Superior septal approach versus left atrial approach for mitral valve replacement: a retrospective cohort study

Abstract OBJECTIVE: To compare the outcomes of superior septal approach and left atrial approach for mitral valve replacement. METHODS: This retrospective cohort study was conducted at the Aga Khan University Hospital, Karachi, and comprised records of patients who had undergone isolated mitral valve replacement from May 2003 to April 2012. Cases were reviewed for the outcomes [primary: loss of normal sinus rhythm; secondary: complications, residual defect and mortality]. Patients with prior history of dysrhythmia, low ejection fraction (\u3c30%), emergency/redo mitral valve replacement and concomitant coronary artery bypass grafting were excluded. SPSS 19 was used for data analysis. RESULTS: Of the 78 patients, 52(66.67%) were of superior septal approach and 26(33.33%) of left atrial approach. Both groups were comparable for baseline variables except cardiopulmonary bypass and cross-clamp times, which were significantly shorter in the superior septal approach group than the left septal approach group (p\u3c0.05). No residual atrial septal defect was found in any approach. Although loss of normal sinus rhythm was observed more frequent in superior septal approach 25(48%) compared to left septal approach 10(38.4%), but the difference was statistically insignificant (p=0.28). Age was the only significant variable affecting loss of normal sinus rhythm after adjusting for approaches. The difference of post-operative complications was also statistically insignificant between superior 9(17.3%) and left septal approach 4(15.38%) (p=1.0)]. CONCLUSIONS: The operative durations were significantly higher in left atrial approach compared to superior septal approach

Phase Pure Synthesis and Morphology Dependent Magnetization in Mn Doped ZnO Nanostructures

Zn 0.95 Mn 0.05 O nanostructures were synthesized using sol gel derived autocombustion technique. As-burnt samples were thermally annealed at different temperatures (400, 600, and 800 ∘ C) for 8 hours to investigate their effect on structural morphology and magnetic behavior. X-ray diffraction and scanning electron microscopic studies demonstrated the improvement in crystallinity of phase pure wurtzite structure of Mn doped ZnO with variation of annealing temperature. Energy dispersive X-ray elemental compositional analysis confirmed the exact nominal compositions of the reactants. Electrical resistivity measurements were performed with variation in temperature, which depicted the semiconducting nature similar to parent ZnO after 5 at% Mn doping. Magnetic measurements by superconducting quantum interference device detected an enhanced trend of ferromagnetic interactions in thermally annealed compositions attributed to the improved structural morphology and crystalline refinement process

Massive Fluid Requirements and an Unusual BUN/Creatinine Ratio for Pre-Renal Failure in Patients with Cholera

Background: Cholera is an important infectious cause of secretory diarrhea. The primary symptom of infection is the sudden onset of watery diarrhea with subsequent volume depletion causing renal insufficiency. The objective of this research is to study the level of dehydration at presentation and subsequent fluid management in Patients with cholera. Methods: This study was conducted on 191 Patients of Cholera admitted at a tertiary care hospital in Karachi, Pakistan during the period of 5 years. Medical charts were evaluated retrospectively for initial hydration status, baseline lab investigations on admission and discharge and fluid therapy given to all the Patients while their stay in the hospital and the data was analyzed on SPSS 15.0. Results: Out of the 191 Patients, 83(43%) were males and 108 (57%) were females with mean age of 42.3 years (SD+/-18.34). The average duration of symptoms was 3.75 days (SD+/-2.04). Of 191 Patients, 175 (92.1%) presented with dehydration, 80 (42.3%) were given Ringer\u27s Lactate (R/L) + Normal Saline (N/S), 45 (24%) Patients were given R/L + N/S + Oral Rehydration Therapy (ORS), 27 (14.3%) of the Patients were kept on R/L only and remaining were given various combinations of R/L, N/S, ORS and Dextrose Saline (D/S). On admission mean Blood Urea Nitrogen (BUN) was 24.54 (SD+/-16.6), mean creatinine was 2.47 (SD+/-2.35) and mean BUN/Creatinine ratio was 11.63 (SD+/-5.7). Conclusion: Aggressive fluid rehydration remains the cornerstone of management of cholera. Instead of presenting with a classical BUN/Creatinine ratio of \u3e20:1, Patients with pre-renal failure in cholera may present with a BUN/Creatinine ratio of \u3c15:1

The burden of stroke and transient ischemic attack in Pakistan: a community-based prevalence study.

BACKGROUND: The burden of cerebrovascular disease in developing countries is rising sharply. The prevalence of established risk factors of stroke is exceptionally high in Pakistan. However, there is limited data on the burden of stroke and transient ischemic attack (TIA) in South Asia. We report the first such study conducted in an urban slum of Karachi, Pakistan. METHODS: Individuals 35 years of age or older were invited for participation in this investigation through simple random sampling. A structured face-to-face interview was conducted using a pre-tested stroke symptom questionnaire in each participant to screen for past stroke or TIA followed by neurological examination of suspected cases. Anthropometric measurements and random blood glucose levels were recorded. Multivariable logistic regression was used to determine the association of vascular risk factors with prevalence of stroke. RESULTS: Five hundred and forty five individuals (49.4% females) participated in the study with a response rate of 90.8%. One hundred and four individuals (19.1%) were observed to have a prior stroke while TIA was found in 53 individuals (9.7%). Overall, 119 individuals (21.8% with 66.4% females) had stroke and/or TIA. Female gender, old age, raised random blood glucose level and use of chewable tobacco were significantly associated with the prevalence of cerebrovascular disease. CONCLUSION: This is the first study demonstrating an alarmingly high life-time prevalence of cerebrovascular disease in Pakistan. Individual and public health interventions in Pakistan to increase awareness about stroke, its prevention and therapy are warranted.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Potential of siltstone and its composites with biochar and magnetite nanoparticles for the removal of cadmium from contaminated aqueous solutions: Batch and column scale studies

© 2020 Elsevier Ltd The present study is the first attempt to evaluate the pilot and batch scale adsorption potential of siltstone (SS) and its nanocomposites with biochar (EDB/SS), magnetite nanoparticles (MNPs/SS) and MNPs/EDB/SS for Cd removal from contaminated water. The SS, EDB/SS, MNPs/SS and MNPs/EDB/SS were characterized with FTIR, XRD, BET, SEM, TEM, TGA and point of zero charge (PZC). The effects of adsorbent dosage, contact time, initial Cd concentration, pH and presence of competing ions were evaluated on the Cd removal and its adsorption. The order for Cd removal was: MNPs/EDB/SS \u3e MNPs/SS \u3e EDB/SS \u3e SS (95.86–99.72% \u3e 93.10–98.5% \u3e 89.66.98–98.40% \u3e 74.90–90%). Column scale experiments yielded maximum retention (95%) of Cd even after 2 h of injection at 100 mg Cd/L. The exhausted SS, EDB/SS, MNPs/SS and MNPs/EDB/SS were reused without losing significant adsorption potential. Similarly, maximum Cd adsorption (117.38 mg/g) was obtained with MNPs/EDB/SS at dose 1.0 g/L. The results revealed that coexisting cations reduced the Cd removal due to competition with Cd ions. The experimental results were better explained with Freundlich isotherm model and pseudo 2nd order kinetic models. The results revealed that SS and its composites can be used efficiently for the removal of Cd from contaminated water

TOXOCARA VITULORUM INFESTATION AND ASSOCIATED RISK FACTORS IN CATTLE AND BUFFALO AT MULTAN DISTRICT, PAKISTAN

ABSTRACT: Toxocara (T) vitulorum is a nematode, which residues in the small intestines o

The Karachi intracranial stenosis study (KISS) Protocol: an urban multicenter case-control investigation reporting the clinical, radiologic and biochemical associations of intracranial stenosis in Pakistan.

Background: Intracranial stenosis is the most common cause of stroke among Asians. It has a poor prognosis with a high rate of recurrence. No effective medical or surgical treatment modality has been developed for the treatment of stroke due to intracranial stenosis. We aim to identify risk factors and biomarkers for intracranial stenosis and to develop techniques such as use of transcranial doppler to help diagnose intracranial stenosis in a cost-effective manner. Methods/Design: The Karachi Intracranial Stenosis Study (KISS) is a prospective, observational, case-control study to describe the clinical features and determine the risk factors of patients with stroke due to intracranial stenosis and compare them to those with stroke due to other etiologies as well as to unaffected individuals. We plan to recruit 200 patients with stroke due to intracranial stenosis and two control groups each of 150 matched individuals. The first set of controls will include patients with ischemic stroke that is due to other atherosclerotic mechanisms specifically lacunar and cardioembolic strokes. The second group will consist of stroke free individuals. Standardized interviews will be conducted to determine demographic, medical, social, and behavioral variables along with baseline medications. Mandatory procedures for inclusion in the study are clinical confirmation of stroke by a healthcare professional within 72 hours of onset, 12 lead electrocardiogram, and neuroimaging. In addition, lipid profile, serum glucose, creatinine and HbA1C will be measured in all participants. Ancillary tests will include carotid ultrasound, transcranial doppler and magnetic resonance or computed tomography angiogram to rule out concurrent carotid disease. Echocardiogram and other additional investigations will be performed at these centers at the discretion of the regional physicians. Discussion: The results of this study will help inform locally relevant clinical guidelines and effective public health and individual interventions

Effect of biochar modified with magnetite nanoparticles and HNO\u3csub\u3e3\u3c/sub\u3e for efficient removal of Cr(VI) from contaminated water: A batch and column scale study

© 2020 Elsevier Ltd Chromium (Cr) poses serious consequences on human and animal health due to its potential carcinogenicity. The present study aims at preparing a novel biochar derived from Chenopodium quinoa crop residues (QBC), its activation with magnetite nanoparticles (QBC/MNPs) and strong acid HNO3 (QBC/Acid) to evaluate their batch and column scale potential to remove Cr (VI) from polluted water. The QBC, QBC/MNPs and QBC/Acid were characterized with SEM, FTIR, EDX, XRD as well as point of zero charge (PZC) to get an insight into their adsorption mechanism. The impact of different process parameters including dose of the adsorbent (1–4 g/L), contact time (0–180 min), initial concentration of Cr (25–200 mg/L) as well as solution pH (2–8) was evaluated on the Cr (VI) removal from contaminated water. The results revealed that QBC/MNPs proved more effective (73.35–93.62-%) for the Cr (VI) removal with 77.35 mg/g adsorption capacity as compared with QBC/Acid (55.85–79.8%) and QBC (48.85–75.28-%) when Cr concentration was changed from 200 to 25 mg/L. The isothermal experimental results follow the Freundlich adsorption model rather than Langmuir, Temkin and Dubinin-Radushkevich adsorption isotherm models. While kinetic adsorption results were well demonstrated by pseudo second order kinetic model. Column scale experiments conducted at steady state exhibited excellent retention of Cr (VI) by QBC, QBC/MNPs and QBC/Acid at 50 and 100 mg Cr/L. The results showed that this novel biochar (QBC) and its modified forms (QBC/Acid and QBC/MNPs) are applicable with excellent reusability and stability under acidic conditions for the practical treatment of Cr (VI) contaminated water

The Pakistan risk of myocardial infarction study: A resource for the study of genetic, lifestyle and other determinants of myocardial infarction in south Asia

The burden of coronary heart disease (CHD) is increasing at a greater rate in South Asia than in any other region globally, but there is little direct evidence about its determinants. The Pakistan Risk of Myocardial Infarction Study (PROMIS) is an epidemiological resource to enable reliable study of genetic, lifestyle and other determinants of CHD in South Asia. By March 2009, PROMIS had recruited over 5,000 cases of first-ever confirmed acute myocardial infarction (MI) and over 5,000 matched controls aged 30-80 years. For each participant, information has been recorded on demographic factors, lifestyle, medical and family history, anthropometry, and a 12-lead electrocardiogram. A range of biological samples has been collected and stored, including DNA, plasma, serum and whole blood. During its next stage, the study aims to expand recruitment to achieve a total of about 20,000 cases and about 20,000 controls, and, in subsets of participants, to enrich the resource by collection of monocytes, establishment of lymphoblastoid cell lines, and by resurveying participants. Measurements in progress include profiling of candidate biochemical factors, assay of 45,000 variants in 2,100 candidate genes, and a genomewide association scan of over 650,000 genetic markers. We have established a large epidemiological resource for CHD in South Asia. In parallel with its further expansion and enrichment, the PROMIS resource will be systematically harvested to help identify and evaluate genetic and other determinants of MI in South Asia. Findings from this study should advance scientific understanding and inform regionally appropriate disease prevention and control strategies