.9 years, rate 131 ± 16 bpm) on maximally tolerated ββ or CCB\u27s, randomized to Ivabradine or escalated ββ/CCB. Ivabradine started @ 2.5 mg BD; increased to 5 mg BD if inadequate response at 1 week (failure to decrease HR \u3c 10% vs baseline). After Holter at 1 month, dose escalated to 7.5 mg BD if needed. RESULTS: Ivabradine resulted in significantly lower HR (81 ± 10 vs 99 ± 9) at 3 months and 6 months (79 ± 8 vs 94 ± 8, p \u3c 0.001). Absolute reduction in HR: 56 ± 15 vs 31 ± 14 bpm and % change in HR: 41 ± 7 vs 24 ± 9%, both p \u3c 0.00001). At 6 months, Ivabradine group had. 1Significantly lower NT Pro BNP (1168 vs 1314 pg/ml), higher 6 min walk distance (410 ± 47 vs 349 ± 54 m, all p \u3c 0.001) 2Better symptom class (EHRA score 1: asymptomatic 84% vs 40%), improvement \u3e1 EHRA class; baseline 60% vs 17% 3Better LA Strain (22.8 ± 2.8% vs 20.6 ± 2.5%) Ivabradine was well tolerated and there was no drug withdrawal. CONCLUSION: Our data suggest that Ivabradine can be an option for rate control in rheumatic AF

Serum Gamma Glutamyltransferase (GGT) in Coronary Artery Disease: Exploring the Asian Indian Connection

BACKGROUND: There is a need to identify novel markers for CAD, independent of traditional CV risk factors. One of these is gamma-glutamyl transferase (GGT), a marker of increased oxidative stress. Given the high prevalence of CAD in Asian Indians, the link of GGT and CAD in them needs to be studied. AIM: To assess GGT in patients with angiographically documented CAD. METHODS AND RESULTS: Two hundred patients aged 58.1 ± 9.95 years, 73% males, hypertension 56%, diabetes 40% were included. Mean GGT was 63.6 ± 44.33 (10–269 U/L). The levels of GGT progressively increased in those with single/double or triple-vessel CAD (36.5, 61.5, and 87 U/L, respectively, P \u3c 0.001). Using objective criteria of CAD burden (SYNTAX and Gensini scores), we reaffirmed these findings. GGT in patients with SYNTAX tertiles 0–22, 23–32, and ≥ 33 was 33, 62, and 97 U/L, respectively and in Gensini tertiles 0–17.65, 17.66–56.65, ≥56.66 was 32, 52, and 88 U/L, respectively, all P \u3c 0.001. SYNTAX score ≥ 23 was present in only 23% patients in GGT tertile 1 (\u3c41 U/L), whereas60% and 94% in GGT tertiles 2 and 3 had SYNTAX ≥ 23. Significant positive correlation was seen between GGT and SYNTAX (r = 0.634) and Gensini score (r = 0.772). CONCLUSIONS: In this study, GGT had an independent correlation with angiographic severity of CAD and SYNTAX and Gensini scores. Although the existing evidence seems biologically plausible, more studies are needed to explore the potential role of this inexpensive marker for predicting disease burden in patients with CAD

RAdiation Dose Attenuation Using RADPAD in CATH Lab for Primary and Secondary Operators – RADAR-CATH STUDY

BACKGROUND: Radiation injury is an important concern for interventional cardiologists and needs to be addressed. RADPAD is a radiation protection drape that has been shown to reduce the radiation exposure of the primary operator (PO). While Indian data on radiation exposure of the PO in the cath lab are scarce, the exposure of the secondary operator (SO) is even less well studied. AIMS: The aim of this study was to evaluate the efficacy of RADPAD drapes in reducing radiation doses in the cath lab for the primary as well as the secondary operator. METHODS: A total of 160 patients (40 patients each with single vessel disease [SVD], double vessel disease [DVD] and triple vessel disease [TVD] undergoing coronary angioplasty, and 40 patients undergoing balloon mitral valvuloplasty [BMV]) were randomised in a 1:1 pattern to undergo a procedure with or without the use of RADPAD. RESULTS: For patients with SVD, DVD and TVD undergoing percutaneous coronary intervention (PCI) and those undergoing BMV, the % reduction with the use of RADPAD reduced the PO\u27s received dose (in mrem) by 65%, 54%, 28% and 67%, respectively, as compared to without RADPAD. The % reduction in relative operator exposure for the PO for the 4 groups was 55%, 34%, 18% and 75%, respectively, with the use of RADPAD. The corresponding % reduction for the SO\u27s received dose (in mrem) was 80%, 63%, 33% and 69% and for relative operator exposure was 74%, 46%, 23% and 76% in the 4 groups, respectively. CONCLUSIONS: RADPAD significantly reduces the radiation exposure of the primary and secondary operator during prolonged complex PCI and BMV procedures

Flecainide for Conversion and Maintenance of Sinus Rhythm After Mitral Valve Replacement in Rheumatic Atrial Fibrillation

BACKGROUND: Despite successful mitral valve replacement (MVR), many patients remain in AF. Flecainide can be useful in these patients but has not been used because of underlying structural heart disease. METHODS: We assessed oral flecainide for conversion and maintenance of SR in 25 patients of chronic rheumatic AF following MVR (age 34.4 yrs, mean AF duration: 3.6 yrs). Non-converters underwent DC cardioversion at 24 h and 4 weeks. Patients received flecainide and bb/diltiazem at discharge. RESULTS: Single oral dose of Flecainide achieved SR in 6/25 (24%) while 19/25 achieved SR after DCC; at24 h 21/25 (84%) were in SR. With mean flecainide dose (93.10 ± 9.40 mg), successful maintenance of SR at 6 months was seen in 16/23 (69.5%). No significant changes in PR interval, QRS duration or QTc were noted; flecainide was well tolerated. Patients in SR had significantly better functional status, QOL scores and higher LA strain at 6 months (25.25 vs 17.43%, p \u3c .0001). Baseline LA diameter ≤ 61 mm predicted SR at 6 months (sensitivity/specificity 93.7% and 85.71%) while the values for AF duration ≤ 4 years and LA strain \u3e 21% for predicting SR were 87.5/71.43% and 100/85.71% respectively. CONCLUSION: Oral flecainide was safe and effective in post MVR rheumatic AF patients; maintenance of SR was achieved in 76% of initial converters and 64% of overall population, with better LA strain values. More studies are needed to validate these results