Midterm results of bovine jugular vein conduit for right ventricular outflow tract reconstruction

Objective: To evaluate the midterm results of Contegra conduit. Methods: The retrospective study comprised patient record at Aga Khan University Hospital, Karachi, of conduits implanted between May 2007 and June 2012. Data collection was made from the clinical notes and from serial echocardiograms by a single cardiologist. The last followup echocardiography was done at the time of data collection in June 2012. SPSS 19 was used for statistical analysis. Results: A total of 18 conduits had been implanted (16-22mm) during the study period. Median age at the time of surgery was 9 years (range: 2.5-16 years). Early mortality was seen in 3 (16.66%) patients, but none was Contegra related. Of the remaining 15 patients, 2 (13.33%) with a diagnosis of Pulmonary Atresia-Ventricular Septal Defect with hypoplastic peripheral Pulmonary Arteries (PA), developed severe distal pressure gradient (50mmHg) across Contegra over a median period of 18 months (range: 12-24 months), with resultant severe regurgitation and needed percutaneous intervention. There was no thrombosis, calcification, anuerysmal dilation or late deaths. Conclusion: At midterm followup, Contegra conduit was associated with low re-intervention rates with satisfactory haemodynamic results. However, long-term durability must be determined for this conduit, especially in patients with Pulmonary Atresia-Ventricular Septal Defect with hypoplastic peripheral Pulmonary Arteries

Anthracycline-induced cardiotoxicity: prospective cohort study from Pakistan

Objectives: To identify anthracycline-induced acute (within 1 month) and early-onset chronic progressive (within 1 year) cardiotoxicity in children younger than 16 years of age with childhood malignancies at a tertiary care centre of Pakistan. Design: Prospective cohort study. Setting: Aga Khan University, Karachi, Pakistan. Participants: 110 children (aged 1 month–16 years). Intervention: Anthracycline (doxorubicin and/or daunorubicin). Outcome measurements: All children who received anthracycline as chemotherapy and three echocardiographic evaluations (baseline, 1 month and 1 year) between July 2010 and June 2012 were prospectively analysed for cardiac dysfunction. Statistical analysis including systolic and diastolic functions at baseline, 1 month and 1 year was carried out by repeated measures analysis of variance. Results: Mean age was 74±44 months and 75 (68.2%) were males. Acute lymphoblastic leukaemia was seen in 70 (64%) patients. Doxorubicin alone was used in 59 (54%) and combination therapy was used in 35 (32%). A cumulative dose of anthracycline /m2was used in 95 (86%). Fifteen (14%) children developed cardiac dysfunction within a month and 28 (25%) children within a year. Of these 10/15 (66.6%) and 12/28 (43%) had isolated diastolic dysfunction, respectively, while 5/15 (33.3%) and 16/28 (57%) had combined systolic and diastolic dysfunction. Seven (6.4%) patients expired due to severe cardiac dysfunction. Eight of 59 (13.5%) children showed dose-related cardiotoxicity (p= Conclusions: Incidence of anthracycline-induced cardiotoxicity is high. Long-term follow-up is essential to diagnose its late manifestations

COVID-19 impact on poultry production and distribution networks in Bangladesh

The COVID-19 pandemic has severely affected numerous economic sectors across the world, including livestock production. This study investigates how the pandemic has impacted the poultry production and distribution network (PDN), analyses stakeholders' changing circumstances, and provides recommendations for rapid and long-term resilience. This is based on a literature review, social media monitoring, and key informant interviews (n = 36) from across the poultry sector in Bangladesh. These included key informants from breeder farms and hatcheries, pharmaceutical suppliers, feed companies, dealers, farmers, middlemen, and vendors. We show that the poultry sector was damaged by the COVID-19 pandemic, partly as a result of the lockdown and also by rumors that poultry and their products could transmit the disease. This research shows that hardly any stakeholder escaped hardship. Disrupted production and transportation, declining consumer demand and volatile markets brought huge financial difficulties, even leading to the permanent closure of many farms. We show that the extent of the damage experienced during the first months of COVID-19 was a consequence of how interconnected stakeholders and businesses are across the poultry sector. For example, a shift in consumer demand in live bird markets has ripple effects that impact the price of goods and puts pressure on traders, middlemen, farmers, and input suppliers alike. We show how this interconnectedness across all levels of the poultry industry in Bangladesh makes it fragile and that this fragility is not a consequence of COVID-19 but has been revealed by it. This warrants long-term consideration beyond the immediate concerns surrounding the COVID-19 pandemic

Multisystem inflammatory syndrome (MIS-C) in Pakistani children: A description of the phenotypes and comparison with historical cohorts of children with Kawasaki disease and myocarditis

Objectives: To determine clinical, laboratory features and outcomes of Multisystem Inflammatory Syndrome in children (MIS-C) and its comparison with historic Kawasaki Disease (KD) and Viral Myocarditis (VM) cohorts.Methods: All children (1 month- 18 years) who fulfilled the World Health Organization criteria of MIS-C presenting to two tertiary care centers in Karachi from May 2020 till August 31st were included. KD and VM admitted to one of the study centers in the last five years prior to this pandemic, was compared to MIS-C.Results: Thirty children with median age of 24 (interquartile range (IQR)1-192) months met the criteria for MIS-C. Three phenotypes were identified, 12 patients (40%) with KD, ten (33%) VM and eight (26%) had features of TSS. Echocardiography showed coronary involvement in 10 (33%), and moderate to severe Left Ventricular dysfunction in 10 (33%) patients. Steroids and intravenous immunoglobulins (IVIG) were administered to 24 (80%) and 12 (41%) patients respectively while 7 (23%) received both. Overall, 20% children expired. During the last five years, 30 and 47 children were diagnosed with KD and VM, respectively. Their comparison with MIS-C group showed lymphopenia, thrombocytosis, and higher CRP as well as more frequent atypical presentation in MIS-C KD group with less coronary involvement. The MIS-C VM was more likely to present with fulminant myocarditis.Conclusions: Our MIS-C cohort is younger with higher mortality compared to previous reports. MIS-C is distinct from historic cohorts of KD and VM in both in clinical features and outcomes

Simulation-optimization of Tarbela Reservoir operation to enhance multiple benefits and to achieve sustainable development goals

Pakistan’s agriculture and economy rely heavily on the Tarbela Reservoir. The present storage capacity of Tarbela is 8.2 BCM and it has been depleted by more than 40% due to sedimentation since 1976. It also has had a 0.94 percent (0.134 BCM) decrease in gross reservoir capacity every year. Historically, the amount of sediment trapped in the Tarbela Reservoir during the period 1976–2020 was 198.5 million tonnes annually. Based on the current operation by the Water and Power Development Authority (WAPDA), the delta is expected to extend to 2.41 km from the dam in 2035. The reservoir will become a run-of-the-river reservoir with a gross storage capacity of 2.87 BCM. This rapid loss of storage capacity will significantly impact reservoir benefits while also putting turbine performance at risk due to abrasion. Slowing the sediment deposition phenomena by a flexible operational strategy is a worthwhile aim from the dam manager’s viewpoint to achieve Sustainable Development Goals (i.e., poverty and hunger alleviation, clean affordable energy, protecting ecosystem etc.). Therefore, for the safe and long-term operation of the turbines, the existing Standard Operating Procedures (SOPs) adopted by WAPDA need to be appraised to delineate their impact on future optimized operations. The aspect of considering static SOPs on the whole period of reservoir operation has not been attempted earlier. The Tarbela Reservoir was selected as a case study to enhance the existing reservoir operation. The methodology relies upon the use of a 1-D sediment transport model in HEC-RAS to study the impact of the operational strategy on sedimentation. In conjunction, the existing reservoir operation of Tarbela was modelled in HEC-ResSim using its physical, operational, and 10-daily time-series data for simulation of releases and hydropower benefits based on a revised elevation-capacity curve for sedimentation. After calibration and validation, the model was applied to predict future reservoir operation impacts on a 5-year basis from 2025 to 2035 for determining storage capacity, irrigation releases, power production and energy generation. It was predicted that as the storage capacity of the reservoir is depleted (by application of the WAPDA current SOPs in future years), the irrigation releases would be increased in the Kharif season (April–September) by 7% and decreased by 50% in the Rabi season (October–March) with a corresponding increase in power generation by 4% and decrease by 37%, respectively, and the average annual energy generation would be decreased by 6.5%. The results showed that a gradual increase in the minimum operating level will slow down delta movement but it will reduce irrigation releases at times of high demand. The findings may assist water managers to improve the Tarbela Reservoir operation to achieve sustainable development goals and to attain societal future benefits

Measures, Gaps, and Mitigation Strategies in Bangladesh’s COVID-19 Response

AbstractThe Coronavirus Disease 2019 (COVID-19) spread rapidly from China to most other countries around the world in early 2020 killing millions of people. To prevent virus spread, world governments implemented a variety of response measures. This paper’s objectives were to discuss the country’s adopted measures to combat the virus through June 2020, identify gaps in the measures’ effectiveness, and offer possible mitigations to those gaps. The measures taken included screening device deployment across international air and land ports, flight suspensions and closures from COVID-19 affected countries, and declaration and extension of a national public holiday (equivalent to lockdowns in other countries). Identified gaps were test kit, PPE, ICU beds, and ventilator shortages, limited public awareness, and insufficient coordination and collaboration among national and international partners. Proper and timely risk mapping, preparedness, communication, coordination, and collaboration among governments and organizations, and public awareness and engagement would have provided sufficient COVID-19 mitigation in Bangladesh. </jats:p

Synthesis, characterization and application of novel MnO and CuO impregnated biochar composites to sequester arsenic (As) from water: Modeling, thermodynamics and reusability

© 2020 Elsevier B.V. The present study aimed at enhancing the adsorption potential of novel nanocomposites of Sesbania bispinosa biochar (SBC) with copper oxide (SBC/CuO) and manganese oxide nanoparticles (SBC/MnO) for the efficient and inexpensive removal of environmentally concerned contaminant arsenic (As) from contaminated water at batch scale. The scanning electron microscopy (SEM), Fourier transform infrared (FTIR) spectroscopy, energy dispersive X-ray (EDX), X-ray diffraction (XRD) and point of zero charge (PZC) analyses proved successful impregnation of the metallic nanoparticles on SBC surface. The results revealed the maximum As removal (96 %) and adsorption (12.47 mg/g) by SBC/CuO composite at 10 mg As/L, optimum pH-4, dose 1.0 g/L and ambient temperature (25 ± 1.5 °C) as compared with SBC (7.33 mg/g) and SBC/MnO (7.34 mg/g). Among four types of adsorption isotherms, Freundlich isotherm demonstrated best fit with R2 \u3e 0.997. While pseudo second-order kinetic model revealed better agreement with kinetic experimental data as matched with other kinetic models. The thermodynamic results depicted that As adsorption on the as-synthesized adsorbents was endothermic and spontaneous in nature with increased randomness. The SBC/CuO displayed excellent reusability and stability over four adsorption/desorption cycles and proved that the as-synthesized SBC/CuO composite may be the efficient adsorbent for practical removal of As from contaminated water

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Effect of Different Techniques on Germination Efficacy and Antioxidant Capacity of Indigenous Legumes of Pakistan

The present study investigated five different strategies for germination, utilizing distinctive substrata like jute bag, separating funnel, muslin cloth, filter paper and aluminum foil followed by evaluation of percent germination, radicle size, weight gain, total phenols and antioxidant activity of eleven indigenous legumes. The results revealed that jute bag displayed the most elevated percent germination in all legumes (84-96) % with the exception of kabuli chick pea, desi chick pea, garbanzo bean and cow pea which demonstrated improved percent germination when filter paper was utilized as substrata. The longest root length (3.1cm) was seen in cow pea when filter paper was used as substrata. It was additionally observed that jute bag demonstrated the highest increment in total phenolic compounds after germination in soy bean i.e. 6.3 mg gallic acid/gram. Among all germinated legumes, cowpea demonstrated the most elevated amount of total antioxidant activity (98.1%) when either filter paper or separating funnel was utilized. The results revealed that every bean requires optimum sprouting technique/conditions inorder to enhance its antioxidant capacity to maximum extent

Effect of Different Techniques on Germination Efficacy and Antioxidant Capacity of Indigenous Legumes of Pakistan

The present study investigated five different strategies for germination, utilizing distinctive substrata like jute bag, separating funnel, muslin cloth, filter paper and aluminum foil followed by evaluation of percent germination, radicle size, weight gain, total phenols and antioxidant activity of eleven indigenous legumes. The results revealed that jute bag displayed the most elevated percent germination in all legumes (84-96) % with the exception of kabuli chick pea, desi chick pea, garbanzo bean and cow pea which demonstrated improved percent germination when filter paper was utilized as substrata. The longest root length (3.1cm) was seen in cow pea when filter paper was used as substrata. It was additionally observed that jute bag demonstrated the highest increment in total phenolic compounds after germination in soy bean i.e. 6.3 mg gallic acid/gram. Among all germinated legumes, cowpea demonstrated the most elevated amount of total antioxidant activity (98.1%) when either filter paper or separating funnel was utilized. The results revealed that every bean requires optimum sprouting technique/conditions inorder to enhance its antioxidant capacity to maximum extent