An effect of left ventricular hypertrophy on mild-to-moderate left ventricular diastolic dysfunction

AbstractObjectivesLeft ventricular diastolic dysfunction (LVDD) is associated with a variety of medical conditions. Left ventricular hypertrophy (LVH) is one of the most common abnormalities that induce LVDD. However, it is unclear whether LVH is a predictor of future LVDD deterioration that leads to diastolic heart failure in patients who already have mild-to-moderate LVDD. In this study, we investigated the effect of LVH on LV diastolic function in mild-to-moderate LVDD patients.MethodsOf the patients with mild-to-moderate LVDD (Grade I and II) with preserved left ventricular ejection fraction (EF), 225 with LVH (LVH group) and 225 without LVH (non-LVH group) were consecutively selected. LVDD was defined by the abnormal patterns of Doppler mitral inflow and tissue Doppler. Left ventricular filling pressure (FP) was estimated by the following formula: 1.9 +1.24× [early mitral inflow velocity (E)/early mitral annular velocity (e')]. The Tei index was implemented to assess global (both systolic and diastolic) left ventricular function. Echocardiographic parameters for LVDD, such as isovolumic relaxation time (IVRT), were compared between the two groups.ResultsFP and Tei index were significantly higher in the LVH group compared to the non-LVH group [15.68 mmHg vs. 14.07 mmHg, P < 0.0001, and 0.58 vs. 0.53, P < 0.003, respectively]. IVRT was significantly longer in the LVH group than in the non-LVH group [103.93 ± 23.93 vs. 95.94 ± 20.16, P < 0.0001].ConclusionsIn mild-to-moderate LVDD patients, both FP and the Tei index were significantly higher when LVH was present. This may suggest LVH as a possible predictor for the future development of severe LVDD and diastolic heart failure

Economics of fish production at Chitwan district, Nepal

A study was conducted in 2016 to analyze the economics of fish production at Chitwan District of Nepal. Three study sites: East, West and South part of Chitwan were selected purposively. A total of 90 households, 30 from each study site were selected randomly and were interviewed by using pre-tested semi structured questionnaire. Secondary data needed for the study were obtained from DADO, MOAD, NARC and other related organizations working on fisheries and aquaculture sector. Descriptive statistics and extended Cobb Douglas production function was used to accomplish the study objectives for which MS-Excel and SPSS 16 were used. The B/C ratio is obtained dividing the gross return by total variable cost incurred. The total cost of production per ha of the pond area was Rs. 743798 per year with 79 and 21 percent variable and fixed cost components, respectively. Feed cost (28 %) was largest cost item followed by cost for labour (25 %), fingerlings (10 %), maintenance (6 %), manure cum fertilizers (5 %), fuel cum energy (3 %) and limestone and others (2%). The average gross return and net profit realized per ha were Rs. 1223934 and Rs. 480135 respectively. The cost, return and profit were calculated to be highest for east Chitwan with highest B/C ratio followed by west Chitwan and south Chitwan. The B/C ratio for the district was found to be 1.63. The return to scale was found to be decreasing with value of 0.654 indicating that 1 percent increment in all the inputs included in the function will increase income by 0.654 percent. Production function analysis, including five variables, showed significant effect of human labour, fingerlings and fuel cum energy cost but feed and manure cum fertilizers cost were insignificant

Assessment of Soil Fertility Status in Rupani Rural Municipality, Saptari, Nepal

As soil fertility is one of the most important factors for soil productivity, soil fertility management is important for sustainable soil management. This study was conducted to determine the soil fertility status of Rupani Rural Municipality, Saptari, Nepal. A total of 60 soil samples were collected randomly from 0-30 cm depth. The exact location of the samples was recorded using a handheld GPS device. All collected samples were analyzed at a regional soil testing laboratory in Saptari to determine their pH, soil texture, nitrogen, phosphorus, potassium, and organic matter status. In addition, fertility status maps were prepared using ArcGIS 10.8 software. The study area consists mainly of 51.66% clay and 18.33% sandy loam soils. The soil pH ranged from highly acidic to slightly alkaline, with pH values ranging from 4.5 to 8.0. Soil organic matter (0.42-3.21%), nitrogen (0.02-0.16%), available phosphorus (40.1-282.35 kg P2O5/ha) and exchangeable potassium (64.8-729.6 kg K2O/ha) are present in the soil with the status of low to high in the study area. In order to improve crop potential and maintain soil nutrient status through the use of site-specific fertilizers, a reduction in the use of chemical fertilizers and various sustainable soil management practices were adopted. This research provides valuable information to policymakers, farmers, and agricultural stakeholders, facilitating evidence-based decision-making for agricultural development and food security in Rupani Rural Municipality, Saptari, Nepal

A Global Collaboration to Develop and Pilot Test a Mobile Application to Improve Cancer Pain Management in Nepal

INTRODUCTION: Quality palliative care, which prioritizes comfort and symptom control, can reduce global suffering from non-communicable diseases, such as cancer. To address this need, the Nepalese Association of Palliative Care (NAPCare) created pain management guidelines (PMG) to support healthcare providers in assessing and treating serious pain. The NAPCare PMG are grounded in World Health Organization best practices but adapted for the cultural and resource context of Nepal. Wider adoption of the NAPCare PMG has been limited due to distribution of the guidelines as paper booklets. METHODS: Building on a long-standing partnership between clinicians and researchers in the US and Nepal, the NAPCare PMG mobile application (“app”) was collaboratively designed. Healthcare providers in Nepal were recruited to pilot test the app using patient case studies. Then, participants completed a Qualtrics survey to evaluate the app which included the System Usability Scale (SUS) and selected items from the Mobile App Rating Scale (MARS). Descriptive and summary statistics were calculated and compared across institutions and roles. Regression analyses to explore relationships (α = 0.05) between selected demographic variables and SUS and MARS scores were also conducted. RESULTS: Ninety eight healthcare providers (n = 98) pilot tested the NAPCare PMG app. Overall, across institutions and roles, the app received an SUS score of 76.0 (a score > 68 is considered above average) and a MARS score of 4.10 (on a scale of 1 = poor, 5 = excellent). 89.8% (n = 88) “agreed” or “strongly agreed” that the app will help them better manage cancer pain. Age, years of experience, and training in palliative care were significant in predicting SUS scores (p-values, 0.0124, 0.0371, and 0.0189, respectively); institution was significant in predicting MARS scores (p = 0.0030). CONCLUSION: The NAPCare PMG mobile app was well-received, and participants rated it highly on both the SUS and MARS. Regression analyses suggest end-user variables important to consider in designing and evaluating mobile apps in lower resourced settings. Our app design and pilot testing process illustrate the benefits of cross global collaborations to build research capacity and generate knowledge within the local context

Climate change and maize agriculture among Chepang communities of Nepal: A review

This paper reviews recent literature concerning effects of climate change on agriculture and its agricultural adaptation strategies, climate change impacts on Chepang communities and their maize farming. Climate change is perhaps the most serious environmental threat to agricultural productivity. Change in temperature and precipitation specially has greater influence on crop growth and productivity and most of these effect are found to be adverse. Climate change has been great global threat with global temperature rise by 0.83 °C and global sea level rise by 0.19 m. Poor countries of the world are more vulnerable to changing climate due to different technological, institutional and resource constraints. In context of Nepal, practices like tree plantation, lowering numbers of livestock, shifting to off farm activities, sloping agricultural land technology (SALT) and shifting cultivation are most common coping strategies. Chepang, one of the most backward indigenous ethnic groups of Nepal are also found to perceive change in the climate. Perception and adaptation strategies followed by different farmers of world including Chepang is mainly found to be effected by household head’s age, size of farm, family size, assessment to credit, information and extension service, training received and transportation. Maize is second most important crop in Nepal in which increase in temperature is favorable in Mountain and its yield is negatively influenced by increase in summer rain and maximum temperature. Local knowledge of indigenous people provides new insights into the phenomenon that has not yet been scientifically researched. So, government should combine this perceptive with scientific climate scenario and should conduct activities in term of adoption strategies and policies to insist targeted and marginalized farmers

Change in Hospitalization Rates Following Transcatheter Left Atrial Appendage Occlusion

IntroductionLeft atrial appendage occlusion (LAAO) is recommended in patients with non-valvular atrial fibrillation (AF) who have contraindications to or are intolerant of long-term oral anticoagulants (OAC), but its impact on hospitalization rates has not been well described. The objective of our study is to describe the incidence of all-cause, bleeding-related, and thrombosis-related hospitalizations before and after LAAO.Material and methodsWe used the Nationwide Readmission Database to include patients aged ≥ 18 years with a diagnosis of AF who underwent transcatheter LAAO during the months of February-November in each year between 2016 and 2018. Patients who died during the index procedure or had missing length of hospital stay or mortality information were excluded.ResultsA total of 27,633 patients were included (median age: 77 years, 41% female) with an average pre- and post-LAAO monitoring period of 6.5 and 5.5 months respectively. Of these, 10,808 (39.1%) patients had one or more admissions prior to the procedure compared to 7,196 (26.0%) after the procedure. There was a 26% reduction in incidence of all-cause admissions (rate ratio (RR) = 0.74, 95% confidence interval (CI): 0.71–0.76; p \u3c 0.001), 49% reduction in bleeding-related admissions (RR = 0.51, 95% CI: 0.48–0.55; p \u3c 0.001), and 71% reduction in thrombosis-related readmissions (RR = 0.29, 95% CI: 0.26–0.33; p \u3c 0.001) after LAAO.ConclusionsIn a contemporary, nationally representative dataset, we found that LAAO is associated with a significant decrease in all-cause, bleeding-related, and thrombosis-related admissions. These findings lend support to the current use of transcatheter LAAO in clinical practice for patients with contraindications to OAC and/or at high risk of bleeding

Left atrial appendage volume as a prognostic Indicator of long-term mortality in Cancer survivors treated with thoracic radiation

Abstract Background Cancer survivors with prior chest radiation therapy (CXRT) frequently present with atrial fibrillation, heart failure, and have higher overall long-term mortality. There are no data examining the utility of left atrial (LA) and LA appendage (LAA) volume-indices to predict clinical outcomes in these patients. Objectives We examined the prognostic value of cardiac phase-dependent 3-D volume-rendered cardiac computerized tomography (CT)-derived LA and LAA volume-indices to predict mortality and major adverse cardiac events (MACE) in cancer survivors treated with thoracic irradiation. Method We screened 625 consecutive patients with severe aortic stenosis who had undergone transcatheter aortic valve replacement from 2012 to 2017. Based on the gated cardiac CT image quality, we included 184 patients (CXRT:43, non-CXRT:141) for further analysis. We utilized multiplane-3D-reconstructed cardiac CT images to calculate LA and LAA volume-indices, and examined the prognostic role of CCT-derived LA and LAA volume-indices in predicting the all-cause mortality, cardiovascular (CV) mortality, and MACE. We used multivariate cox-proportional hazard analysis to identify the clinical predictors of survival. Results Overall, the CXRT group had significantly elevated LAA volume-index compared to non-CXRT group (CXRT:11.2 ± 8.9 ml/m2; non-CXRT:8.6 ± 4.5 ml/m2, p = 0.03). On multivariate cox-proportional hazard analysis, the elevated LAA volume and LAA volume-index were the strongest predictors of reduced survival in CXRT group compared to non-CXRT group (LAA volume: RR = 1.03,95% CI 1.0–1.01, p = 0.01; and LAA volume index: RR = 1.05, 95% CI 1.0–1.01, p = 0.03). LAA volume > 21.9 ml was associated with increased mortality. In contrast, LA volume was not a significant predictor of mortality. Conclusion We describe a novel technique to assess LA and LAA volume using 3-D volume-rendered cardiac CT. This study shows enlarged LAA volume rather than LA volume carries a poor prognosis in cancer-survivors treated with prior CXRT. Compared to conventionally reported markers, LAA volume of > 21.9 ml was incremental to that of other risk factors

Left atrial appendage volume as a prognostic Indicator of long-term mortality in Cancer survivors treated with thoracic radiation.

BACKGROUND: Cancer survivors with prior chest radiation therapy (CXRT) frequently present with atrial fibrillation, heart failure, and have higher overall long-term mortality. There are no data examining the utility of left atrial (LA) and LA appendage (LAA) volume-indices to predict clinical outcomes in these patients. OBJECTIVES: We examined the prognostic value of cardiac phase-dependent 3-D volume-rendered cardiac computerized tomography (CT)-derived LA and LAA volume-indices to predict mortality and major adverse cardiac events (MACE) in cancer survivors treated with thoracic irradiation. METHOD: We screened 625 consecutive patients with severe aortic stenosis who had undergone transcatheter aortic valve replacement from 2012 to 2017. Based on the gated cardiac CT image quality, we included 184 patients (CXRT:43, non-CXRT:141) for further analysis. We utilized multiplane-3D-reconstructed cardiac CT images to calculate LA and LAA volume-indices, and examined the prognostic role of CCT-derived LA and LAA volume-indices in predicting the all-cause mortality, cardiovascular (CV) mortality, and MACE. We used multivariate cox-proportional hazard analysis to identify the clinical predictors of survival. RESULTS: Overall, the CXRT group had significantly elevated LAA volume-index compared to non-CXRT group (CXRT:11.2 ± 8.9 ml/m CONCLUSION: We describe a novel technique to assess LA and LAA volume using 3-D volume-rendered cardiac CT. This study shows enlarged LAA volume rather than LA volume carries a poor prognosis in cancer-survivors treated with prior CXRT. Compared to conventionally reported markers, LAA volume of \u3e 21.9 ml was incremental to that of other risk factors