Percutaneous transmitral balloon commissurotomy (PTMC): Procedural success and immediate results at Ahmed Gasim Cardiac Center

Background: Balloon valvuloplasty for stenosed mitral and pulmonary valves has been practiced with good results for the last two years in Ahmed Gasim Cardiac Centre, Khartoum Sudan. Objectives: The aim of this study is to audit percutaneous trans-mitral balloon commissurotomy [PTMC] in our current set up. Methods: One hundred and eight patients underwent percutaneous transvenous mitral commissurotomy (PTMC) from April- 2004 to December-2005 in Ahmed Gasim cardiac center. Results: 67% percent of the patients were females. Age range was from 13years to 65years and the mean age was 27years. 27% were under 21 years of age and 12% had special problems. The procedural success was achieved in 94.5% patients, in two patients we failed to dilate a tough septum, in other two the balloon got stuck to the septum and failed to cross the MV, while two patients had successful emergency MVR (due to inadvertent puncture of the RA and cardiac tamponade). There was no mortality related to the procedure, significant mitral regurgitation of > grade 2 didn't occur. No patient developed systemic embolization. Optimal results were achieved in 91.6% patients and in 92% of the patients with special problems. Hemodynamic data in the Cath. Lab showed left atrial mean (±SD) pressure dropped from 32 (±3.2) mmHg to 12 (±2.4) mmHg. LA-LV gradient dropped from an average of 25 to 5 mmHg. Echocardiographic assessment showed mean (±SD) mitral valve area increased from 0.86 (±0.19) cm2 to 1.9 (±0.5) cm2 (

The physiological responses of cacao to the environment and the implications for climate change resilience. A review

Cacao (Theobroma cacao L.) is a tropical perennial crop which is of great economic importance to the confectionary industry and to the economies of many countries of the humid tropics where it is grown. Some recent studies have suggested climate change could severely impact cacao production in West Africa. It is essential to incorporate our understanding of the physiology and genetic variation within cacao germplasm when discussing the implications of climate change on cacao productivity and developing strategies for climate resilience in cacao production. Here we review the current research on the physiological responses of cacao to various climate factors. Our main findings are 1) water limitation causes significant yield reduction in cacao but genotypic variation in sensitivity is evident, 2) in the field cacao experiences higher temperatures than is often reported in the literature, 3) the complexity of the cacao/ shade tree interaction can lead to contradictory results, 4) elevated CO2 may alleviate some negative effects of climate change 5) implementation of mitigation strategies can help reduce environmental stress, 6) significant gaps in the research need addressing to accelerate the development of climate resilience. Harnessing the significant genetic variation apparent within cacao germplasm is essential to develop modern varieties capable of high yields in non-optimal conditions. Mitigation strategies will also be essential but to use shading to best effect shade tree selection is crucial to avoid resource competition. Cacao is often described as being sensitive to climate change but genetic variation, adaptive responses, appropriate mitigation strategies and interactive climate effects should all be considered when predicting the future of cacao production. Incorporating these physiological responses to various environmental conditions and developing a deeper understanding of the processes underlying these responses will help to accelerate the development of a more resource use efficient tree ensuring sustainable production into the future