A comparative study of metformin and glyburide in gestational diabetes mellitus

Background: Incidence of gestational diabetes mellitus (GDM) is increasing worldwide. GDM provides a window of opportunity for the primary prevention of the type 2 diabetes by preventing transgeneration transmission to fetus. Insulin in management of GDM has many drawbacks, so use of OHAs has been increased worldwide.Methods: Randomized control trial was performed in patients with GDM who required medical management. Subjects were randomized into two groups and treated with Metformin and Glyburide, results were compared.Results: While comparing efficacy of metformin and glyburide in this study for maternal variables; the failure rate of metformin was found to be 9.39 times higher compared to glyburide. Glyburide was associated with 9.5 times more risk to develop hypoglycemia in mother compared to metformin. While comparing neonatal variables nursery admission was found to be more and statistically significant in neonates whose mother has received glyburide compared to metformin (p=0.03, RR=2.26). Though statistically insignificant, LGA fetuses and neonatal hypoglycemia were 2.1 times more in glyburide group compared to metformin.Conclusions: Though glyburide can be effective alternative to metformin and insulin for GDM, it is associated with higher risk of maternal hypoglycemia, neonatal hypoglycemia, LGA fetuses and higher rate of nursery admissions compared to metformin. Higher adverse neonatal outcomes with glyburide use question the widespread use of glyburide as first line management modality in GDM and also as an alternative to insulin as advised by many groups

Control chart applications in healthcare: a literature review

The concept of Statistical process control (SPC) was given by the physicist Walter Shewhart in order to improve the industrial manufacturing. The SPC was firstly applied in laboratory and after then shifted to patient level in hospitals. As there is more involvement of human in healthcare, the chances of errors are also more. SPC i.e., control chart can help in determining the source of errors by identifying the special and common causes of variations. This paper presents the review of literature on the application of SPC and control chart in healthcare sector. Forty articles are selected out of 142 potentially relevant searched studies. Selected studies are categorised into eight departments. Literature survey shows that most of work on control chart applications in healthcare is carried out in Surgery, Emergency and Epidemiology departments. US, UK and Australia are the main customers where maximum amount of work was done. The US is the country where control chart in healthcare sector have been used at regular interval. This shows the gap of deploying control chart in different departments and different countries as well. The CUSUM and EWMA chart came into picture in healthcare sector after 2008 and are used at regular interval

Spectral energy and angular distributions of bremsstrahlung radiation produced by 3.5 keV electrons in scattering with a free SF

Absolute double differential cross sections (DDCS) of bremsstrahlung (BS) radiation produced by 3.5 keV electrons in scattering with a free SF6 molecule were measured by using a Si-PIN photodiode detector in the angular detection range of 45°−110° relative to the direction of incident electrons. Angular distributions of the BS photons are found to be anisotropic. The experimental DDCS spectra are compared with the theoretical calculations obtained from atomic-field BS formulations of Kissel–Quarles–Pratt (KQP) using the “additivity hypothesis”. A fair agreement is observed between the measured results and those obtained from the KQP calculations for both the energy and the angular spectral distributions of BS radiation. The measured anisotropy of bremsstrahlung radiation is reproduced reasonably well by a modified Sommerfeld formula, if the relative velocity β is chosen to be half of the incident electron velocity β0. The measured anisotropy may be described by a parameter P, which is compared with the degree of polarisation obtained from theoretical calculations. Further, it is noted that the molecular weight, geometry and the number of constituent atoms present in the considered molecule do not seem to influence the usefulness of “additivity hypothesis”. In conclusion, the present results have once again corroborated the validity of “additivity hypothesis” for predicting the spectral distributions of molecular bremsstrahlung produced by keV-electrons

Impact Energy and Angular Dependence of L X-ray Emission from a Thick Polycrystalline Tungsten Element Induced by 15–25 keV Electrons

The impact energy and angular dependence of L X-rays of a thick polycrystalline tungsten (W; atomic number, Z = 74) target induced by 15–25 keV electrons has been measured at different angles varying from 15° to 75° at intervals of 5° using a Si PIN photodiode detector. The variation of measured relative intensity of Ll, Lα, Lβ and Lγ characteristic lines as a function of incidence angle is found to be anisotropic and the measured variation compares well with the PENELOPE simulation results. The angular variation of intensity ratio of Ll/Lα and Lβ/Lα shows anisotropic distribution, whereas the angular variation of the Lγ/Lα ratio exhibits almost isotropic distribution within the uncertainty of measurements. These measured ratios are found to be in good agreement with Monte Carlo (MC) calculations. The measured intensity ratios of Lβ/Lα and Lγ/Lα at a given incidence angle show a linear dependence with impact energy and exhibit good agreement with simulation results; however, the measured intensity ratio of Ll/Lα shows a non-linear variation with the impact energy and yields poor agreement with theoretical calculations

Efficacy of enhanced external counterpulsation: our experience

Aims Enhanced external counterpulsation therapy is a non-invasive, non-pharmacological outpatient treatment option for refractory angina pectoris. Our aim is to evaluate its efficacy in Nepalese refractory angina pectoris patients. Materials and methods It was single centre prospective study conducted from 2010 August to 2013 December. All thirty one (n=31) consecutive patients, referred for and received 35 hours of treatment were included in this study. The distance covered in six minute walk test before and after the treatment was recorded and compared. Patients were followed each with the questionnaires about their anginal symptoms before and after the treatment. Results In our study 19(61.3%) were male and 12(38.7%) female. The mean age was 65.7±9.3 years. Most patients had multi vessel disease. Twelve patients had previous history of revascularization. In 6 minute walk test there was significant difference in mean distance covered before and after the treatment. Most patients experienced decrease in the angina symptom. They had decreased in severity and frequency of angina, resulting in decreased use of sublingual nitrates. Conclusion EECP can be safe and effective treatment option for patients with RAP

Electron excited multiply charged argon ions studied by means of an energy resolved electron-ion coincidence technique

Multiply charged argon ions produced from decay of L-shell hole states by impact of a continuous beam of 3.5 keV electrons are studied for the first time using an energy resolved electron-ion coincidence technique. The TOF spectra of argon ions are measured in coincidence with 18-energy selected electrons emitted in a wide energy range (126–242 eV). The coincidence measurement between the energy selected electrons and the correlated ions specifies the individual decay channel for various multiply charged ions. New experimental data are obtained and reported on the correlation probability for production of argon ions with charge states 1+ to 4+ as a function of ejected electrons in the considered energy range. The relative correlation probability of producing different charge state ions and corresponding physical processes involved in their production are presented and discussed. It has been found that the maximum probability for production of Ar2+ ions correlated to ejected Auger electrons in the energy range of 205–209 eV is 100%. No theoretical predictions are available to compare with these results. The present study shows further that not only the auto-ionization and normal Auger transitions but also several other decay processes including Coster-Kronig transitions followed by Auger cascades with a fraction of shake process play important role in producing ions with charge states 1+ to 4+

Prevalence of Conventional Risk Factors in ST Segment Elevation Myocardial Infarction Patients in Shahid Gangalal National Heart Centre, Nepal

Introduction: Smoking, diabetes mellitus, hypertension, and dyslipidemia are labelled as conventional risk factors for coronary artery disease. Prevalence of these risk factors varies across populations. This study aimed to assess the prevalence of these conventional risk factors in patients, who were discharged from our hospital, with the diagnosis of ST elevation myocardial infarction. Methods: Medical records of 495 ST elevation myocardial infarction patients discharged from our centre in between January 2012 to December 2012 were retrospectively reviewed to evaluate the prevalence of conventional risk factors. Results: Clear dominance (75%) of male patients was seen. Inferior wall myocardial infarction (29.9%) was the most common diagnosis followed by anterior wall myocardial infarction (25.1%). Hypertension (65%), smoking (57.8%) and dyslipidemia (45.5%) were the most common risk factors. Diabetes (31.1%) was the least common. Prevalence of hypertension, dyslipidemia was similar among male and female. Smoking was statistically common in male (76.8%vs 49.5%),though diabetes was common in female (36.5%vs.29.3%) not statistically significant. Conclusions: Conventional risk factors are common among ST elevation myocardial infarction patients. Early detection and treatment of these risk factors play a vital role for the prevention of coronary artery disease. Much more focus should be stressed on preventive programs throughout the country. Keywords: coronary artery disease; diabetes; dyslipidemia; hypertension; smoking; ST elevation myocardial infarction

Highly improved photoreduction of carbon dioxide to methanol using cobalt phthalocyanine grafted to graphitic carbon nitride as photocatalyst under visible light irradiation

International audienc

Highly improved photoreduction of carbon dioxide to methanol using cobalt phthalocyanine grafted to graphitic carbon nitride as photocatalyst under visible light irradiation

A substantially improved methanol yield was achieved from the photoreduction of carbon dioxide under visible light by using a hybrid photocatalyst consisting of molecular cobalt phthalocyanine tetracarboxylic acid (CoPc-COOH) complex immobilized to the organic semiconductor graphitic carbon nitride (g-C3N4) and triethylamine as sacrificial electron donor. The structural and morphological features of the hybrid photocatalyst determined by various techniques like FTIR, UV–Vis, Raman, XPS, TGA, BET etc. After 24 h of light irradiation, the methanol yield by using g-C3N4/CoPc-COOH photocatalyst (50 mg) was found to be 646.5 mmol g�1cat or 12.9 mmol g�1cat with conversion rate 538.75 mmol h�1 - g�1cat. However, the use of homogeneous CoPc-COOH (6.5 mmol Co, equivalent to g-C3N4/CoPc-COOH) and g-C3N4 (50 mg) provided 88.5 lmol (1770 lmol g�1cat) and 59.2 lmol (1184 lmol g�1cat) yield of methanol, respectively under identical conditions. The improved photocatalytic efficiency of the hybrid was attributed to the binding ability of CoPc-COOH to CO2 that provided the higher CO2 concentration on the support. Further, the semiconductor support provided better electron mobility and charge separation with the integrated benefit of facile recovery and recycling of the material at the end of the reduction process