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Conduction abnormalities are commonly noted after alcohol septal ablation (ASA). This was a retrospective, observational study where we studied the incidence of new onset conduction abnormalities post ASA. 23 patients, who underwent ASA over a period of 5 years, were included in the study. Baseline conduction abnormalities were noted in 26% patients (n = 6). Transient complete heart block (CHB) was noted in 21.7% (n = 5) whereas new onset right bundle branch block (RBBB) was seen in 60.8% (n = 14). Left bundle branch block was uncommon (4.3%,n = 1). Permanent pacemaker implantation was done in 4.3% (n = 1) for CHB. Conduction anomalies are frequent after ASA with RBBB being most common.

Long term outcome data after BMS implant is not available from the Indian subcontinent. This is a prospective observational study which aims to study long term outcomes after BMS implant at a tertiary care centre. 100 consecutive patients underwent BMS implant and were followed up for 20 years. LAD was the most common vessel involved and different types of BMS were implanted. All-cause mortality was noted in 21% (n = 21) whereas cardiac mortality was seen in 16% (n = 16). Cumulative revascularisation free survival at 20 years was 71%. The study showed that long term outcomes after BMS implant were fare and acceptable.

Background: The role of late gadolinium enhancement (LGE) in cardiac MRI (CMR) as prognostic marker in non-ischemic dilated cardiomyopathy (NIDCM) is evolving. Objective: To study the effect of LGE in the prognosis of NIDCM patients. Methods: 112 consecutive NIDCM patients, who underwent CMR, were prospectively followed up for 745 ± 320 days. Primary end point was occurrence of MACE {composite of all-cause mortality, resuscitated cardiac arrest, sustained ventricular tachycardia (VT)/appropriate ICD shock, heart failure (HF) hospitalization}. Results: LGE was present in 44 out of 112 patients (39%). The primary end point (MACE) was significantly higher in LGE + ve group compared to the LGE –ve group (72.7% vs. 29.4%; p 14% of LV predicted MACE with 90.6% sensitivity and 86% specificity. HR of LGE extent >14% of LV for MACE is 6.12; p 14% of LV volume were strongest predictor of MACE. Conclusion: LGE and its extent >14% predicts adverse cardiac events in NIDCM irrespective of LVEF and LGE location, pattern or distribution. This study emphasises the role of CMR in risk stratification of NIDCM patients and guiding therapy.

The COVID 19 global pandemic has engulfed humanity with a huge impact on health systems across the world. Many patients develop myocardial injury which can lead to significant cardiovascular complications including HF. This will require aggressive management strategies which are evolving. Guideline directed drug therapy including ACEI/ARB/ARNI is to be continued in patients with pre-existing HF. Long-term cardiovascular effects of COVID-19 are yet to be ascertained. Protection of health care personnel from contracting the disease should be given high priority.

Background Long-term data on outcomes of participants hospitalized with heart failure (HF) from low- and middle-income countries are limited. Methods and Results In the Trivandrum Heart Failure Registry (THFR) in 2013, 1205 participants from 18 hospitals in Trivandrum, India, were enrolled. Data were collected on demographics, clinical presentation, treatment, and outcomes. We performed survival analyses, compared groups and evaluated the association between heart failure (HF) type and mortality, adjusting for covariates that predicted mortality in a global HF risk score. The mean (standard deviation) age of participants was 61.2 (13.7) years. Ischemic heart disease was the most common cause (72%). The in-hospital mortality rate was higher for participants with HF with reduced ejection fraction (HFrEF; 9.7%) compared with those with HF with preserved ejection fraction (HFpEF; 4.8%; P = .003). After 3 years, 540 (44.8%) participants had died. The all-cause mortality rate was lower for participants with HFpEF (40.8%) compared with HFrEF (46.2%; P = .049). In multivariable models, older age (hazard ratio [HR] 1.24 per decade, 95% confidence interval [CI] 1.15-1.33), New York Heart Association functional class IV symptoms (HR 2.80, 95% CI 1.43-5.48), and higher serum creatinine (HR 1.12 per mg/dL, 95% CI 1.04-1.22) were associated with all-cause mortality. Conclusions Participants with HF in the THFR have high 3-year all-cause mortality. Targeted hospital-based quality improvement initiatives are needed to improve survival during and after hospitalization for HF.

Objective: Warfarin is the most commonly prescribed oral anticoagulant, although having a narrow therapeutic index and wide interindividual variability. The aim of this study was to replicate the utility of VKORC1 (−1639G>A) rs9923231 genotyping in predicting the mean daily dose and to evaluate its ability to categorize warfarin-treated patients to high-, intermediate-, or low-dose categories in the South Indian population. Materials and methods: A cohort of 222 warfarin-treated patients was genotyped using restriction fragment length polymorphism method. The influence of the rs9923231 polymorphism on the variations in the mean daily dose was compared using one-way analysis of variance and linear regression analysis. Discriminatory ability of the rs9923231 polymorphism to group the patients into ordered dose categories was assessed by estimating the proportional odds ratios using the ordered logit regression analysis. Results: The frequency of AA genotype and A allele in the study sample was found to be 1.8% and 9.23%, respectively, which was similar to reports from other South Indian populations. The mean daily dose required to achieve the optimum international normalized ratio was significantly lower in AA homozygous genotype carriers (3.99 ± 1.67 mg/day) and GA heterozygous (4.26 ± 1.57 mg/day) compared to the GG genotype carriers (5.51 ± 2.13 mg/day), p = 0.003. The A allele carriers (GA+AA genotypes) had a 3.23 higher odds of being grouped as a low-dose requiring category compared to non-carriers (95% CI 1.49–6.98, p = 0.003). Conclusions: These preliminary results strongly support the use of VKORC1 (−1639G>A) rs9923231 polymorphism for genetically guided initial warfarin dosing in South Indian patients with heart valve replacements. Keywords: VKORC1, Polymorphism, Warfarin, Pharmacogenetics, Regression

We evaluated the cardioprotective effect of Amalaki Rasayana (AR), a rejuvenating Ayurvedic drug prepared from Phyllanthusemblica fruits in the reversal of remodeling changes in pressure overload left ventricular cardiac hypertrophy (LVH) and age-associated cardiac dysfunction in male Wistar rats. Six groups (aging groups) of 3 months old animals were given either AR or ghee and honey (GH) orally; seventh group was untreated. Ascending aorta was constricted using titanium clips in 3 months old rats (N = 24; AC groups) and after 6 months, AR or GH was given for further 12 months to two groups; one group was untreated. Histology, gene and protein expression analysis were done in heart tissues. Chemical composition of AR was analyzed by HPLC, HPTLC and LC-MS. AR intake improved (P P P

Background: Chronic and persistent alcohol use is known to induce sexual dysfunction, but it is often unexplored and untreated in routine clinical practice. Objective: To study the prevalence and typology of sexual dysfunction and its clinical correlates among male patients seeking treatment for alcohol dependence. Materials and Methods: 60 male subjects (aged 18-50 years) meeting the criteria for alcohol dependence syndrome (ADS), according to DSM-IV were enrolled for the study. Data regarding socio- demographic and clinical details were recorded on a semi-structured proforma designed for the study. They were assessed for sexual dysfunction using a Sexual Dysfunction Checklist, constructed using items from the Diagnostic Criteria for Research (ICD-10) for sexual dysfunction and Arizona Sexual Experience Questionnaire (ASEX) and for severity of alcohol dependence using the Severity of Alcohol Dependence Questionnaire (SADQ). Results: 58.3 % had one or more sexual dysfunction as per ASEX, the most common being inability to reach orgasm (60%), dissatisfaction with orgasm (58.3%) and erectile dysfunction (56.7%). As per sexual dysfunction checklist, dissatisfaction with own sexual performance (58.3%), anorgasmia (56.7%) and erectile dysfunction (53.3%) were the most common. Longer duration of alcohol consumption and dependence, high levels of intake and sever dependence appeared to be the most significant predictors of developing sexual dysfunction. Conclusion: SD is highly prevalent in patients with alcohol dependence and all domains of sexual functioning are affected. Anorgasmia is quite common in patients with alcohol dependence. Longer duration of consumption and dependence and heavy drinking proportionately increases the risk. Clinicians need to routinely evaluate sexual functioning in alcoholic patients and address the same.

Introduction: To study effects of various sites of right ventricular pacing lead implantation on left ventricular function by 2-dimensional (2D) speckle tracking for radial strain and LV dyssynchrony. Methods: This was retrospective prospective study. Fifteen patients each with right ventricular (RV) apical (RV apex and apical septum) and non-apical (mid septal and low right ventricular outflow tract [RVOT]) were programmed to obtain 100% ventricular pacing for evaluation by echo. Location and orientation of lead tip was noted and archived by fluoroscopy. Electrocardiography (ECG) was archived and 2D echo radial dyssynchrony was calculated. Results: The baseline data was similar between two groups. Intraventricular dyssynchrony was significantly more in apical location as compared to non-apical location (radial dyssynchrony: 108.2 ± 50.2 vs. 50.5 ± 24, P < 0.001; septal to posterior wall delay [SLWD] 63.5 ± 27.5 vs. 34 ± 10.7, P < 0.001, SPWD 112.5 ± 58.1 vs. 62.7 ± 12.1, P = 0.003). The left ventricular ejection fraction was decreased more in apical location than non apical location. Interventricular dyssynchrony was more in apical group but was not statistically significant. The QRS duration, QTc and lead thresholds were higher in apical group but not statistically significant. Conclusion: Pacing in non apical location (RV mid septum or low RVOT) is associated with less dyssynchrony by specific measures like 2D radial strain and correlates with better ventricular function in long term.

Background: In the recent decades, increasing number of females have been seeking de-addiction services yet data in this regard is very limited from across the globe as well as from India. Objectives: The aim of this research was to study the gender differences in demographic and clinical profile and psychiatric co-morbidity among patients with alcohol dependence syndrome (ADS). Methods: This cross sectional study was conducted at Shridevi Institute of Medical Sciences and Research Hospital, a tertiary care center located in Tumkur, India, during year 2015 to 2016. Seventy male and 50 female subjects (aged 18 to 50 years) meeting the criteria for ADS, were assessed using socio-demographic and clinical proforma, severity of alcohol dependence questionnaire (SADQ), and mini international neuropsychiatric interview (MINI). Results: For females, mean age at presentation was 41.38 years (standard deviation, SD = ± 6.43), the majority belonged to a nuclear family (72%) (Parents and their children living together), had low socio-economic class (68%), and studied up to Seventh standard (86%) compared to males, whose mean age at presentation was 39.65 years (SD = ± 7.76), majority belonged to a joint family (54.28%) (three generation living together), middle socio-economic class (55.71%), studied to the eighth standard and above (52.85%). Females compared to males started alcohol use at a later age, drunk for shorter duration and lesser quantity per day. Stress was the foremost reason cited for initiation of drinking and physical sickness to seek medical treatment by both. Females have more co-morbid psychiatric problems compared to males. Conclusions: A number of important gender differences with regards to alcoholism have been found, which have implications for planning gender sensitive, multi-dimensional treatment, and preventive programmers.

Heart failure (HF) is recognized as a major public health problem in both the low and high- income countries. However, data are scarce on the burden, prevailing practice patterns and long-term health outcomes of HF patients in India. The Kerala heart failure registry (KHFR) is a multi-centric, prospective, and hospital based registry in Kerala, India. Consecutive patients admitted with the diagnosis of acute heart failure satisfying the European Society of Cardiology (ESC) criteria will be enrolled in the registry. Data on demographic, clinical, laboratory, imaging, other diagnostics and therapeutic approaches employed and the usage of guideline based medical therapy will be collected as part of the registry. Additionally, all registered patients will be followed-up regularly at 1-month, and thereafter at every 3-months. Both mortality and hospital admission data will be collected during the follow-up visits. We will be recruiting 7500 HF patients in the KHFR. Once completed, KFHR is going to be the largest HF registry in India. We will validate a HF mortality risk score developed based on a previously conducted Trivandrum Heart Failure Registry in the KHFR patients. Keywords: Heart failure, Registry, Coronary artery disease, Cardiomyopathy, Guideline directed medical therapy

Objective To evaluate the presentation, management, and outcomes of patients hospitalized for heart failure (HF) in Trivandrum, India. Methods The Trivandrum Heart Failure Registry (THFR) enrolled consecutive admissions from 13 urban and five rural hospitals in Trivandrum with a primary diagnosis of HF from January to December 2013. Clinical characteristics at presentation, treatment, in-hospital outcomes, and 90-day mortality data were collected. ‘Guideline-based’ medical treatment was defined as the combination of beta-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and aldosterone receptor blockers in patients with left ventricular systolic dysfunction (LVSD). Results We enrolled 1205 cases (834 men, 69%) into the registry. Mean (standard deviation) age was 61.2 (13.7) years. The most common HF aetiology was ischaemic heart disease (IHD) (72%). Heart failure with preserved ejection fraction (≥45%) constituted 26% of the population. The median hospital stay was 6 days (interquartile range = 4–9 days) with an in-hospital mortality rate of 8.5% (95% confidence interval 6.9–10.0). The 90-day all-cause mortality rate was 2.43 deaths per 1000 person-days (95% confidence interval 2.11–2.78). Guideline-based medical treatment was given to 19% and 25% of patients with LVSD during hospital admission and at discharge, respectively. Older age, lower education, poor ejection fraction, higher serum creatinine, New York Heart Association functional class IV, and suboptimal medical treatment were associated with higher risk of 90-day mortality. Conclusion Patients hospitalized with HF in the THFR were younger, more likely to be men, had a higher prevalence of IHD, reported longer length of hospital stay, and higher mortality compared with published data from other registries. We also identified key areas for improving hospital-based HF medical care in Trivandrum.

Background Epidemiological data on pulmonary hypertension (PH) are scarce from developing countries including India. Methods We established a multi-center registry of PH, the PRO-KERALA registry, in Kerala, India. Fifty hospitals enrolled consecutive adult (>18 years) patients for one year. Echocardiographic criteria (right ventricular systolic pressure – RVSP > 50 mmHg) or invasively obtained mean pulmonary artery pressure > 25 mmHg was the criteria for entry. Results There were 2003 patients (52% Women, mean age 56 ± 16.1 years) enrolled. The mean RVSP was 68.2 (SD = 17.9) mmHg. Majority of the study participants (59%) belonged to group 2 of the WHO Nice Classification 2013 (PH secondary to left heart disease). One-fifth (21.2%) belonged to group 1, while 13.3%, 3.8% and 2.4% of the study population belonged to groups 3, 4 and 5 respectively. More than a quarter (27%) reported PH due to left heart disease with valvular disease etiology; while 20.7% had coronary artery disease. The other common etiological factors were chronic obstructive pulmonary disease (10.6%), congenital heart disease (14.6%), idiopathic pulmonary hypertension (5.8%), and chronic thromboembolic pulmonary hypertension (3.8%). Only one of two patients with pulmonary artery hypertension was receiving PH specific therapies. The use of combination therapy was negligible and PH-specific therapies were prescribed off-label to a small proportion of patients too. Conclusion PRO-KERALA is the first PH registry from South Asia and the second largest globally. Left heart diseases attribute to three fifths of patients with PH. Utilization rates of PH specific drug therapies are remarkably lower than the Western population.

In day to day life resource management plays an important role. Especially some forms of the resources like fuel which are non-renewable in nature needs to be managed in a proper way in order to avoid economical loss. This issue needs to be rectified with a proper solution. Major part of the transportation depends on buses and fleets', having reliable control for the management over the fleets using minimal human resource, money is duly needed. This provides (control) saving of fuel due to the unmaintained condition of the vehicle. So, we have developed this solution which provides fleet organizations to have secured, reliable and remote control over the fleet of its organization using Internet of Things (IoT). This fuel continuously monitors the status of the vehicle using fuel sensors, GPS based Odometer provides status related information of the vehicle to the fleet control management. The control management from remote place using IoT platform can provide precautionary measures for driver in maintaining the vehicle.

Face recognition is growingly becoming a very remarkable field in machine learning and artificial intelligence. In this paper, we introduce a modified scheme for face recognition based on the hybrid color model along with the Gabor Feature Extraction and Principal Component Analysis (PCA). Our algorithm is tested on two face databases namely, 'The MUCT Database' and 'The FEI Database' for recognition accuracy. In addition to the various issues posed by the database such as variations in expression, illumination, ethnicity etc. we have also considered tackling and alleviating the problem of small sample size by taking only one image per person for the training set. Recognition accuracies up to 100% are obtained for MUCT database and a maximum accuracy of 87.43% is obtained for FEI database. Through these results, it is justifiable that our methodology has performed better than many of the existing algorithms specific to the databases that are considered in our experiment.

Background There are sparse data on outcomes of patients with heart failure (HF) from India. The objective was to evaluate hospital readmissions and 1-year mortality outcomes of patients with HF in Kerala, India. Methods We followed 1,205 patients enrolled in the Trivandrum Heart Failure Registry for 1 year. A trained research nurse contacted each participant every 3 months using a structured questionnaire which included hospital readmission and mortality information. Results The mean (SD) age was 61.2 (13.7) years, and 31% were women. One out of 4 (26%) participants had HF with preserved ejection fraction. Only 25% of patients with HF with reduced ejection fraction received guideline-directed medical therapy at discharge. Cumulative all-cause mortality at 1 year was 30.8% (n = 371), but the greatest risk of mortality was in the first 3 months (18.1%). Most deaths (61%) occurred in patients younger than 70 years. One out of every 3 (30.2%) patients was readmitted at least once over 1 year. The hospital readmission rates were similar between HF with preserved ejection fraction and HF with reduced ejection fraction patients. New York Heart Association functional class IV status and lack of guideline-directed medical treatment after index hospitalization were associated with increased likelihood of readmission. Similarly, older age, lower education status, nonischemic etiology, history of stroke, higher serum creatinine, lack of adherence to guideline-directed medical therapy, and hospital readmissions were associated with increased 1-year mortality. Conclusions In the Trivandrum Heart Failure Registry, 1 of 3 HF patients died within 1 year of follow-up during their productive life years. Suboptimal adherence to guideline-directed treatment is associated with increased propensity of readmission and death. Quality improvement programs aiming to improve adherence to guideline-based therapy and reducing readmission may result in significant survival benefits in the relatively younger cohort of HF patients in India.

Background Recognizing patterns of coronary heart disease (CHD) risk in families helps to identify and target individuals who may have the most to gain from preventive interventions. The overall goal of the study is to test the effectiveness and sustainability of an integrated care model for managing cardiovascular risk in high risk families. The proposed care model targets the structural and environmental conditions that predispose high risk families to development of CHD through the following interventions: 1) screening for cardiovascular risk factors, 2) providing lifestyle interventions 3) providing a framework for linkage to appropriate primary health care facility, and 4) active follow-up of intervention adherence. Methods Initially, a formative qualitative research component will gather information on understanding of diseases, barriers to care, specific components of the intervention package and feedback on the intervention. Then a cluster randomized controlled trial involving 740 families comprising 1480 participants will be conducted to determine whether the package of interventions (integrated care model) is effective in reducing or preventing the progression of CHD risk factors and risk factor clustering in families. The sustainability and scalability of this intervention will be assessed through economic (cost-effectiveness analyses) and qualitative evaluation (process outcomes) to estimate value and acceptability. Scalability is informed by cost-effectiveness and acceptability of the integrated cardiovascular risk reduction approach. Discussion Knowledge generated from this trial has the potential to significantly affect new programmatic policy and clinical guidelines that will lead to improvements in cardiovascular health in India. Trial registration number NCT02771873, registered in May 2016 ( https://clinicaltrials.gov/ct2/show/results/NCT02771873 )

Background We undertook this study to validate the impact of FFR-guided coronary interventions among Indian patients, which is not readily available as of date. Our patients differ from their western counterparts, both in terms of risk profile (younger, more metabolic syndrome, lipid rich diet) as well as their coronary size. Methods We retrospectively evaluated 282 patients with intermediate stenosis in their coronary arteries, who underwent FFR to assess the functional severity of the lesion. There were 3 groups: Group 1–FFR > 0.8 and kept on medical follow-up; Group 2–FFR ≤ 0.8 and underwent revascularisation; and Group 3–FFR ≤ 0.8 and refused to undergo revascularization. 281(99.6%) patients had regular follow-up in our clinic. Results Median age-57 years (range = 28–78). Males = 230, 90 patients were in Group 1, 175 in group 2 (PCI in 144 & CABG in 31) and 17 in group 3. Median follow-up of patients was 17.9 months (2 to 56 months). Three patients(3.4%) in Group 1 had MACE (1 STEMI, 2 UA); 4 patients (2.3%) in Group 2 had Non-STE-ACS; 7 patients (41%) in Group 3 had MACE (3 deaths with acute LVF, 2 NSTEMI, 2 STEMI) Conclusion In our experience, MACE events were not higher in patients with FFR > 0.8 and kept under medical therapy and were similarly lower in patients with FFR ≤0.8 and underwent revascularisation (p = 0.73). Also MACE events were higher in patients with FFR ≤ 0.8 and did not undergo revascularisation compared to other two appropriately treated groups (p = 0.03). FFR based revascularization decision appears to be a safe strategy in Indian patients.

Sinus of valsalva aneurysm is considered to be one of the rarest complications of inflammatory aortitis. Herewith, we are reporting a young male patient who presented to us with severe aortic regurgitation. On evaluation, he was found to have unruptured sinus of valsalva aneurysm. CT angiography and magnetic resonance imaging have shown value in the diagnosis of sinus of valsalva aneurysm.

We consider the problem of detecting whether a compromised router is maliciously manipulating its stream of packets. In particular, we are concerned with a simple yet effective attack in which a router selectively drops packets destined for some victim. Unfortunately, it is quite challenging to attribute a missing packet to a malicious action because normal network congestion can produce the same effect. Modern networks routinely drop packets when the load temporarily exceeds their buffering capacities. Previous detection protocols have tried to address this problem with a user -defined threshold: too many dropped packets imply malicious intent. However, this heuristic is fundamentally unsound; setting this threshold is, at best, an art and will certainly create unnecessary false positives or mask highly focused attacks. We have designed, developed, and implemented a compromised router detection protocol that dynamically infers, based on measured traffic rates and buffer sizes, the number of congestive packet losses that will occur. Once the ambiguity from congestion is removed, subsequent packet losses can be attributed to malicious actions.

Background There are no recent data on prevalence of coronary artery disease (CAD) in Indians. The last community based study from Kerala, the most advanced Indian state in epidemiological transition, was in 1993 that reported 1.4 % definite CAD prevalence. We studied the prevalence of CAD and its risk factors among adults in Kerala. Methods In a community-based cross sectional study, we selected 5167 adults (mean age 51 years, men 40.1 %) using a multistage cluster sampling method. Information on socio-demographics, smoking, alcohol use, physical activity, dietary habits and personal history of hypertension, diabetes, and CAD was collected using a structured interview schedule. Anthropometry, blood pressure, electrocardiogram, and biochemical investigations were done using standard protocols. CAD and its risk factors were defined using standard criteria. Comparisons of age adjusted prevalence were done using two tailed proportion tests. Results The overall age-adjusted prevalence of definite CAD was 3.5 %: men 4.8 %, women 2.6 % (p

Objective: To evaluate the effect of percutaneous closure of patent ductus arteriosus (PDA) on left ventricular (LV) systolic and diastolic function in children. Background: Limited studies are available on alteration in LV hemodynamics, especially diastolic function, after PDA closure. Methods: Thirty-two consecutive children with isolated PDA treated by trans-catheter closure were studied. The LV systolic and diastolic function were assessed by two-dimensional (2D) echocardiography and tissue Doppler imaging 1 day before the PDA closure, on day 1, and on follow-up. Results: At baseline, none of the patients had LV systolic dysfunction. On day 1 post-PDA closure, 8 (25%) children developed LV systolic dysfunction. The baseline LV ejection fraction (LVEF), LV end-systolic dimension (LVESD), and PDA diastolic gradient predicted the post-closure LVEF. Patients who developed post-closure LV systolic dysfunction had poorer LV diastolic function than those who did not. LV diastolic properties improved after PDA closure; however, the improvement in LV diastolic properties lagged behind the improvement in the LV systolic function. All children were asymptomatic and had normal LVEF on follow up of >3 months. Conclusions: Percutaneous closure of PDA is associated with the reversible LV systolic dysfunction. Improvement in the LV diastolic function lags behind that in the LV systolic function.

Background Coronary Artery Disease (CAD) is a leading cause of death and disability in Kerala, India. Metabolic syndrome (MS) is a constellation of established risk factors for CAD. We aimed to estimate the prevalence of MS and evaluate the association between MS and CAD using a community-based sample population. Methods A cross-sectional community based survey was conducted in urban and rural areas of Kerala in 2011. We included 5063 individuals for analysis. Age standardized prevalence of MS, associated diagnoses (hypertension, diabetes and hypercholesterolemia) and other potential risk factors were assessed for men and women in both urban and rural locations. Univariate and multivariate logistic regression models were developed to identify participant characteristics that are associated with MS. Results After standardization for age and adjustment for sex and urban-rural distribution, the prevalence of metabolic syndrome in Kerala was 24%, 29% and 33% for the NCEP ATP III, IDF and AHA/NHLBI Harmonization definitions, respectively. The mean (SD) age of the participants was 51 (14) years, and 60% were women. Women had a higher prevalence of MS than men (28% versus 20% for ATP III, p

Visual Attention algorithms have been extensively used for object detection in images. However, the use of these algorithms for video analysis has been less explored. Many of the techniques proposed, though accurate and robust, still require a huge amount of time for processing large sized video data. Thus this paper introduces a fast and computationally inexpensive technique for detecting regions corresponding to moving humans in surveillance videos. It is based on the dynamic saliency model and is robust to noise and illumination variation. Results indicate successful extraction of moving human regions with minimum noise, and faster performance in comparison to other models. The model works best in sparsely crowded scenarios.

Spiking Neural Networks are the third generation of Artificial Neural Networks and is fast gaining interest among researchers in image processing applications. The paper attempts to provide a state-of-the-art of SNNs in image processing. Several existing works have been surveyed and the probable research gap has been exposed.

Ascending aortic constriction is the most common and successful surgical model for creating pressure overload induced cardiac hypertrophy and heart failure. Here, we describe a detailed surgical procedure for creating pressure overload and cardiac hypertrophy in rats by constriction of the ascending aorta using a small metallic clip. After anesthesia, the trachea is intubated by inserting a cannula through a half way incision made between two cartilage rings of trachea. Then a skin incision is made at the level of the second intercostal space on the left chest wall and muscle layers are cleared to locate the ascending portion of aorta. The ascending aorta is constricted to 50–60% of its original diameter by application of a small sized titanium clip. Following aortic constriction, the second and third ribs are approximated with prolene sutures. The tracheal cannula is removed once spontaneous breathing was re-established. The animal is allowed to recover on the heating pad by gradually lowering anesthesia. The intensity of pressure overload created by constriction of the ascending aorta is determined by recording the pressure gradient using trans-thoracic two dimensional Doppler-echocardiography. Overall this protocol is useful to study the remodeling events and contractile properties of the heart during the gradual onset and progression from compensated cardiac hypertrophy to heart failure stage.

The development of high speed electronic devices tends to relevant changes in the designing of the converters for power applications mainly on the speed, size, reliability and efficiency. This paper proposes the hardware implementation of two level DC-DC boost converter. The proposed system has 12V - 48V boost converter with lamp loads by using dSPACE 1104 controller. Conventional DC-DC converters have the disadvantages of operating at high duty cycle, high switch voltage stress and high diode peak current. The major advantage of two level DC-DC boost converter are continuous input current, transformerless which allows high switching frequency and more levels can be added without modifying the main circuit. The two level DC-DC boost converter is validated by comparing simulation and hardware results under different duty ratio.

BackgroundThere is paucity of reliable contemporary data on prevalence of coronary artery disease (CAD) and risk factors in Indians. Only a few studies on prevalence of CAD have been conducted in Kerala, a Southern Indian state. The main objective of the Cardiological Society of India Kerala Chapter Coronary Artery Disease and Its Risk Factors Prevalence Study (CSI Kerala CRP Study) was to determine the prevalence of CAD and risk factors of CAD in men and women aged 20–79 years in urban and rural settings of three geographical areas of Kerala.MethodsThe design of the study was cross-sectional population survey. We estimated the sample size based on an anticipated prevalence of 7.4% of CAD for rural and 11% for urban Kerala. The derived sample sizes for rural and urban areas were 3000 and 2400, respectively. The urban areas for sampling constituted one ward each from three municipal corporations at different parts of the state. The rural sample was drawn from two panchayats each in the same districts as the urban sample. One adult from each household in the age group of 20–59 years was selected using Kish method. All subjects between 60 and 79 years were included from each household. A detailed questionnaire was administered to assess the risk factors, history of CAD, family history, educational status, socioeconomic status, dietary habits, physical activity and treatment for CAD; anthropometric measurements, blood pressure, electrocardiogram and fasting blood levels of glucose and lipids were recorded.

Today, algae have recently received a lot of attention as a new biomass source for the production of renewable bio fuels. CO2, a green house gas is necessary for the culturing of microalgae. The main aim of this work is to study the interaction among the various factors affecting the growth rate and lipid production of different micro alga species from CO2 for the production of bio fuels. In this work the microalgae were modelled as independent agents. CO2 is assumed as the source of carbon for the growth and reproduction of microalgae. Algal systems can remove CO2 from flue gases. The effect of CO2 concentration, light intensity and reproduction ability was modelled in NetLogo software. Lipid production rate was also modelled. A comparison of how two different species behaved with respect to these variables was done by running the model with assigned selected values for these variables. It was found that under certain conditions the two species could have a synergistic effect on each other's growth and/or lipid production.

Aim: In India, coronary angiography (CAG) is usually performed in rheumatic heart disease (RHD) patients before valve replacement surgery if there is any suspicion of coronary artery disease (CAD) or the patient is aged >40 years. The aims of the present study were (1) to find the prevalence of CAD, CAD patterns and its association with various CAD risk factors in RHD patients and (2) to study the association of inflammation seen in RHD with prevalence of CAD. Materials and Methods: The records of 1204 RHD patients who underwent CAG before surgery from 2001 to 2010 were evaluated. Patients of RHD with significant CAD (≥50% stenosis) were compared with age- and sex-matched patients of RHD with no CAD and atherosclerotic CAD patients. All RHD patients with embolic acute coronary artery syndrome were excluded from the study. Results: One-hundred and nine (9.05%) RHD patients had significant CAD (males 65.1% and females 34.9%). The mean age was 52.8 ± 8.6 years (52.3 ± 8.9 years for males and 53.6 ± 8 years for females). Involvement of mitral valve was seen in 66.1%, aortic valve in 7.3% and both valves in 26.6% in these patients. Single-vessel disease, double-vessel disease or triple-vessel disease was present in 58.7%, 27.5% and 13.8%, respectively. Left main coronary artery was involved in 4.6% of the cases. Left anterior descending (LAD) was the most common vessel involved (68.9%), followed by right coronary artery (44.1%) and left circumflex artery (42.3%). Univariate analysis showed that polymorphonuclear leucocyte count was significantly higher (P = 0.037; odds ratio: 1.03 with 95% confidence interval: 1.001–1.056) in RHD CAD patients than the atherosclerotic CAD patients. Conclusion: The prevalence of CAD in patients with RHD is similar to other Indian studies but lower than the Western countries. Single-vessel involvement, mostly LAD, is more common among these patients. CAD risk factor is less common than the atherosclerotic patients. CAD in these patients may be attributed to the inflammatory state seen with RHD.

Objective: The data of 51 patients (33 females) who underwent excision of left atrial (LA) myxoma were retrospectively reviewed for correlation of tumour size and electrocardiographic (ECG) findings. Methods and results: Mean age was 39.1 ± 15 years (range 9–53 years). The LA enlargement (LAE) on ECG was defined by standard criteria. The LAE in ECG in these patients did not correlate with echocardiographic LA dimensions or with the degree of left ventricular (LV) inflow obstruction. But it was found that the presence of LAE in ECG predicted maximum tumour dimension of >5 cm and correlated with the degree of mitral regurgitation (MR). The LAE in ECG disappeared following surgery in 87.5% of patients. Conclusion: The LA enlargement on ECG in a patient with LA myxoma signifies larger tumour size or the presence of significant MR but is not necessarily associated with an increased LA size or LV inflow obstruction.

A jet loop reactor system has been developed for use with reaction systems such as coal liquefaction that are gas-liquid mass transfer limited. The reactor system has the ability to process slurries and permits better control of free-radical generation/reaction and provides higher mass-transfer rates than conventional reactors. The developmental efforts for the reactor system where carried out using model reactions such as naphthalene hydrogenation. The reactor system performed better than conventional tubing bomb microreactors and required considerably less catalyst. The reactor system provided higher conversions even at higher temperatures and was operating in a regim where gas- liquid mass transfer whas only partially controlling

Background Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) presents rarely in adulthood and is treated by different surgical techniques with varying results. This study was undertaken to evaluate the feasibility of reestablishment of a dual coronary system in older children and adults with emphasis on direct aortic implantation. Methods From 2002 to 2010, 10 patients aged 10 to 51 years (median age, 24 years) underwent surgical correction of ALCAPA. Median weight was 44.5 kg. All the patients except 2 were symptomatic. Two patients were in atrial fibrillation. Eight patients had varying degrees of mitral regurgitation, which was severe in 2. In all patients, the left coronary artery was arising from the facing sinus of the pulmonary artery. Direct left main coronary implantation into the aorta was feasible in all patients. Mitral valve replacement was done in 4 patients. Results At a median follow-up of 5.5 years there was no new angina or infarction. One patient died 3 months postsurgery due to intracerebral bleed. Echocardiography demonstrated normal antegrade flow in the transferred left coronary artery, with 2 patients having persistent moderate mitral regurgitation. Coronary angiography done on follow-up in one patient revealed a patent transferred left coronary artery with distal development of new atherosclerotic lesion. Conclusions Direct reimplantation of the ALCAPA is considered technically more difficult and hazardous in adults. With increased experience with coronary transfer technique, direct aortic implantation is feasible in adult cases. This provides a more physiologic correction and reestablishment of a dual coronary system with a better outcome.

Background Pulmonary hypertension (PH) is a disease associated with a high morbidity and mortality. There is paucity of data regarding PH from the developing countries including India. Idiopathic pulmonary arterial hypertension is the most important etiological factor in the western world, but PH secondary to rheumatic heart disease, chronic obstructive pulmonary disease and untreated congenital heart disease could well be the predominant causes in developing countries like India. The main objective of the PROKERALA study – Pulmonary hypertension Registry Of Kerala is to collect data regarding the etiology, practice patterns and one-year outcomes of patients diagnosed to have PH. Methods The study is a hospital-based registry in the state of Kerala supported and funded by the Cardiological Society of India, Kerala Chapter. A total of 77 hospitals have agreed to participate in the registry. PH was defined as systolic pulmonary artery pressure derived by echocardiography of more than 50 mmHg (by tricuspid regurgitation jet) or mean PA pressure more than 25 mmHg obtained at cardiac catheterization. A detailed questionnaire is administered which includes the demographic characteristics, risk factors, family history, ECG data, 6 minute walk test distance, chest X ray findings and echocardiographic data. Details of PH specific therapy and one-year follow-up data are collected. From a preliminary survey in the region, we estimated that we will be able to collect 2000 cases over a period of one year.