Search

Objectives: To compare the frequency of severe mitral regurgitation after percutaneous mitral balloon valvuloplasty (PMBV) via Inoue balloon and multi-track balloon technique in our population. Methodology: In this retrospective observational study which was conducted at a tertiary care cardiac center of Karachi, Pakistan between 2015 and 2020 on Hospital registry of PMBV patients. Data were categorized in to two groups, Inoue balloon or multi-track balloon technique. Post procedure echocardiographic and catheterization parameters and in-hospital outcomes and complications, including severe MR, were compared between two groups. Results: Out of 470 PMBV procedures, 286 (60.9%) were performed with multi-track and 184 (39.1%) with Inoue balloon. Improvement in mitral value area was significantly higher with multi-track as compared to Inoue balloon (0.66±0.31 cm2 vs. 0.56±0.29 cm2; p

Rajesh Kumar,1 Mahesh Kumar Batra,1 Sanam Khowaja,1 Ali Ammar,1 Ashok Kumar,1 Jehangir Ali Shah,1 Jawaid Akbar Sial,1 Tahir Saghir,1 Musa Karim2 1Adult Cardiology Department, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan; 2Research Department, National Institute of Cardiovascular Diseases (NICVD), Karachi, PakistanCorrespondence: Rajesh KumarNational Institute of Cardiovascular Diseases (NICVD), Karachi, PakistanEmail rajeshnarsoolal@gmail.comObjective: Promising results of CHA2DS2-VASc score have been reported for the prediction of contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI). However, data of its predictive strength in the context of primary PCI are not available. Therefore, in this study, we have assessed predictive value of CHA2DS2-VASc score for CI-AKI after primary PCI.Methods: This analytical cross-sectional study was conducted between January 2021 and June 2021 at the National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan. Inclusion criteria of the study was consecutive adult patients who had undergone primary PCI. Baseline CHA2DS2-VASc score was calculated, and either a 25% or 0.5 mg/dL increase in post-procedure serum creatinine level as compared to baseline level was categorized as CI-AKI.Results: A total of 691 patients were included, of which 82.1% (567) were male. CI-AKI after primary PCI was observed in 63 (9.1%) patients, out of which 66.7% (42) of patients had CHA2DS2-VASc score of ≥ 2. The area under the curve (AUC) for the score was 0.725 [0.662 to 0.788] with a sensitivity and specificity of 66.7% [63.1% to 70.2%] and 66.7% [53.7% to 78.1%], respectively, at a cut-off value of ≥ 2. In multivariable analysis, left ventricular ejection fraction ≤ 30% and CHA2DS2-VASc ≥ 2 were found to be independent predictors with adjusted odds ratios of 2.19 [1.06– 4.5] and 2.13 [1.13– 4.01], respectively.Conclusion: CHA2DS2-VASc score has a good predictive value for the prediction of CI-AKI after primary PCI. Criteria of CHA2DS2-VASc ≥ 2 can be used for the risk stratification of CI-AKI after primary PCI.Keywords: ST elevation myocardial infarction, STEMI, percutaneous coronary intervention, primary PCI, contrast-induced acute kidney injury, CI-AKI, CHA2DS2-VASc score, contrast-induced nephropathy, CIN

The biological structure of the Syrian marine environment still shows a rapid and steady increase in the number of warm water species, many of which have become dominant and invasive. In the latest field data during 2020-2021, the presence of the black sea urchin Diadema antillarum (Philippi, 1845) was recorded for the first time in several locations in Latakia and Ras al-Bassit coast, and its massive spread at depths of 5-8 m, accompanied by invasive species of macroalgae, sponges, crustaceans and mollusks.. It is noteworthy that this species is one of the most widespread and important species of sea urchins in some tropical areas, and this is the first record in the Mediterranean Sea and the Syrian coast It is important as it prey on macroalgae and has an effective role in the health of some of the most important areas of biodiversity in the world.

Objectives: To evaluate the quality of life (QOL) after percutaneous coronary intervention (PCI) using short-form health survey (SF-36) questionnaire at a tertiary care hospital in Pakistan. Methodology: It was a cross-sectional study conducted at a tertiary care cardiac center in Pakistan. A total of 433 adult patients who undergone PCI at least six months before were included. The QOL was assessed using Urdu translated version of SF-36 questionnaire. QOL scores were computed on eight domains role physical (RP), role emotional (RE), bodily pain (BP), physical function (PF), mental health (MH), vitality, general health perception (GHP), and social function (SF) along with two summary scores for mental (MCS) and physical component (PPS). Results: The highest mean score was reported for BP (73.8±19.7) followed by PF (61.7±24.3). In comparison to a year before, 52.9% and 24.7% rated their QOL somewhat better and much better respectively. Score for PF, RE, and RF were significantly higher in male, while, vitality was higher for female. Score of PPS was significantly higher for male whereas MCS score was higher for female. An increasing trend, with respect to patients’ perception of QOL compared to an year ago, was observed on five out of eight domains namely GHP, PF, RP, RE, and BP. Conclusion: Improved QOL, compared to a year ago, is reported by most of the patients. An acceptable (>50) mean score was observed on most of the QOL domains of SF-36 and it was found to be positively related to the patient stated degrees of QOL.

Objectives: Premature coronary artery disease (CAD) is on the rise in our population, and multivessel disease (MVD) is no longer an uncommon finding in young patients. Therefore, aim of this study was to determine the predictors of MVD in young patients who presented with ST-Segment Elevation Myocardial Infarction (STEMI). Methodology: For this study, we enrolled 294 young adult (18-40 years) patients with STEMI. MVD was diagnosed based on angiography. Demographic characteristics and baseline risk profiles were considered for the univariate and multivariate analyses to determine the predictors of MVD. Results: Out of 294 patients, 90.5% (266) were males, and the mean age was 35.45 ± 4.07 years. Our 24.1% (71) patients were hypertensive (HTN), and 36.1% (106) were smokers. A total of 94 patients had MVD. Patients with MVD were older and more likely to have diabetes (DM) and HTN than their counterparts. Only age and DM were found to be significant independent predictors of MVD. The risk of developing MVD was higher in diabetics, with adjusted odds ratios (ORs) [95% CI] of 2.47 [1.23-4.97; p=0.011]. Conclusion: In conclusion, we showed that age and DM are independent predictors of MVD in a young Pakistani adult population presenting with STEMI. However, none of the other risk factors, such as obesity, male gender or smoking, were found to be significantly associated with MVD in Pakistani adults with premature CAD. Although significantly associated, HTN does not prove to be an independent predictor of multivessel CAD in young adults.

Rapid and reliable processing methods for forming ordered block copolymer (BCP) materials with low defect density in a thin film geometry are required for many nanotechnology applications. Vertical...

International audience; Translocation t(4;12)(q11-13;p13) is a recurrent but very rare chromosomal aberration in acute myeloid leukaemia (AML) resulting in the non-constant expression of a CHIC2/ETV6 fusion transcript. We report clinico-biological features, molecular characteristics and outcomes of 21 cases of t(4;12) including 19 AML and two myelodysplastic syndromes (MDS). Median age at the time of t(4;12) was 78 years (range, 56–88). Multilineage dysplasia was described in 10 of 19 (53%) AML cases and CD7 and/or CD56 expression in 90%. FISH analyses identified ETV6 and CHIC2 region rearrangements in respectively 18 of 18 and 15 of 17 studied cases. The t(4;12) was the sole cytogenetic abnormality in 48% of cases. The most frequent associated mutated genes were ASXL1 (n = 8/16, 50%), IDH1/2 (n = 7/16, 44%), SRSF2 (n = 5/16, 31%) and RUNX1 (n = 4/16, 25%). Interestingly, concurrent FISH and molecular analyses showed that t(4;12) can be, but not always, a founding oncogenic event. Median OS was 7.8 months for the entire cohort. In the 16 of 21 patients (76%) who received antitumoral treatment, overall response and first complete remission rates were 37% and 31%, respectively. Median progression-free survival in responders was 13.7 months. Finally, t(4;12) cases harboured many characteristics of AML with myelodysplasia-related changes (multilineage dysplasia, MDS-related cytogenetic abnormalities, frequent ASXL1 mutations) and a poor prognosis.

International audience; In this article, a high power 4H-SiC NPN BJT is demonstrated with a blocking voltage greater than 10 kV when its theoretical value is around 13 kV. The device design was extracted from a previous reported model and a fabrication process with eleven mask levels was performed. The maximum recorded common-emitter current gain is 20 at a current density 178 A/cm 2 .

Data-driven models for predicting fire and explosion-related properties have been improved greatly in recent years using machine-learning algorithms. However, choosing the best machine learning approach is still a challenging task. Therefore, in this study, the predictability comparisons have been made with the different machine learning methods used to model the MIT for iron dust. The MIT of iron dust was determined using the Godbert-Greenwald furnace for seventy unique combinations of dispersion pressures and dust concentrations. The data has been divided into 'Training Set' and 'Testing Set'. The implementation and efficacy of machine learning and statistical approaches have been demonstrated through real-time experimental results. The support vector machines (SVM) regression models were trained with various kernel functions to enhance the performance of the resultant model. The cubic kernel function was found suitable for training SVMs. Besides, a feed-forward artificial neural network with the backpropagation algorithm and a polynomial surface fit model have also been developed to predict the MIT. For statistical phenomena, such as MIT, predictive modelling based on real-time experimental data is critical. If an accurate estimate of the combustible dust's minimum ignition temperature is confirmed, it is possible to ensure that the temperatures of the surrounding hot surfaces do not rise to that level, preventing an explosion. An overall comparison of predictive models has been given with unseen test data set. All the trained models yielded comparable results with unseen test data set. However, the SVM model with Bayesian optimizer approach can effectively assess the risk of ignition based on dust MIT under the influence of dispersion pressure and dust cloud concentration among all the approaches adopted in this study.

Cognitive Radio (CR) can be defined as a technology that allows users to change the transmission parameters as required to increase the spectrum efficiency. Because of this mechanism, some threats emerge. Two major threats are found in CR. The first is the Primary User Emulation Attack (PUEA), where the attacker is able to transmit at a forbidden time slot effectively, emulating the signals of the primary user. This makes all the system users believe that the spectrum is occupied by a good primary user. The second threat is known as the spectrum sensing data falsification attack (SSDF). In this case, the attackers send false observation information, intentionally or unintentionally, to the fusion center (FC), causing it to make the wrong decision. In this study, the scheme presented was based on a users' reputation for secure spectrum access in cognitive radio networks. Each Secondary User (SU) performs local sensing and then forwards the sensing results to the main fusion center FC. The FC makes the final decision about the presence of the primary user based on the proposed approach. The schemes substantially reduce the effect of cognitive users with low reputation values while improving the impact of cognitive users with the high reputation values on the final decision. It has been verified that the proposed approach can improve the sensing performance under the impact of a different number of reliable and unreliable users in a CR network. Results based on simulation show that the proposed scheme outperforms the traditional majority scheme despite a high number of malicious users.

Fibrous filter made up of non-woven material was utilized in many industrial applications for increasing the collection efficiency and the quality factor. But there exists a competing effect among the fibre diameter, filtration efficiency, pressure drop, and sometime type of aerosol (liquid or solid) plays a crucial role in the performance of the fibrous filter. To avoid overdesigning of the filter along with better performance, optimum set of parameters are to be decided before the manufacturing process. In the current effort, the desirability approach and along with the "Response Surface Methodology (RSM)" were considered to optimize filtration efficiency and pressure drop simultaneously. In this perspective, the impact of Filtration velocity (v), Basis weight (ϕ), Particle diameter (dp), and Packing fraction (α) on filtration efficiency (η) and pressure drop (Pd) was studied. Based on the outcome, the predicted values lie within experimental data through smart agreement. The maximum percentage (%) error was only 3% and 6% filtration efficiency (η) and pressure drop (Pd), which determine the effectiveness of this useful model. The most dominant factor which affects the filtration efficiency (η) was found to be the Basis weight (ϕ), followed by packing fraction. However, in the case of pressure drop, the most dominant factors were filtration speed followed by the pachining fraction. Moreover, artificial neural network (ANN) models are developed for the prediction of filtration efficiency and pressure drop. The model accuracy has been estimated by calculating "Mean Square Error (MSE), Mean Absolute Error (MAE), and coefficient of determination (R2)". Both models show promising results when compared with experimental data with the R2 value of 98.50-99.86. The optimized values of the maximum filtration efficiency and minimum pressure drop simultaneously were obtained for v = 5, ϕ = 59.60, dp = 52.23, α = 0.24 according to desirability approach.

Background According to the WHO, 300,000 people die every year as a result of burn injuries. In this study, we aim to discuss the epidemiology and outcomes of burn patients who were admitted to Al Mowasat hospital in Damascus, Syria. Methods A retrospective cohort research was conducted from January 2017 to December 2021. All accessible paper-based medical records of burn injury patients admitted to the hospital were evaluated. ABSI score was used to classify injury degree. Chi-square test and logistic regression model were used to study the association between demographic variables and outcomes. Results Of the 641 patients, 367 (57.3%) were male and 274 (42.7%) were female. Children represented more than half of our sample 377 (58.8%). The most common cause of burn was flame burns 393 (61.3%), followed by scalding 199 (31.0%). Most of the patients had a more than 10% TBSA of burns 511(79.7%). Children had higher rates of leaving against medical advice (25.7%) than adults (17.8%). Children and patients who needed respiratory support were more likely to die than others 2.545 (1.079–6.004), 9.208 (4.061–20.879), respectively. Conclusion The situation of burn patients in Syria requires more attention and care to reduce mortality and morbidity. Focusing on the young age group to prevent such life-limiting injuries should be a priority.

The performance of a multistage centrifugal compressor is highly influenced by the ambient conditions, especially during the summer seasons; their capacity shrinks and thus the power requirement for compression will increase. The prime cause of these constraints is the interstage cooling limitations. This study simulates various suction conditions of a multistage compressor on Aspen HYSYS® and suggests its debottlenecking by making the suction temperatures comparable to winter seasons. This is achieved by installing an additional exchanger at the downstream of each interstage cooler, cooling down the gas further by using absorption refrigeration chillers. These chillers are powered up by the waste heat recovered from the exhaust steam coming from the prime mover, steam turbine, of the same compressor. This modification will save a considerable amount of power (663 kW), net savings (Gross Savings – OPEX: 72 289 $/y), and reduce the carbon footprint (954 ton/y) of the overall process.

This paper is an attempt to prove the assumption that William Golding is a failure who claims to have written his novel Lord of the Flies on the idea of human nature. He considers that he wrote about human nature in general, but he is a Western and has those ideas of being superior to other people. He takes all his characters from among the English boys. Not a single character who is shown as civilized belongs to a marginalized race. This act of Golding reveals his ethnocentric attitude. He does not bother to include a female character in this novel. All his characters are male. It shows his androcentric nature. Though he tries to put the evil like every man whenever he wants to show the brutality or savagery of a human, in the form of his chosen English boys, he portrays them as the hunters of Africa or paints them with mud. In doing so, he is affiliating savagery with the blacks and Indians. Thus, he propagates the same stereotypical concept of “Orients” as uncivilized and savages. Golding relies solely on the biological factors of human nature. He ignores to consider any social problem for the conflict of the two groups of boys. These social factors may include political system, religion, or Marxism. This research work has proved that Golding’s self-critique of human nature in the novel is a failure on his part.

The great diversity in Pakistani folklore is evident from the distinguishedvariety of cultural folk assets of each province of Pakistan. The current paperexplores and analyses the most popular folklores, in the genres of both proseand poetry from the perspective of quest for identity. The paper tries to findout the answer to the question if Pakistani cultural heritage of oral traditioni.e., folklores have quest for identity or go beyond that. The paper alsoexplores the motives behind the search for identity. The translated folkloresare then analyzed qualitatively using interpretive method, particularly throughthe perspective of hermeneutic-interpretive research based on performancetheory of folklores. Hermeneutic-interpretive research technique is chosenhere because the folklores are based on the ideological and cultural traditionsof a specific region, and the proper understanding requires the study in thespecific relevant domain of hermeneutics. This research is important for thepropagation, preservation and revival of Pakistani culture as presentedthrough folklores. This research aims at developing the interest and draw theattention of researchers on cultures and traditions to revive and enliven therichness and fertility of varieties in Pakistani culture

Corn dust is a highly energetic substance and frequently found in the food manufacturing industries. It not only poses occupational safety hazards such as suffocation or lung disorders for exposed persons but is often extremely explosible in ignition sensitive environment. This probability of explosion can be assessed and minimised with in-depth knowledge of controlling parameters/physical properties that trigger the ignition. This research takes into account the minimum ignition temperature (MIT), which is the control parameter for explosion risk assessment. MIT relies on multiple factors, such as moisture content, particle size, dust concentration, dispersion pressure, humidity and environmental temperature. In this study, the ignition of corn dust clouds was analysed using a Godbert Greenwald furnace for different combinations of dispersion pressure and concentrations. Test findings revealed that the minimum ignition temperature rises with a decrease in particle size. However, the minimum ignition temperature decreases with increased dispersion pressure and concentration until a specific value known as optimal value for ignition. Moreover, this work focuses on a statistical approach of polynomial surface fitting to forecast the MIT based on the combined impact of concentration and dispersion pressure on MIT for corn dust in a real-time experiment. The minimum value of the Bayesian Information Criterion (BIC) was used to select the most appropriate polynomial model due to its authenticity and strong reputation. An artificial neural network (ANN) is also used as a predictive tool to develop a model that can forecast the MIT with a defined combination of dispersion pressures and corn dust concentrations. As soon as an appropriate estimation of this minimum ignition temperature of the combustible dust is confirmed, it is possible to ensure that the temperatures of the surrounding hot surfaces do not rise to that point to prevent the explosion. The predictive results obtained from ANN were found to be good when compared with the polynomial surface fit. Several models with different numbers of neurons have been trained with different transfer functions. For the training, validation, and test phases, R values are around 1.0, i.e., 0.9863, 0.9930, and 0.9893, respectively. The overall R value was 0.9875 for the proposed network. The findings were considered to be acceptable as the overall value of R was close to 1.0. The network obtained sufficiently comparable findings with the research conducted by Kasalova and Balog.