Relationship between exercise induced dyspnea and functional capacity with doppler-derived diastolic function

Background Dyspnea is the frequent cause of exercise intolerance and physical inactivity among patients referred for exercise tolerance test. Diastolic dysfunction has shown significant correlation with exercise capacity and exercise induced dyspnea. To find out the frequency of diastolic dysfunction (DD) and the relationships between impaired exercise capacity and exercise induced dyspnea with DD by Doppler-derived indices among patients referred for stress test in a tertiary care hospital of Karachi. Methods For this study 135 consecutive patients who were referred for stress test at our non-invasive lab were screened for eligibility. Patients with valvular pathology, atrial fibrillation (AF) and coronary artery disease (CAD) were excluded. Stress test was performed on treadmill using Bruce protocol. Assessment of diastolic function as determined by trans-mitral flow velocity pattern was carried at baseline and at peak exercise. We evaluated impaired exercise capacity and exercise induced dyspnea using validated Borg Scale among study subjects. Results Study subjects 88% were males, mean age was 46 ± 16 years, BMI 27 ± 5 kg/m2, prevalence of diabetes mellitus (DM) 15%, hypertension 28% and smoking 21%. Exercise induced DD occurred among 44.6%. Patients with exercise induced DD had lower exercise capacity (9.2 vs. 10.2 METS; p = 0.04) and higher Borg Scale (5.2 vs. 4.0; p \u3c 0.001). DD at baseline was present in 25(26%) of patients so they were excluded from the study. Five patients develop ischemia during stress test so were also excluded. So final analysis was done on 105 patients. Among patients without DD at baseline, there was significant vicariate linear inverse correlation between post exercise E/A ratio and Borg scale (r = −0.23; p = 0.02) and exercise capacity was assessed by exercise duration and MET (r-0.825; p = 0.04). Multivariate regression analysis revealed post exercise E/A ratio as an independent determinant of severity of exercise induced dyspnea and impaired exercise tolerance. Conclusion DD is significantly associated with impaired functional capacity and dyspnea among patients referred for exercise tolerance test

Survival of patients treated with intra-aortic balloon counterpulsation at a tertiary care center in Pakistan – patient characteristics and predictors of in-hospital mortality

BACKGROUND: Intra-aortic balloon counterpulsation (IABC) has an established role in the treatment of patients presenting with critical cardiac illnesses, including cardiogenic shock, refractory ischemia and for prophylaxis and treatment of complications of percutaneous coronary interventions (PCI). Patients requiring IABC represent a high-risk subset with an expected high mortality. There are virtually no data on usage patterns as well as outcomes of patients in the Indo-Pakistan subcontinent who require IABC. This is the first report on a sizeable experience with IABC from Pakistan. METHODS: Hospital charts of 95 patients (mean age 58.8 (± 10.4) years; 78.9% male) undergoing IABC between 2000–2002 were reviewed. Logistic regression was used to determine univariate and multivariate predictors of in-hospital mortality. RESULTS: The most frequent indications for IABC were cardiogenic shock (48.4%) and refractory ischemia (24.2%). Revascularization (surgical or PCI) was performed in 74 patients (77.9%). The overall in-hospital mortality rate was 34.7%. Univariate predictors of in-hospital mortality included (odds ratio [95% CI]) age (OR 1.06 [1.01–1.11] for every year increase in age); diabetes (OR 3.68 [1.51–8.92]) and cardiogenic shock at presentation (OR 4.85 [1.92–12.2]). Furthermore, prior CABG (OR 0.12 [0.04–0.34]), and in-hospital revascularization (OR 0.05 [0.01–0.189]) was protective against mortality. In the multivariate analysis, independent predictors of in-hospital mortality were age (OR 1.13 [1.05–1.22] for every year increase in age); diabetes (OR 6.35 [1.61–24.97]) and cardiogenic shock at presentation (OR 10.0 [2.33–42.95]). Again, revascularization during hospitalization (OR 0.02 [0.003–0.12]) conferred a protective effect. The overall complication rate was low (8.5%). CONCLUSIONS: Patients requiring IABC represent a high-risk group with substantial in-hospital mortality. Despite this high mortality, over two-thirds of patients do leave the hospital alive, suggesting that IABC is a feasible therapeutic device, even in a developing country

Genome-wide association identifies nine common variants associated with fasting proinsulin levels and provides new insights into the pathophysiology of type 2 diabetes.

OBJECTIVE: Proinsulin is a precursor of mature insulin and C-peptide. Higher circulating proinsulin levels are associated with impaired β-cell function, raised glucose levels, insulin resistance, and type 2 diabetes (T2D). Studies of the insulin processing pathway could provide new insights about T2D pathophysiology. RESEARCH DESIGN AND METHODS: We have conducted a meta-analysis of genome-wide association tests of ∼2.5 million genotyped or imputed single nucleotide polymorphisms (SNPs) and fasting proinsulin levels in 10,701 nondiabetic adults of European ancestry, with follow-up of 23 loci in up to 16,378 individuals, using additive genetic models adjusted for age, sex, fasting insulin, and study-specific covariates. RESULTS: Nine SNPs at eight loci were associated with proinsulin levels (P < 5 × 10(-8)). Two loci (LARP6 and SGSM2) have not been previously related to metabolic traits, one (MADD) has been associated with fasting glucose, one (PCSK1) has been implicated in obesity, and four (TCF7L2, SLC30A8, VPS13C/C2CD4A/B, and ARAP1, formerly CENTD2) increase T2D risk. The proinsulin-raising allele of ARAP1 was associated with a lower fasting glucose (P = 1.7 × 10(-4)), improved β-cell function (P = 1.1 × 10(-5)), and lower risk of T2D (odds ratio 0.88; P = 7.8 × 10(-6)). Notably, PCSK1 encodes the protein prohormone convertase 1/3, the first enzyme in the insulin processing pathway. A genotype score composed of the nine proinsulin-raising alleles was not associated with coronary disease in two large case-control datasets. CONCLUSIONS: We have identified nine genetic variants associated with fasting proinsulin. Our findings illuminate the biology underlying glucose homeostasis and T2D development in humans and argue against a direct role of proinsulin in coronary artery disease pathogenesis

Characterizations of Twenty (2020-2021) Proposed Discrete Distributions

In this paper, certain characterizations of twenty newly proposed discrete distributions: the discrete gen- eralized Lindley distribution of El-Morshedy et al.(2021), the discrete Gumbel distribution of Chakraborty et al.(2020), the skewed geometric distribution of Ong et al.(2020), the discrete Poisson X gamma distri- bution of Para et al.(2020), the discrete Cos-Poisson distribution of Bakouch et al.(2021), the size biased Poisson Ailamujia distribution of Dar and Para(2021), the generalized Hermite-Genocchi distribution of El-Desouky et al.(2021), the Poisson quasi-xgamma distribution of Altun et al.(2021a), the exponentiated discrete inverse Rayleigh distribution of Mashhadzadeh and MirMostafaee(2020), the Mlynar distribution of Fr¨uhwirth et al.(2021), the flexible one-parameter discrete distribution of Eliwa and El-Morshedy(2021), the two-parameter discrete Perks distribution of Tyagi et al.(2020), the discrete Weibull G family distribution of Ibrahim et al.(2021), the discrete Marshall–Olkin Lomax distribution of Ibrahim and Almetwally(2021), the two-parameter exponentiated discrete Lindley distribution of El-Morshedy et al.(2019), the natural discrete one-parameter polynomial exponential distribution of Mukherjee et al.(2020), the zero-truncated discrete Akash distribution of Sium and Shanker(2020), the two-parameter quasi Poisson-Aradhana distribution of Shanker and Shukla(2020), the zero-truncated Poisson-Ishita distribution of Shukla et al.(2020) and the Poisson-Shukla distribution of Shukla and Shanker(2020) are presented to complete, in some way, the au- thors’ works

Torrefaction interpretation through morphological and chemical transformations of agro-waste to porous carbon-based biofuel

In the current study, two agro-waste lignocellulosic corncob (CC) and rice husk (RH) were thermally torrefied at 200–300 °C into a porous carbon-enriched biofuel. The scanning electron microscopy (SEM) of produced biofuel confirmed the rounded, homogenous, and spherical structure of the produced biofuels with higher porosity at a temperature between 250 and 300 °C with 60 min retention time. Brunauer-Emmett-Teller (BET) analysis indicated the high surface area (CC: 1.19–2.87 m2 g−1 and RH: 1.22–2.67 m2 g−1) and pore volume (CC: 1.23–2.81 ×10−3 m3 g−1 and RH: 1.46–2.58 ×10−3 m3 g−1). Crystallinity index decline percent (CC= 62.87% and RH=57.10%) estimated thermal stability and rise in amorphous cellulose reformation during (250–300 °C)/60 min that would efficiently hydrolyze during oxidative pyrolysis carbon reactive sites the rise in surface area and total pore’s volume, having higher conversion rate as compared to raw materials. Carbon content was upgraded to 94% by eliminating hydrogen and oxygen from lignocellulosic agro-waste to produce energy-dense CC and RH. The lignin macromolecule transformation extent was estimated by O/C trend, which was equal to 63% and 47% for CC and RH, respectively, at 300 °C for 60 min. Due to low bulk density and pre-grinding energy requirements, torrefied biofuel with decomposed fibrous structure have lower transportation costs

Drug eluting stents: data from a clinical registry

Objective: To assess the characteristics and short-term outcome of patients, undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES), in routine clinical practice.Design: Observational study.PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, from 2002 to 2003.PATIENTS AND Methods: All the patients who underwent PCI with DES at cath lab, AKUH, during the year 2002 and 2003 were included. Data was collected from database and by reviewing clinical records. Follow-up data for a period of 6-9 months was collected from the clinical records and by a telephone interview where required.Results: A total of 141 patients underwent PCI with DES at AKUH during the year 2002 and 2003. This study was predominantly male dominated (approximately 77%), with a mean age of 55+/-11 years. Thirty-nine percent were diabetics, and 53% were hypertensives. Twelve percent of patients had prior coronary artery bypass graft surgery (CABG) and 17% had prior PCI. Two or more than two lesions were attempted in 55% of patients. Majority (84.4%) of lesions were moderate to high risk category. Six to nine months follow-up was available in 133 (94%) patients. The only death was due to heart failure in the presence of a patent stent. Nearly 8% had clinical angina and 3.8% had myocardial infarction (MI) during follow-up. Target lesion revascularization (TLR) was performed in 4.6%. Major adverse cardiac events (MACE), defined as death, MI, and TLR occurred in 6.8% of patients.CONCLUSION: This data shows that DES are being used in a broad variety of clinical settings in routine or real life clinical practice. The outcome is excellent and comparable to randomized trials

Impact of Age and Sex on Cardiovascular Magnetic Resonance Measurements After Tetralogy of Fallot Repair

status: publishe