Cardiac tamponade on ECPELLA: a case report of a unique hemodynamic picture

Extracorporeal membrane oxygenation is rapidly becoming a preferred therapy for short-term hemodynamic support in cardiogenic shock, along with the use of devices such as Impella (Abiomed, Andover, MA). The two together can create unique hemodynamics resulting in altered presentation of common hemodynamic conditions such as tamponade. We present a case of a patient with fulminant myocarditis requiring veno-arterial extracorporeal membrane oxygenation and Impella support. The patient later developed a pericardial effusion with atypical tamponade physiology which masked the left ventricular systolic function recovery. We further highlight the complex hemodynamics of cardiac tamponade in patients with such mechanical circulatory support and its implications on echocardiography

સંસ્કૃત સાહિત્યમાં વિશિષ્ટાદ્વૈતી વૈષ્ણવ સ્તોત્રો : એક અધ્યયન

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A comparative study of efficacy and safety of pitavastatin versus atorvastatin in the patients of dyslipidemia in medicine department of a tertiary care teaching hospital

Background: Cardiovascular diseases (CVDs) are the major cause of death globally. Dyslipidemia is one of the most significant risk factors for CVD. 3-hydroxy 3-methyl glutaryl coenzyme A reductase inhibitors (statins), which are used for the treatment of dyslipidemia, has a beneficial effect in both primary and secondary prevention of CVD. Hence, this study was done to compare the efficacy and safety of atorvastatin versus pitavastatin in patients of dyslipidemias.Methods: After obtaining ethical clearance from institution and written informed consent from patients, 100 patients included in the study were randomly allocated to any of the following two groups. (1) Group A: Tablet atorvastatin 10 mg given orally once a day for 12 weeks. (2) Group B: Tablet pitavastatin 2 mg given orally once a day for 12 weeks. The primary endpoint of the study was a comparative assessment of change in lipid profile (triglyceride, low-density lipoprotein [LDL], high-density lipoprotein [HDL]) from baseline and after 12 weeks. The secondary endpoint involved recording all the adverse effects during the study.Results: Analysis of the baseline and post 12 weeks lipid levels by non-parametric unpaired t-test showed a statistically significant increase in HDL-cholesterol (HDL-C) in Group B as compared to Group A (p=0.028 i.e. p<0.05). However, there was no significant difference between two groups in decreasing LDL-cholesterol (LDL-C) (p=0.615).Conclusions: In this study, pitavastatin is found to be more efficacious than atorvastatin in increasing HDL-C levels, while as efficacious as atorvastatin in decreasing LDL-C in dyslipidemic patients. Atorvastatin is better tolerated than pitavastatin

Effect of varying levels of bypass fat on digestibilities of nutrients and balances of N, P and Ca in lactating Jaffrabadi buffaloes

Lactating Jaffrabadi buffaloes (24; first to fourth lactation and average body weight 650.0 kg) were randomly divided into 4 groups of 6 animals each as per completely randomized design and allocated to 4 dietary treatments as T1,T2, T3 and T4. Experimental buffaloes were offered commercial concentrate mixture and cotton seed cake in equal proportion (50:50) to fulfil the protein requirements as per ICAR (1998) along with the basal diet of 10 kg seasonal green and mature pasture grass hay ad lib. Commercial bypass fat was provided to all experimental buffaloes at the rate of 150g per animal for first 15 days prior to parturition and at the rate of 0, 10g, 20g and 30g /kg milk yield in T1, T2, T3 and T4 groups, respectively post partum. DMI, Per cent DMI and DMI/kg W0.75 of lactating buffaloes remained non significant among different treatment groups during entire experiment. Lactating buffaloes also showed non-significant differences in body weight and biometry during different phases of experiment. Differences in water intake (l/day, l/100kg B.W., l/kg W0.75 and l/kg DMI) by different levels of bypass fat supplementation were also non significant. Digestibility of the rations for DM, OM, CP, EE, CF and NFE were not significantly affected by addition of supplemental fat. Nitrogen, phosphorus and calcium balances were positive and non significant among different treatment groups. Plane of nutrition as per ICAR nutritional requirements for Indian buffaloes was comparable among different dietary treatments. Overall results indicates that bypass fat supplementation has positive but non significant effect on nutrient utilization in different groups

Contrast-enhanced Ultrasound Assessment of Treatment Response in a Patient with Multifocal Hepatocellular Carcinoma Treated with Transarterial Chemo and Radioembolization

Minimally invasive locoregional therapies have become important treatment options for patients with intermediate or late-stage hepatocellular carcinoma (HCC) who are ineligible for surgical resection or liver transplantation. Imaging modalities are essential for procedural guidance and for assessing treatment response thereafter. We report a unique finding of a patient with multifocal HCC treated with transarterial radioembolization (TARE) with yttrium-90 (Y90) and transarterial chemoembolization (TACE). We compared contrast-enhanced ultrasound (CEUS) with contrast-enhanced magnetic resonance imaging (CE-MRI) in the evaluation of treatment response to demonstrate advantages of CEUS imaging technique and its early detection of viable tumor

Influence of peripartum dietary supplementation of choline and fat in protected form on production performance of Gir cows

In this experiment, the effects of supplementing choline and fat in rumen protected form during peripartum period on feed intake, milk production and composition of Gir cows were studied. Twenty four Gir cows of 1st to 3rd parity were used from 30 days pre-partum through 60 days post-partum and randomly assigned to four equal treatment groups (n=6) on the basis of their parity, body weight and previous lactation yield. Control diet was fed to cows in group T1 (control). Additionally, rumen protected choline (RPC) @45 g/d in group T2; rumen protected fat (RPF) 80 g/d in group T3 and RPC @45 g/d + RPF @80 g/d in group T4 were supplemented along with control diet. The treatments significantly affected dry mater intake (DMI) and milk production of cows. DMI was increased in the cows fed with RPC as compared to control. Milk yield, 4% fat-corrected milk, solid-corrected milk and energy- corrected milk were higher in the cows fed with RPC and RPF alone or in combination, as compared to control. No synergistic effect was observed with these supplements on DMI or milk production. None of these supplements influenced the milk composition significantly, however yield of milk fat, protein and lactose were higher in all the nutrient supplemented cows compared to control. Net return over feed cost was higher in supplemented cows compared to control. Results indicated that supplementation of RPC or RPF can improve feed intake and productive performance of Gir cows for overall economic benefits

Prediction of self-compacting concrete elastic modulus using two symbolic regression techniques

yesThis paper introduces a novel symbolic regression approach, namely biogeographical-based programming (BBP), for the prediction of elastic modulus of self-compacting concrete (SCC). The BBP model was constructed directly from a comprehensive dataset of experimental results of SCC available in the literature. For comparison purposes, another new symbolic regression model, namely artificial bee colony programming (ABCP), was also developed. Furthermore, several available formulas for predicting the elastic modulus of SCC were assessed using the collected database. The results show that the proposed BBP model provides slightly closer results to experiments than ABCP model and existing available formulas. A sensitivity analysis of BBP parameters also shows that the prediction by BBP model improves with the increase of habitat size, colony size and maximum tree depth. In addition, among all considered empirical and design code equations, Leemann and Hoffmann and ACI 318-08’s equations exhibit a reasonable performance but Persson and Felekoglu et al.’s equations are highly inaccurate for the prediction of SCC elastic modulus

Implementation of modified artificial bee colony (ABC) optimization technique for minimum cost design of welded structures

Welded structures are widely used in many engineering load carrying structures such as columns, towers for wind turbine or water tanks, offshore and submarine structures, girders, stiffened doors, etc. welding is a costly fabrication process and proper sequence and welding process effect the cost of a huge structure. Keeping this in view two different problems from the literature for the cost optimization of welded structures are considered in this paper. The optimization procedure is carried out using artificial bee colony (ABC) optimization technique. Classical ABC is modified to increase the convergence rate of the original algorithm. Comparison of both the variants is experimented on many bench mark examples from the literature and also on two cost optimization problems of welded structures. The results of the considered techniques are compared with the previously published results. The considered techniques have given much better results in comparison to the previously tried approaches and also modified ABC has shown superiority over classical ABC

Modified meta-heuristics using random mutation for truss topology optimization with static and dynamic constraints

In this paper, simultaneous size and topology optimization of planar and space trusses subjected to static and dynamic constraints are investigated. All the benchmark trusses consider discrete cross-sectional areas to consider the practical aspect of manufacturing. Moreover, Trusses are considered with multiple loading conditions and subjected to constraints for natural frequencies, element stresses, nodal displacements, Euler buckling criteria, and kinematic stability conditions. Truss topology optimization (TTO) can be accomplished by the removal of superfluous elements and nodes from the highly hyper static truss also known as the ground structure and results in the saving of the mass of the truss. In this method, the difficulties arise due to the singular solution and unnecessary analysis; therefore, FEA model is reformed to resolve these difficulties. The static and dynamic responses to the TTO problems are challenging due to its search space, which is implicit, non-convex, non-linear, and often leading to divergence. Modified meta-heuristics are effective optimization methods to handle such problems in actual fact. In this paper, modified versions of Teaching–Learning-Based Optimization (TLBO), Heat Transfer Search (HTS), Water Wave Optimization (WWO), and Passing Vehicle Search (PVS) are proposed by integrating the random mutation-based search technique with them. This paper compares the performance of four modified and four basic meta-heuristics to solve discrete TTO problems