Disparity in Physician Recognition of QT interval duration and associated Mortality

Background QT interval prolongation is associated with all-cause mortality (1,2). American Heart Association/American College of Cardiology (AHA/ACC) recommends considering QTc interval above 99th percentile as abnormally prolonged, to prevent Torsade de Pointes (TdP). Methods This is a retrospective chart review of 291 EKG’s (162 unique), from patients visiting our facility at Valley Baptist Medical Center (Harlingen) from January 2016 to March 2020. All EKG’s were read, the measured QT interval was corrected for heart rate using the Bazett formula. Simple descriptive statistics were created with all variables considered: patient age, gender, interpreting physician, report/ documentation of long QT, presence of U-wave falsely prolonging QT, and death. Correlation analysis was done, with linear mixed models to assess prolongation to account for repeated measures on some patients. Results The average age of patients was 65.7 years (SD=17.2, range:18-98) and 70.3% was male gender. EKGs were reviewed by a cardiologist or ER doctor 59.99%, 40.06% respectively. 4 EKG’s (1.3%) were not reviewed by a physician. The 90th and 99th percentile QTc (milliseconds) was 517 and 588.1 respectively. U-wave was included in the measurement of QT interval 1.7% times, contributed to false reporting of QTc above the 99th percentile once. Using the 90th percentile cutoff, cardiologist documented prolonged QT (57.1%, 12/21) more often than an ER doctor (45.45%, 5/11) [p-value= 0.529]. Of the reported deaths (12/162), arrhythmia-related deaths (80%) are more likely associated with QTc above 50th percentile i.e., 475 ms than non-arrhythmia related death (14.7%) [p-value= 0.022]. QT prolongation was not documented in any death summary. Conclusion The observed trend is for cardiologists less likely to make an error than ER doctors, though not statistically significant. Based on the results of the study, this problem is likely not acted upon and may be associated with increased mortality (more likely arrhythmia-related death). Long QT duration is a common problem and these results suggest further studies needed. References 1) Charlotte Gibbs, Jacob Thalamus, Doris Tove Kristoffersen, Martin Veel Svendsen, Øystein L Holla, Kristian Heldal, Kristina H Haugaa, Jan Hysing, QT prolongation predicts short-term mortality independent of comorbidity, EP Europace, Volume 21, Issue 8, August 2019, Pages 1254–1260. 2) de Bruyne MC, Hoes AW, Kors JA, Hofman A, van Bemmel JH, Grobbee DE. Prolonged QT interval predicts cardiac and all-cause mortality in the elderly. The Rotterdam Study. Eur Heart J. 1999 Feb;20(4):278-84

Seasonal Variation of Groundwater Quality for Irrigational uses in Gadilam River Basin, Tamil Nadu, India

The present research work pertains to the Gadilam river basin groundwater quality for irrigation uses with respect to the Archaean formation, the Quaternary formation, the Tertiary formation and the Cretaceous formation. Experiments were carried out for two seasons (rainy season and summer season) for two successive years (November 2018 and June 2019). Overall, 120 groundwater samples were collected from the Gadilam river basin, excluding the reserved forest area. The 50 samples were collected from the Archaean formation, 34 samples from the Quaternary formation, and 35 samples from the Tertiary Formation. The remaining sample is from the Cretaceous formation. Based on the obtained analysed data, the following agricultural water quality parameters were calculated using the following expressions: The irrigational quality parameters are used, such as sodium percentage (Na%), sodium adsorption ratio (SAR), Kelly’s ratio (KR), permeability index (PI), magnesium ratio (MR), residual sodium carbonate (RSC), and potential salinity (PS) are calculated and assessed for irrigation purposes

Development and Validation of Stability Indicating RP-HPLC Method for the Simultaneous Estimation of Cabotegravir and Rilpivirine in Bulk and Tablet Dosage Form

A simple, Accurate, precise method was developed for the simultaneous estimation of the Cabotegravir and Rilpivirine in bulk and Tablet dosage form. Chromatogram was run through Denali C18 (150 x 4.6 mm, 5µ). Mobile phase containing Buffer 1.0% OPA: Acetonitrile taken in the ratio 60:40 was pumped through column at a flow rate of 1.0 mL/min. Buffer used in this method was 0.1% OPA buffer. Temperature was maintained at 30°C. Optimized wavelength selected was 260.0 nm. Retention time of Cabotegravir and Rilpivirine were found to be 3.020 min and 2.281 min. % RSD of the Cabotegravir and Rilpivirine were and found to be 0.9 and 0.6 respectively. % Recovery was obtained as 100.60% and 100.54% for Cabotegravir and Rilpivirine respectively. LOD, LOQ values obtained from regression equations of Cabotegravir and Rilpivirine were 0.91, 2.74 and 3.88, 11.72 respectively. % Assay was obtained as 100.32% and 100.42% for Cabotegravir and Rilpivirine respectively. Regression equation of Cabotegravir is y =4099.x + 5230, y = 6957.x + 26409 of Rilpivirine. Retention times were decreased and that run time was decreased, so the method developed was simple and economical that can be adopted in regular Quality control test in Industries

WEAKLY NONLINEAR STABILITY ANALYSIS OF A NON-UNIFORMLY HEATED NON-NEWTONIAN FALLING FILM

ABSTRACT A thin liquid layer of a non-Newtonian film falling down an inclined plane that is subjected to non-unifor

HEALTH RELATED QUALITY OF LIFE ASSESSMENT USING ST. GEORGE'S RESPIRATORY QUESTIONNAIRE IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS ON COMBINED INHALED CORTICOSTEROIDS AND BRONCHODILATORS

Objective: Chronic diseases like COPD have significant effects on patient's health-related quality of life (HRQoL). HRQoL measures additional indices as compared to objective measurements like spirometry. Our aim is to assess and compare the disease-specific quality of life in Chronic Obstructive Pulmonary Disease patients using St. George's Respiratory Questionnaire (SGRQ-C) receiving Salmeterol/Fluticasone (SF), Formoterol/Budesonide (FB), Formoterol/Fluticasone (FF).Methods: A prospective, open-label, randomized, parallel group study conducted at a tertiary care teaching hospital in South India. A 6-months follow-up of 90 patients with severe and very severe COPD randomized to receive Salmeterol/Fluticasone, Formoterol/Budesonide, and Formoterol/Fluticasone in appropriate doses according to their global initiative for chronic obstructive lung disease (GOLD) severity. After spirometry, St. George's Respiratory Questionnaire (SGRQ-C) was administered at baseline and after 180 d to assess improvement in lung function and HRQoL. Statistical analysis used: Data analyzed using SPSS version: 13.0. General linear repeated measures using the post-hoc Bonferroni method assessed significance between treatment groups.Results: Significant decrease (P<0.05) in each SGRQ-C domains and total scores as well as improvement in FEV1 (P<0.05) was observed in all study subjects. The mean SGRQ-C total score for the group I subjects (SF) at the initial visit was 86.69 and the scores reduced to 58.78 at final visit (i.e. after using SF for 6 mo). This reduction was highly significant statistically (t=10.989, p=0.000) at 95% CI. The mean SGRQ-C total scores for group II subjects (FB) at initial visit were 85.85 and the scores reduced to 67.98 at the final visit. This reduction was highly significant statistically (t=9.669, p=0.000) at 95% CI. The mean SGRQ-C total scores for group III subjects (FF) at initial visit were 83.96 and the scores reduced to 70.37 at final visit (after 6 mo). This reduction was highly significant statistically (t=12.285, p=0.000) at 95% CI.Conclusion: Maximum improvement in HRQoL (P<0.05) was noted in patients receiving Salmeterol/Fluticasone with respect to SGRQ-C (activity, impact and total) scores and FEV1. This improvement with SF was due to its greater effect in patients with severe and very severe chronic obstructive pulmonary disease. There was a significant improvement in QoL with SF as compared to FB and FF in severe and very severe COPD patients. Subsequently, the three combined inhaled corticosteroids and bronchodilators showed similar improvements in lung functions and Health related quality of life throughout the study.Â

Evaluation and phytochemical screening and antibacterial activity of Ficus dalhousiae Miq

The aim of the present study was to isolate the Extract from the leaves of Ficus dalhousiae Miq and subse-quently evaluate their antibacterial and antifungal activity. The crude various extracts of the plant n-Hexane, Chloroform, Ethyl acetate, Methanol extract was obtained by using continuous soxhlation tech-nique using soxhlet apparatus. The antibacterial activity of plant extract were carried using cup plate method against three bacterial species Staphylococcus aures, Bacillus subtilis, Escherichia coli using agar diffusion method. those are compared with standard reference drug Ciprofloxacin. This study confirmed that bark extracts have more active constituents compare to leaf extracts. by pharmacological evaluation of Ficus dalhousea Miq. Various extracts, most of them are capable of showing moderate antibacterial activity

COVID-19: understanding pathology & management in Unani medical perspective

The whole world is facing a big challenge to fight against COVID-19 as it is a novel disease, highly infectious and having no treatment yet. Traditional Unani medicine is reviewed with an aim to find some solution for this disease prevention control and management. Unani medical literature is extensively reviewed and found that there are some presentations similar to this disease and management of those clinical syndromes could be applied in present scenario. Major symptoms like fever, cough, fatigue, shortness of breath and rhinorrhoea are reviewed from Unani medical text having similar etiology and interlinked pathology. It is demonstrated that in cold & humid atmospheric conditions in persons having Fuzlat (waste) in their body, Nazla (fall) of Balghami Rutubaat (phlegmatic fluids) from head comes towards lungs, infected there resulting in Zatur Riya (pneumonia/pneumonitis) and Humma Mawazba (fever caused by abnormal humour Dam) and /or Humma Mutbiqa (fever caused by abnormal humour Balgham). The bad atmospheric condition favours spread of this infection to other people who come in contact with such patient. The detailed description of this Unani concepts & interpretation is given below