Treatment-Resistant Hypertension in Individuals of High BMI

Objective: To determine the frequency of treatment-resistant hypertension in individuals of high BMI and factors associated with resistant hypertension Study Design: Comparative cross-sectional study Place and Duration of Study: Pak Emirates Military hospital , Rawalpindi Pakistan,from Nov 2020 to Oct 2021. Methodology: Patients being managed for essential hypertension at the medical outpatient department were included in the study. Body mass index was calculated at the time of routine evaluation during the outpatient visit, and a detailed evaluation regarding the number of anti-hypertensive medications used was carried out on patients with a body mass index>25.Resistant hypertension was diagnosed if the blood pressure of the patient was not controlled on three or more antihypertensive medications. Results: A total of 600 patients with hypertension and a body mass index of more than 25 were included in the final analysis. Out of 600 patients, 489(81.5%) had essential hypertension, which was not treatment resistant, while 111(18.5%) had resistant hypertension. Statistical analysis showed that type 2 diabetes mellitus and cigarette smoking had a statistically significant relationship (p-value<0.05) with resistant hypertension among patients with high body mass index. Conclusion: Resistant hypertension was a fairly common diagnosis among patients suffering from hypertension and having a body mass index of more than 25. Patients who had comorbid diabetes mellitus or who were cigarette smokers were more at risk of having resistant hypertension in our data set

Biopsy Proven Renal Morphology Cognizance into its Four-Year Evolving Pattern; A Pakistani Perspective

Objective: To determine the pattern of Biopsy Proven Renal Diseases (BPRD) in a single tertiary care centre in Islamabad, Pakistan. Study Design: Cross-sectional study. Place and Duration of Study: Department of Nephrology, KRL Hospital, Islamabad Pakistan, from Mar 2016 to Nov 2020. Methodology: The archival records of all native renal biopsies performed in adults (>18 years) were retrospectively analyzed.The biopsies were performed according to standard indications and evaluated by light microscopy and immunofluorescence. Results: A total of 134 renal biopsies were studied. Among these, 85(61.1 %) were males, and 49(36.5 %) were females. The mean age was 44.70±14.63 years. Primary glomerulonephritis’s were the predominant group of diseases found in 93(69.4%) cases. Membranous nephropathy (MN) was the most common lesion in 52(38.8%), followed by focal segmental Glomerulosclerosis (FSGS) in 22(16.4%) cases. Chronic tubulointerstitial nephritis (Ch. TIN) 12(9.0%) was the third most common lesion among all biopsies. Other diagnoses included lupus nephritis (LN) 10(7.5%) and IgA nephropathy (IgAN) 9(6.7%). One sample one-sided t-test was used to estimate the minimum proportion of occurrence of different biopsies in our concerned population. The estimated minimum proportion of membranous nephropathy (MN) was 0.31, with a p-value of 0.034. Conclusion: We concluded that primary Glomerulonephritis (PGN) is the most common renal disease, and membranous nephropathy is the most common biopsy-proven Glomerulopathy in our concerned population

A novel method for life estimation of power transformers using fuzzy logic systems: An intelligent predictive maintenance approach

Power transformers are a fundamental component of the modern power distribution network. The fault-free operation of step-up and step-down transformers is of prime importance to the continuous supply of electrical energy to the consumers. To ensure such efficient operation, power distribution companies carry out routine maintenance of distribution transformers through preplanned schedules. The efficacy of such maintenance depends on a proper understanding of the transformer and its components and efficient prediction of faults in these components. There are several components whose condition can be studied to predict transformer failures and therefore the overall health of a transformer. These include transformer windings, insulations, transformer oil, core insulations, and ferromagnetic cores. This work develops a new, simplified fuzzy logic-based method to predict the health of a transformer by taking into account the state of several individual components. Case studies are used to demonstrate the efficacy of the developed method

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Comparison of Anti Hypertensive Effect of Fixed Dose Enalapril and Losartan in Essential Hypertension

Background: Angiotensin converting enzyme inhibitors and angiotensin receptor blockers are being extensively used these days for treatment of mild to moderate hypertension. The selection of either of the two drugs is usually based on physician preference. The purpose of the study was to compare antihypertensive effect of fixed dose Enalapril and Losartan in Essential Hypertension. Methods: In this interventional study therapeutic option of Enalapril (Group 1) ) and Losartan (Group 2) were offered to 100 newly diagnosed cases of hypertension . The patients were followed on subsequent visits (6 in total) and the systolic and diastolic blood pressures were recorded carefully. Results: Total number of patients becoming normotensive with Enalapril was 38 (out of 50) and with Losartan were 28 (out of 50). Conclusion: Enalapril had significantly better antihypertensive effect than Losartan in essential hypertension at the end of six months therapy

Common uropathogens and their antimicrobial susceptibility patterns at a tertiary care hospital in Pakistan

Introduction: Urinary tract infections (UTIs) are one of the most frequent infections encountered by doctors. It can be a significant source of morbidity for some patients. Microbes are growing resistant to commonly prescribed antimicrobials and UTIs are becoming more difficult to treat day by day. The study aimed to investigate the common uropathogens encountered in our geographical region and to study their antibacterial susceptibility patterns.Material and Methods: It was a retrospective descriptive study carried out in the Armed Forces Institute of Urology, in collaboration with the Armed Forces Institute of Pathology, Rawalpindi, Pakistan, during the year 2019. Positive reports for urine culture and sensitivity performed during the last two years were studied to document various isolates and their antimicrobial sensitivity.Results: A total of 3191 positive urine cultures in the last two years (2017-2019) were studied. Escherichia coli (66%), followed by Klebsiella Pneumonia (12%) were the most frequently encountered organisms. Overall resistance to Ciprofloxacin was 66%, Cotrimoxazole was 62%, Gentamycin was 40%, Fosfomycin (9.5%) followed by Meropenem (28%) and Nitrofurantoin (35%) were the most sensitive antibiotics.Conclusion: Gram-negative bacilli are the predominant organisms responsible for urinary tract infections. These uropathogens show significant resistance to routinely used antibiotics. Fosfomycin and Nitrofurantoin are suitable oral anti-bacterials for patients with UTI, whereas Meropenem is suitable if an injectable therapy is required. Our study may act as a guide for the choice of empiric antibiotics based on local resistant patterns. &nbsp

An Improved Control Strategy for Three-Phase Power Inverters in Islanded AC Microgrids

Microgrids (MGs) are composed of multiple distributed generators (DGs) interfaced to micronetwork through paralleled connected power inverters (PIs). Load sharing among multiple DG units is an important task for autonomous operation of microgrids. In order to realize satisfactory power sharing and voltage regulation between DG units, different voltage droop control strategies have been reported in the literature. In the medium voltage (MV) microgrids, power sharing, and voltage regulation often deteriorate due to dependence on nontrivial feeder impedances. The conventional control strategies are subject to steady-state active and reactive power-sharing errors along with system voltage and frequency deviations. Furthermore, complex microgrid configurations either in looped or meshed networks often make power balancing and voltage regulations more challenging. This paper presents an improved control strategy that can be extended for radial networks in order to enhance the accuracy of power sharing and voltage regulation. The proposed control strategy considers load voltage magnitude regulation as opposed the voltage regulation at inverters terminals. At the same time, a supervisory control loop is added to observe and correct system frequency deviations. This proposed method is aimed at replacing paralleled inverter control methods hitherto used. Simulation studies of the proposed scheme in comparison with the conventional control strategy in MATLAB/Simulink validate the effectiveness of the proposed strategy

Temporal and Evolving Data Warehouse Design

The data model of the classical data warehouse (formally, dimensional model) does not offer comprehensive support for temporal data management. The underlying reason is that it requires consideration of several temporal aspects, which involve various time stamps. Also, transactional systems, which serves as a data source for data warehouse, have the tendency to change themselves due to changing business requirements. The classical dimensional model is deficient in handling changes to transaction sources. This has led to the development of various schemes, including evolution of data and evolution of data model and versioning of dimensional model. These models have their own strengths and limitations, but none fully satisfies the above-stated broad range of aspects, making it difficult to compare the proposed schemes with one another. This paper analyses the schemes that satisfy such challenging aspects faced by a data warehouse and proposes taxonomy for characterizing the existing models to temporal data management in data warehouse. The paper also discusses some open challenges