COMPARISON OF KIDNEY DISEASE PREVALENCE IN TYPE 2 DIABETIC PEOPLE AND NON-DIABETIC PEOPLE: A CROSS-SECTIONAL STUDY.

Aim: The key motive of this research is to evaluate the frequency of kidney diseases in subjects with type 2 diabetes vs. nondiabetic patients. For the estimation of the similarity between the relation of normoalbuminuria and microalbuminuria with type 2 diabetes and on which point renal diseases different percentage of the patient of type 2 diabetes lies. Materials and Methods: This was a cross-sectional study of 200 cases organized at a tertiary care center in Bihar, India. 100 patients with type 2 diabetes and 100 nondiabetic patients of the same age and gender were included. The study was performed for 24 months, and all the patients were 20-80 years of age. Results: It was evaluated that the incidence of kidney diseases in subjects with diabetes was higher in contrast to non-diabetic subjects. No gender-wise variation was found. The majority of the patients had a period of diabetes between 5 and 10 years. Hypertension was common in both the groups that are type 2 diabetic and nondiabetic. Conclusion: Chronic kidney diseases are highly frequent in diabetic patients. There is a need to deal with hypertension, increased BMI, and weight. Recommendation: An antihypertensive regimen that includes an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB) is recommended for Type 2 diabetic patients

Study of price variation analysis of fluoroquinolones eye drops manufactured by various pharmaceutical companies in India

Background: Fluoroquinolone eye drops is being prescribed by Opthalmologist in many ocular diseases as conjunctivitis, keratitis, bacterial corneal ulcers etc in more and more amount. There are many brands of fluoroquinolones drugs available in Indian market. Costly drugs can lead to economic burden on patients. Modifications in pharmaceutical policy are required, and prices of the drug should be controlled in effective way for all the drugs. Hence this study was done to assess the cost variation of fluoroquinolones opthalmic solutions available in Indian market.Methods: The maximum and minimum price of each brand of the drug in INR was noted by using CIMS January to April 2020 edition and Drug Today April to June 2020 volume 1. The cost ratio and the percentage cost variation for individual drug brands was calculated. The cost of each eye drop was calculated. At last the cost ratio and percentage cost variation of various brands was compared.Results: Percentage variation in cost for fluoroquinolones eye preparations marketed in India was found to be Eye drop Ciprofloxacin (0.3%) of 5 ml:210.39, Eye drop Ciprofloxacin (0.3%) of 10 ml:162, Eye drop Gatifloxacin (0.3%) of 5 ml:156, Eye drop Moxifloxacin (0.5%) of 5 ml:196.95, Eye drop Ofloxacin (0.3%) of 5 ml:245.16, Eye drop Ofloxacin (0.3%) of 10 ml:62.5, Eye drop Norfloxacin (0.3%) of 5 ml:120.68, Eye drop Sparfloxacin (0.3%):8.31, Eye drop Lomefloxacin (0.3%):16.17.Conclusions: There is a wide difference in the cost of different brands of fluoroquinolones eye preparations available in India. The clinicians prescribing these drugs should be aware of these variations in cost to reduce the cost of drug therapy

Breakdown voltage modelling for leatherite paper dielectrics using fuzzy logic technique & estimating the lifetime using step-stress test

OBJECTIVE The real insulation systems are often heterogeneous and some times nonlinear. Quality of insulation is accessed in terms of break down strengths. Partial discharge caused in insulation system by local defects and the resultant overstressing caused by them ultimately lead to breakdown. So the estimation has to be done properly to save insulation from failure. The use of modern computers in bdv analysis has lead to the estimation based on fuzzy logic modeling. The mamdani fuzzy logic using triangular and trapezoidal mf used for the modeling. The bdv got from the modeling section is used to get the weibull parameters using MLE. The shape parameters are used for the life estimation of the dielectric. DESCRIPTION Fuzzy logic modeling is widely used in those fields where the boundary between having a property and not having it is not sharp. The construction of this model can be viewed as a process in which a collection of objects called variables and parameters of the model are related by some other objects called the operators of the model. In the present case it is tried to estimate the bdv of dielectrics depending upon various input conditions. The most important source of partial discharge and breakdown in dielectrics is the voids. Voids are produced due to process control errors at the time of production of most of the solid dielectrics. This is a gas discharged event. The test dielectric is taken as leatherite paper and the estimation is based on data experimentally generated in the laboratory using a CIGRE-2 electrode. The choice of test procedure to know the breakdown voltage of a typical insulation material on insulation system is determined by the test objective. Constant voltage tests provide reliable comprehensive data for the distribution function of the breakdown time but is very time consuming. An accelerated test with increase in voltage stress in discrete steps is quite often used for an electrical insulation study and is widely accepted by the insulation designers. With this method the stress at which the insulation breaks down and time to failure is taken as 6 observed variable The effect of void dimensions on the output is studied and implemented in MATLAB environment. The various steps in modeling include study of the range variation, grouping, rule list generation and simulation. Present system is a MISO system having three inputs (thickness of dielectric, depth and diameter of void) and one output (bdv). The min max algorithm is used as t-norm and s-norm operator. Coa is used for difuzzification. Programming approach is adopted for estimation. The surface plot is plotted to study the variation. Weibull probability has gained wide acceptance in the statistical treatment of time to electrical breakdown of solid dielectrics. It seems to fit experimental data well. MLE is used for parameter estimation. Confidence interval is chosen to get lower and upper limits of the parameters within which the estimation lie for a surety. Throughout the experiment the step stress test is considered. The inverse power law is applied to life estimation. From the slope of the graph the slope is to be found out and used for estimating the life. RESULTS In the mamdani fuzzy logic modeling using the triangular and trapezoidal mf the Mae is found out to be 1.4% and 1.324% respectively. The weibull parameters and life estimation values have close resemblance with the experimentally generated value. CONCLUSION Fuzzy logic provides an easier and a better computation technique based on the fuzzyness of rules. By accurately choosing the parameters and deciding the rule bases the error can be significantly reduced. The weibull parameter calculation using MLE and lifetime also found to be in good agreement. Thus the results indicates that the modeling can be well implemented for such kind of estimation

Twin Circumflex Coronary Artery with anomalous origin from left main trunk — a rare variant

Coronary artery anomaly in form of dual origin of the circumflex artery is a rare anomaly. Though mostly described as having separate origin, both arising from left main coronary as twin circumflex artery itself has not been reported so far. Here we report a case of 57-year old male patient who had presented with ST elevation anterior wall myocardial infarction. His angiogram revealed left main trunk which was giving a left circumflex artery (LCx). On further coursing, left main trunk was trifurcating into left anterior descending artery (LAD), ramus intermedius and second left circumflex artery. Second circumflex branch was giving larger obtuse marginal branch while right coronary artery was smooth, non-dominant, and normal flowing artery. There was discrete eccentric stenosis with critical lesion in proximal LAD for which patient refused any intervention. Based on angiographic findings, it was diagnosed as a twin circumflex, both arising from left main trunk as one coming before the bifurcation while another after the bifurcation. An extensive search of literature and to the best of our knowledge, such type of anomaly is being reported for the first time

„Dystalna ochrona farmakologiczna” przez podanie diltiazemu do pomostu naczyniowego w ramach leczenia wstępnego podczas interwencji w obrębie pomostu naczyniowego z żyły odpiszczelowej

Percutaneous coronary intervention (PCI) of vein graft lesions is associated with a high risk of peri-procedural myocardial infarction and greater mortality than routine native coronary intervention. Embolic protection devices have been advocated to reduce the risk of distal embolisation during vein graft PCI. Here, we report the case of a 72 year-old diabetic male smoker who had coronary artery bypass surgery three years previously who presented with acute coronary syndrome. Repeat coronary angiography revealed patent grafts except for a discrete eccentric critical lesion in ostium of saphenous vein graft to obtuse marginal. The lesion was crossed using a 0.014” runthrough wire (Terumo, Japan). Intragraft diltiazem (5 mg) was administered through the guiding catheter each time before predilatation and stenting (total dose = 30 mg). It was finally stented by deploying a 3.5 × 23 mm Xience Prime everolimus-eluting stent (Abbott, USA) at 13 atm pressure achieving TIMI III flow. He was discharged the next day with acetylsalicylic acid — 75 mg/day, ticagrelor — 90 mg twice daily, atorvastatin — 40 mg/day, metoprolol — 100 mg/day, and ramipril — 5 mg/day. The patient has been doing extremely well since then, with regular follow-ups at our institute.Przezskórna interwencja wieńcowa (PCI) w obrębie wszczepionego pomostu żylnego wiąże się z wysokim ryzykiem okołozabiegowego zawału serca i większą śmiertelnością niż rutynowe zabiegi tego typu w naczyniach natywnych. Zaleca się stosowanie urządzeń zabezpieczających przed zatorami w celu obniżenia ryzyka odległych zatorów w trakcie PCI w pomoście żylnym. Autorzy przedstawili przypadek 72-letniego pacjenta, aktywnego palacza, z ostrym zespołem wieńcowym, u którego 3 lata wcześniej wykonano chirurgiczne pomostowanie aortalno-wieńcowe. Powtórna koronarografia wykazała drożność stentu poza nieciągłą ekscentryczną krytyczną zmianą w miejscu połączenia pomostu z żyły odpiszczelowej z gałęzią brzeżną. Przez zwężenie przeprowadzono prowadnik angioplastyczny 0,014” typu runthrough (Terumo, Japonia). Przed każdą predylacją balonową i implantacją stentu do pomostu podawano diltiazem (5 mg) przez cewnik prowadzący (łączna dawka = 30 mg). Ostatecznie w miejscu zwężenia umieszczono i rozprężono stent uwalniający ewerolimus Xience Prime 3,5 × 23 mm (Abbott, USA), stosując ciśnienie 13 atm. Uzyskano przepływ TIMI III. Pacjenta wypisano następnego dnia z zaleceniem przyjmowania następujących leków: kwasu acetylosalicylowego — 75 mg/dobę, tikagreloru — 90 mg 2 razy/dobę, atorwastatyny — 40 mg/dobę, metoprololu — 100 mg/dobę i ramiprilu — 5 mg/dobę. Od czasu zabiegu chory czuł się bardzo dobrze i regularnie zgłaszał się na wizyty kontrolne do placówki autorów

Unraveling and Entrapment leading to acute loss of jailed wire and its long term follow-up: case report

Jailed wire technique i.e wiring of the side branch (SB) before main vessel (MV) stenting is recommended to keep it open when the SB is deemed important ( > 2mm). Rarely, it becomes difficult to retrieve the jailed wire behind the stent and it may suffer fracture or entrapment, although exceedingly rare. It may be asymptomatic or can lead to abrupt closure of side branch resulting into periprocedural myocardial infarction. Here, we report a case of 56-old male who had undergone percutaneous coronary intervention (PCI) of proximal left anterior descending artery in 2012 during which jailed balance middle weight wire (BMW, Abott Vascular, USA) of diagonal branch got unravelled and entrapped. As patient was asymptomatic, he was conservatively managed. 6-years later, he suffered acute inferior wall myocardial infarction with complete heart block. Primary angioplasty of totally occluded right coronary artery was done with 3x38 mm Xience prime stent (Everolimus eluting stent; Abott vascular, USA). In coronary angiography of left system, left anterior descending and diagonal branches were completely patent. The fractured and retained jailed wire was still in diagonal branch with no displacement in comparison with previous coronary angiography. The patient was discharged in stable cardiac condition with appropriate follow up advise. To the best of our knowledge, this is the longest follow up of entrapped, and fractured BMW wire

Ostre zapadnięcie się całkowicie rozprężonego stentu III generacji w trakcie przezskórnej interwencji wieńcowej w obrębie rozwidlenia tętnic

Acute stent recoil or radial collapse of a stent is a rare phenomenon leading to subsequent acute stent thrombosis or in-stent restenosis as delayed sequelae. Reduced strut thickness, a larger stent/vessel ratio, and a larger balloon/stent ratio are factors leading to stent recoil. Here, we report a case of acute recoil or radial collapse of Promus Element Plus, a third-generation everolimus-eluting stent with thin stent struts in a 66 year-old male who underwent bifurcation percutaneous coronary intervention of left anterior descending artery (LAD) and diagonal branch (D1). Following kissing balloon inflation at 16 atm pressure after deployment of stents in LAD and D1, acute radial collapse of stent in proximal LAD was noted. It was successfully bailed out by further multiple, short sequential inflations using same size noncompliant balloon. Acute radial collapse probably occurred due to inflation at higher pressure with an oversized balloon, and relatively thin struts of the stent.Ostre zmniejszenie średnicy stentu lub zapadnięcie się stentu to rzadkie zjawisko, którego następstwem jest ostra zakrzepica w stencie lub późniejsze powikłanie w postaci restenozy w obrębie stentu. Czynnikami przyczyniającymi się do zmniejszenia średnicy stentu są mniejsza grubość rozpórek, wyższy współczynnik średnica stentu/średnica referencyjna naczynia oraz wyższy współczynnik średnica balonu/średnica stentu. Autorzy przedstawili przypadek ostrego zmniejszenia średnicy stentu lub zapadnięcia się stentu Promus Element Plus — stentu III generacji uwalniającego ewerolimus, z cienkimi rozpórkami — u 66-letniego pacjenta, u którego wykonano przezskórną interwencję wieńcową w obrębie rozwidlenia gałęzi międzykomorowej przedniej (LAD) i gałęzi diagonalnej D1. Po napełnieniu balonów (jednocześnie użyto 2 balonów — technika kissing balloon) pod ciśnieniem 16 atm i rozprężeniu stentów umieszczonych w LAD i D1 zaobserwowano ostre zapadnięcie się stentu w proksymalnym odcinku LAD. Sytuację udało się uratować, kilkakrotnie napełniając balon w krótkich sekwencjach. Zastosowano niepodatny balon o tym samym rozmiarze. Przyczynami ostrego zapadnięcia się stentu były przypuszczalnie napełnienie balonu o zbyt dużym rozmiarze z zastosowaniem zbyt wysokiego ciśnienia oraz stosunkowo cienkie rozpórki stentu

Intravascular knot as a complication of tortuosity at innominate-arch junction unravelled by counter-clockwise rotation- simple solution to complex problem

Transradial approach scores over transfemoral approach as it is associated with less complications, mortality, and morbidity. Though right sided approach is more convenient for manipulating catheters and devices, aorto-subclavian tortuosity may result into looping, entrapment, kinking, and rarely intravascular knot formation. Here, we describe a case of a 60-year old female which had gone transradial catheterization from right side. Due to aorto-innominate tortuosity, excessive clockwise torque was applied to the catheter to cannulate right coronary artery which resulted into pressure damping, and intravascular knot formation in brachial artery. It was unravelled by counter clockwise rotation of catheter, and thus completing the procedure

Balloon assisted trapping (BAT) and retrieval of fractured and impacted coronary angioplasty balloon catheter: simple solution to a complex problem

Fracture of catheter fragment in a coronary artery during percutaneous coronary angioplasty is a rare complication, which may result into embolization or impaction leading to complete or near complete occlusion of respective territory, arrhythmia, or rarely sudden death. Here, we report an unusual complication of a broken balloon catheter during angioplasty of a calcified right coronary artery in a 78-year old female which was successfully retrieved by balloon assisted trapping in guiding catheter