Factors affecting reintubations after cardiac and thoracic surgeries in cardiac intensive care unit of a tertiary care hospital

Background: Reintubation and readmission after cardiothoracic surgeries are not uncommon, and its reasons are multifactorial. The study goal was to identify the factors that contribute reintubation after cardiac and thoracic surgery in tertiary care hospital and to compare the outcome with international benchmark.Methodology: A prospective, observational study was planned in Cardiac Intensive Care Unit (CICU). The study included all those patients who required readmission in CICU due to endotracheal intubation following cardiac and thoracic surgeries. The study was conducted from January to December 2016. The primary focus was to identify the reasons for reintubation within 72 h of extubation after CICU discharge and its association with outcome.Results: Out of 750 patients who shifted out from CICU following successful extubation, only 32 were readmitted and among them in 25 patients (3.33%) were reintubated and their reasons reintubation were noted. Patients underwent a coronary artery bypass grafting (CABG) with valve replacement had a higher incidence of reintubation 3/39 (7.69%) when compared with CABG 13/517 (2.51%) and 4/135 (2.96%) valve procedure alone. Single cause of endotracheal reintubation was observed in 7 patients (28%), in which 5 patients (20%) had respiratory and 2 patients had (8%) cardiac reason while 18 patients (72%) were observed with multisystem involvement, in which 7 patients (28%) had both respiratory and cardiovascular causes, and 2 (8%) had both respiratory and neurological causes. More than 70% cause of endotracheal reintubation was both respiratory and cardiovascular. The CICU stay after reintubations was 12.88 ± 16.88 days and the hospital stay prolonged to 23.84 ± 21.61 days.Conclusion: Reasons of reintubation were mainly respiratory and cardiac. The rate of reintubations is high when multisystem involvement is there. CICU, hospital stay, and mortality are increases after reintubation

Physiological responses of seven varieties of soybean [Glycine max (L.) Merr.] to salt stress

In agriculture, salinity is one of the most significant abiotic stresses that plants confront and harms agricultural productivity, physiological, growth and development processes. In the present study, there were 7 different varieties of soybean (Ajmeri, William-82, D.A, PSC-60, Rawal-1, NARC-1 and NARC-2,) were tested under NaCl concentration level (0 mM and 150 mM) to determine their physiological performance under control and experimental conditions. The present investigation aimed to select salt tolerant varieties. Under salt stress, different varieties have differed significantly in the biological yield, chlorophyll contents, antioxidant activity and ionic concentrations. The results showed that among the seven varieties evaluated NARC-1 and NARC-2 are producing higher biological yield and antioxidant activity than others under 150 mM NaCl. NARC-1 and NARC-2 under 150 mM NaCl concentration produced significantly higher biomass in comparison with other varieties and similarly enhance the antioxidant activity by decreasing the catalase activity. The relative water content (RWC) of plants was measured 15, 30, 45 and 60 days after the treatment was applied, as well as at harvest time, along with the grain yield and characters related to yield. The 7 different soybean varieties tested showed significant differences in grain yield and yield-associated characters when exposed to NaCl salinity. The salinity had a greater impact on Ajmeri and William than on NARC-1 and NARC-2. Under salt stress, the grain yield of the NaRC-1 and NARC-2 varieties was 70% and 65% respectively, while the yields of the Ajmeri and William varieties were 41% and 38% respectively. The salinity-induced decrease in grain yield was traced to fewer pods per plant, fewer seeds per pod and a lighter weight per 100 grains. However, the number of pods per plant was most affected compared to the other characters. It was also observed that Na+ ion concentrations were elevated in the shoot under salt stress in all varieties. However, NARC-1 and NARC-2 showed low salt concentration in shoot as compared to other varieties. SDS-PAGE revealed significant variations in the protein profile of seedling soybean varieties. NARC-1 and NARC-2 have shown a unique banding pattern under salt stress with a molecular weight of 60 and 130 kDa. The results indicate that salinity (NaCl) triggered an antioxidant response in tolerant varieties (NARC-1 and NARC-2) of Glycine max (L.). This study suggested that both varieties have more capability and appropriate survival under salt stress as compared to other varieties

The Portrayal of the United States in the Context of Drone Attacks: A Study of Pakistani Print Media

The drone attacks from the United States on the tribal areas of Pakistan were in the spotlight Pakistani media since 2004. These attacks also remained as the debating issue that they have taken lives of incident people along with the terrorists. The present study is an exploratory study about the image of the United States in context to drone attacks. To do so, drawing on framing theory editorials from leading newspapers were analyzed by using the qualitative content analysis method. The study also compared the editorial coverage of two newspapers regarding the image of the United States have been treated in editorials related to the drone attacks. The findings revealed that daily Jang is more inclined to positively present the image of the United States than Nawa-i-waqt. The study also revealed that daily Nawa-i-waqt published editorials on drone attacks more frequently than the daily Jan

Exploring Brand Awareness, Customer Loyalty and Perceived Quality: how they ensure Profitability and generate Purchase Intention: A study on cosmetic industry of Pakistan

The research looks at the reseller's view of the brand's reputation, quality and customer loyalty on the profitability and purchasing of the brand. In addition, the research focuses on clarifying the role of the purchasing power intermediary in the relationship between brand awareness and profitability, quality and profitability, brand awareness and profitability. The investigation was of a causal nature and data was collected from 200 retailers. The results showed the brand awareness and loyally meaningless impact, while the observed quality had a significant impact on profitability. In addition, the results revealed a significant impact on brand awareness, quality knowledge and loyalty for purchasing purposes. The conciliation Sobel test showed that procurement intensity only conveys the relationship between observed quality and profitability.&nbsp

How to Generate Store Loyalty? Exploring the Role of Preferential Treatment and Salesperson Trust: Mediating role of Commitment to Salesperson

This article describes how much the importance and impact of preferential treatment by salespersons & customers-salespersons relationship & trust for store loyalty. Providing preferential treatment and customer trust to salesperson can be very useful for managers so that customers can be loyal. This long-term relationship helps retailers gain profits and survive in business. A questionnaire was used to collect data. Most of the data were collected from Faisalabad University students by using convenience sampling, but some of the respondents responsible for different spheres were also included in generalizability. A sufficient number of females have also been included according to the needs of the research. Both preferential treatment and trust in salesperson have a positive impact on the build-up of store loyalty. The results also that trust in the salesperson is more affecting the customer's commitment to the salesperson and thus creates loyal customers.&nbsp

Advanced discrete-time controller design with application to motion control

Ph.DDOCTOR OF PHILOSOPH

Multimedia Traffic Engineering in Next Generation Networks

Due to high speed Internet and Multimedia applications, future wireless communication are expected to support multimedia traffic such as voice, video and text with a variety of Quality of Service (QoS) requirements and make efficient use of radio resources. Such kind of traffic requires high level of QoS guarantees. Traffic management is a process of regulating the traffic over network. Since, multimedia traffic is more sensitive, therefore it requires special measures while transmission, especially in wireless networks. There are different queuing disciplines which are used to police the traffic, the Priority Queue and RIO (RED with In/Out) are queuing disciplines, PQ is used to prioritize the traffic, and the later is used to drop the lower priority packets at the time of congestion. Proposed solution is the integration of Priority Queue with RIO, which will serve as a classifier to prioritize the traffic and then it will also serve as a scheduler by dropping lower priority traffic when the congestion state occur. Simulation results show that by applying proposed Traffic Management Strategy (PriRIO), it assigns stable bandwidth to the Multimedia Traffic Flow and enhances its throughput. It also shows that Packet Losses for Multimedia Traffic are very minor, that is, equivalent to none. Further, delay values for Multimedia traffic also remain below the Best Effort traffic flows. Thus, on the basis of these simulation results and analysis, PriRIO outperforms significantly, as compare to other Traffic Management Strategies

Transatrial access for left atrial pressure (LAP) monitoring line placement in arterial switch operation (ASO) in neonates

Left Atrial pressure monitoring is a useful and accurate method to guide Left ventricle filling in the patients who undergo Arterial switch operation for transposition of great arteries. We have used a different technique in three TGA patients for LA pressure monitoring line placement. After cleaning and draping,right internal jugular vein (rt IJV) located through 22G venous cannula, guide wire was put in followed by sliding the 22Gx8cm vygon arterial catheter over the guide wire into the right atrium that was directed transatrially into LA by the operating surgeon during atrial septum repair. The catheter was secured by silk on the neck and dressed with transparent dressing and was kept for a period of 48-72hrs. LA pressure monitoring is helpful in anticipating LV dysfunction in ASO