QRS duration and echocardiographic evidence of left ventricular dyssynchrony in patients with left ventricular systolic dysfunction

OBJECTIVE: To determine the association between left ventricular (LV) dyssynchrony assessed by tissue Doppler imaging (TDI) in patients with left ventricular ejection fraction (LVEF) \u3c 35% and prolonged ventricular depolarization on electrocardiography. STUDY DESIGN: A cross-sectional study. PLACE AND DURATION OF STUDY: The Aga Khan University, Karachi, from June to September 2007. METHODOLOGY: All patients with LVEF \u3c 35% were included. Apical 2-D images were obtained in 4 chamber and 2 chamber views. TDI pulse wave Doppler parameters were measured from these 2 color-coded images. Time interval between the onset of QRS complex and the peak systolic velocity per region was derived. Patients with valvular heart disease, mitral annular calcification, atrial fibrillation and paced rhythm were excluded. Fischer\u27s exact test was used to determine the association between QRS duration and left ventricular dyssynchrony. RESULTS: A total of 60 patients were included. Twenty one patients had QRS duration of \u3e 120 msec. Out of those 21 patients, a total of 6 patients (28.6%) had evidence of dyssynchrony on TDI. Five patients (23.8%) had dyssynchrony on the basis of basal septal and basal lateral velocity difference (p=0.045) and 6 patients (28.6%) had evidence of dyssynchrony based on basal anterior and basal inferior velocity difference (p=0.018). Out of the remaining 39 patients with narrow QRS complex, only 2 patients (5.1%) had dyssynchrony on TDI. CONCLUSION: The study demonstrates a significant association between prolonged QRS duration and left ventricular dyssynchrony on TDI. Therefore, such patients should be screened for prolonged QRS duration on ECG before cardiac resynchronization therapy (CRT)

REAL TIME CONTINGENCY MEASURES FOR CROP MANAGEMENT UNDER RAINFED CONDITIONS IN SHIWALIK FOOTHILLS

Not AvailableIn the North-Eastern part of the Punjab about 0.393 mha area (7.8 % of state area) in the Shivalik foot hills known as Kandi stretches from Dhar Kalan block of Pathankot district to Dera Bassi block of SAS Nagar, covering parts of Pathankot, Hoshiarpur, Shahid Bhagat Singh Nagar, Roop Nagar and SAS Nagar districts.The per capita availability of food grains in the Kandi belt is low which is 1871 g/day as compared to 3188 g/day in the rest of Punjab. Despite having surplus food grain production in Punjab, Kandi belt is still facing the problem of food security.Not Availabl

N-acetyl-B-D-glucosaminidase and inflammatory response after cardiopulmonary bypass

OBJECTIVE: To determine the changes in activity of plasma N-acetyl-beta-D-glucosaminidase, a marker for inflammation as well as renal, pulmonary and cardiac damage and proinflammatory cytokines in patients undergoing coronary artery bypass grafting and find out the relationship between their plasma levels with clinical outcome of patients. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: The Aga Khan University, Karachi, from January to June 2003. PATIENTS AND METHODS: N-acetyl-beta-D-glucosaminidase (NAG) activity and concentrations of tumor necrosis factor-alpha of (TNFalpha), interleukin 6 (IL-6), interleukin 8 (IL8) and granulocyte-macrophage colony stimulating factor (GM-CSF) were monitored in plasma samples of 12 angina patients undergoing coronary artery bypass grafting (CABG), before, immediately after and 5 days post-surgical procedure. Serum glucose concentrations were also monitored in those patients. Patient\u27s clinical condition was monitored during this time period. RESULTS: No significant increase was observed in plasma NAG activity (a marker of inflammation) or in plasma levels of TNFalpha, IL-6, IL-8 and GM-CSF immediately after surgery, indicating that cardiopulmonary bypass itself does not produce any significant amount of inflammation immediately after CABG. However, 5 days post surgery, there was a significant increase in plasma NAG activity (p=0.001), TNFalpha (p=0.047) and GM-CSF (p=0.045). There was no relationship between plasma NAG activity and clinical outcome because various parameters of renal, cardiac and pulmonary functions, though slightly affected, remained within the normal limits. CONCLUSION: Increased levels of NAG and TNFalpha did not affect clinical outcome. However, data suggest that NAG can be a potential marker for inflammation and end organ damage following CABG. An increase in GM-CSF on day 5 following CABG indicates enhanced body\u27s defense mechanism against infection

Lack of association of methylenetetrahydrofolate reductase 677C\u3eT mutation with coronary artery disease in a Pakistani population

Pakistanis belong to the South Asian population which has the highest known rate of coronary artery disease. Folic acid deficiency also appears to be highly prevalent in this population. Methylenetetrahydrofolate reductase (MTHFR) 677C\u3eT polymorphism decreases the activity of this enzyme and can be associated with mild to moderate hyperhomocysteinemia in homozygotes, particularly when there is folic acid deficiency, as well as with coronary artery disease. To assess the value of genotyping the MTHFR 677C\u3eT dimorphism, we carried out a case-control study of dimorphism 677C\u3eT for putative association with myocardial infarction (MI) among Pakistani nationals. We investigated a sample population of 622 Pakistanis consisting of 225 controls and 397 patients with clinical diagnosis of acute MI (AMI). MTHFR C677T alleles were determined by assays based on polymerase chain reaction and restriction endonuclease analysis. Frequencies of C alleles were 0.87 among controls and 0.86 among AMI patients. The MTHFR 677C\u3eT dimorphism showed no association with MI (chi(2) = 0.25, 1df, P=0.62), serum levels of folate and vitamin B12 and plasma level of vitamin B6. A significant association, however, was found between homozygous 677T genotype and plasma levels of homocysteine. Multivariate analysis of the data showed that in case of log homocysteine, age and MTHFR genotypes were significantly different (PT polymorphism, though associated with homocysteine levels, confers no significant risk of coronary artery disease in the Pakistani population investigated here. We suggest that the higher incidence of AMI in South Asia occurs through mechanisms other than the MTHFR related pathways

Presence and Dispersion of Organic and Inorganic Contaminants in Groundwater

This paper offers an extensive examination of studies published in the recent past and highlights the documented issues surrounding groundwater pollution, its sources, and distribution worldwide. The depletion of groundwater resources and the deteriorating overall quality present a significant cause for concern, particularly as a large human population relies on groundwater as a drinking water source. The review focuses on various factors contributing to groundwater pollution, including anthropogenic activities, hydro climatological influences, and natural processes. Special attention is given to organic contaminants such as pesticides, herbicides, and emerging pollutants, which have been found to have a substantial impact on groundwater quality. Additionally, the review covers pollution caused by inorganic pollutants like arsenic and other heavy metals, with a particular emphasis on regions experiencing a higher incidence of these contaminants in groundwater. Furthermore, the paper includes a compilation of studies that highlight the increased occurrence of waterborne illnesses resulting from fecal and microbial contamination, often caused by inadequate sanitary practices. To provide a comprehensive understanding of the global groundwater pollution problem, the review also encompasses an examination of contaminants like fluoride and nitrate

Quantitative response of wheat to sowing dates and irrigation regimes using ceres-wheat model

An experiment was conducted at Punjab Agricultural University, Ludhiana during 2014–15 and 2015–16, keeping four sowing dates {25th Oct (D1), 10th Nov (D2), 25th Nov (D3) and 10th Dec (D4)} in main plots and five irrigation schedules {irrigation at 15 (FC15), 25 (FC25), 35 (FC35) and 45 (FC45) % depletion of soil moisture from field capacity (FC) and a conventional practice} in sub plots. The objective of the study was to evaluate the performance of CERES-Wheat model for simulating yield and water use under varying planting and soil moisture regimes. The simulated and observed grain yield was higher in D1, with irrigation applied at FC15 as compared to all other sowing date and irrigation regime combinations. Simulated grain yield decreased by 19% with delay in sowing from 25th October to 10th December because of 8% reduction in simulated crop evapotranspiration. Simulated evapotranspiration decreased by 16%, wheat grain yield by 23% and water productivity by 15% in drip irrigation at 45% depletion from field capacity as compared to drip irrigation at 15% of field capacity. It was further revealed that the model performed well in simulating the phenology, water use and yield of wheat

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Not Available

Not AvailableHydrologic models play an important role in understanding the erosion process, quantification of runoff and sediment yield at the watershed scale and to identify the best management practices. In this study, the WEP watershed model has been applied to simulate storm wise runoff and sediment yield from a small forest watershed having an area of 21.3 ha located in Shivalik foot-hills. The watershed was divided into 35 hill slopes and 25 channel Climate file was generated by CLIGEN software using observed meteorological data. For each hills lope and channel soil, slope and land use management files were prepared. The sensitivity analysis of the model shows that the model output is sensitive to hydraulic conductivity, rill erodibility, inter-rill erodibility, and critical shear of the soil. The model was calibrated and validated using observed data on runoff and sediment yield pertaining to 22 storms (20012004). The model simulated storm runoff with reasonable accuracy as corroborated by low values of RMSE (4.5mm), percent error (11.36) and high values of correlation coefficient (0.96), and model efficiency (87.54%). The model also performed satisfactorily in simulating sediment yield as indicated by the values RMSE of 0.33 Mg/h percent error 13.83, correlation coefficient of 0.85 and model efficiency of 83.18%. In quantifying total runoff and sediment yield, the percent simulation error was well within the acceptable limits. The results of the study indicate the suitability of the WEPP model for its future application in Shivalik foot-hills.Not Availabl

OPERATIONAL RESEARCH PROJECT AT A GLANCE

Not AvailableSub mountainous undulating areas (Zone- (1) locally known as kandi region stretches over North–Eastern border of Punjab, constituting 7.8 per cent of total geographical area of the state). Small, scattered and fragmented land h o l d i n g s , l ow r i s k bear ing capaci ty of farmers, erratic rains and frequent dry spells, severe soil erosion and unawareness of improved crop production technologies results in lower crop yields. Moreover, little knowledge of agricultural based subsidiary income generating activities also leads to poor economic growth of rainfed farmers. To enhance the productivity and net returns on sustainable basis, All India Coordinated Operational Research Project for Dryland Agriculture was started at eight AICRPDA centers [Arjia (Rajasthan), Ballowal Saunkhri (Punjab), Hisar (Haryana), Indore (M.P), Ranchi (Bihar), Bangalore (Karnataka), Anantapur (A.P), Solapur (M.P)] by CRIDA-ICAR. In Punjab, All India Coordinated Operational Research Project (ORP) was initiated in the year 1976 at Garhshankar. Since its inception, this research project has been in operation in different districts of kandi region within the domain of R.R.S, Ballowal Saunkhri (P.A.U) with the mandate to disseminate the proven rainfed agricultural technologies for its testing and refinement at farmers' fields under rainfed conditions.Not Availabl