Congestion in acute heart failure trials and registries: a systematic review

Introduction: The term “congestion” is used to describe a broad range of clinical presentations. Congestion is a variably understood and assessed entity. Patients develop a mixture of central (pulmonary) and/or peripheral (non-pulmonary) symptoms of congestion. These are likely to have different pathophysiological mechanisms. The presence of subclinical congestion is an independent risk factor for early re-hospitalisation and morbidity. Novel techniques to assess congestion have been developed, but their clinical role is not yet established. Methods: I performed two systematic reviews of acute heart failure (AHF) trials and registries from Jan 1, 2001 to Dec 31, 2018 on EMBASE and MEDLINE to determine the methods and techniques used to assess and grade congestion. The search terms utilised were “acute heart failure”, “decompensated heart failure” and “hospitalized heart failure”. The minimum enrolment numbers were 180 patients for randomised trials and 2,000 patients for registries. Results: 18 major acute heart failure registries and 21 major trials were analysed. There are no standardised methods for assessing central or peripheral congestion. Acute heart failure trials preferentially recruited patients with pulmonary congestion (manifesting as dyspnoea at rest). In 6 of 8 trials with available data, this was mandatory for 100% of patients. By contrast, for large registry trials this rate ranged from 34 to 73%. Dyspnoea on exertion was a more predominant presentation (61 to 95%). With the exception of a chest X-ray, no trial or registry routinely utilised non-invasive (e.g. lung ultrasound) or invasive (e.g. right heart catheterisation) techniques to objectively and systematically quantify either congestion on recruitment or congestion on discharge. Conclusion: Congestion is variably assessed and defined. Internationally agreed definitions of the presence and severity of congestion are required. These definitions should include conventional symptoms and signs as well as newer methods of assessing congestion. Trials of treatments for central or peripheral congestion may have different inclusion criteria

Changes in left atrial deformation in hypertrophic cardiomyopathy: Evaluation by vector velocity imaging.

OBJECTIVES: Hypertrophic cardiomyopathy (HCM) represents a generalized myopathic process affecting both ventricular and atrial myocardium. We assessed the global and regional left atrial (LA) function and its relation to left ventricular (LV) mechanics and clinical status in patients with HCM using Vector Velocity Imaging (VVI). METHODS: VVI of the LA and LV was acquired from apical four- and two-chamber views of 108 HCM patients (age 40 ± 19years, 56.5% men) and 33 healthy subjects, all had normal LV systolic function. The LA subendocardium was traced to obtain atrial volumes, ejection fraction, velocities, and strain (ϵ)/strain rate (SR) measurements. RESULTS: Left atrial reservoir (ϵsys,SRsys) and conduit (early diastolic SRe) function were significantly reduced in HCM compared to controls (P  - 1.8s(- 1) was 81% sensitive and 30% specific, SRa> - 1.5s(- 1) was 73% sensitive and 40% specific. By multivariate analysis global LVϵsys and LV septal thickness are independent predictors for LAϵsys, while end systolic diameter is the only independent predictor for SRsys, P < .001. CONCLUSION: Left atrial reservoir and conduit function as measured by VVI were significantly impaired while contractile function was preserved among HCM patients. Left atrial deformation was greatly influenced by LV mechanics and correlated to severity of phenotype

Waste management methods and sustainablity

© Springer International Publishing Switzerland 2015. Waste in its different forms is a significant environmental issue that receives a great deal of attention worldwide. Waste is generated as a result of production and consumption (domestic and industrial) activities and tends to increase with the level of prosperity and economic development of the country. Cost efficient, technology-based and sustainable management of both solid and liquid waste is crucial to economic growth and development of a healthy society in any given region. This chapter reviews traditional as well as modern approaches to solid waste management (SWM) and wastewater treatment. Sustainable methods of waste reduction, waste reuse and recycling are the preferred options when managing waste. There are many environmental benefits that can be derived from the use of these methods. They reduce or prevent greenhouse gas emissions, lessen the release of pollutants, conserve resources, save energy and minimise the demand for waste treatment technology and space. Establishment of sanitary landfills that meet standard hygienic requirements is the most widely adopted method of disposing of solid waste in developed countries. Vermicomposting and biogas technology produce reusable manure and combustible gas respectively from organic solid waste while waste-to-energy (incineration of waste) has quickly emerged as one of the most attractive renewable energy options. Wastewater if not properly disposed of, could be hazardous to human health and environment. Natural aquatic and terrestrial treatment systems with the environment-friendly designs and low-cost sanitation provide benefits for the reuse of water. Wise uses of aquatic and terrestrial plants are a means of several natural wastewater treatment methods. A decentralized wastewater treatment is being considered for most communities because of its economic and environmental advantages. Apart from natural treatment methods, membrane technology, nanotechnology, microbial fuel cells and electrocoagulation offer newer approaches to handling wastewater in a sustainable manner. The overall sustainable development ensures the path of reconciliation for society, environment, and economy in the long-term. People who generate waste, institutions who handle it and the local governance are key partners in an efficient waste management system. Need for education to create awareness on the importance of waste treatment and the sustainability aspects of the emerging technologies remains critical at all societal and governmental levels. Applications of information and communication technologies offer ingenious solutions to the problem of waste management

Monitoring bacterial diversity in a full-scale municipal wastewater treatment plant in dubai by fluorescence in situ hybridization technique

In this study, the bacterial diversity in the activated sludge system of a full-scale municipal wastewater treatment plant in Dubai was monitored over a period of one year using ribosomal RNA (rRNA) targeted oligonucleotide probes for a defined phylogenetic group of bacteria by the Fluorescence in situ hybridization (FISH) technique. The largest fraction of the bacterial community in the sludge samples belonged to the gamma-subgroup of proteobacteria (25%) followed by gram positive bacteria of high G+C content(16%), gram positive bacteria with low G+C content (9 %), beta-proteobacteria (8%) and alpha-proteobacteria (5 %) with respect to the population percentages stained by DAPI (4,6-diamino-2-phenylindole). A specific nocardioform actinomycete, simultaneously targeted by both HGC69a and MNP1 probes, was predominantly found throughout the study period in all activated sludge mixed liquor samples. The nocardioform actinomycetes group members were detected in both branched and single cell morphotypes. Most of the previously published genus and species specific probes failed to hybridize to the sludge samples. In conclusion, the overall bacterial community populations detected by the sub-group specific 16S rRNA targeted oligonucleotide probes in FISH technique remained almost constant throughout the period of study irrespective of treatment plant conditions

Regression Analysis for the Forecasting of Production and Yield of Wheat Crop in Sindh and Punjab.

Wheat is an important and major agriculture crop of Pakistan. The purpose of this study is to fit the Simple regression model and to forecast the value of each indicator for planning purpose. The data set of 30 years (i.e. 1988 – 2018) for Punjab Wheat and Sindh Wheat are collected from Pakistan Bureau of Statistics, Agricultural Statistics of Pakistan and internet also investigated. Econometrics techniques (Trend Curves, Lagged Models, Simple Regression, Correlation and Moving Averages) are applied using Minitab software and MS Excel and observed that: The changes in all indicators with respect to time are positive. The changes in Production for Sindh are less than for Punjab which shows better consistency towards Production of Sindh than that of Punjab. The changes in Yield for Punjab Wheat are larger than for Sindh Wheat. Yield of Wheat Sindh is more consistent than Wheat Punjab. For Production, Poly-2(PP), Poly-6(PS) Exponential and lagged-1 models are preferred due to better results. Key words: Simple Regression, Exponential Model, Lagged Model, Data, Production, Forecasting, etc. DOI: 10.7176/JBAH/9-16-06 Publication date: August 31st 2019

Role of community health nurse in earthquake affected areas

The role of Community Health Nurses (CHNs) outside the traditional hospital setting is meant to provide and promote the health care needs of the community. Such nurses can play a substantial role in the community setting including emergencies like disasters. This became evident after the earthquake of October 8, 2005 in Pakistan. The objective was to address the issues, faced by primary healthcare providers working in earthquake-affected areas focusing on participatory approach. The experience of the interventions done by CHN by a guided frame work (assessment, planning, implementation and evaluation components) is described. Issues identified by CHN included: lack of training of health care providers, lack of collaboration, communication between the medical and management staff due to poor infrastructure of the healthcare facilities. The interventions were carried out, utilizing existing resources. Efforts were directed to build capacity of health care providers at grass root level to fill in gaps of health care delivery system for sustainable change. Overall, working in the earthquake affected areas is challenging. Health leadership should foresee role of CHN in emergencies where quality healthcare interventions are essential