Diagnosis of pulmonary embolism with helical CT scan

Objective: To determine the role of helical C.T. scan in the diagnosis of pulmonary embolism.SETTING: Radiology department, Aga Khan University Hospital. One year prospective study May 2001 to May 2002.Methods: Sixty patients suspected of having pulmonary embolism were included in this study. Helical C.T. scan chest was performed from aortic arch to lung bases with intravenous contrast medium. Images were acquired in mediastinal and lung windows. Image interpretation was performed on the console and hard copies for main branch and segmental thrombus.Results: Fifteen patients were diagnosed of having pulmonary embolism on C.T. scan. Clinical correlation and follow up with pulmonary angiography and Doppler ultrasound of leg was carried out. Pulmonary angiography was performed in one patient with embolectomy done after confirmation of diagnosis. 8 patients had associated DVT confirmed on Doppler sonography. Sensitivity of helical C.T. is 93.75%, specificity 100% and positive predictive value 95.65%.CONCLUSION: Helical CT scan is a quick, easy and accurate imaging modality for diagnosing pulmonary embolism

Haleeb: Rejuvenating the Market Leader of the Past

With over a decade-long absence from the market, Haleeb Foods Limited had decided to relaunch its flagship brand ‘Haleeb’ within the processed milk category. While the enthusiasm was high, the fact that Haleeb was returning to the market after a decade posed serious challenges for the branding team. The product category and customer expectations had evolved over the years and strong competitors, that is, Olper’s (Engro Foods Limited) and MilkPak (Nestle), had emerged. Haleeb’s branding team had to decide on how to take the brand forward after being absent from the mainstream

The role of magnetic resonance cholangiopancreatography (MRCP) in obstructive jaundice

Objective: To evaluate the diagnostic value of MRCP in studying the sites and cause of obstructive jaundice in comparison with other imaging modalities at the Department of Radiology, Aga Khan University Hospital, from January 1999 to May 2001.Methods: Forty nine consecutive patients included 19 men and 30 women, suspected of obstructive jaundice. Patients underwent ultrasound (n = 49), CT (n = 11), ERCP (n = 25) and biliary surgery (n = 17). Final diagnosis was established by surgical exploration, endoscopic sphincterectomy, cytology and clinical follow up.Results: Of the 49 patients 17 had choledocholithiasis. Twenty five patients had malignant strictures, out of which 11 had non-specific malignant strictures, 7 had pancreatic carcinoma, 3 had Klatskin tumors, 3 had periampullary carcinoma and 1 had gallbladder carcinoma. Six patients had benign strictures and 1 patient had choledochal cyst. Overall, MRCP was sensitive (88%) and specific (96.8%) in detecting choledocholithiasis. MRCP sensitivity and specificity in detecting benign main bile duct stricture was equal to 83.3% and 97.6% respectively, and 92% and 100% for malignant stricture.CONCLUSION: Our prospective study confirms that MRCP, a noninvasive and well tolerated imaging technique is of value in the diagnosis of obstructive jaundice

Percutaneous Mitral Valve Repair versus Optimal Medical Therapy in Patients with Functional Mitral Regurgitation: A Systematic Review and Meta-Analysis

Objectives. To compare percutaneous mitral valve repair (PMVR) with optimal medical therapy (OMT) in patients with heart failure (HF) and severe functional mitral regurgitation (FMR). Background. Many patients with HF and FMR are not suitable for surgical valve replacement and remain symptomatic despite maximal OMT. PMVR has recently emerged as an alternative solution. Methods. We performed a systematic review and a meta-analysis to address this question. Cochrane CENTRAL, MEDLINE, and Scopus were searched for randomized (RCT) and nonrandomized studies comparing PMVR with OMT in patients with HF and FMR. Primary endpoint was all-cause midterm mortality (at 1 and 2 years). Secondary endpoints were 30-day mortality and cardiovascular mortality and HF hospitalizations, at maximum follow-up. Studies including mixed cohort of degenerative and functional MR were allowed initially but were excluded in a secondary sensitivity analysis for each of the study’s end points. This meta-analysis was performed following the publication of two RCTs (MITRA-FR and COAPT). Results. Eight studies (six observational, two RCTs) comprising 3,009 patients were included in the meta-analysis. In comparison with OMT, PMVR significantly reduced 1-year mortality (RR: 0.70 [0.56, 0.87]; p=0.002; I2=47.6%), 2-year mortality (RR: 0.63 [0.55, 0.73]; p\u3c0.001; I2=0%), and cardiovascular mortality (RR: 0.32 [0.23, 0.44]; p\u3c0.001; I2=0%). No significant difference between PMVR+OMT and OMT was noted in HF hospitalization (HR: 0.69 [0.40, 1.20]; p=0.19; I2=85%) and 30-day mortality (RR: 1.13 [0.68, 1.87]; p=0.16; I2=0%). Conclusions. In comparison with OMT, PMVR significantly reduces 1-year mortality, 2-year mortality, and cardiovascular mortality in patients with HF and severe MR

Utility of the CHA2DS2-VASc score for predicting ischaemic stroke in patients with or without atrial fibrillation: a systematic review and meta-analysis

AIMS: Anticoagulants are the mainstay treatment for stroke prevention in patients with non-valvular atrial fibrillation (NVAF), and the CHA2DS2-VASc score is widely used to guide anticoagulation therapy in this cohort. However, utility of CHA2DS2-VASc in NVAF patients is debated, primarily because it is a vascular scoring system, which does not incorporate atrial fibrillation related parameters. Therefore, we conducted a meta-analysis to estimate the discrimination ability of CHA2DS2-VASc in predicting ischaemic stroke overall, and in subgroups of patients with or without NVAF. METHODS AND RESULTS: PubMed and Embase databases were searched till June 2020 for published articles that assessed the discrimination ability of CHA2DS2-VASc, as measured by C-statistics, during mid-term (2-5 years) and long-term (\u3e5 years) follow-up. Summary estimates were reported as random effects C-statistics with 95% confidence intervals (CIs). Seventeen articles were included in the analysis. Nine studies (n = 453 747 patients) reported the discrimination ability of CHA2DS2-VASc in NVAF patients, and 10 studies (n = 138 262 patients) in patients without NVAF. During mid-term follow-up, CHA2DS2-VASc predicted stroke with modest discrimination in the overall cohort [0.67 (0.65-0.69)], with similar discrimination ability in patients with NVAF [0.65 (0.63-0.68)] and in those without NVAF [0.69 (0.68-0.71)] (P-interaction = 0.08). Similarly, at long-term follow-up, CHA2DS2-VASc had modest discrimination [0.66 (0.63-0.69)], which was consistent among patients with NVAF [0.63 (0.54-0.71)] and those without NVAF [0.67 (0.64-0.70)] (P-interaction = 0.39). CONCLUSION: This meta-analysis suggests that the discrimination power of the CHA2DS2-VASc score in predicting ischaemic stroke is modest, and is similar in the presence or absence of NVAF. More accurate stroke prediction models are thus needed for the NVAF population

Improved salinity tolerance in early growth stage of maize through salicylic acid foliar application

Soil salinity threatens agricultural production worldwide by constraining plant growth and final crop yield. The early stages are most sensitive to salinity, in response to which salicylic acid (SA) has demonstrated beneficial effects in various plant species. Based on this, a maize (Zea mays L.) pot experiment was set up combining three levels of soil salinity (0, 6 and 12 dS m–1), obtained through NaCl addition, with three levels of SA (0, 300 and 600 mM), applied by leaf spraying 20 days after seedling emergence. Fifteen days later, the following traits were assessed: morphology (plant height, leaf number), growth (root and shoot dry weight), leaf water status [relative water content (RWC), elec-trolyte leakage (EL)], pigments (chlorophyll a and b, carotenoids, anthocyanin), antioxidant enzymes (peroxidase, catalase, ascor-bate peroxidase, vitamin C), oxidative stress markers (H2O2, mal-ondialdehyde), osmo-regulating compounds (free amino acids, soluble proteins and sugars, proline), hormones [indole-3-acetic acid, gibberellic acid (GA), abscisic acid (ABA), ethylene], ele-ment (Na, K, Ca, Mg and Cl) concentration and content in roots, stem and leaves. Salinity severely affected maize growth (–26% total dry weight), impaired leaf water status (–31% RWC), reduced photosynthetic pigments, enhanced all antioxidant enzymes and oxidative stress markers, two osmo-regulating compounds (soluble sugars and proline) out of four, and all hormones except GA. SA was shown effective in containing most of the stress effects, while supporting plant defences by upgrading anti-oxidant activities (reduced oxidative stress markers), increasing cell membrane stability (–24% EL) and leaf water status (+20% RWC), and reducing plant stress signalling (–10% ABA and –20% ethylene). Above all, SA contrasted the massive entry of noxious ions (Na+ and Cl–), in favour of K+, Ca2+ and Mg2+ accumulation. Lastly, salicylic acid was shown beneficial for maize growth and physiology also under non-saline condition, suggesting a potential use in normal field conditions

Investigation of input and output energy for wheat production : a comprehensive study for Tehsil Mailsi (Pakistan)

The global increasing food demand can be met by efficient energy utilization in mechanized agricultural productions. In this study, input–output energy flow along with CO2 emissions for different wheat production cases (C-I to C-V) were investigated to identify the one that is most energy-efficient and environment-friendly case. Data and information about input and output sources were collected from farmers through questionnaires and face-to-face interviews. Input and output sources were converted into energy units by energy equivalents while CO2 emissions were calculated by emission equivalents. Data envelopment analysis (DEA) was conducted to compare technical efficiencies of the developed cases for optimization of inputs in inefficient cases. Results revealed that case C-Ⅴ (higher inputs, larger fields, the tendency of higher fertilizer application and tillage operations) has the highest energy inputs and outputs than the rest of the cases. Moreover, it possesses the lowest energy use efficiency and energy productivity. The highest CO2 emissions (1548 kg-CO2/ha) referred to C-Ⅴ while lowest emissions per ton of grain yield were determined in C-Ⅳ (higher electricity water pumping, moderate energy input). The grain yield increases directly with input energy in most of the cases, but it does not guarantee the highest values for energy indices. C-Ⅲ (moderate irrigations, educated farmers, various fertilizer applications) was found as an optimum case because of higher energy indices like energy use efficiency of 4.4 and energy productivity of 153.94 kg/GJ. Optimum input and better management practices may enhance energy proficiency and limit the traditionally uncontrolled CO2 emissions from wheat production. Therefore, the agricultural practices performed in C-Ⅲ are recommended for efficient cultivation of wheat in the studied area.The global increasing food demand can be met by efficient energy utilization in mechanized agricultural productions. In this study, input–output energy flow along with CO2 emissions for different wheat production cases (C-I to C-V) were investigated to identify the one that is most energy-efficient and environment-friendly case. Data and information about input and output sources were collected from farmers through questionnaires and face-to-face interviews. Input and output sources were converted into energy units by energy equivalents while CO2 emissions were calculated by emission equivalents. Data envelopment analysis (DEA) was conducted to compare technical efficiencies of the developed cases for optimization of inputs in inefficient cases. Results revealed that case C-Ⅴ (higher inputs, larger fields, the tendency of higher fertilizer application and tillage operations) has the highest energy inputs and outputs than the rest of the cases. Moreover, it possesses the lowest energy use efficiency and energy productivity. The highest CO2 emissions (1548 kg-CO2/ha) referred to C-Ⅴ while lowest emissions per ton of grain yield were determined in C-Ⅳ (higher electricity water pumping, moderate energy input). The grain yield increases directly with input energy in most of the cases, but it does not guarantee the highest values for energy indices. C-Ⅲ (moderate irrigations, educated farmers, various fertilizer applications) was found as an optimum case because of higher energy indices like energy use efficiency of 4.4 and energy productivity of 153.94 kg/GJ. Optimum input and better management practices may enhance energy proficiency and limit the traditionally uncontrolled CO2 emissions from wheat production. Therefore, the agricultural practices performed in C-Ⅲ are recommended for efficient cultivation of wheat in the studied area.King Saud University, Riyadh, Saudi Arabi

A Rapid Assessment of the Availability and Use of Obstetric Care in Nigerian Healthcare Facilities

Background: As part of efforts to reduce maternal deaths in Nigeria, pregnant women are being encouraged to give birth in healthcare facilities. However, little is known about whether or not available healthcare facilities can cope with an increasing demand for obstetric care. We thus carried out this survey as a rapid and tactical assessment of facility quality. We visited 121 healthcare facilities, and used the opportunity to interview over 700 women seeking care at these facilities. Findings Most of the primary healthcare facilities we visited were unable to provide all basic Emergency Obstetric Care (bEmOC) services. In general, they lack clinical staff needed to dispense maternal and neonatal care services, ambulances and uninterrupted electricity supply whenever there were obstetric emergencies. Secondary healthcare facilities fared better, but, like their primary counterparts, lack neonatal care infrastructure. Among patients, most lived within 30 minutes of the visited facilities and still reported some difficulty getting there. Of those who had had two or more childbirths, the conditional probability of a delivery occurring in a healthcare facility was 0.91 if the previous delivery occurred in a healthcare facility, and 0.24 if it occurred at home. The crude risk of an adverse neonatal outcome did not significantly vary by delivery site or birth attendant, and the occurrence of such an outcome during an in-facility delivery may influence the mother to have her next delivery outside. Such an outcome during a home delivery may not prompt a subsequent in-facility delivery. Conclusions: In conclusion, reducing maternal deaths in Nigeria will require attention to both increasing the number of facilities with high-quality EmOC capability and also assuring Nigerian women have access to these facilities regardless of where they live

First narrow-band search for continuous gravitational waves from known pulsars in advanced detector data

Spinning neutron stars asymmetric with respect to their rotation axis are potential sources of continuous gravitational waves for ground-based interferometric detectors. In the case of known pulsars a fully coherent search, based on matched filtering, which uses the position and rotational parameters obtained from electromagnetic observations, can be carried out. Matched filtering maximizes the signalto- noise (SNR) ratio, but a large sensitivity loss is expected in case of even a very small mismatch between the assumed and the true signal parameters. For this reason, narrow-band analysis methods have been developed, allowing a fully coherent search for gravitational waves from known pulsars over a fraction of a hertz and several spin-down values. In this paper we describe a narrow-band search of 11 pulsars using data from Advanced LIGO’s first observing run. Although we have found several initial outliers, further studies show no significant evidence for the presence of a gravitational wave signal. Finally, we have placed upper limits on the signal strain amplitude lower than the spin-down limit for 5 of the 11 targets over the bands searched; in the case of J1813-1749 the spin-down limit has been beaten for the first time. For an additional 3 targets, the median upper limit across the search bands is below the spin-down limit. This is the most sensitive narrow-band search for continuous gravitational waves carried out so far