Wake Forest University long-term follow-up of type 2 myocardial infarction: The Wake-Up T2MI Registry

BACKGROUND: The Wake-Up T2MI Registry is a retrospective cohort study investigating patients with type 2 myocardial infarction (T2MI), acute myocardial injury, and chronic myocardial injury. We aim to explore risk stratification strategies and investigate clinical characteristics, management, and short- and long-term outcomes in this high-risk, understudied population. METHODS: From 1 January 2009 to 31 December 2010, 2846 patients were identified with T2MI or myocardial injury defined as elevated cardiac troponin I with at least one value above the 99th percentile upper reference limit and coefficient of variation of 10% ( \u3e 40 ng/L) and meeting our inclusion criteria. Data of at least two serial troponin values will be collected from the electronic health records to differentiate between acute and chronic myocardial injury. The Fourth Universal Definition will be used to classify patients as having (a) T2MI, (b) acute myocardial injury, or (c) chronic myocardial injury during the index hospitalization. Long-term mortality data will be collected through data linkage with the National Death Index and North Carolina State Vital Statistics. RESULTS: We have collected data for a total of 2205 patients as of November 2018. The mean age of the population was 65.6 +/- 16.9 years, 48% were men, and 64% were white. Common comorbidities included hypertension (71%), hyperlipidemia (35%), and diabetes mellitus (30%). At presentation, 40% were on aspirin, 38% on beta-blockers, and 30% on statins. CONCLUSION: Improved characterization and profiling of this cohort may further efforts to identify evidence-based strategies to improve cardiovascular outcomes among patients with T2MI and myocardial injury

Erythromelalgia: An Uncommon Presentation Precipitated by Aspirin Withdrawal

Erythromelalgia is a rare disorder frequently associated with myeloproliferative disorders. We describe a case of elderly patient diagnosed with myeloproliferative disorder in remission. The patient was on aspirin for secondary prevention of stroke and was taken off aspirin and developed erythromelalgia within two weeks of withdrawal of aspirin. After restarting aspirin, patient’s symptoms improved within 2 weeks

Does diversification affect capital structure and profitability in Pakistan?

Diversification has become a common strategy of corporate risk management along with availing other potential benefits. The intent of this study is to identify and analyze the nature of relationship that exists between diversification and capital structure as well as profitability in Pakistan. For this purpose we use the 10 years’ (2000-2009) data of all the companies of chemical and food sector listed at the Karachi Stock Exchange (KSE). We find that the diversified firms are more profitable. Using independent variables of firm size, growth and tangibility the results show that whenever significant, the relationship is associated with greater amount of debt held by the firm

A time-efficient web-based teaching tool to improve medical knowledge and decrease ABIM failure rate in select residents

AIM: The American Board of Internal Medicine (ABIM) exam\u27s pass rate is considered a quality measure of a residency program, yet few interventions have shown benefit in reducing the failure rate. We developed a web-based Directed Reading (DR) program with an aim to increase medical knowledge and reduce ABIM exam failure rate. METHODS: Internal medicine residents at our academic medical center with In-Training Examination (ITE) scores ≤ 35 th percentile from 2007 to 2013 were enrolled in DR. The program matches residents to reading assignments based on their own ITE-failed educational objectives and provides direct electronic feedback from their teaching physicians. ABIM exam pass rates were analyzed across various groups between 2002 and 2013 to examine the effect of the DR program on residents with ITE scores ≤ 35 percentile pre- (2002-2006) and post-intervention (2007-2013). A time commitment survey was also given to physicians and DR residents at the end of the study. RESULTS: Residents who never scored ≤ 35 percentile on ITE were the most likely to pass the ABIM exam on first attempt regardless of time period. For those who ever scored ≤ 35 percentile on ITE, 91.9% of residents who participated in DR passed the ABIM exam on first attempt vs 85.2% of their counterparts pre-intervention (p \u3c 0.001). This showed an improvement in ABIM exam pass rate for this subset of residents after introduction of the DR program. The time survey showed that faculty used an average of 40±18 min per week to participate in DR and residents required an average of 25 min to search/read about the objective and 20 min to write a response. CONCLUSIONS: Although residents who ever scored ≤ 35 percentile on ITE were more likely to fail ABIM exam on first attempt, those who participated in the DR program were less likely to fail than the historical control counterparts. The web-based teaching method required little time commitment by faculty

Assessing Water Consumption of Major Crops in the Command Area of Malwah Distributary, Shaheed Benazirabad, Sindh.

Soil and water are vital natural resources on which agriculture sector growth and village livelihood depend and having the proper knowledge of the Soil, Plant, and water relationship are extremely important to achieve sustainable agricultural productivity. Pakistan has entered the 21st century with the rising challenge to meet food and fiber requirements for its population for domestic consumption and export. Without having appropriate knowledge about the intense water need of plants, most of the agricultural land in Pakistan is still being irrigated by conventional methods, which in turn produces so many problems and reduces the agricultural productivity putting extra stress on the country’s economy, so to avoid these issues, it is extremely necessary to provide the required quantity of water to plant, which will only be possible by consideration and accurate estimation of Evapotranspiration of plant so to enhance awareness and practice of water-saving agriculture in Pakistan to increase the agricultural commodities. In this study, estimation of Actual Evapotranspiration ( ETa ) of Malwah Distributary located in Shaheed Benazirbad, Sindh was selected from Command area of Rohri Canal, ET of four different crops; Cotton, Fallow, Rice and Sugarcane for the period of Rabi 2019-2020 and Kharif 2020 was estimated by using satellite-based evapotranspiration mapping tool namely METRIC REFLUX. The actual ET for each season was obtained using the Reference ET fraction (ETrf) of satellite data and reference ET(ETr) obtained from the literature. The classified crop mask was obtained using maximum likelihood classification on bands 8,4, and 3 of sentinel-2 images of the year 2020. The overall accuracy obtained is 93% with a kappa coefficient 0.921841. The average Actual Evapotranspiration of different crops namely, banana, cotton, rice, and sugarcane were found to be 1527.2 mm, 536.6 mm, 386.80 mm, and 814.02 m

Systematic review and meta-analysis of mortality and digoxin use in atrial fibrillation

Background: There is growing controversy regarding the association between digoxin and mortality in atrial fibrillation (AF). The aim of this analysis was to systematically review digoxin use and risk of mortality in patients with AF. Methods: MEDLINE, EMBASE, GoogleScholar, CINAHL, meeting abstracts, presentations, and Cochrane central databases were searched from inception through December 2014, without language restrictions. For a study to be selected, it had to report the risk of mortality associated with digoxin use in AF patients as an outcome measure. Data were extracted by 2 independent authors. Evidence tables were created. Results: A total of 16 studies (6 post hoc analyses of randomized controlled trials) with 111,978 digoxin users and 389,643 non-digoxin users were included. In a random effects model, patients treated with digoxin had a 27% increased risk of all-cause mortality (pooled HR 1.27; 95% CI 1.19–1.36) and 21% increased risk of cardiovascular mortality (pooled HR 1.21; 95% CI 1.12–1.30) compared with those who did not use digoxin. In a random effects model, the association of digoxin with all-cause mortality was stronger for AF patients without heart failure (pooled HR 1.47; 95% CI 1.25–1.73) than AF patients with heart failure (pooled HR 1.21; 95% CI 1.07–1.36, interaction p = 0.06). Conclusions: Digoxin use in AF is associated with increased risk of all-cause and cardiovascular mortalities. The effect size was larger for AF patients without heart failure than AF patients with heart failure. The study suggests further directed analyses to study the effect that is suggested by this meta-analysis, especially in AF without heart failure.

EPDM Based Double Slope Triangular Enclosure Solar Collector: A Novel Approach

Solar heating is one of the important utilities of solar energy both in domestic and industrial sectors. Evacuated tube heaters are a commonly used technology for domestic water heating. However, increasing cost of copper and nickel has resulted in huge initial cost for these types of heaters. Utilizing solar energy more economically for domestic use requires new concept which has low initial and operating costs together with ease of maintainability. As domestic heating requires only nominal heating temperature to the range of 60–90°C, therefore replacing nickel coated copper pipes with any cheap alternate can drastically reduce the cost of solar heater. We have proposed a new concept which utilizes double slope triangular chamber with EPDM based synthetic rubber pipes. This has reduced the initial and operating costs substantially. A detailed analytical study was carried out to design a novel solar heater. On the basis of analytical design, a prototype was manufactured. Results obtained from the experiments were found to be in good agreement with the analytical study. A maximum error of 10% was recorded at noon. However, results show that error is less than 5% in early and late hours

Effects of Growing Media and Irrigation Interval on Growth of Amaryllis (Amaryllis Belladonna)

Four combinations of various growing media i.e. garden soil, canal silt, farm yard manure,  mushroom compost,  leaf mold and  poultry manure and four irrigation intervals (i.e. 5, 10, 15 and 20 days) were  trailed to investigate their effects on growth and flowers production of Amaryllis belladonna, at Horticulture Nursery of University of Agriculture, Peshawar during 2012.Growing medium composed of garden soil, canal silt, and mushroom compost resulted in early emergence (18.66 days), maximum leaf length (47.87cm), leaf width (2.44 cm), number of leaves (13.55). Maximum leaf length (48.16cm), leaf width (2.36 cm), number of leaves per plant (13.55), was noted at irrigation interval of 10 days. Since Mushroom compost growing media and 10 days irrigation interval interaction showed significant result among most of the parameters observed hence for better growth growing media garden soil + canal silt + mushroom compost with 10 days irrigation interval is recommended. Keywords: Emergence, leaf length & width

Spectrum of Breast Diseases in a Breast Clinic of a Tertiary Care Hospital

Background: To determine the pattern and clinical presentation of breast diseases in different age groups presenting to a breast clinic. Methods: It was a retrospective descriptive study which included all patients presenting to a breast clinic for three years. Age at presentation, symptoms, clinical features, investigations, operative findings and specimen reports were recorded and submitted for analysis. . Results: A total of 3568 patients were included. Mastalgia was the commonest findings (39.42%) followed by fibroadenoma(15.83%) and carcinoma of breast (12.61%). Pain in the breast was the commonest presenting symptom (40.38%). Lump in the breast was found in 22.84%, while pain and lump were present in 27.27% of patients. Among carcinoma breast, intra ductal carcinoma was the commonest (57.55%) followed by malignant phyllodes tumour (17.77%). Conclusion: Most common breast diseases presenting in our setting are mastalgia, fibroadenoma and breast carcinoma. Dedicated breast clinic in our public sector hospitals is need of time. It will help to create awareness about breast diseases among general public and will be a source to collect data about disease burden so that future policies can be streamline