A Study on Correlation of Carotid Artery Intima-Media Thickness (As a Marker of Atherosclerosis) with Activity and Duration of Rheumatoid Arthritis

INTRODUCTION: Rheumatoid arthritis (RA) is a systemic chronic inflammatory disease in which etiology is unknown. It is the commonest inflammatory arthritis affecting 0.5 to 1 percent of general population all over the world. It is characterized by symmetric polyarthritis involving peripheral joints, resulting in joint destruction and disability. Although it is a disease of joints, abnormal immunological responses can lead to a variety of extra-articular manifestations including the involvement of blood vessels and heart. As compared to general population, people with rheumatoid arthritis experience disability, increased mortality and shortened life expectancy. Cardiovascular involvement is the leading cause of mortality in patients with Rheumatoid arthritis. This increased mortality due to cardiovascular involvement has been attributed to accelerated atherosclerosis which has been found to be independent of traditional risk factors for atherosclerosis. Accelerated atherosclerosis in Rheumatoid arthritis has been attributed to inflammation5, increased homocysteine levels, imbalance in homeostasis, immobility, decreased antioxidants level, side effects due to medications, and abnormal lipid levels. Among the above mentioned causes, inflammation has the strongest association for accelerated atherosclerosis in Rheumatoid arthritis patients. In RA patients, indirect evidence of accelerated atherosclerosis comes from studies involving measurement of Carotid artery intima media thickness (CIMT) as a marker of atherosclerotic burden and cardiovascular risk. Measurement of CIMT is an economical and noninvasive test which is quite reliable and sensitive for assessment of atherosclerosis. Increased atherosclerosis in carotid arteries is indicative of atherosclerosis in multiple vascular beds including coronary arteries. So, measurement of CIMT is an important surrogate marker of increased cardiovascular risk including acute coronary syndrome. Early diagnosis of atherosclerosis by measuring CIMT might trigger the preventive steps against atherosclerosis in RA patients thereby decreasing cardiovascular mortality. In this background, a cross sectional study of CIMT in 40 cases of Rheumatoid arthritis patients of various age groups and duration of symptoms was conducted in south Indian patients, in southern districts of Tamilnadu, who were attending Government Rajaji Hospital, Madurai. The study was undertaken in the department of medicine, Government Rajaji Hospital, Madurai. AIMS AND OBJECTIVES OF THE STUDY A) To determine whether carotid artery intima media thickness (CIMT) is advanced in patients with Rheumatoid arthritis (RA), as compared to healthy controls. B) To study the correlation if any between Carotid Intima Media Thickness (CIMT) and duration of Rheumatoid arthritis. C) To study the correlation if any between Carotid Intima Media Thickness (CIMT) and activity of Rheumatoid arthritis. MATERIALS AND METHODS: Setting: Rheumatology outpatient clinic, Government Rajaji Hospital (GRH), Madurai, Tamilnadu. Design of the Study: Matched cross sectional study. Period of Study: April2012 – October 2012. Details of Study Materials and Methods: The study was performed in 40 Rheumatoid arthritis (RA) patients and 40 healthy control subjects. The RA patients were selected from consecutive patients attending Rheumatology outpatient clinic at Govt. Rajaji Hospital (GRH), Madurai, who were diagnosed according to 2010 American College of Rheumatology-European League against Rheumatism (ACR-EULAR) criteria. 40 healthy controls were selected from among the people who were attending local health-check program at GRH Madurai. Written informed consent was taken from all cases and controls. The following exclusion criteria were used to avoid confounding by other known risk factors for atherosclerosis: a) Hypertension (BP > 140/90 mmHg) or use of antihypertensive medications. b) Hypercholesterolemia (Total cholesterol>240mg/dl, LDL >160 mg/dl, triglycerides >200 mg/dl) or use of lipid lowering medication. c) Diabetes Mellitus (diagnosed according to WHO criteria) or use of anti-diabetic medication. d) History of coronary artery disease. e) History of cerebrovascular accidents (CVA). All the subjects included in our study (both cases and controls) were not known cases of IHD (ischemic heart disease), Diabetes Mellitus, or Hypertension and did not suffer any cerebrovascular events in the past. And also did not have any evidence of hepatic or renal impairment. RESULTS: Total of 40 cases were enrolled for the study. Among them 12 cases (30%) were males and 28 cases (70%) were females. So, females form the major number in our study. Control subjects were also in similar distribution as that of cases in relation to total number and gender distribution. CONCLUSION: In this cross sectional study on Rheumatoid arthritis, • Carotid intima media thickness in RA cases was found to be significantly increased when compared to age and sex matched healthy controls indicating that Rheumatoid arthritis is an independent risk factor for accelerated atherosclerosis. • Increase in carotid intima media thickness was found to be directly related to the duration of the disease. • Our study did not show significant relationship between disease activity and carotid intima media thickness. So, early diagnosis of evidence of unfavorable vascular profile in RA patients and instituting appropriate preventive therapies can decrease the cardiovascular mortality due to Rheumatoid arthritis

Ethyl 2-Cyano-5-Oxo-5-(thiophen-2-yl)-3-(3,4,5-trimethoxyphenyl) Pentanoate

In the title compound, C21H23NO6S, the dihedral angle between the thio­pene and benzene rings is 88.66 (6)°. In the crystal, mol­ecules are connected by C—H⋯N and C—H⋯O hydrogen bonds, forming a tape along [10-1]. In addition, C—H⋯π and π–π stacking [centroid–centroid distance = 3.879 (2) Å between the thio­phene rings] inter­actions are observed

2-(4-Chlorophenyl)-6-methyl-4-(3-methylphenyl)quinoline

In the title compound, C(23)H(18)ClN, the dihedral angles between the quinoline unit and the chloro­benzene and methyl­benzene rings are 2.57 (9) and 56.06 (9)°, respectively. The crystal structure is stabilized by π–π inter­actions [minimum ring centroid separation = 3.733 (2) Å]

6,7-Dimethoxy-2,4-diphenylquinoline

In the title structure of the title compound, C23H19NO2, two conformationally similar molecules (A and B) comprise the asymmetric unit. The dihedral angle between phenyl rings bridged by the quinoline moiety are 76.25(8)° in molecule A and 70.39(9)° in molecule B. In the crystal, the independent molecules are connected by C - HO hydrogen bonds and the resulting dimeric aggregates are linked by �-� inter-centroid distance = 3.7370(8)à and C - H� interactions, forming a three-dimensional architecture

Association between mean platelet volume and Microalbuminuria in Type 2 Diabetes Mellitus Patients

Background: Type 2 DM is characterized by increased platelets activation, hence platelet functional markers like the mean platelet volume (MPV) can play a vital role in identifying subjects at high risk of developing microvascular complications. Objectives: To study the association between mean platelet volume and micro albuminuria and to analyse factors associated with MPV in patients with Type 2 diabetes mellitus. Materials & Methods: A cross sectional study was conducted in the department of internal medicine, Velammal medical college and hospital, between June 2016 and December 2016. Subjects with DM, with age > 20 years were included. Latex Turbidimetric method was used to assess urine micro albumin. Results: A total of 269 diabetic patients with mean duration of disease of 4.84 years were included. There was a moderate, statistically significant positive correlation between HbA1 C level and Mean platelet volume (PCC=-0.198, p value 0.001). The other factors had shown no statistically significant correlation with MPV. There was a Statistically significant mild negative correlation between serum uric acid and MPV (PCC= -0.196, p value 0.001). The mean MPV in people with low and high Urine micro albumin was 7.716 ± 0.876 and 7.705 ± 0.890 respectively, and the difference was statistically not significant. Conclusion: Poor glycaemic control may lead to higher MPV in diabetic population. Very minimal and statistically non-significant difference was observed in mean MPV value between subjects with high micro albuminuria and low micro albuminuria

Synthesis and crystal structure of 1-(2-Bromo-4,5-dimethoxybenzyl)-benzod1,2,3triazole

The title compound C15H14N3O2Br, was synthesized and characterized by X-ray diffraction analysis. The compound crystallizes in triclinic crystal class in the space group P1. The cell parameters are a = 7.057(1)Å, b = 8.142(1)Å, c = 13.738(2)Å, α = 90.039(7)°, β = 96.869(5)°, γ = 108.047(8)° and Z = 2. The final residual factor R1 = 0.0513

Supramolecular frame work in 4-(Methylsulfonyl)piperazin-1-ium 2,4,6-trinitrophenolate via hydrogen bond and ?···? interactions

The molecule, 4-(Methylsulfonyl)piperazin-1-ium 2,4,6-trinitrophenolate is crystallized in the monoclinic crystal system under space group P21/c and with unit cell parameters a = 6.951(5) Å, b = 21.915(16) Å, c = 11.566(7) Å, ß = 110.9(3)° and Z = 4. The crystal and molecular structure of the molecule was stabilized by hydrogen bond interactions, N—H···O and C—H···O and were visualized through the Hirshfeld surface analysis. © 201

6,7-Dimethoxy-2,4-diphenylquinoline

In the title structure of the title compound, C23H19NO2, two conformationally similar molecules (A and B) comprise the asymmetric unit. The dihedral angle between phenyl rings bridged by the quinoline moiety are 76.25 (8)° in molecule A and 70.39 (9)° in molecule B. In the crystal, the independent molecules are connected by C—H...O hydrogen bonds and the resulting dimeric aggregates are linked by π–π [inter-centroid distance = 3.7370 (8) Å] and C—H...π interactions, forming a three-dimensional architecture

Machine Learning Approach: Prediction of Surface Roughness in Dry Turning Inconel 625

Roughness is a prime parameter in any process/operation as it aids in confirming the quality status of the product. The insert and workpiece would develop a lot of friction and as a result, it generates heat in the cutting zone, which affects the machined surface. The speed, feed, and depth of cut were chosen as processing factors. L27 Orthogonal array is used based on the Taguchi technique. The regression analysis is used to develop an equation to predict the roughness. The impact of the processing factors on the machined surface is studied with help of ANOVA (Analysis of Variance). Furthermore, the estimation of surface roughness is carried out using a machine learning-based model-feed forward (nonlinear autoregressive network) NARX network, and the evaluated surface roughness is compared with the values predicted by the regression model and experimental results. The average percentage error observed with the predicted values by NARX is observed as 3.01%, which is lower than the average percentage error observed by the regression model 5.131%. Thus, this work provides the best machine learning approach to the prognosis of the roughness in dry turning of Inconel 625, which would save a lot of time and unnecessary wastage of the work material