Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 23

Search results for: C. Rajan

23 Effect of Copper Particle on the PD Characteristics in a Coaxial Duct with Mixture of SF6 (10%) and N2 (90%) Gases

Authors: B. Rajesh Kamath, J. Sundara Rajan, M. K. Veeraiah, M. Z. Kurian

Abstract:

Insulation performance of a gas insulated system is severely affected by particle contaminants. These metallic particles adversely affect the characteristics of insulating system. These particles can produce surface charges due to partial discharge activities. These particles which are free to move enhance the local electric fields. This paper deals with the influence of conducting particle placed in a co-axial duct on the discharge characteristics of gas mixtures. Co-axial duct placed in a high pressure chamber is used for the purpose. A gas pressure of 0.1, 0.2 and 0.3 MPa have been considered with a 10:90 SF6 and N2 gas mixtures. The 2D and 3D histograms of clean duct and duct with copper particle are discussed in this paper.

Keywords: B. Rajesh Kamath, J. Sundara Rajan, M. K. Veeraiah, M. Z. Kurian

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22 Load Flow Analysis: An Overview

Authors: P. S. Bhowmik, D. V. Rajan, S. P. Bose

Abstract:

The load flow study in a power system constitutes a study of paramount importance. The study reveals the electrical performance and power flows (real and reactive) for specified condition when the system is operating under steady state. This paper gives an overview of different techniques used for load flow study under different specified conditions.

Keywords: Load Flow Studies, Y-matrix and Z-matrix iteration, Newton-Raphson method, Fast Decoupled method, Fuzzy logic, Artificial Neural Network.

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21 Measurement of Small PD-S in Compressed SF6(10%) - N2(90%) Gas Mixture

Authors: B. Rajesh Kamath, J. Sundara Rajan

Abstract:

Partial Discharge measurement is a very important means of assessing the integrity of insulation systems in a High Voltage apparatus. In compressed gas insulation systems, floating particles can initiate partial discharge activities which adversely affect the working of insulation. Partial Discharges below the inception voltage also plays a crucial in damaging the integrity of insulation over a period of time. This paper discusses the effect of loose and fixed Copper and Nichrome wire particles on the PD characteristics in SF6-N2 (10:90) gas mixtures at a pressure of 0.4MPa. The Partial Discharge statistical parameters and their correlation to the observed results are discussed.

Keywords: Gas Insulated transmission Line, Sulphur HexaFlouride, metallic Particles, Partial Discharge (PD), InceptionVoltage (Vi), Extinction Voltage (Ve), PD Statistical parameters.

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20 Challenges in Video Based Object Detection in Maritime Scenario Using Computer Vision

Authors: Dilip K. Prasad, C. Krishna Prasath, Deepu Rajan, Lily Rachmawati, Eshan Rajabally, Chai Quek

Abstract:

This paper discusses the technical challenges in maritime image processing and machine vision problems for video streams generated by cameras. Even well documented problems of horizon detection and registration of frames in a video are very challenging in maritime scenarios. More advanced problems of background subtraction and object detection in video streams are very challenging. Challenges arising from the dynamic nature of the background, unavailability of static cues, presence of small objects at distant backgrounds, illumination effects, all contribute to the challenges as discussed here.

Keywords: Autonomous maritime vehicle, object detection, situation awareness, tracking.

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19 IBFO_PSO: Evaluating the Performance of Bio-Inspired Integrated Bacterial Foraging Optimization Algorithm and Particle Swarm Optimization Algorithm in MANET Routing

Authors: K. Geetha, P. Thangaraj, C. Rasi Priya, C. Rajan, S. Geetha

Abstract:

This paper presents the performance of Integrated Bacterial Foraging Optimization and Particle Swarm Optimization (IBFO_PSO) technique in MANET routing. The BFO is a bio-inspired algorithm, which simulates the foraging behavior of bacteria. It is effectively applied in improving the routing performance in MANET. In results, it is proved that the PSO integrated with BFO reduces routing delay, energy consumption and communication overhead.

Keywords: Ant Colony Optimization, Bacterial Foraging Optimization, Hybrid Routing Intelligent Algorithm, Naturally inspired algorithms, Particle Swarm Optimization.

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18 Soliton Interaction in Multi-Core Optical Fiber: Application to WDM System

Authors: S. Arun Prakash, V. Malathi, M. S. Mani Rajan

Abstract:

The analytical bright two soliton solution of the 3- coupled nonlinear Schrödinger equations with variable coefficients in birefringent optical fiber is obtained by Darboux transformation method. To the design of ultra-speed optical devices, Soliton interaction and control in birefringence fiber is investigated. Lax pair is constructed for N coupled NLS system through AKNS method. Using two-soliton solution, we demonstrate different interaction behaviors of solitons in birefringent fiber depending on the choice of control parameters. Our results shows that interactions of optical solitons have some specific applications such as construction of logic gates, optical computing, soliton switching, and soliton amplification in wavelength division multiplexing (WDM) system.

Keywords: Optical soliton, soliton interaction, soliton switching, WDM.

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17 Conceptual Design of an Aircraft with Maglev Landing System

Authors: Nishanth Murugan, Mohammed Niyasdeen Nejaamtheen, S. Sounder Rajan

Abstract:

The accelerated growth in aircraft industries desire effectual schemes, programs, innovative designs of advanced systems to accomplishing the augmenting need for home-free air transportation. In this paper, a contemporary conceptual design of an airplane has been proposed without landing gear systems in order to reducing accidents, time consumption, and to eliminating drawbacks by using superconducting levitation phenomenon. This invention of an airplane with superconductive material coating, on the solar plexus region assist to reduce weight by approximately 4% of the total takeoff weight, and cost effective. Moreover, we conjectured that superconductor landing system reduces ground friction, mission fuel, total drag, take-off and landing distance.

Keywords: Aircraft landing system, Magnetic levitation, Superconductors, Take-off and landing.

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16 Investigation on Novel Based Metaheuristic Algorithms for Combinatorial Optimization Problems in Ad Hoc Networks

Authors: C. Rajan, N. Shanthi, C. Rasi Priya, K. Geetha

Abstract:

Routing in MANET is extremely challenging because of MANETs dynamic features, its limited bandwidth, frequent topology changes caused by node mobility and power energy consumption. In order to efficiently transmit data to destinations, the applicable routing algorithms must be implemented in mobile ad-hoc networks. Thus we can increase the efficiency of the routing by satisfying the Quality of Service (QoS) parameters by developing routing algorithms for MANETs. The algorithms that are inspired by the principles of natural biological evolution and distributed collective behavior of social colonies have shown excellence in dealing with complex optimization problems and are becoming more popular. This paper presents a survey on few meta-heuristic algorithms and naturally-inspired algorithms.

Keywords: Ant colony optimization, genetic algorithm, Naturally-inspired algorithms and particle swarm optimization.

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15 An Analysis of Compression Methods and Implementation of Medical Images in Wireless Network

Authors: C. Rajan, K. Geetha, S. Geetha

Abstract:

The motivation of image compression technique is to reduce the irrelevance and redundancy of the image data in order to store or pass data in an efficient way from one place to another place. There are several types of compression methods available. Without the help of compression technique, the file size is knowingly larger, usually several megabytes, but by doing the compression technique, it is possible to reduce file size up to 10% as of the original without noticeable loss in quality. Image compression can be lossless or lossy. The compression technique can be applied to images, audio, video and text data. This research work mainly concentrates on methods of encoding, DCT, compression methods, security, etc. Different methodologies and network simulations have been analyzed here. Various methods of compression methodologies and its performance metrics has been investigated and presented in a table manner.

Keywords: Image compression techniques, encoding, DCT, lossy compression, lossless compression, JPEG.

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14 Hybrid Genetic-Simulated Annealing Approach for Fractal Image Compression

Authors: Y.Chakrapani, K.Soundera Rajan

Abstract:

In this paper a hybrid technique of Genetic Algorithm and Simulated Annealing (HGASA) is applied for Fractal Image Compression (FIC). With the help of this hybrid evolutionary algorithm effort is made to reduce the search complexity of matching between range block and domain block. The concept of Simulated Annealing (SA) is incorporated into Genetic Algorithm (GA) in order to avoid pre-mature convergence of the strings. One of the image compression techniques in the spatial domain is Fractal Image Compression but the main drawback of FIC is that it involves more computational time due to global search. In order to improve the computational time along with acceptable quality of the decoded image, HGASA technique has been proposed. Experimental results show that the proposed HGASA is a better method than GA in terms of PSNR for Fractal image Compression.

Keywords: Fractal Image Compression, Genetic Algorithm, HGASA, Simulated Annealing.

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13 Investigation on Bio-Inspired Population Based Metaheuristic Algorithms for Optimization Problems in Ad Hoc Networks

Authors: C. Rajan, K. Geetha, C. Rasi Priya, R. Sasikala

Abstract:

Nature is a great source of inspiration for solving complex problems in networks. It helps to find the optimal solution. Metaheuristic algorithm is one of the nature-inspired algorithm which helps in solving routing problem in networks. The dynamic features, changing of topology frequently and limited bandwidth make the routing, challenging in MANET. Implementation of appropriate routing algorithms leads to the efficient transmission of data in mobile ad hoc networks. The algorithms that are inspired by the principles of naturally-distributed/collective behavior of social colonies have shown excellence in dealing with complex optimization problems. Thus some of the bio-inspired metaheuristic algorithms help to increase the efficiency of routing in ad hoc networks. This survey work presents the overview of bio-inspired metaheuristic algorithms which support the efficiency of routing in mobile ad hoc networks.

Keywords: Ant colony optimization algorithm, Genetic algorithm, naturally inspired algorithms and particle swarm optimization algorithm.

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12 Investigation on Novel Based Naturally-Inspired Swarm Intelligence Algorithms for Optimization Problems in Mobile Ad Hoc Networks

Authors: C. Rajan, K. Geetha, C. Rasi Priya, S. Geetha

Abstract:

Nature is the immense gifted source for solving complex problems. It always helps to find the optimal solution to solve the problem. Mobile Ad Hoc NETwork (MANET) is a wide research area of networks which has set of independent nodes. The characteristics involved in MANET’s are Dynamic, does not depend on any fixed infrastructure or centralized networks, High mobility. The Bio-Inspired algorithms are mimics the nature for solving optimization problems opening a new era in MANET. The typical Swarm Intelligence (SI) algorithms are Ant Colony Optimization (ACO), Artificial Bee Colony (ABC), Particle Swarm Optimization (PSO), Modified Termite Algorithm, Bat Algorithm (BA), Wolf Search Algorithm (WSA) and so on. This work mainly concentrated on nature of MANET and behavior of nodes. Also it analyses various performance metrics such as throughput, QoS and End-to-End delay etc.

Keywords: Ant Colony Algorithm, Artificial Bee Colony algorithm, Bio-Inspired algorithm, Modified Termite Algorithm.

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11 Gel-Based Autologous Chondrocyte Implantation (GACI) in the Knee: Multicentric Short Term Study

Authors: Shaival Dalal, Nilesh Shah, Dinshaw Pardiwala, David Rajan, Satyen Sanghavi, Charul Bhanji

Abstract:

Autologous Chondrocyte Implantation (ACI) is used worldwide since 1998 to treat cartilage defect. GEL based ACI is a new tissue-engineering technique to treat full thickness cartilage defect with fibrin and thrombin as scaffold for chondrocytes. Purpose of this study is to see safety and efficacy of gel based ACI for knee cartilage defect in multiple centres with different surgeons. Gel-based Autologous Chondrocyte Implantation (GACI) has shown effectiveness in treating isolated cartilage defect of knee joint. Long term results are still needed to be studied. This study was followed-up up to two years and showed benefit to patients. All enrolled patients with a mean age of 28.5 years had an average defect size of3 square centimeters, and were grade IV as per ICRS grading. All patients were followed up several times and at several intervals at 6th week, 8th week, 11th week, 17th week, 29th week, 57th week after surgery. The outcomes were measured based on the IKDC (subjective and objective) and MOCART scores.

Keywords: Knee, chondrocyte, autologous chondrocyte implantation, gel.

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10 A Review: Comparative Analysis of Arduino Micro Controllers in Robotic Car

Authors: C. Rajan, B. Megala, A. Nandhini, C. Rasi Priya

Abstract:

Robotics brings together several very different engineering areas and skills. There are various types of robot such as humanoid robot, mobile robots, remotely operated vehicles, modern autonomous robots etc. This survey paper advocates the operation of a robotic car (remotely operated vehicle) that is controlled by a mobile phone (communicate on a large scale over a large distance even from different cities). The person makes a call to the mobile phone placed in the car. In the case of a call, if any one of the button is pressed, a tone equivalent to the button pressed is heard at the other end of the call. This tone is known as DTMF (Dual Tone Multiple Frequency). The car recognizes this DTMF tone with the help of the phone stacked in the car. The received tone is processed by the Arduino microcontroller. The microcontroller is programmed to acquire a decision for any given input and outputs its decision to motor drivers in order to drive the motors in the forward direction or backward direction or left or right direction. The mobile phone that makes a call to cell phone stacked in the car act as a remote.

Keywords: Arduino Micro-controller, Arduino UNO, DTMF, Mobile phone, Robotic car.

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9 Hydraulic Studies on Core Components of PFBR

Authors: G. K. Pandey, D. Ramadasu, I. Banerjee, V. Vinod, G. Padmakumar, V. Prakash, K. K. Rajan

Abstract:

Detailed thermal hydraulic investigations are very  essential for safe and reliable functioning of liquid metal cooled fast  breeder reactors. These investigations are further more important for  components with complex profile, since there is no direct correlation  available in literature to evaluate the hydraulic characteristics of such  components directly. In those cases available correlations for similar  profile or geometries may lead to significant uncertainty in the  outcome. Hence experimental approach can be adopted to evaluate  these hydraulic characteristics more precisely for better prediction in  reactor core components.  Prototype Fast Breeder Reactor (PFBR), a sodium cooled pool  type reactor is under advanced stage of construction at Kalpakkam,  India. Several components of this reactor core require hydraulic  investigation before its usage in the reactor. These hydraulic  investigations on full scale models, carried out by experimental  approaches using water as simulant fluid are discussed in the paper. 

Keywords: Fast Breeder Reactor, Cavitation, pressure drop, Reactor components.

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8 Mixed Micellization Study of Adiphenine Hydrochloride with 1-Decyl-3-Methylimidazolium Chloride

Authors: Abbul B. Khan, Neeraj Dohare, Rajan Patel

Abstract:

The mixed micellization of adiphenine hydrochloride (ADP) with 1-decyl-3-methylimidazolium chloride (C10mim.Cl), was investigated at different mole fractions and temperatures by surface tension measurements. The synergistic behavior (i.e., non-ideal behavior) for binary mixtures was explained by the deviation of critical micelle concentration (cmc) from ideal critical micelle concentration (cmc*), micellar mole fraction (Xim) from ideal micellar mole fraction (Xiideal), the values of interaction parameter (β) and activity coefficients (fi) (for both mixed micelles and mixed monolayer). The excess free energy (ΔGex) for the ADP- C10mim.Cl binary mixtures explain the stability of mixed micelles in comparison to micelles of pure ADP and C10mim.Cl. Interfacial parameters, i.e., Gibbs surface excess (Гmax), minimum head group area at air/ water interface (Amin), and free energy of micellization (ΔG0m) were also evaluated for the systems.

Keywords: Adiphenine hydrochloride, Critical micelle concentration, Interaction parameter, Activity coefficient.

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7 Optimized Energy Scheduling Algorithm for Energy Efficient Wireless Sensor Networks

Authors: S. Arun Rajan, S. Bhavani

Abstract:

Wireless sensor networks can be tiny, low cost, intelligent sensors connected with advanced communication systems. WSNs have pulled in significant consideration as a matter of fact that, industrial as well as medical solicitations employ these in monitoring targets, conservational observation, obstacle exposure, movement regulator etc. In these applications, sensor hubs are thickly sent in the unattended environment with little non-rechargeable batteries. This constraint requires energy-efficient systems to drag out the system lifetime. There are redundancies in data sent over the network. To overcome this, multiple virtual spine scheduling has been presented. Such networks problems are called Maximum Lifetime Backbone Scheduling (MLBS) problems. Though this sleep wake cycle reduces radio usage, improvement can be made in the path in which the group heads stay selected. Cluster head selection with emphasis on geometrical relation of the system will enhance the load sharing among the nodes. Also the data are analyzed to reduce redundant transmission. Multi-hop communication will facilitate lighter loads on the network.

Keywords: WSN, wireless sensor networks, MLBS, maximum lifetime backbone scheduling.

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6 Analysis of Lower Extremity Muscle Flexibility among Indian Classical Bharathnatyam Dancers

Authors: V. Anbarasi, David V Rajan, K. Adalarasu

Abstract:

Musculoskeletal problems are common in high performance dance population. This study attempts to identify lower extremity muscle flexibility parameters prevailing among bharatanatyam dancers and analyze if there is any significant difference exist between normal and injured dancers in flexibility parameters. Four hundred and one female dancers and 17 male dancers were participated in this study. Flexibility parameters (hamstring tightness, hip internal and external rotation and tendoachilles in supine and sitting posture) were measured using goniometer. Results of our study it is evident that injured female bharathnatyam dancers had significantly (p < 0.05) high hamstring tightness on left side lower extremity compared to normal female dancers. The range of motion for left tendoachilles was significantly (p < 0.05) high for the normal female group when compared to injured dancers during supine lying posture. Majority of the injured dancers had high hamstring tightness that could be a possible reason for pain and MSDs.

Keywords: External rotation (ER), Internal rotation (IR), Musculoskeletal disorder (MSD), Range of motion (ROM)

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5 Influence of Valve Lift Timing on Producer Gas Combustion and Its Modeling Using Two-Stage Wiebe Function

Authors: M. Sreedhar Babu, Vishal Garg, S. B. Akella, Shibu Clement, N. K. S Rajan

Abstract:

Producer gas is a biomass derived gaseous fuel which is extensively used in internal combustion engines for power generation application. Unlike the conventional hydrocarbon fuels (Gasoline and Natural gas), the combustion properties of producer gas fuel are much different. Therefore, setting of optimal spark time for efficient engine operation is required. Owing to the fluctuating tendency of producer gas composition during gasification process, the heat release patterns (dictating the power output and emissions) obtained are quite different from conventional fuels. It was found that, valve lift timing is yet another factor which influences the burn rate of producer gas fuel, and thus, the heat release rate of the engine. Therefore, the present study was motivated to estimate the influence of valve lift timing analytically (Wiebe model) on the burn rate of producer gas through curve fitting against experimentally obtained mass fraction burn curves of several producer gas compositions. Furthermore, Wiebe models are widely used in zero-dimensional codes for engine parametric studies and are quite popular. This study also addresses the influence of hydrogen and methane concentration of producer gas on combustion trends, which are known to cause dynamics in engine combustion.

Keywords: Combustion Duration, crank angle, mass fraction burnt, producer gas, wiebe combustion model, wide open throttle.

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4 Feasibility Study on the Use of HEMS for Thermal Comfort and Energy Saving in Japanese Residential Buildings

Authors: K. C. Rajan, H. B. Rijal, Kazui Yoshida, Masanori Shukuya

Abstract:

The electricity consumption in the Japanese household sector has increased with higher rate than that of other sectors. This may be because of aging and information oriented society that requires more electrical appliances to make the life better and easier, under this circumstances, energy saving is one of the essential necessity in Japanese society. To understand the way of energy use and demand response of the residential occupants, it is important to understand the structure of energy used. Home Energy Management System (HEMS) may be used for understanding the pattern and the structure of energy used. HEMS is a visualization system of the energy usage by connecting the electrical equipment in the home and thereby automatically control the energy use in each device, so that the energy saving is achieved. Therefore, the HEMS can provide with the easiest way to understand the structure of energy use. The HEMS has entered the mainstream of the Japanese market. The objective of this study is to understand the pattern of energy saving and cost saving in different regions including Japan during HEMS use. To observe thermal comfort level of HEMS managed residential buildings in Japan, the field survey was made and altogether, 1534 votes from 37 occupants related to thermal comfort, occupants’ behaviors and clothing insulation were collected and analyzed. According to the result obtained, approximately 17.9% energy saving and 8.9% cost saving is possible if HEMS is applied effectively. We found the thermal sensation and overall comfort level of the occupants is high in the studied buildings. The occupants residing in those HEMS buildings are satisfied with the thermal environment and they have accepted it. Our study concluded that the significant reduction in Japanese residential energy use can be achieved by the proper utilization of the HEMS. Better thermal comfort is also possible with the use of HEMS if energy use is managed in a rationally effective manner.

Keywords: Energy reduction, thermal comfort, HEMS market, thermal environment.

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3 Trapping Efficiency of Diesel Particles Through a Square Duct

Authors: Francis William S, Imtiaz Ahmed Choudhury, Ananda Kumar Eriki, A. John Rajan

Abstract:

Diesel Engines emit complex mixtures of inorganic and organic compounds in the form of both solid and vapour phase particles. Most of the particulates released are ultrafine nanoparticles which are detrimental to human health and can easily enter the body by respiration. The emissions standards on particulate matter release from diesel engines are constantly upgraded within the European Union and with future regulations based on the particles numbers released instead of merely mass, the need for effective aftertreatment devices will increase. Standard particulate filters in the form of wall flow filters can have problems with high soot accumulation, producing a large exhaust backpressure. A potential solution would be to combine the standard filter with a flow through filter to reduce the load on the wall flow filter. In this paper soot particle trapping has been simulated in different continuous flow filters of monolithic structure including the use of promoters, at laminar flow conditions. An Euler Lagrange model, the discrete phase model in Ansys used with user defined functions for forces acting on particles. A method to quickly screen trapping of 5 nm and 10 nm particles in different catalysts designs with tracers was also developed. Simulations of square duct monoliths with promoters show that the strength of the vortices produced are not enough to give a high amount of particle deposition on the catalyst walls. The smallest particles in the simulations, 5 and 10 nm particles were trapped to a higher extent, than larger particles up to 1000 nm, in all studied geometries with the predominant deposition mechanism being Brownian diffusion. The comparison of the different filters designed with a wall flow filter does show that the options for altering a design of a flow through filter, without imposing a too large pressure drop penalty are good.

Keywords: Diesel Engine trap, thermophoresis, Exhaust pipe, PM-Simulation modeling.

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2 Formulation and in vitro Evaluation of Ondansetron Hydrochloride Matrix Transdermal Systems Using Ethyl Cellulose/Polyvinyl Pyrrolidone Polymer Blends

Authors: Rajan Rajabalaya, Li-Qun Tor, Sheba David

Abstract:

Transdermal delivery of ondansetron hydrochloride (OdHCl) can prevent the problems encountered with oral ondansetron. In previously conducted studies, effect of amount of polyvinyl pyrrolidone, permeation enhancer and casting solvent on the physicochemical properties on OdHCl were investigated. It is feasible to develop ondansetron transdermal patch by using ethyl cellulose and polyvinyl pyrrolidone with dibutyl pthalate as plasticizer, however, the desired flux is not achieved. The primary aim of this study is to use dimethyl succinate (DMS) and propylene glycol that are not incorporated in previous studies to determine their effect on the physicochemical properties of an OdHCl transdermal patch using ethyl cellulose and polyvinyl pyrrolidone. This study also investigates the effect of permeation enhancer (eugenol and phosphatidylcholine) on the release of OdHCl. The results showed that propylene glycol is a more suitable plasticizer compared to DMS in the fabrication of OdHCl transdermal patch using ethyl cellulose and polyvinyl pyrrolidone as polymers. Propylene glycol containing patch has optimum drug content, thickness, moisture content and water absorption, tensile strength, and a better release profile than DMS. Eugenol and phosphatidylcholine can increase release of OdHCl from the patches. From the physicochemical result and permeation profile, a combination of 350mg of ethyl cellulose, 150mg polyvinyl pyrrolidone, 3% of total polymer weight of eugenol, and 40% of total polymer weight of propylene glycol is the most suitable formulation to develop an OdHCl patch. OdHCl release did not increase with increasing the percentage of plasticiser. DMS 4, PG 4, DMS 9, PG 9, DMS 14, and PG 14 gave better release profiles where using 300mg: 0mg, 300mg: 100mg, and 350mg: 150mg of EC: PVP. Thus, 40% of PG or DMS appeared to be the optimum amount of plasticiser when the above combination where EC: PVP was used. It was concluded from the study that a patch formulation containing 350mg EC, 150mg PVP, 40% PG and 3% eugenol is the best transdermal matrix patch compositions for the uniform and continuous release/permeation of OdHCl over an extended period. This patch design can be used for further pharmacokinetic and pharmacodynamic studies in suitable animal models.

Keywords: Ondansetron hydrochloride, dimethyl succinate, eugenol.

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1 Outcomes of Pregnancy in Women with TPO Positive Status after Appropriate Dose Adjustments of Thyroxin: A Prospective Cohort Study

Authors: Revathi S. Rajan, Pratibha Malik, Nupur Garg, Smitha Avula, Kamini A. Rao

Abstract:

This study aimed to analyse the pregnancy outcomes in patients with TPO positivity after appropriate L-Thyroxin supplementation with close surveillance. All pregnant women attending the antenatal clinic at Milann-The Fertility Center, Bangalore, India- from Aug 2013 to Oct 2014 whose booking TSH was more than 2.5 mIU/L were included along with those pregnant women with prior hypothyroidism who were TPO positive. Those with TPO positive status were vigorously managed with appropriate thyroxin supplementation and the doses were readjusted every 3 to 4 weeks until delivery. Women with recurrent pregnancy loss were also tested for TPO positivity and if tested positive, were monitored serially with TSH and fT4 levels every 3 to 4 weeks and appropriately supplemented with thyroxin when the levels fluctuated. The testing was done after an informed consent in all these women. The statistical software namely SAS 9.2, SPSS 15.0, Stata 10.1, MedCalc 9.0.1, Systat 12.0 and R environment ver.2.11.1 were used for the analysis of the data. 460 pregnant women were screened for thyroid dysfunction at booking of which 52% were hypothyroid. Majority of them (31.08%) were subclinically hypothyroid and the remaining were overt. 25% of the total no. of patients screened were TPO positive. The various pregnancy complications that were observed in the TPO positive women were gestational glucose intolerance [60%], threatened abortion [21%], midtrimester abortion [4.3%], premature rupture of membranes [4.3%], cervical funneling [4.3%] and fetal growth restriction [3.5%]. 95.6% of the patients who followed up till the end delivered beyond 30 weeks. 42.6% of these patients had previous history of recurrent abortions or adverse obstetric outcome and 21.7% of the delivered babies required NICU admission. Obstetric outcomes in our study in terms of midtrimester abortions, placental abruption, and preterm delivery improved for the better after close monitoring of the thyroid hormone [TSH and fT4] levels every 3 to 4 weeks with appropriate dose adjustment throughout pregnancy. Euthyroid women with TPO positive status enrolled in the study incidentally were those with recurrent abortions/infertility and required thyroxin supplements due to elevated Thyroid hormone (TSH, fT4) levels during the course of their pregnancy. Significant associations were found with age>30 years and Hyperhomocysteinemia [p=0.017], recurrent pregnancy loss or previous adverse obstetric outcomes [p=0.067] and APLA [p=0.029]. TPO antibody levels >600 I U/ml were significantly associated with development of gestational hypertension [p=0.041] and fetal growth restriction [p=0.082]. Euthyroid women with TPO positivity were also screened periodically to counter fluctuations of the thyroid hormone levels with appropriate thyroxin supplementation. Thus, early identification along with aggressive management of thyroid dysfunction and stratification of these patients based on their TPO status with appropriate thyroxin supplementation beginning in the first trimester will aid risk modulation and also help avert complications.

Keywords: Antinuclear antibody, Subclinical hypothyroidism, Thyroxin, TPO antibody.

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