Peripartum cardiomyopathy: ten year experience at a tertiary care hospital in Pakistan.

Background: There is very little literature regarding peripartum cardiomyopathy from the Asian countries. We conducted this study to determine demographic details, clinical presentations, complications and recovery of left ventricular (LV) systolic function in peripartum cardiomyopathy (PPCMP) patients of Pakistani origin. Method: A ten year retrospective case series of PPCMP was conducted at the Aga Khan University Hospital. Patients were also followed up for six months after presentation, with special regard to improvement in the LV function. Results: Total 45 patients were included, 25 (55.5%) primigravida and 8 (17.7%) gravida 2 and the remaining 12 (26.6%) were multigravida. Fourteen patients (31.1%) presented during pregnancy and 31 (68.8%) after delivery. All patients presented with CHF and three (6.6%) were complicated with ventricular tachycardia (VT) at presentation. LV systolic dysfunction was present in 39 (86.66%) patients and RV dysfunction in 15 (33.3%) patients. Two patients had LV clot and thromboembolic stroke occurred in another 4 patients. All patients received standard treatment except three patients who had asthma and could not be given beta blockers. Echocardiogram was repeated after 6 month and in 32 (71.1%) patients LV functions recovered to normal. RV function improved in all except 2 (4.4%) patients. All patients were discharged in stable condition. Conclusion: Significant numbers of PPCMP patients, who had severe LV dysfunction at presentation recovered their LV functions at six month follow u

Takotsubo cardiomyopathy: ten year experience at a tertiary care hospital in Pakistan.

Objective: There is very little literature regarding Takotsubo Cardiomyopathy (TTC) from the Asian Countries other than Japan and Korea. We conducted this study to determine the demographics, clinical presentations, complications and recovery of left ventricular (LV) systolic function in TTC patients of Pakistani origin. Methods: A ten years retrospective case series study of TTC was conducted at the Aga Khan University Hospital. Patients were followed for up to six months after presentation, with special emphasis on the recovery of LV function. Conclusion: TTC is classically triggered by an acute illness or by extreme stress and a triggering incident may not always be identified. It usually presents in the guise of an acute coronary syndrome (ACS). Our data was congruent with the existing literature, except for more heart failure and cardiogenic shock. Average Troponin-I (Tn-I) levels were also higher as compared to western population. The reason for more severity in our patients may be late presentation or different level of response to stress

Spontaneous coronary artery dissection: a rare cause of acute coronary syndrome.

We present a case of a 71-year-old man, with a history of hypertension and dyslipidaemia, who presented with typical cardiac chest pain and palpitations of 2 h duration. The examination revealed irregular pulse of 138 bpm, blood pressure 115/75 mm Hg, variable first and normal second heart sounds. The lungs were clear to auscultation. The ECG showed atrial fibrillation with a rapid ventricular rate. His heart rate was controlled with β blockers and the acute coronary syndrome treatment protocol was initiated. His baseline blood reports were within normal limits and two serial troponin I tests were negative. Coronary angiogram showed dissection in the left coronary system extending into the branch vessels and 30-40% stenosis in the right coronary artery. The patient underwent coronary artery bypass graft as an emergent case. He suffered a mild stroke postsurgery with complete functional recovery. He is being followed up in the clinic and has performed well

Growth Pattern and Morphological Variation of Labeo calbasu Found in Indus River, Sindh-Pakistan

The present work reports the length–weight relationships (LWR) and condition factor relationships for Labeo calbasu collected from Upstream (Matyari) Kotri barrage at, River Indus, Pakistan, because stock assessment helps the fisheries managers to conserve the commercially important fish. Morphological characters of fish as well as Length-weight relationship are an important tool for fishery management. The results of LWR (W= aLb), for L calbasu.  Representing negative allometric growth pattern. LWRs and condition factor relationships were found significantly correlated. A total of 200 and 190 specimens from upstream and downstream were collected, respectively. The assessed values of length-weight correlation and condition factor were calculated as Kn=39.663 (LeCren), and K=11.915 (Fulton) for upstream and Kn=44.066 and K=13.872 for downstream. Length-weight was found with a strong correlation of n= 2.892, a=0.0235 with r2=0.934 for upstream population then the downstream population.  The results of this work would be beneficial for sustainable management as well as fishery managers. 

Application of Quality of Experience in Networked Services: Review, Trend & Perspectives

Full text embargoed until 17.10.2019 (publisher's embargo period, 12 months

Binary composite (TiO2-Gr) based nano-enhanced organic phase change material: Effect on thermophysical properties

The latent heat storage technology using Phase Change Materials (PCMs) has recently been extensively utilized in energy conservation and management to reduce energy consumption. To improve the thermal conductivity of PCMs, they have been incorporated with nanoparticles. In this article, we report, Titanium dioxide-Graphene (TiO2:Gr) binary composite (1 wt% TiO2: 0.1, 0.5, 1 and 2 wt% of Graphene (Gr)) with Paraffin wax (PW) to improve the thermophysical properties added with sodium dodecylbenzene sulphonate (SDBS) as surfactant. Ultraviolet-visible spectrometer (UV–VIS), Fourier transform infrared spectroscopy (FT-IR), Differential scanning calorimeter (DSC), Thermogravimetric analyzer (TGA), Field Emission Scanning Electron Microscopy (FESEM) and Thermal property analyzer (TEMPOS) were used for material characterizations. The latent heat capacity of the PW/Titanium oxide (TiO2) composite and the PW/TiO2-Gr binary composites were improved by 8.62% and 10.02%, respectively, in comparison to base PCM. The thermal conductivity of the composite PCMs with PW/TiO2-1.0 and PW/TiO2Gr-1.0 is 120% and 179% higher than base PW. The FT-IR spectra demonstrated no chemical interaction between the PW and the nanoparticles. TGA results presented improved thermal stability by integration of the TiO2-Graphene particles into the matrix of paraffin wax. The light transmission of the prepared composite was reduced by 58.30% related to base PW, resulted increased light absorption and, subsequently, enhanced photothermal conversion. The composite's improved thermal conductivity and enthalpy make it a strong contender for use in TES and solar photovoltaics thermal systems

Thermal conductivity and Thermal properties enhancement of Paraffin/Titanium Oxide based Nano enhanced Phase change materials for Energy storage

The Latent heat storage (LHS) based on phase change materials (PCMs) has a critical part to demonstration in preserving and efficiently utilizing energy, resolving demand-supply mismatches, and boosting the efficiency of energy systems. However, they have a low thermal performance inherent in it because the low thermal conductivity (TC) of PCMs. Paraffin organic PCMs have several advantages such as higher LHS, nontoxic, abundant in nature and inexpensive, whereas TiO2 nanoparticle is type of hydrophilic group having tendency to improve TC. In this research TiO2 in different concentration (0.1, 0.5, 1, and 2 wt percent) with surfactant sodium dodecyl benzene sulphonate (SDBS) added into Paraffin RT44 HC PCM using two step techniques, and the thermophysical properties were broadly discussed. Thermogravimetric analyzer (TGA), Fourier transform infrared spectroscopy (FT-IR) and Thermal property analyzer (TEMPOS) were used for the characterization of prepared composite nano-enhanced phase change materials (NePCM). Additionally, the effect of nanoparticles on TC was investigated. The highest TC was obtained with PW/TiO2-1.0 by an increment of 86.36% as related with base PW. The FTIR spectrum of the composite PW/TiO2 confirmed no interaction between PW and TiO2, resulting in a more chemical stable composite. The addition of TiO2 to PW enhance the degrading temperature 10 C by making it more thermal stable. Grounded on the results it can be concluded that the developed composite is suitable for thermal energy storage (TES), photovoltaic thermal (PVT) systems, and hot water applications

Societal issues concerning the application of artificial intelligence in medicine

Medicine is becoming an increasingly data-centred discipline and, beyond classical statistical approaches, artificial intelligence (AI) and, in particular, machine learning (ML) are attracting much interest for the analysis of medical data. It has been argued that AI is experiencing a fast process of commodification. This characterization correctly reflects the current process of industrialization of AI and its reach into society. Therefore, societal issues related to the use of AI and ML should not be ignored any longer and certainly not in the medical domain. These societal issues may take many forms, but they all entail the design of models from a human-centred perspective, incorporating human-relevant requirements and constraints. In this brief paper, we discuss a number of specific issues affecting the use of AI and ML in medicine, such as fairness, privacy and anonymity, explainability and interpretability, but also some broader societal issues, such as ethics and legislation. We reckon that all of these are relevant aspects to consider in order to achieve the objective of fostering acceptance of AI- and ML-based technologies, as well as to comply with an evolving legislation concerning the impact of digital technologies on ethically and privacy sensitive matters. Our specific goal here is to reflect on how all these topics affect medical applications of AI and ML. This paper includes some of the contents of the “2nd Meeting of Science and Dialysis: Artificial Intelligence,” organized in the Bellvitge University Hospital, Barcelona, Spain.Peer ReviewedPostprint (author's final draft

Effects of Climate Change on Mountain Waters: A Case Study of European Alps

The Alps play a vital role in the water supply of the region through the rivers Danube, Rhine, Po and Rhone while they are crucial to the ecosystem. Over the past two centuries, we witnessed the temperature to increase by +2 degrees, which is approximately three times higher than the global average. Under this study, the Alps are analyzed using regional climatic models for possible projections in order to understand the climatic changes impact on the water cycle, particularly on runoff. The scenario is based on assumptions of future greenhouse gases emissions. The regional model results show the consistent warming trend in the last 30-year span: temperature in winter may increase by 3 to 4.5°C and summers by 4 to 5.5°C. The precipitation regime may also be altered: increasing about 10-50% in winter and decreasing about 30-60% in summer. The changes in the amount of precipitation are not uninformed. Differences are observed particularly between the North West and South East part of the Alps. Due to the projected changes in alpine rainfall and temperature patterns, the seasonality of alpine flow regime will also be altered: massive rise will occur in winter and a significant reduction in summer. The typical low flow period during winter will also be shifted to late summer and autumn