Correlation of Atrial Fibrillation with Left Atrial Volume in Patients with Mitral Stenosis. a Single Centre Study From Pakistan

Background: Rheumatic heart disease has a strong association with mitral valve stenosis. Atrial fibrillation is one of the most common complications of this condition and is a poor prognostic factor. Early detection and prompt management of atrial fibrillation can help to improve the quality of life and increase the life expectancy of the patients. We carried out this study to investigate the significance of left atrial volumetric changes in mitral stenosis and its correlation with atrial fibrillation. Methodology: We audited the data of 60 patients of rheumatic heart disease who had mitral valve stenosis. The patients were randomized into atrial fibrillation (Group A) and normal sinus rhythm (Group B). We conducted this cross-sectional analytical study at Cardiology Department, Mayo Hospital, Lahore, from 1st February 2017 to 31st January 2018. We only included those patients who consented to be a part of this study and fulfilled our predefined inclusion criteria. Left atrial volume was measured by prolate ellipse method and biplane methods on echocardiography. The Data was analyzed on SPSS v20. Results: Sixty patients were included in the study. Among the subjects, thirty-six (60%) were males, and twenty-four (40%) were females. Atrial fibrillation was noted in 43.33% of the patients of mitral valve stenosis. There was a marked difference in the mean volume of the left atrium among the two groups. We observed that the mean area of the mitral valve for Group A patients was larger than that of patients in Group B. Our study showed an inverse correlation between left atrial volume and mitral valve area among Group A patients. Conclusion: Patients of mitral stenosis are at an increased risk of developing atrial fibrillation if the left atrial volume is increasing. All patients with mitral stenosis should have routine echocardiography & measurement of left atrial volumes, so that proper treatment can be started if the left atrial volume is increasing, to prevent atrial fibrillation

A whole-health-economy approach to antimicrobial stewardship: Analysis of current models and future direction.

Antimicrobial stewardship (AMS) strategies are widely implemented in single healthcare sectors and organisations; however, the extent and impact of integrated AMS initiatives across the whole health economy are unknown. Assessing degree of integration of AMS across the whole health economy and its impact is essential if we are to achieve a ‘One Health’ approach to addressing antimicrobial resistance (AMR), and therefore we searched systematically for and analysed published examples of integrated AMS initiatives to address this gap. Application of a system-level framework to analyse integration of AMS initiatives across and within healthcare sectors shows that integration is emerging but needs strengthening. Findings from a small number of evaluations in high-income countries suggest that antimicrobial prescribing and healthcare-associated infections can be reduced using a multisectoral integrated AMS approach. More robust research designs to evaluate and understand the impact of multisectoral integrated AMS are needed, particularly with respect to differing health systems in different countries and local organisational contexts. Our analysis highlights a number of challenges and ways forward for enhancing the delivery of AMS through an integrated approach

Lifetime Constraints for Late Dark Matter Decay

We consider a class of late-decaying dark-matter models, in which a dark matter particle decays to a heavy stable daughter of approximately the same mass, together with one or more relativistic particles which carry away only a small fraction of the parent rest mass. Such decays can affect galactic halo structure and evolution, and have been invoked as a remedy to some of the small scale structure-formation problems of cold dark matter. There are existing stringent limits on the dark matter lifetime if the decays produce photons. By considering examples in which the relativistic decay products instead consist of neutrinos or electron-position pairs, we derive stringent limits on these scenarios for a wide range of dark matter masses. We thus eliminate a sizable portion of the parameter space for these late decay models if the dominant decay channel involves Standard Model final states.Comment: 13 pages, 7 figures. Replaced to match published version. Discussion expanded. References added. Accepted by Phys. Rev

Mahkamah Konstitusi Dan Kontrak Outsourcing

The Amendment of the 1945 Constitution of the Republic of Indonesia has made the sovereignty still retained by the people, no more represented and fully held by the People\u27s Consultative Assembly like when the constitutional system of Indonesia was still embracing supremacy of parliament. In the constitutional perspective, the standing and relation between the state and people is becoming more obvious. Hence, in the case that constitutional dispute happened, there should have been an adjudication forum for solving the dispute. Therefore, Contitutional Court Of the Republic of Indonesia is established and designed constitutionally to solve the constitutional dispute through The Amendment of the 1945 Constitution of the Republic of Indonesia. Settlement of constitutional dispute through the review of constitutionality of norms in the regulation of outsourcing contract in The Labour Law at Contitutional Court of the Republic of Indonesia, with specific issue “the Contract of Employment for a specified time” that is regulated in Article 65 paragraph (7) and Article 66 paragraph (2) b of Labour Law is declaredconditionally unconstitutional

Hukum Dan Keadilan Sosial Dalam Perspektif Hukum Ketatanegaraan

Law in this discussion is the law that is deliberately formed (by designed) by the state, not the law that occurs naturally in the society, which constitute the crystallization of human interaction within the society as the subject of law. Law is known as the common law or customary law and the second is the religious law, in particular, Islam with its Islamic law. The process of formation of common law or customary law is from the bottom upward (bottom-up process) while the establishment of islamic law is from top to bottom (top-down). The same as the nature of the process of formation of Islamic law is the in question in this discussion, which is the law called state legislation, or which is also usually known as laws and regulations. The only difference is, Islamic law is made by God, Allah SWT, while the maker of statutory laws is a state institution of which the major function is to make laws (legislative power). Legislation is interrelated to with humanity and justice, both in the establishment, implementation, and enforcement. This can be proven by tracing since the establishment of the state, particularly Indonesia, because the law is one of the implementation of state functions. State is established on the basis of motivation associated with humanity and justice, so that the objectives and the foundations are also related to humanity and justice. The State and the law is an instrument of humanity and justice, therefore, state and law must be related to humanity and justice, and thus, also would not be enough in the instrumental perspective, the state and the law itself without humanity and justice in serving the society