Search results for: Vikas Malik

Authors: Vivek Agrawal, Vikas Tripathi, Nitin Seth

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This study examines several critical dimensions of eservice quality overlooked in the existing literature and proposes a model and instrument framework for measuring customer perceived e-service quality in the banking sector. The initial design was derived from a pool of instrument dimensions and their items from the existing literature review by content analysis. Based on focused group discussion, nine dimensions were extracted. An exploratory factor analysis approach was applied to data from a survey of 323 respondents. The instrument has been designed specifically for the banking sector. Research data was collected from bank customers who use electronic banking in a developing economy. A nine-factor instrument has been proposed to measure the e-service quality. The instrument has been checked for reliability. The validity and sample place limited the applicability of the instrument across economies and service categories. Future research must be conducted to check the validity. This instrument can help bankers in developing economies like India to measure the e-service quality and make improvements. The present study offers a systematic procedure that provides insights on to the conceptual and empirical comprehension of customer perceived e-service quality and its constituents.

Keywords: Testing, instrument, e-service quality, factor analysis.

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Authors: Parvaneh Shabanzadeh, Malik Hj Abu Hassan, Leong Wah June, Maryam Mohagheghtabar

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Clustering is one of an interesting data mining topics that can be applied in many fields. Recently, the problem of cluster analysis is formulated as a problem of nonsmooth, nonconvex optimization, and an algorithm for solving the cluster analysis problem based on nonsmooth optimization techniques is developed. This optimization problem has a number of characteristics that make it challenging: it has many local minimum, the optimization variables can be either continuous or categorical, and there are no exact analytical derivatives. In this study we show how to apply a particular class of optimization methods known as pattern search methods to address these challenges. These methods do not explicitly use derivatives, an important feature that has not been addressed in previous studies. Results of numerical experiments are presented which demonstrate the effectiveness of the proposed method.

Keywords: Clustering functions, Non-smooth Optimization, Nonconvex Optimization, Pattern Search Method.

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Authors: Vikas Tewari, K.R. Pardasani

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Calcium is very important for communication among the neurons. It is vital in a number of cell processes such as secretion, cell movement, cell differentiation. To reduce the system of reactiondiffusion equations of [Ca2+] into a single equation, two theories have been proposed one is excess buffer approximation (EBA) other is rapid buffer approximation (RBA). The RBA is more realistic than the EBA as it considers both the mobile and stationary endogenous buffers. It is valid near the mouth of the channel. In this work we have studied the effects of different types of buffers on calcium diffusion under RBA. The novel thing studied is the effect of sodium ions on calcium diffusion. The model has been made realistic by considering factors such as variable [Ca2+], [Na+] sources, sodium-calcium exchange protein(NCX), Sarcolemmal Calcium ATPase pump. The proposed mathematical leads to a system of partial differential equations which has been solved numerically to study the relationships between different parameters such as buffer concentration, buffer disassociation rate, calcium permeability. We have used Forward Time Centred Space (FTCS) approach to solve the system of partial differential equations.

Keywords: rapid buffer approximation, sodium-calcium exchangeprotein, Sarcolemmal Calcium ATPase pump, buffer disassociationrate, forward time centred space.

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Authors: Zahra Gharineiat, Malik Khalfan

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The significance of emissions from the road transport sector (such as air pollution, noise, etc) has grown considerably in recent years. In Australia, 14.3% of national greenhouse gas emissions in 2000 were the transport sector-s share which 12.9% of net national emissions were related to a road transport alone. Considering the growing attention to the green house gas(GHG) emissions, this paper attempts to provide air pollution modeling aspects of environmental consequences of the road transport by using one of the best computer based tools including the Geographic Information System (GIS). In other word, in this study, GIS and its applications is explained, models which are used to model air pollution and GHG emissions from vehicles are described and GIS is applied in real case study that attempts to forecast GHG emission from people who travel to work by car in 2031 in Melbourne for analysing results as thematic maps.

Keywords: Geographic Information System (GIS), Green HouseGas(GHG) emission, sustainable development, transportation

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Authors: Sapna Mishra, Peeyush Kumar, Anushree Malik

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The spores of entomopathogenic fungi, Beauveria bassiana was evaluated for their compatibility with four surfactants; SDS (sodium dodyl sulphate) and CABS-65 (calcium alkyl benzene sulphonate), Tween 20 (polyethylene sorbitan monolaureate) and Tween 80 (polyoxyethylene sorbitan monoleate) at six different concentrations (0.1%, 0.5%, 1%, 2.5%, 5% and 10%). Incubated spores showed decrease in concentrations due to conversion of spores to hyphae. The maximum germination recorded in 72 h incubated spores varied with surfactant concentration at 49-68% (SDS), 39- 53% (CABS), 78-92% (Tween 80) and 80-92% (Tween 20), while the optimal surfactant concentration for spore germination was found to be 2.5-5%. The surfactant effect on spores was more pronounced with SDS and CABS-65, where significant deterioration and loss in viability of the incubated spores was observed. The effect of Tween 20 and Tween 80 were comparatively less inhibiting. The results of the study would help in surfactant selection for B. bassiana emulsion preparation.

Keywords: Beauveria bassiana, spore, surfactant, compatibility, germination.

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Authors: Bushra Malik, Saad Zafar

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Inadequate curriculum for software engineering is considered to be one of the most common software risks. A number of solutions, on improving Software Engineering Education (SEE) have been reported in literature but there is a need to collectively present these solutions at one place. We have performed a mapping study to present a broad view of literature; published on improving the current state of SEE. Our aim is to give academicians, practitioners and researchers an international view of the current state of SEE. Our study has identified 70 primary studies that met our selection criteria, which we further classified and categorized in a well-defined Software Engineering educational framework. We found that the most researched category within the SE educational framework is Innovative Teaching Methods whereas the least amount of research was found in Student Learning and Assessment category. Our future work is to conduct a Systematic Literature Review on SEE.

Keywords: Mapping Study, Software Engineering, Software Engineering Education, Literature Survey.

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Authors: Arunima Shukla, Vikas Almadi, Devesh Jaiswal, Sunil Saini, Bhusan S. Patil

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Lightning protection consists of three main parts; mainly air termination system, down conductor, and earth termination system. Earth termination system is the most important part as earth is the sink and source of charges. Therefore, even when the charges are captured and delivered to the ground, and an easy path is not provided to the charges, earth termination system would lead to problems. Soil has significantly different resistivities ranging from 10 Ωm for wet organic soil to 10000 Ωm for bedrock. Different methods have been discussed and used conventionally such as deep-ground-well method and altering the length of the rod. Those methods are not considered economical. Therefore, it was a general practice to use charcoal along with salt to reduce the soil resistivity. Bentonite is worldwide acceptable material, that had led our interest towards study of bentonite at first. It was concluded that bentonite is a clay which is non-corrosive, environment friendly. Whereas bentonite is suitable only when there is moisture present in the soil, as in the absence of moisture, cracks will appear on the surface which will provide an open passage to the air, resulting into increase in the resistivity. Furthermore, bentonite without moisture does not have enough bonding property, moisture retention, conductivity, and non-leachability. Therefore, bentonite was used along with the other backfill material to overcome the dependency of bentonite on moisture. Different experiments were performed to get the best ratio of bentonite and carbon backfill. It was concluded that properties will highly depend on the quantity of bentonite and carbon-based backfill material.

Keywords: Backfill material, bentonite, conducting soil, grounding material, low resistivity.

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Authors: Vikas Tewari, Shivendra Tewari, K. R. Pardasani

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Calcium is a vital second messenger used in signal transduction. Calcium controls secretion, cell movement, muscular contraction, cell differentiation, ciliary beating and so on. Two theories have been used to simplify the system of reaction-diffusion equations of calcium into a single equation. One is excess buffer approximation (EBA) which assumes that mobile buffer is present in excess and cannot be saturated. The other is rapid buffer approximation (RBA), which assumes that calcium binding to buffer is rapid compared to calcium diffusion rate. In the present work, attempt has been made to develop a model for calcium diffusion under excess buffer approximation in neuron cells. This model incorporates the effect of [Na+] influx on [Ca2+] diffusion,variable calcium and sodium sources, sodium-calcium exchange protein, Sarcolemmal Calcium ATPase pump, sodium and calcium channels. The proposed mathematical model leads to a system of partial differential equations which have been solved numerically using Forward Time Centered Space (FTCS) approach. The numerical results have been used to study the relationships among different types of parameters such as buffer concentration, association rate, calcium permeability.

Keywords: Excess buffer approximation, Na+ influx, sodium calcium exchange protein, sarcolemmal calcium atpase pump, forward time centred space.

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Authors: K. Badron, A. F. Ismail, A. L. Asnawi, N. F. A. Malik, S. Z. Abidin, S. Dzulkifly

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The occurrences of precipitation, also commonly referred as rain, in the form of "convective" and "stratiform" have been identified to exist worldwide. In this study, the radar return echoes or known as reflectivity values acquired from radar scans have been exploited in the process of classifying the type of rain endured. The investigation use radar data from Malaysian Meteorology Department (MMD). It is possible to discriminate the types of rain experienced in tropical region by observing the vertical characteristics of the rain structure. .Heavy rain in tropical region profoundly affects radiowave signals, causing transmission interference and signal fading. Required wireless system fade margin depends on the type of rain. Information relating to the two mentioned types of rain is critical for the system engineers and researchers in their endeavour to improve the reliability of communication links. This paper highlights the quantification of percentage occurrences over one year period in 2009.

Keywords: Stratiform, convective, tropical region, attenuation radar reflectivity.

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Authors: Malik I. Al-Amayreh, Mohammad I. Kilani, Ahmed S. Al-Salaymeh

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This work presents a Computational Fluid Dynamics (CFD) simulation of a butterfly valve used to control the flow of combustible gas mixture in an industrial process setting.The work uses CFD simulation to analyze the flow characteristics in the vicinity of the valve, including the pressure distributions and Frequency spectrum of the pressure pulsations downstream the valves and the vortex shedding allow predicting the torque fluctuations acting on the valve shaft and the possibility of generating mechanical vibration and resonance.These fluctuations are due to aerodynamic torque resulting from fluid turbulence and vortex shedding in the valve vicinity. The valve analyzed is located in a pipeline between two opposing 90o elbows, which exposes the valve and the surrounding structure to the turbulence generated upstream and downstream the elbows at either end of the pipe.CFD simulations show that the best location for the valve from a vibration point of view is in the middle of the pipe joining the elbows.

Keywords: Butterfly Valve Vibration Analysis, Computational Fluid Dynamics, Fluid Flow Circuit Design, Fluid Mechanics.

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Authors: Malik Ghulam Behlol, Alison Fox, Faiza Masood, Sabiha Arshad

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This paper explores the barriers to the application of learning-supportive assessment at teaching practicum while investigating the role of university teachers (UT), cooperative teachers (CT), prospective teachers (PT) and heads of the practicum schools (HPS) in the selected universities of Pakistan and the UK. It is a qualitative case study and data were collected through the lesson observation of UT in the pre-service teacher education setting and PT in practicum schools. Interviews with UT, HPS, and Focus Group Discussions with PT were conducted too. The study has concluded that as compared to the UK counterpart, PTs in Pakistan face significant barriers in applying learning-supportive assessment in the school practicum settings because of large class sizes, lack of institutionalised collaboration between universities and schools, poor modelling of the lesson, ineffective feedback practices, lower order thinking assignments, and limited opportunities to use technology in school settings.

Keywords: Learning supportive assessment, pre-service teacher education, theory-practice gap, teacher education.

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Authors: Priyanka Malik A, Rishu Chaujar B, Mridula Gupta C, R.S. Gupta D

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In this paper, for the first time, a two-dimensional (2D) analytical drain current model for sub-100 nm multi-layered gate material engineered trapezoidal recessed channel (MLGMETRC) MOSFET: a novel design is presented and investigated using ATLAS and DEVEDIT device simulators, to mitigate the large gate leakages and increased standby power consumption that arise due to continued scaling of SiO2-based gate dielectrics. The twodimensional (2D) analytical model based on solution of Poisson-s equation in cylindrical coordinates, utilizing the cylindrical approximation, has been developed which evaluate the surface potential, electric field, drain current, switching metric: ION/IOFF ratio and transconductance for the proposed design. A good agreement between the model predictions and device simulation results is obtained, verifying the accuracy of the proposed analytical model.

Keywords: ATLAS, DEVEDIT, NJD, MLGME- TRCMOSFET.

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Authors: Javed Khan, Aamir Saeed Malik, Nidal Kamel, Sarat Chandra Dass, Azura Mohd Affandi

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Low contrast images can result from the wrong setting of image acquisition or poor illumination conditions. Such images may not be visually appealing and can be difficult for feature extraction. Contrast enhancement of color images can be useful in medical area for visual inspection. In this paper, a new technique is proposed to improve the contrast of color images. The RGB (red, green, blue) color image is transformed into normalized RGB color space. Adaptive histogram equalization technique is applied to each of the three channels of normalized RGB color space. The corresponding channels in the original image (low contrast) and that of contrast enhanced image with adaptive histogram equalization (AHE) are morphed together in proper proportions. The proposed technique is tested on seventy color images of acne patients. The results of the proposed technique are analyzed using cumulative variance and contrast improvement factor measures. The results are also compared with decorrelation stretch. Both subjective and quantitative analysis demonstrates that the proposed techniques outperform the other techniques.

Keywords: Contrast enhancement, normalized RGB, adaptive histogram equalization, cumulative variance.

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Authors: Ammar Anwar Khan, Nissar R. Wani, Nazar Malik, Abdulrehman Al-Arainy, and Saad Alghuwainem

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Power cables are vulnerable to failure due to aging or defects that occur with the passage of time under continuous operation and loading stresses. PD detection and characterization provide information on the location, nature, form and extent of the degradation. As a result, PD monitoring has become an important part of condition based maintenance (CBM) program among power utilities. Online partial discharge (PD) localization of defect sources in power cable system is possible using the time of flight method. The information regarding the time difference between the main and reflected pulses and cable length can help in locating the partial discharge source along the cable length. However, if the length of the cable is not known and the defect source is located at the extreme ends of the cable or in the middle of the cable, then double ended measurement is required to indicate the location of PD source. Use of multiple sensors can also help in discriminating the cable PD or local/ external PD. This paper presents the experience and results from online partial discharge measurements conducted in the laboratory and the challenges in partial discharge source localization.

Keywords: Power cables, partial discharge localization, HFCT, condition based monitoring.

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Authors: Diptendu Das, Vikas Kumar Rahi, V. A. Juvekar, R. Bhattacharya

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Extraction of Fe(III) from aqueous solution using Trin- butyl Phosphate (TBP) as carrier needs a highly acidic medium (>6N) as it favours formation of chelating complex FeCl3.TBP. Similarly, stripping of Iron(III) from loaded organic solvents requires neutral pH or alkaline medium to dissociate the same complex. It is observed that TBP co-extracts acids along with metal, which causes reversal of driving force of extraction and iron(III) is re-extracted back from the strip phase into the feed phase during Liquid Emulsion Membrane (LEM) pertraction. Therefore, rate of extraction of different mineral acids (HCl, HNO3, H2SO4) using TBP with and without presence of metal Fe(III) was examined. It is revealed that in presence of metal acid extraction is enhanced. Determination of mass transfer coefficient of both acid and metal extraction was performed by using Bulk Liquid Membrane (BLM). The average mass transfer coefficient was obtained by fitting the derived model equation with experimentally obtained data. The mass transfer coefficient of the mineral acid extraction is in the order of kHNO3 = 3.3x10-6m/s > kHCl = 6.05x10-7m/s > kH2SO4 = 1.85x10-7m/s. The distribution equilibria of the above mentioned acids between aqueous feed solution and a solution of tri-n-butyl-phosphate (TBP) in organic solvents have been investigated. The stoichiometry of acid extraction reveals the formation of TBP.2HCl, HNO3.2TBP, and TBP.H2SO4 complexes. Moreover, extraction of Iron(III) by TBP in HCl aqueous solution forms complex FeCl3.TBP.2HCl while in HNO3 medium forms complex 3FeCl3.TBP.2HNO3

Keywords: Bulk Liquid Membrane (BLM) Transport, Iron(III) extraction, Tri-n-butyl Phosphate, Mass Transfer coefficient.

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Authors: Khalil Ur Rehman, M. Y. Malik, Usman Ali

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In this paper, the problem proposed by Von Karman is treated in the attendance of additional flow field effects when the liquid is spaced above the rotating rigid disk. To be more specific, a purely viscous fluid flow yield by rotating rigid disk with Navier’s condition is considered in both magnetohydrodynamic and hydrodynamic frames. The rotating flow regime is manifested with heat source/sink and chemically reactive species. Moreover, the features of thermophoresis and Brownian motion are reported by considering nanofluid model. The flow field formulation is obtained mathematically in terms of high order differential equations. The reduced system of equations is solved numerically through self-coded computational algorithm. The pertinent outcomes are discussed systematically and provided through graphical and tabular practices. A simultaneous way of study makes this attempt attractive in this sense that the article contains dual framework and validation of results with existing work confirms the execution of self-coded algorithm for fluid flow regime over a rotating rigid disk.

Keywords: Nanoparticles, Newtonian fluid model, chemical reaction, heat source/sink.

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Authors: Safaa Al-Ali, Ahmad Shahin, Fadi Chakik

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Image coding based on clustering provides immediate access to targeted features of interest in a high quality decoded image. This approach is useful for intelligent devices, as well as for multimedia content-based description standards. The result of image clustering cannot be precise in some positions especially on pixels with edge information which produce ambiguity among the clusters. Even with a good enhancement operator based on PDE, the quality of the decoded image will highly depend on the clustering process. In this paper, we introduce an ambiguity cluster in image coding to represent pixels with vagueness properties. The presence of such cluster allows preserving some details inherent to edges as well for uncertain pixels. It will also be very useful during the decoding phase in which an anisotropic diffusion operator, such as Perona-Malik, enhances the quality of the restored image. This work also offers a comparative study to demonstrate the effectiveness of a fuzzy clustering technique in detecting the ambiguity cluster without losing lot of the essential image information. Several experiments have been carried out to demonstrate the usefulness of ambiguity concept in image compression. The coding results and the performance of the proposed algorithms are discussed in terms of the peak signal-tonoise ratio and the quantity of ambiguous pixels.

Keywords: Ambiguity Cluster, Anisotropic Diffusion, Fuzzy Clustering, Image Compression.

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Authors: Gaurav D. Sonawane, Vikas G. Sargade

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The present investigation is a study of the effect of advanced Physical Vapor Deposition (PVD) coatings on cutting temperature residual stresses and surface roughness during Duplex Stainless Steel (DSS) 2205 turning. Austenite stabilizers like nickel, manganese, and molybdenum reduced the cost of DSS. Surface Integrity (SI) plays an important role in determining corrosion resistance and fatigue life. Resistance to various types of corrosion makes DSS suitable for applications with critical environments like Heat exchangers, Desalination plants, Seawater pipes and Marine components. However, lower thermal conductivity, poor chip control and non-uniform tool wear make DSS very difficult to machine. Cemented carbide tools (M grade) were used to turn DSS in a dry environment. AlTiN and AlTiCrN coatings were deposited using advanced PVD High Pulse Impulse Magnetron Sputtering (HiPIMS) technique. Experiments were conducted with cutting speed of 100 m/min, 140 m/min and 180 m/min. A constant feed and depth of cut of 0.18 mm/rev and 0.8 mm were used, respectively. AlTiCrN coated tools followed by AlTiN coated tools outperformed uncoated tools due to properties like lower thermal conductivity, higher adhesion strength and hardness. Residual stresses were found to be compressive for all the tools used for dry turning, increasing the fatigue life of the machined component. Higher cutting temperatures were observed for coated tools due to its lower thermal conductivity, which results in very less tool wear than uncoated tools. Surface roughness with uncoated tools was found to be three times higher than coated tools due to lower coefficient of friction of coating used.

Keywords: Cutting temperatures, DSS2205, dry turning, HiPIMS, surface integrity.

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Authors: B. A. Mir, Asim Malik

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Bottom ash is a by-product of the combustion process of coal in furnaces in the production of electricity in thermal power plants. In India, about 75% of total power is produced by using pulverized coal. The coal of India has a high ash content which leads to the generation of a huge quantity of bottom ash per year posing the dual problem of environmental pollution and difficulty in disposal. This calls for establishing strategies to use this industry by-product effectively and efficiently. However, its large-scale utilization is possible only in geotechnical applications, either alone or with soil. In the present investigation, bottom ash was collected from National Capital Power Station Dadri, Uttar Pradesh, India. Test samples of bottom ash admixed with 20% clayey soil were prepared and treated with different cement content by weight and subjected to various laboratory tests for assessing its suitability as an engineered construction material. This study has shown that use of 10% cement content is a viable chemical additive to enhance the mechanical properties of bottom ash, which can be used effectively as an engineered construction material in various geotechnical applications. More importantly, it offers an interesting potential for making use of an industrial waste to overcome challenges posed by bottom ash for a sustainable environment.

Keywords: Bottom ash, environmental pollution, solid waste, sustainable environment, waste utilization.

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Authors: Saghir Ahmad, Abid Hussain Ch., Atif Khalil, Misbah Malik

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The major purpose of the study was to identify the institutional environments’ strengths, weaknesses, opportunities and threats of University of the Punjab, Lahore. The target population of the study was teachers of University of the Punjab Lahore. The sample of 235 teachers (155 males, 80 females) were selected through multistage stratified sampling technique. A questionnaire regarding the institutional environments of University SWOT Analysis “Strengths, Weaknesses, Opportunities, and Threats” was used to collect the required data for this study. The questionnaire consisted of two parts. The first part comprised of the demographic information (faculty, department, gender, teacher rank), while the second part included the statements regarding SWOT analysis (strengths, weaknesses, opportunities and threats). Reliability index (Cronbach’s Alpha) of the questionnaire was 0.87, which is statistically acceptable. Analysis of the data indicated that there was significant difference in the opinion of respondents. Teachers of Islamic studies and Laws had difference in their opinions regarding the institutional environment strengths, and opportunities and it was supported by the findings of the study. There was significant difference in opinions of male and female teachers regarding strengths and opportunities of university. And there was no significant difference in opinions of male and female teachers regarding weaknesses and threats of university.

Keywords: Institutional environments, SWOT analysis, teachers, University of the Punjab.

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Authors: Ibrahim Abdel Gadir Malik, Dafalla Siddig Dafalla, Abdelazim Ibrahim

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Jabal Omar is located in the western side of Makkah city in Saudi Arabia. The proposed Jabal Omar Development project includes several multi-storey buildings, roads, bridges and below ground structures founded at various depths. In this study, geological mapping and site inspection which covered pre-selected areas were carried out within the easily accessed parts. Geological features; including rock types, structures, degree of weathering, and geotechnical hazards were observed and analyzed with specified software and also were documented in form of photographs. The presence of joints and fractures in the area made the rock blocks small and weak. The site is full of jointing; it was observed that, the northern side consists of 3 to 4 jointing systems with 2 random fractures associated with dykes. The southern part is affected by 2 to 3 jointing systems with minor fault and shear zones. From the field measurements and observations, it was concluded that, the Jabal Omar intruded by andesitic and basaltic dykes of different thickness and orientation. These dykes made the outcrop weak, highly deformed and made the rock masses sensitive to weathering.

Keywords: Rock, slope, stabilization, protection, Makkah.

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Authors: Insaf Ajili, Malik Mallem, Jean-Yves Didier

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Human motion recognition has been extensively increased in recent years due to its importance in a wide range of applications, such as human-computer interaction, intelligent surveillance, augmented reality, content-based video compression and retrieval, etc. However, it is still regarded as a challenging task especially in realistic scenarios. It can be seen as a general machine learning problem which requires an effective human motion representation and an efficient learning method. In this work, we introduce a descriptor based on Laban Movement Analysis technique, a formal and universal language for human movement, to capture both quantitative and qualitative aspects of movement. We use Discrete Hidden Markov Model (DHMM) for training and classification motions. We improve the classification algorithm by proposing two DHMMs for each motion class to process the motion sequence in two different directions, forward and backward. Such modification allows avoiding the misclassification that can happen when recognizing similar motions. Two experiments are conducted. In the first one, we evaluate our method on a public dataset, the Microsoft Research Cambridge-12 Kinect gesture data set (MSRC-12) which is a widely used dataset for evaluating action/gesture recognition methods. In the second experiment, we build a dataset composed of 10 gestures(Introduce yourself, waving, Dance, move, turn left, turn right, stop, sit down, increase velocity, decrease velocity) performed by 20 persons. The evaluation of the system includes testing the efficiency of our descriptor vector based on LMA with basic DHMM method and comparing the recognition results of the modified DHMM with the original one. Experiment results demonstrate that our method outperforms most of existing methods that used the MSRC-12 dataset, and a near perfect classification rate in our dataset.

Keywords: Human Motion Recognition, Motion representation, Laban Movement Analysis, Discrete Hidden Markov Model.

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

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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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