Trends In Permanent Pacemakers’ Implantation: Where Do We Stand?

Objective: To determine the Trends In Permanent Pacemakers’ Implantation: Where Do We Stand? Methodology: The study was conducted at cardiology department of Pakistan Institute of Medical Sciences, Islamabad. Study duration was two years from April 2010 to March 2018. In this study the retrospectively data was analyzed to see the trend in the rate of annual implantation of permanent pacemaker’s and patient’s demographics. Data for the study was extracted from the hospital records of cardiac devices implantation. All the information was recorded via study proforma. Analysis of the data was done by the SPSS version 20. Results: Total 1670 procedure were analyzed retrospectively. Mean age of patients at the time of implantation was 60.47 ± 16.357 Std Deviation. Single chamber devices were 1030 and dual chambers pacemakers remained 535 in the study population. Complication rate remain 2.2% during the procedure. 62.8% devices were implanted on payment from patients and the rest 37.2% on donation from various resources. The trend of single and dual chamber devices remain constant in the study period. However dual chamber devices implantation ratio increased in 2017 due to donation of devices and government sponsorship scheme. Conclusion: There is a significant increase in the implantation of cardiac devices, the trend closely follows the financial status of patients and the supply of devices from various donor agencies

Venous puncture in permanent pacemakers implantation, when easy become difficult

Objective: To share our experience in the field of device implantation with particular emphasis on the venous punctures.Methodology: This study was conducted in Cardiology Department at Hayat Abad Medical Complex Peshawar. All those patients who presented to Cardiology department Hayat Abad Medical Complex Peshawar for implantation of permanent pacemakers due to any reason were brought to catheterization laboratory after explaining the procedure. Chest scrubbed and draped and after venogram of the desired side axillary vein was punctured by Seldinger technique and if there was failure to puncture the vein after a few attempts, the position of the vein reconfirmed with venogram and reattempted. In few cases vein used to change its path after the initial failed attempts. After venous access skin incision was made superolateral to the puncture side, pocket constructed and lead position and pulse generator attached and wound closed in layers.Results: A total of 484 pacemakers were implanted in the study period. Dual chamber pacemakers were 136 (28.09%) and single chamber pacemakers were 348 (71.90%). There were left sided persistent SVC in 2 cases and totally obstructed vein on both side in one patient. Procedure was shifted to right side in 10 patients due to unsuitable veins on left side. Vein change its tract in 07 cases.Conclusion: Sound anatomical understanding venous course is crucial for safe venous puncture and successful PPM implantation

Immediate Procedural Success of Primary Percutaneous Intervention in Patients with Acute ST Segment Elevation Myocardial Infarction

Objective: To determine the frequency of immediate procedural success of Primary PCI in patients with Acute ST segment elevation Myocardial infarction. Methodology: This observational study was conducted at Cardiology unit of P.I.M.S, Islamabad from April 2018 to October 2018. Study included 43 patients with STEMI. All of them had primary PCI. The main outcome variable was frequency of procedural success which was described as frequency distribution table. Results: Procedural success was achieved among all (100%) patients.  There were 16.3% patients who developed contrast induced nephropathy (recovered), they all were diabetics. There were 4.6% patients who developed hematoma. No other complications seen Conclusions: Immediate procedural success of primary PCI is high (almost successful in every case) and should be offered to the patients with STEMI whenever the facility is available. Keywords: ST-segment elevation myocardial infarction; primary percutaneous coronary intervention

Strain selection, growth productivity and biomass characterization of novel microalgae isolated from fresh and wastewaters of upper Punjab, Pakistan

<p>The present study was focussed on selection of fast-growing microalgae with higher lipid content using cheaper growth media, aimed to reduce the cost of algal biomass production. Samples were collected from 40 different sites from fresh and wastewater bodies. Based on morphological differences, two microalgae (SSG and SA) from wastewater and three (OP, DFM and JRC) from fresh water habitat were selected for further characterization. The specific growth rates (g Day ⁻¹ L⁻¹) of the OP, DFM, JRC, SA and SSG were found to be 0.614, 0.638, 0.734, 1.06 and 1.02, respectively, whereas the doubling time (<i>T_d</i>) was shown to be as 39.30, 36.48, 22.08, 12.24 and 12.98 h, respectively, when cultured without controlled temperature and CO₂ supply, in a locally designed photobioreactor. All five microalgae shown considerable growth at a range of pH 6.0–9.0 with a peak activity within pH range 7.5–8.5. The OP, DFM and JRC contained 27%, whereas SSG and SA shown 39% lipid content. The phylogenetic analyses based on the 18S rRNA gene sequence have shown that studied microalgal strains may be novel species.</p

Nitrate pollution of ground water and impacts of nitrogenous fertilizers and irrigation on dynamics of NO3-N movement in soils of Punjab, Pakistan

Increase in N application rates may eventually raise the potential groundwater N-pollution. This survey study was conducted by Soil Chemistry Section, ISCES to assess the NO3 contents of soil from 0 to 120 cm depth with different intervals. For this purpose, the soil and water samples were collected from Okara, Vehari Sialkot, Chiniot, Hafizabad, Sahiwal and Multan districts. The results showed that nitrate leaching occurred but it is only up to 2 feet soil depth. The NO3-N contents were maximum at two upper depths (i.e. 0-30 cm and 30-60 cm) and then decreased gradually downward. The highest average NO3-N content was found at 0-30 cm soil depth and the lowest were found at 90-120 cm. The data also revealed that mean NO3-N content at 0-30, 30-60, 60-90 and 90-120 cm depths were 16.85±4.05, 15.21±4.77, 9.94±3.36 and 6.54±2.62 mg kg-1, respectively, whereas NO3-N content at same depths were ranged from 11.50-26.20, 6.53-21.15, 5.24-16.12, 1.45-9.36 mg kg-1, respectively. The results regarding underground water samples (tube well) from the same sites from all the three districts showed that NO3 were found in all the water samples but it was only in traces and their concentration were not much higher to create the health hazardous problem owing to NO3 leaching. The data showed that the highest NO3 contents did not exceed than 8.61 and 10.6 ppm in Multan and Sahiwal districts respectively, which were much lower than permissible limit i.e. 50 ppm (FAO). Similarly, the nitrate content in underground water are well below the maximum admissible limit of WHO i.e. 50 mg L-1

Influence of wastewater irrigation on soil chemical properties and buildup of heavy metals in soil

The contamination of soil and plants by heavy metals is one of the crucial issues to be faced in the world including Pakistan and requires attention because heavy metals above their normal ranges are highly threatened to both plants and animals. To monitor this situation, a survey study was conducted to diagnose the concentration of toxic metals and other chemical properties of wastewater irrigated soils. For this purpose, soil samples were collected from various districts of Punjab, Pakistan and analyzed for heavy metals (cadmium, lead, chromium, nickel) and chemical properties such as electric conductivity, pH, organic matter and macronutrients (Nitrogen, Phosphorus, Potassium and Sodium contents). Result showed that pH of wastewater irrigated surface soil was alkaline in nature. Results also revealed that use of wastewater irrigation improved the O.M content (upto 2%) in soils. Macronutrient dynamics also increased specially build up in total N up to 0.12%, Olsen P (45 mg kg-1), Extractable K and Na (608, 1525 mg kg-1 respectively) was also observed in soils of wastewater irrigated areas. Furthermore, results also indicated that the concentration of heavy metal, cadmium was ranged from 0.004-3.44 mg kg-1, lead 0.05-279.3 mg kg-1, chromium 0.004-683 mg kg-1 and nickel 0.01-221.7 mg kg-1 in wastewater irrigated areas of Punjab. It was observed that, 28, 19, 15 and 5% samples were found above the permissible limits (35, 100, 0.8 and 85 mg kg-1) of Ni, Cr, Cd and Pb, respectively. Based on the results, the order of heavy metal contamination in the wastewater irrigated soil of Punjab occurred as Ni&gt;Cr&gt;Cd&gt;Pb. This study concluded that untreated wastewater affect chemical properties of soil as well as degrades soil quality and at the same time it’s continues use ultimately responsible for buildup of heavy metals in soils.