Thrombolytic therapy in acute myocardial infarction in Pakistan.

To characterize features of acute myocardial infarction (AMI) in a Pakistani population, and assess the role of thrombolysis in our country, we studied 194 consecutive admitted patients with enzyme positive AMI. Males were affected three times more frequently; women, although affected less, had a higher incidence of complications than men. Premature coronary artery disease (CAD) was present in 50% patients presenting with AMI. An unusually high incidence of anterior wall myocardial infarction (39%) was seen. Complications were frequent with a predominance of LV failure symptoms. Cardiogenic shock was associated with a very high mortality, in excess of 93%. Streptokinase (SK) was administered in 60% patients with suspected transmural AMI. A statistically significant reduction in mortality was seen in the group that received SK (15.2%) compared to those who did not receive SK (24.7%), (p = \u3c 0.05)

A rare case of suture material obstructing the closure mechanism of a prosthetic aortic valve: a case report

Prosthetic aortic valve dysfunction presenting as aortic regurgitation is a complication of mechanical valve replacement. We describe a case of late valve dysfunction caused by an annular suture of excessive length obstructing the closure mechanism of a bileaflet prosthetic valve

Environment Friendly Energy Cooperation in Neighboring Buildings : A Transformed Linearization Approach

Funding Information: Funding: This work was supported in part by the National Research Foundation of Korea-Grant funded by the Korean Government (Ministry of Science and ICT) under Grant NRF-2020R1A2B5B02002478, and in part by the Sejong University Research Faculty Program (20212023). Publisher Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland.Peer reviewedPublisher PD

How to manage the left subclavian artery during endovascular stenting of the thoracic aorta

We performed a systematic review of the literature to establish whether revascularisation of the left subclavian territory is necessary when this artery is covered by a stent. We retrieved data from 99 studies incorporating 4906 patients. Incidences of left-arm ischaemia (0.0% vs 9.2%, p=0.002) and stroke (4.7% vs 7.2%, p≪0.001) were significantly less following revascularisation, although mortality (10.5% vs 3.4%, p=0.032) and endoleak incidence (25.8% vs 12.6%, p=0.008) were increased. No significant differences in spinal-cord ischaemia were seen. Revascularisation may reduce downstream ischaemic complications but can cause significant risk. Indications must be carefully considered on an individual patient basi

Effectiveness of 10-valent pneumococcal conjugate vaccine against vaccine-type invasive pneumococcal disease in Pakistan

Objective: To assess the effectiveness of 10-valent pneumococcal conjugate vaccine (PCV10) against invasive pneumococcal disease (IPD) due to vaccine serotypes of Streptococcus pneumoniae post introduction of the vaccine into the routine immunization program in Pakistan.Methods: A matched case-control study was conducted at 16 hospitals in Sindh Province, Pakistan. Children aged (eligible to receive PCV10) who presented with radiographically confirmed pneumonia and/or meningitis were enrolled as cases. PCR for the lytA gene was conducted on blood (for radiographic pneumonia) and cerebrospinal fluid (for meningitis) samples to detect S. pneumoniae. The proportion of IPD due to vaccine serotypes (including vaccine-related serogroups) was determined through serial multiplex PCR. For each case, at least five controls were enrolled from children hospitalized at the same institution, matched for age, district, and season.Results: Of 92 IPD patients enrolled during July 2013 to March 2017, 24 (26.0%) had disease caused by vaccine serotypes. Most case (87.5% of 24) and control (66.4% of 134) children had not received any PCV10 doses. The estimated effectiveness of PCV10 against vaccine-type IPD was 72.7% (95% confidence interval (CI) -7.2% to 92.6%) with at least one dose, 78.8% (95% CI -11.9% to 96.0%) for at least two doses, and 81.9% (95% CI -55.7% to 97.9%) for all three doses of vaccine.Conclusion: The vaccine effectiveness point estimates for PCV10 were high and increased with increasing number of doses. However, vaccine effectiveness estimates did not reach statistical significance, possibly due to low power. The findings indicate the likely impact of vaccine in reducing the burden of vaccine-type IPD if vaccine uptake can be improved

Clinical and echocardiographic characteristics of patients with significant pericardial effusion requiring pericardiocentesis

Objective: Clinical and echocardiographic features of significant pericardial effusion (PE) have been reported from the west. Currently there is lack of published data from this part of the world, we reviewed all consecutive cases of significant PE requiring echocardiographic assisted pericardiocentesis to analyze the clinical and echocardiographic features of these patients.Methods: Forty four consecutive patients who underwent echocardiography assisted pericardiocentesis at the Aga Khan University Hospital (AKUH) between January 1988 and May 2001 re included in this review.Results: Most common presenting symptoms were dyspnea (89%) and fever (36%). Elevated JVP and pulsus paradoxus were documented in 59% and 41% of patients respectively. Sinus tachycardia (75%) and low voltage (34%) were the most common ECG findings. Malignancy (45-51%) and tuberculosis (27%) were among the most frequent causes of PE. One patient died during echocardiography-assisted pericardiocentesis.CONCLUSION: The symptoms and physical findings of haemodynamically significant PE are frequently nonspecific. Transthoracic echocardiography is the gold standard for rapid and confirmatory diagnosis of PE and cardiac tamponade. The most common cause of PE was malignancy followed by tuberculosis. Pericardiocentesis under echocardiographic guidance is a safe and effective treatment for significant PE

Mechanism of activation and regulation of Deubiquitinase activity in MINDY1 and MINDY2

Of the eight distinct polyubiquitin (polyUb) linkages that can be assembled, the roles of K48-linked polyUb (K48-polyUb) are the most established, with K48-polyUb modified proteins being targeted for degradation. MINDY1 and MINDY2 are members of the MINDY family of deubiquitinases (DUBs) that have exquisite specificity for cleaving K48-polyUb, yet we have a poor understanding of their catalytic mechanism. Here, we analyze the crystal structures of MINDY1 and MINDY2 alone and in complex with monoUb, di-, and penta-K48-polyUb, identifying 5 distinct Ub binding sites in the catalytic domain that explain how these DUBs sense both Ub chain length and linkage type to cleave K48-polyUb chains. The activity of MINDY1/2 is inhibited by the Cys-loop, and we find that substrate interaction relieves autoinhibition to activate these DUBs. We also find that MINDY1/2 use a non-canonical catalytic triad composed of Cys-His-Thr. Our findings highlight multiple layers of regulation modulating DUB activity in MINDY1 and MINDY2

A comprehensive design and optimization of an offset strip-fin compact heat exchanger for energy recovery systems

Energy recovery in conventional thermal systems like power plants, refrigeration systems, and air conditioning systems has enhanced their thermodynamic and economic performance. In this regard, compact heat exchangers are the most employed for gas to gas energy recovery because of their better thermal performance. This paper presents an economic optimization of a crossflow plate-fin heat exchanger with offset strip fins. A detailed software-based numerical code for thermal, hydraulic, economic, and exergy analysis is developed for three fin geometries. Genetic Algorithm, parametric, and normalized sensitivity analyses are used to discover the most influential parameters to optimize the total cost. The parametric study showed that with the increase of mass flow rates and plate spacing, outlet stream cost and operating cost increased due to the rise in pressure drops. Finally, the optimization reduced the operational cost by ∼78.5%, stream cost by ∼64.5%, and total cost by ∼76.8%