Surgical Ventricular Restoration: An Operation to Reverse Remodeling - Clinical Application (Part II)

The first part of the article dealt with the basic science behind the evolution of ventricular restoration procedures and the rationale for the use of novel surgical techniques. The second part describes the preoperative workup of patients in advanced heart failure, the core information required to determine the surgical approach and the essential principles and techniques of ventricular restoration. It then examines the effects of ventricular restorative procedures on pump function and clinical outcomes, the results of the worldwide experience with ventricular restoration and concludes with more recent advances in this field

Surgical Ventricular Restoration: An Operation To Reverse Remodeling - The Basic Science (Part I)

Congestive heart failure as a consequence of ischemic heart disease is an increasing medical problem. Notwithstanding the huge advances in the medical and conventional surgical management of heart failure, eventual outcomes remain suboptimal. This 2 part article outlines the magnitude of the problem, the limitations of conventional therapies as they exist, and the use of newer procedures that directly address the restoration of ventricular pump function

Near field communication enabled mobile payments: preliminary study

The ubiquitous computing has made consumers life easy, it has given the new way to interact with family and friends and perform many activities which were impossible in previous time. One of the profound achievement of ubiquitous computing is Mobile Payment and an advanced mode of the mobile payment is the near field communication mobile payment. In this study the authors have proposed theoreti-cal near field communication mobile payment model that is based on extended unified technology acceptance and use of technology (UTAUT2) .In this paper, the author have performed the pilot study to validate the variables and to verify their reliability among the proposed items. The results has proven that there is a reliability among the items in variables, as the Cronbach’s alpha value for the vari-ables is above or equal to 0.7

Struggling with long-time low uptake of modern contraceptives in Pakistan

Background: Efforts to expand access to reproductive health care in Pakistan date as far back as the early 1950s. Despite such efforts, the fertility rate has declined at a slower pace compared to that in neighbouring countries.Aims: To explore the underlying reasons and challenges for long-time low contraceptive use among female clients and key service providers of community-based family planning programmes in Pakistan.Methods: A qualitative study was carried out with a total of 10 focus group discussions and 7 in-depth interviews with female clients and key service providers. The data were analysed using qualitative content analysis.Results: The intra-family dynamics, that is, influence of husbands and mothers-in-law, were significant in shaping the decision-making and choice of family planning methods. In addition, inadequate counselling skills, insufficient training for service providers, weak supportive supervision, interrupted supply of contraceptives, and delays in salary disbursement were among the key family planning programme challenges.Conclusion: Despite a well-designed community-based FP programme, providers\u27 counselling skills need to be enhanced. However, this has to be combined with sufficient training, supportive supervision and contraceptive availability

Effect of Strenuous Exercise on Various Blood Parameters in Polo Horses at High Altitude (3,734 M)

Horses require heaps of energy in order to perform well. Proper care and management should therefore be provided to the racehorses so as to keep they perform at their optimum. The experiment used for normal horses. The blood samples were collected in the morning before subjecting the horses to polo match/ strenuous exercise and immediately after the physical activity. Various blood tests such as the complete blood count, lipid, protein tests were done. Significant elevations in the white blood cells (WBC), hemoglobin (Hb) and some serological parameters in the blood polo horses were recorded after exercise. This study confirmed the findings of exercise on different blood parameters which can be possibly used as an index of fitness in horses

Prevalence of Muscle Dysmorphia and Associated Health Activities in Male Medical Students in Karachi, Pakistan

Background: Muscle Dysmorphia (MD) is a subtype of body dysmorphic disorder (BDD) and is currently classified under anxiety disorders (subheading: Obsessive-compulsive disorder) in DSM 5. MD is hypothesized to affect the self-esteem and social outlook of the younger generation. MD shows a higher rate in males and may influence their self-confidence rendering them more prone towards using steroids, supplementary proteins and other drugs to alter their physical outlooks as shown in previous studies. This problem has been on the rise lately due to revolutionary advancement in the media and film industry and the abrupt changes about the standards of physical good looks and body shapes. With the lack of studies done in our population, our study will be helpful to consider the prevalence of the disease in our setting and increase awareness in the general public and clinicians. We hope to help clinicians/ therapists find better options in managing the disease. Materials: We performed a cross-sectional study with a sample size of 246 medical school students in Karachi to collect data through self-administered questionnaires. We used the DSM 5 criteria for the diagnosis of BDD and additional questions on the presence of MD. Nutritional habits, exercise routines, use of supplements and drugs were also obtained for exploratory analysis. Results: Our study predicted the prevalence of MD to be 25%. Other main findings included statistical significant associations between MD and the thoughts and practice of steroid use for muscularity. Conclusion: MD is an underdiagnosed and often unrecognized disease that we believe has significant consequences for the young male population. Further work is needed on this in our part of the world. Our research, we believe, can be a stepping stone for further studies that would incorporate wider populations

Computational analysis of third-grade liquid flow with cross diffusion effects: application to entropy modeling

The key goal of this current study is to analyze the entropy generation with cross diffusion effects. The third-grade type non-Newtonian fluid model is used in this study. The current flow problem is modelled with stretching plate. Modified Fourier heat flux is replaced the classical heat flux. The appropriate transformation is availed to convert the basic boundary layers equations into ODEs and then verified by homotopy algorithm. The consequences of various physical quantities on temperature, velocity, entropy and concentration profile are illustrated graphically

Coronary-artery bypass surgery in patients with left ventricular dysfunction

The role of coronary-artery bypass grafting (CABG) in the treatment of patients with coronary artery disease and heart failure has not been clearly established.Between July 2002 and May 2007, a total of 1212 patients with an ejection fraction of 35% or less and coronary artery disease amenable to CABG were randomly assigned to medical therapy alone (602 patients) or medical therapy plus CABG (610 patients). The primary outcome was the rate of death from any cause. Major secondary outcomes included the rates of death from cardiovascular causes and of death from any cause or hospitalization for cardiovascular causes.The primary outcome occurred in 244 patients (41%) in the medical-therapy group and 218 (36%) in the CABG group (hazard ratio with CABG, 0.86; 95% confidence interval [CI], 0.72 to 1.04; P=0.12). A total of 201 patients (33%) in the medical-therapy group and 168 (28%) in the CABG group died from an adjudicated cardiovascular cause (hazard ratio with CABG, 0.81; 95% CI, 0.66 to 1.00; P=0.05). Death from any cause or hospitalization for cardiovascular causes occurred in 411 patients (68%) in the medical-therapy group and 351 (58%) in the CABG group (hazard ratio with CABG, 0.74; 95% CI, 0.64 to 0.85; P<0.001). By the end of the follow-up period (median, 56 months), 100 patients in the medical-therapy group (17%) underwent CABG, and 555 patients in the CABG group (91%) underwent CABG.In this randomized trial, there was no significant difference between medical therapy alone and medical therapy plus CABG with respect to the primary end point of death from any cause. Patients assigned to CABG, as compared with those assigned to medical therapy alone, had lower rates of death from cardiovascular causes and of death from any cause or hospitalization for cardiovascular causes. (Funded by the National Heart, Lung, and Blood Institute and Abbott Laboratories; STICH ClinicalTrials.gov number, NCT00023595.)

Insights from the STICH trial: Change in left ventricular size after coronary artery bypass grafting with and without surgical ventricular reconstruction

ObjectiveThe present analysis of the Surgical Treatment for Ischemic Heart Failure randomized trial data examined the left ventricular volumes at baseline and 4 months after surgery to determine whether any magnitude of postoperative reduction in end-systolic volume affected survival after coronary artery bypass grafting alone compared with bypass grafting plus surgical ventricular reconstruction.MethodsOf the 1000 patients randomized, 555 underwent an operation and had a paired imaging assessment with the same modality at baseline and 4 months postoperatively. Of the remaining 455 patients, 424 either died before the 4-month study or did not have paired imaging tests and were excluded, and 21 were not considered because they had died before surgery or did not receive surgery.ResultsSurgical ventricular reconstruction resulted in improved survival compared with coronary artery bypass grafting alone when the postoperative end-systolic volume index was 70 mL/m2 or less. However, the opposite was true for patients achieving a postoperative volume index greater than 70 mL/m2. A reduction in the end-systolic volume index of 30% or more compared with baseline was an infrequent event in both treatment groups and did not produce a statistically significant survival benefit with ventricular reconstruction.ConclusionsIn patients undergoing coronary artery bypass grafting plus surgical ventricular reconstruction, a survival benefit was realized compared with bypass alone, with the achievement of a postoperative end-systolic volume index of 70 mL/m2 or less. Extensive ventricular remodeling at baseline might limit the ability of ventricular reconstruction to achieve a sufficient reduction in volume and clinical benefit