Myxedema crisis is a severe life threatening form of decompensated hypothyroidism which is associated with a high mortality rate. Infections and discontinuation of thyroid supplements are the major precipitating factors while hypothermia may not play a major role in tropical countries. Low intracellular T3 leads to cardiogenic shock, respiratory depression, hypothermia and coma. Patients are identified on the basis of a low index of suspicion with a careful history and examination focused on features of hypothyroidism and precipitating factors. Arrythmias and coagulation disorders are increasingly being identified in myxedema crisis. Thyroid replacement should be initiated as early as possible with careful attention to hypotension, fluid replacement and steroid replacement in an intensive care facility. Studies have shown that replacement of thyroid hormone through ryles tube with a loading dose and maintenance therapy is as efficacious as intravenous therapy. In many countries T3 is not available and oral therapy with T4 can be used effectively without major significant difference in outcomes. Hypotension, bradycardia at presentation, need for mechanical ventilation, hypothermia unresponsive to treatment, sepsis, intake of sedative drugs, lower GCS and high APACHE II scores and Sequential Organ Failure Assessment (SOFA) scores more than 6 are significant predictors of mortality in myxedema crisis. Early intervention in hypothyroid patients developing sepsis and other precipitating factors and ensuring continued intake of thyroid supplements may prevent mortality and morbidity associated with myxedema crisis.

Cardiovascular disease is increased in individuals with type 1 or type 2 diabetes mellitus (DM). Left ventricular hypertrophy (LVH), which is an ominous prognostic sign and an independent risk factor for cardiac events, is often present in type 2 DM patients. The aim of our cross-sectional study was to evaluate the prevalence of LVH, and risk factors for its development, in normotensive type 2 diabetic patients without antihypertensive medication. The objectives of the study were to find out the prevalence of high left ventricular mass (LVM) in normotensive type 2 diabetic patients and compare it with nondiabetics and to uncover the risk factors for the development of high LVM in normotensive type 2 diabetic patients. A total of 130 age- and sex-matched subjects were selected (65 cases, diabetic normotensive, and 65 controls, nondiabetic normotensive) and baseline data were collected. LVM and left ventricular mass index (LVMI) were calculated using echocardigraphic parameters and body surface area. LVMI was significantly higher in patients with type 2 DM compared with age-, sex-matched healthy population (104.9 ± 21 vs. 78.5 ± 22.7 g/m2, respectively; P < 0.05). BMI, HbA1c, and duration of diabetes were significantly associated with LVH whereas sexes, age, PPBS, were not.

A high current electron cyclotron resonance proton ion source is designed and developed for the low energy high intensity proton accelerator at Bhabha Atomic Research Centre. The plasma discharge in the ion source is stabilized by minimizing the reflected microwave power using four stub auto tuner and magnetic field. The optimization of extraction geometry is performed using PBGUNS code by varying the aperture, shape, accelerating gap, and the potential on the electrodes. While operating the source, it was found that the two layered microwave window (6 mm quartz plate and 2 mm boron nitride plate) was damaged (a fine hole was drilled) by the back-streaming electrons after continuous operation of the source for 3 h at beam current of 20-40 mA. The microwave window was then shifted from the line of sight of the back-streaming electrons and located after the water-cooled H-plane bend. In this configuration the stable operation of the high current ion source for several hours is achieved. The ion beam is extracted from the source by biasing plasma electrode, puller electrode, and ground electrode to +10 to +50 kV, -2 to -4 kV, and 0 kV, respectively. The total ion beam current of 30-40 mA is recorded on Faraday cup at 40 keV of beam energy at 600-1000 W of microwave power, 800-1000 G axial magnetic field and (1.2-3.9) × 10(-3) mbar of neutral hydrogen gas pressure in the plasma chamber. The dependence of beam current on extraction voltage, microwave power, and gas pressure is investigated in the range of operation of the ion source.

A high current Electron Cyclotron Resonance (ECR) proton ion source has been developed for low energy high intensity proton accelerator at Bhabha Atomic Research Centre. Langmuir probe diagnostics of the plasma generated in this proton ion source is performed using Langmuir probe. The diagnostics of plasma in the ion source is important as it determines beam parameters of the ion source, i.e., beam current, emittance, and available species. The plasma parameter measurement in the ion source is performed in continuously working and pulsed mode using hydrogen as plasma generation gas. The measurement is performed in the ECR zone for operating pressure and microwave power range of 10(-4)-10(-3) mbar and 400-1000 W. An automated Langmuir probe diagnostics unit with data acquisition system is developed to measure these parameters. The diagnostics studies indicate that the plasma density and plasma electron temperature measured are in the range 5.6 × 10(10) cm(-3) to 3.8 × 10(11) cm(-3) and 4-14 eV, respectively. Using this plasma, ion beam current of tens of mA is extracted. The variations of plasma parameters with microwave power, gas pressure, and radial location of the probe have been studied.

Electron cyclotron resonance (ECR) proton source at 50 keV, 50 mA has been designed, developed, and commissioned for the low energy high intensity proton accelerator (LEHIPA). Plasma characterization of this source has been performed. ECR plasma was generated with 400-1100 W of microwave power at 2.45 GHz, with hydrogen as working gas. Microwave was fed in the plasma chamber through quartz window. Plasma density and temperature was studied under various operating conditions, such as microwave power and gas pressure. Langmuir probe was used for plasma characterization using current voltage variation. The typical hydrogen plasma density and electron temperature measured were 7x10(11) cm(-3) and 6 eV, respectively. The total ion beam current of 42 mA was extracted, with three-electrode extraction geometry, at 40 keV of beam energy. The extracted ion current was studied as a function of microwave power and gas pressure. Depending on source pressure and discharge power, more than 30% total gas efficiency was achieved. The optimization of the source is under progress to meet the requirement of long time operation. The source will be used as an injector for continuous wave radio frequency quadrupole, a part of 20 MeV LEHIPA. The required rms normalized emittance of this source is less than 0.2 pi mm mrad. The simulated value of normalized emittance is well within this limit and will be measured shortly. This paper presents the study of plasma parameters, first beam results, and the status of ECR proton source.