bluuebunny/crossref_metadata_2025_split huggingface dataset:
TRANS-CATHETER AORTIC VALVE IMPLANTATION (TAVI)-A CASE SERIES AT AFIC/NIHD
Authors: Siddiqui Abdul Hameed , Aziz Sohail , Maken Ghulam Rasool , Khan Ali Nawaz , Saif Mohsin , Tuyyab Farhan , Khan Kumail Abbas , Raja Waseem , Kamran Javeria , Janjua Anam Fatima 
Published: January 2021

Objective: To share our experience of percutaneous trans-catheter aortic valve implantation in patients with severe symptomatic aortic stenosis.
Study Design: A retrospective cross sectional study.
Place and Duration of Study: The study was conducted at Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD) Rawalpindi, from Mar 2015 to Feb 2020.
Methodology: Retrospective analysis of all consecutive patients who underwent percutaneous trans-catheter aortic valve implantation was done to assess its immediate, short and long term outcome and safety. Twenty patients have undergone trans-catheter aortic valve implantation since 2015 in the institute. Base line blood chemistry including creatinine clearance, ultra-sonography abdomen, carotid Doppler, chest X-ray, High-Resolution Computed Tomography chest was done in all cases as part of the protocol. Mean age of the patients was 73 ± 7.91. There were sixteen males (80.0%) and four females (20.0%). All patients under went procedure through transfemoral route. Valve structure and peripheral vasculature for suitability of the procedure was assessed by computerized coronary tomographic angiography with TAVI protocol. In eleven patients aortic valve was trileaflet (55.0%) and in remaining nine it was bicuspid (45.0%). Mean gradient across the valve pre-procedure was 56.37 ± 9.14. Thirteen patients (65.0%) presented with angina/dysnoea NYHA III, 6 patients with syncope (30.0%) and one (5.0%) had heart failure. Two patients had undergone previous coronary artery bypass surgery. Procedure was carried out under general anesthesia in all patients except one. Balloon expandable Edwards Sapienvalve was implanted in two patients and self-expandable Core Valve/Evolut R in eighteen patients.
Results: Seventeen patients underwent the procedure successfully with reduction of the mean gradients immediately after valve implantation to less than 15 mmHg recorded in the cath labangiographically subsequently complemented by transthoracic echocardiography. There were 3 deaths during the index hospitalization. Two occurred in the catheterization laboratory, one death was due to development of severe acute aortic regurgitation and second was due to acute coronary obstruction. Third death occurred due to acute kidney injury after seven days. Five patients died in next three months during follow up. One patient required permanent pacemaker because of development of left bundle branch block and second degree atrio-ventricular block post procedure.
Conclusion: Transcatheter aortic valve implantation in patients with severe symptomatic aortic stenosis is a very effective and procedurally safe option and reasonable alternative to surgical valve replacement in high operative risk individuals.
EFFECT OF MODIFIED ULTRAFILTRATION ON HEMODYNAMICS IN PEDIATRIC CARDIAC SURGERY AT ARMED FORCES INSTITUTE OF CARDIOLOGY/ NATIONAL INSTITUTE OF HEART DISEASES (AFIC/NIHD)
Authors: Rehman Muneeb Ur , Rao Tariq , Niaz Naila , Nafees Shahid , Azad Naseem , Umar Muhammad Shoaib 
Published: January 2021

Objective: To observe the effect of modified ultrafiltration on hemodynamics of pediatric patients.
Study Design: A descriptive cross-sectional study.
Place and Duration of Study: Pediatric Cardiac Surgery department, AFIC/NIHD Rawalpindi, from Jun 2019 to Dec 2019.
Methodology: A total of 60 pediatric patients were included undergoing open-heart surgery with cardiopulmonary bypass, having age ≤6 years and weights ≤15kg. To assess hemodynamics parameters observed were pre modified ultrafiltration and post modified ultrafiltration measurements of haemoglobin level, systolic pressure, diastolic pressure, central venous pressure and the number of transfusions given after off-bypass. The data was entered and analyzed in SPSS-23.
Results: The pre-operative mean Hb level of the 60 sampled patients was 12.08 ± 2.89 g/dl. The findings taken pre modified ultrafiltration and post modified ultrafiltration of haemoglobin level was (9.91 ± 0.91 g/dl and 13.09 ± 1.38 g/dl, p<0.05) after an average filtration of 370.83 ± 66.56 ml of the filtrate. The mean of systolic pressure was (61.3 ± 2.01 mmHg and 70.68 ± 1.76 mmHg, p<0.05), diastolic pressure was (49.95 ± 1.35 and 59.7 ± 6.85, p<0.005), Central Venous Pressure was (10.07 ± 1.18 and 9.9 ± 1.09, p>0.005) compared pre modified ultrafiltration and post modified ultrafiltration respectively.
Conclusion: The study concluded that modified ultrafiltration has a significant impact on haemoglobin levels after bypass, decreases the allogenic transfusions and also improve the hemodynamics of the patient.
DECISION MAKING FOR DEVICE CLOSURE IN ADULTS WITH ‘HYPERTENSIVE PDA’–NON-INVASIVE CRITERIA: IMMEDIATE RESULTS
Authors: Beg Ahsan , Malik Abdul , Mahmood Amjad , Younas M , Fayaz Fakher -e- 
Published: January 2021

Objective: To find the mean pulmonary artery pressures (PAP) in adults (>12 years) Patent Ductus Arteriosus (PDA) with ‘reversible pulmonary hypertension’ after the device closure. Residual PDA and immediate complications (embolization, pulse loss, obstruction in the aorta or pulmonary artery) are to be reported.
Study Design: Retrospective study.
Place and Duration of Study: Tertiary Care Referral Hospital, from Aug 2007 to Jun 2020.
Methodology: This retrospective study is descriptive. Data collected by convenience sampling from 3 tertiary care referral hospital. 981 patients were undergone PDA device closure during the period from Aug 2007 to June 2020. After informed consent, an initial assessment was done by history, clinical examination, x-ray chest PA view, electrocardiography (ECG), and transthoracic echocardiography (TTE). Reversible pulmonary hypertension was labeled based on non-invasive criteria including room air saturation >93% and cardiomegaly on x-ray chest. Patients who had <93% and normal heart size on x-ray chest were excluded. The lower limit for age was 12 years.
Results: Nine Hundred Eighty One patients had undergone PDA device closure. 32 (n=32/981 3.3%) had fulfilled our inclusion criteria. The mean age was 22 ± 9 (13–45) years. Mean weight was 41 ± 11 (25-66) kg. Successful device closure was done in 30 patients (93.7%). Mean diameter of PDA was 7 ± 0.1 (4.5-13 mm. Mean PAP decreased from 59 ± 13 mmHg to 38 ± 19 mmHg (p<0.05). Commonest device used was Shasma duct occluder (n=16/32 50%) followed by Occlutech Duct Occluder (n=7/32 21.9%), while 2 had muscular VSD device (n=5/32 15.6%). In 2 patients, there was an underestimation of the size of PDA so the device was retrieved and replaced with another larger one successfully. Two patients had the device fully dropped into the main pulmonary artery before it was released. Larger size device was not available at that time so the patients were referred for surgery. None of our patients had device embolization or residual shunt on echo performed next day to the procedure. Neither any patient had residual pulmonary hypertension on echocardiography. There was no significant obstruction in the aorta in any patients. Two patients had mild left pulmonary artery obstruction. There was no significant obstruction in the aorta in any of our patients. There was pulse loss in 3 patients which were treated successfully with heparin infusion with no residual damage.
Conclusion: Device closure is a feasible option in adults with hypertensive PDA while the decision of reversibility is based on non-invasive criteria.
IN-HOSPITAL EARLY COMPLICATIONS IN DIABETICS VS NON DIABETICS WITH ACUTE ST ELEVATION MYOCARDIAL INFARCTION AGE GROUP 30-70 YEARS
Authors: Khan Gul , Khan Imtiaz Ahmed , Khan Fahad Ahmad , Farhan Shaheer , Kamran Javeria , Janjua Anam Fatima , Samore Naseer Ahmed , Khan Sadaf , Aziz Sohail , Siddiqui Abdul Hameed 
Published: January 2021

Objective: To determine in hospital early complications in diabetics’ vs non diabetics with acute ST elevation myocardial infarction.
Study Design: Comparative cross-sectional study.
Place and Duration of Study: The study was conducted in emergency departments and adult cardiology wards of Armed Forces Institute of Cardiology/National Institute of Heart Diseases, from Aug to Nov 2019.
Methodology: A comparative cross sectional study was conducted on 380 patients (190 patients with diabetes and 190 patients without diabetes) who presented with acute ST-Elevation MI in age group 30 to 70 years to emergency department of Armed Forces Institute of Cardiology/National Institute of Heart Disease during specified period. Patients with rescue PCI and new onset of LBBB were also included. Patients with age group lesser than 30 years or greater than 70 years with STEMI were excluded. Sampled with consecutive non probability technique in patients was assessed with ECG, cardiac enzymes, transthoracic echocardiography, renal Doppler and RFTs. All patients were admitted in wards and were followed up during hospital stay. Patients were evaluated and their record of Primary PCI and thrombolysis was also noted. Data was entered and analyzed with SPSS-23.
Results: A total of 380 patients with STEMI were included in this study consisting of 292 (76.8%) male and 88 (23.1%) female from 30 to 70 years. The patients were divided in two groups i.e. diabetic and non-diabetic, 190 patients were included in each group. It was found that frequency of ST-Elevation MI was higher in diabetic group as compared to non-diabetic group. All the patients were analyzed for complications occurred after STElevation MI. LV failure, Brady arrhythmias, atrial fibrillation, post MI angina and cardiogenic shock were the main complications noted. It was found that all these complications are more in diabetic group post MI angina which occurred most frequently in non-diabetic group.
Conclusion: In our study we observed that left ventricular failure and arrhythmias were the major complications. Mortality was higher in diabetic patients than non-diabetic patients. In both groups PPCI and SK reduced mortality. Post MI angina were found more frequent in non-diabetic group.
FETAL ECHOCARDIOGRAPHY: 12 YEARS EXPERIENCE AT AFIC /NIHD
Authors: Akbar Hajira , Ansari Asma , Nawaz Sadaf , Khalil Hafsa , Akhter Khurram , Mehmood Amjad , Sadiq Nadeem , Sultan Mehboob , Nafees Shahid 
Published: January 2021

Objective: To determine the frequency of congenital cardiac lesions in pregnant women reporting for fetal echocardiogram and correlate with obstetrical risk factors.
Study Design: Descriptive cross-sectional study.
Place and Duration of Study: To be conducted at pediatric cardiology and obstetrical unit of AFIC/NIHD and CMH Rawalpindi, from Jan 2009 to Jan 2020.
Methodology: Pregnant women referred for fetal echocardiogram from 19-49 years of age were enrolled. Echo was done between 20 to 36 weeks gestation. Primary outcome was the nature of cardiac lesion and gestation at diagnosis. Neonatal scan was done at follow up to confirm cardiac diagnosis. Secondary outcome was obstetrical risk factors which were the reason for referral. This included age consanguinity, family history, previous history of intrauterine death or early neonatal death, maternal and paternal diseases. Data was collected and analyzed n frequencies and percentage. Chi-square was applied for association between variable and p-valve 0.05 was considered significant.
Results: A total of n=967 pregnant women referred to outpatient department for fetal echocardiogram. Congenital cardiac lesion were detected in n=83 patients. Majority of patients had CAVSD (1.2%) CCAVB (1.2%) followed by ASD (1.1%) VSD (0.9%) Abnormal heart rate (0.8%) Single ventricle (0.3%). Most significant maternal age group was between 21 to 30 and 30-40 years (43.7 and 46.2%). Only 3% below 20 years and 6.7% above40 years of age. Most important maternal risk factor was previous off spring 0.5% past family history 0.3% and abnormal obstetrical ultrasound 0.3% Followed by maternal diabetes 0.1% and maternal hypertension 0.1%. The yield of detection of congenital cardiac lesions was 8.3%.
Conclusions: Congenital cardiac diseases are the second most common congenital anomaly and huge burden n pediatric population. Timely diagnosis and referral can be lifesaving.
FREQUENCY OF ACUTE KIDNEY INJURY AMONG PATIENTS UNDERGOING CORONARY ANGIOGRAPHY
Authors: Khan Sajid , Siddiqui Abdul Hameed , Samin Ariz , Mustafa Syed Hassan , Gul Akhtar , Mazhar Muhammad Waqas 
Published: January 2021

Objective: To determine the frequency of acute kidney injury among patients undergoing coronary angiography.
Study Design: Descriptive cross-sectional study.
Place and Duration of Study: Department of Cardiology, Hayatabad Medical Complex, Peshawar, from Jan 2018 to Jul 2018.
Methodology: This study was conducted in the in the Department of Cardiology, Hayatabad Medical Complex, Peshawar from 22nd Jan 2018 to 22nd Jul 2018. Through a descriptive cross-sectional study design, a total of 116 patients scheduled for coronary angiography were included in the study in a consecutive manner and baseline / follow up serum creatinine was recorded to detect acute kidney injury.
Results: In this study 116 patients were included, 61.2% males and 38.8% females. Mean age of the patients was 55.6 years with a standard deviation of 6.6 years. Mean baseline serum creatinine level was 0.9 ± 0.11mg/dl which was 1.5 ± 0.11 48 hours after coronary angiography (p 0.000). AKI was recorded in 19.8% of patients.
Conclusion: Acute kidney injury after coronary angiography is not uncommon in our population. More studies are recommended on its risk factors and complications to draw future directions for its control and prevention.
COMPARISON BETWEEN HEMODYNAMIC CHANGES OF ATRACURIUM AND CISATRACURIUM IN PATIENTS UNDERGOING CABG SURGERY
Authors: Ali Muhammad , Hussain Syed Aqeel , Siddiqi Rashad , Khan Fahad Ahmad , Javaid Rehana , Khan Rahmeen Pervaiz 
Published: January 2021

Objective: To compare the hemodynamic effects of Atracurium versus Cisatracurium in Cardiac Patients Undergoing coronary artery bypass graft Surgery.
Study Design: Randomized controlled trial.
Place and Duration of Study: The study was conducted at Armed Forces Institute of Rawalpindi, a tertiary care hospital, after seeking hospital ethics committee permission, from Apr 2019 to Oct 2019. Methodology: A total of 200 consecutive patients were randomized into two equal groups, group-A and group-C (100 in each group). Group-A patients were induced with 0.5mg/kg of Atracurium, followed by infusion @ 10μg/kg/min whereas group C patients received Cisatracurium @ 0.2mg/kg at induction, followed by infusion @ 2μg/kg/min during the maintainence phase. Systolic blood pressure, diastolic blood pressure, Mean arterial pressure and heart rate were noted at different intervals of both groups. Decrease in systolic blood pressure of >20% from baseline or a value <90 mmHg was considered as hypotension.
Results: The mean age of patients was 57.5 ± 6.75 years and 56.52 ± 4.46 years in group A and group C respectively. Systolic and diastolic blood pressure was better maintained with cisatracurium than atracurium. Also Mean arterial pressure remained more stable with cisatracurium (p<0.05), but after opening of sternum and before going on cardiopulmonary bypass, the difference was insignificant in both groups (p>0.05). Heart rate remained more steady with cisatracurium (p<0.05) but had insignificant difference before going on cardiopulmonary bypass (p>0.05).
Conclusion: Cisatracurium found to be more suitable drug in maintaining the stable hemodynamics and preventing fluctuations in pressure in cardiac patients undergoing on-pump bypass surgery.
DEMOGRAPHICS AND MAJOR INDICATIONS FOR THE WARFARIN USE, THE COMPLIANCE RATE AND THE FACTORS CONTRIBUTING IN NON-ADHERENCE AMONG PATIENTS PRESENTING TO A TERTIARY CARDIAC CENTER OF PAKISTAN
Authors: Nazir Muhammad Talha Bin , Siddiqui Muhammad Mujtaba Ali , Khan Hamid Sharif , Saif Mohsin , Kousar Shabana , Sajid Muhammad Usman 
Published: January 2021

Objective: To assess the impact of a dedicated hospital based warfarin clinic assessing patients’ knowledge and improving the drug compliance in a tertiary cardiac center of Pakistan.
Study Design: Descriptive cross sectional study.
Place and Duration of Study: Rawalpindi Institute of Cardiology from Jan 2019 to Jul 2019.
Methodology: Patients presenting in the anticoagulation clinic using warfarin for different cardiovascular indications from Jan to Jul 2019 were included in the study. Patients were assessed for their underlying cardiovascular condition, their international normalized ratio levels checked using a standard technique. The patients’ knowledge about the drug and the degree of compliance was judged by eight-item Morisky Medication Adherence Scale (MMAS-8). The patients were thoroughly counseled and reassessed six months later assessing the improvement in compliance with the warfarin therapy.
Results: Total number of 401 patients using warfarin for different cardiovascular diseases were studied. The mean age was 43.3 ± 13.3 years with 218 (54.5%) patients being male. Most of the patient 300 (75%) belonged to the low socio-economic group with average monthly income of <PKR 10,000/$65. In addition, 61.4% of the patients belonged to the rural set up. Mechanical valve replacement made the bulk of the indication for warfarin therapy with 44.7% of patients with mechanical mitral valve, 14% with mechanical double valve and 13% with mechanical aortic valve replacement. 13.7% of the patients on warfarin therapy had atrial fibrillation while 6.9% either had venous thromboembolism and pulmonary embolism. The compliance was good in 76.1% on baseline visit which increased to 86.7% on the first visit at six-month interval. Residence in rural areas and low socioeconomic status were the two factors contributing to poorer compliance which improved on the first visit.
Conclusion: Low socioeconomic status and residents of rural areas were resulting in comparatively poorer compliance with warfarin therapy which improved by educating such patients in specific warfarin clinic.
Eficacia y eficiencia en la enseñanza media chilena desde los datos SIMCE 1994,1998 y 2001
Authors: Redondo Rojo Jesús M. , Descouvieres Carrillo Carlos , Rojas Patuelli Karina 
Published: January 2021

En el artículo se aborda la calidad de la educación en el 2º Medio mediante el análisis de la eficiencia de los colegios y liceos. Se utilizan los datos de la prueba nacional SIMCE de 2º Medio de 1994, 1998 y 2001. La eficiencia se calcula mediante regresión lineal múltiple de la eficacia (logro escolar = resultados SIMCE), con control de variables de input: inversión por alumno, nivel educativo de los padres y vulnerabilidad educativa.
Los resultados SIMCE dependen en un 69% de las tres variables de input estudiadas, siendo imputable a los centros escolares en un 31 %. Las diferencias en eficiencia entre las redes pública y privada apenas alcanza a 1.75 puntos promedio (hay que tener en cuenta que no se ha podido controlar la selección de alumnos por los centros). Los centros financiados con fondos públicos son los que muestran un progreso en su eficiencia en el estudio longitudinal, especialmente los municipales.
Los resultados apuntan a que el mercado en la educación no está justificado empíricamente para mejorar la calidad y eficiencia en la educación, aunque si para generar negocios con la educación.
Impacto de la gestión en la calidad educativa de las organizaciones educativas
Authors: López Alfaro Pablo 
Published: January 2021

Existen factores que afectan negativamente la calidad de los resultados de las organizaciones educativas, entre ellos la ausencia de una evaluación clara de su gestión y de las variables relevantes para el funcionamiento efectivo de estas organizaciones, como son: la satis¬facción de los beneficiarios, los resultados que ésta entrega a la sociedad en la cual se desarrolla y el impacto que en ella tienen los servicios que la escuela les reporta.
En el presente trabajo se propone un modelo causal que identifica algunas variables que inciden en la gestión de las organizaciones escolares y las relaciones entre dichas variables, así como el efecto que el análisis de la gestión tiene en los resultados de estas organizaciones y se releva la importancia de someter a cualquier modelo de evaluación o diagnóstico a una validación empírica, no sólo para detectar cuáles son aquellas variables que necesariamente deben ser consideradas como relevantes en el modelo, sino principalmente para conocer las interrelaciones existentes entre las mismas y el impacto que cada una de ellas tiene en la calidad de la gestión que se está evaluando.
LIBERALISMO, DEMOCRACIA E A QUESTÃO DO TRABALHO
Authors: Albinati Ana Selva Castelo Branco 
Published: January 2021

RESUMO
Tendo como base o pensamento de Marx sobre o Estado – sua gênese e sua razão de ser –, refletimos aqui sobre a relação entre liberalismo e democracia e a tensão entre esses dois projetos no desenvolvimento do capitalismo e suas implicações sobre as condições de trabalho. Marx, ao analisar a diferença entre a relação Estado-sociedade que se verifica da passagem do mundo medieval ao mundo moderno, chama a atenção para a autonomização do Estado em relação à sociedade, processo que leva à cisão entre o indivíduo em sua vida privada e o cidadão. Contrapondo-se à reflexão hegeliana que via no Estado moderno a possibilidade de reconciliação entre os interesses particulares e os interesses universais, Marx desvela o Estado como uma instância que se ergue sobre as contradições da vida social, sendo, por isso, impotente para resolvê-las. Pretendemos desenvolver neste artigo a questão: se o Estado responde aos antagonismos próprios da vida social, antagonismos vinculados ao modo de produção, o que é o Estado moderno senão o Estado liberal, quando seu pressuposto é a propriedade privada? E sendo assim, como compreender a relação entre liberalismo e democracia enquanto elementos da relação entre o Estado e a sociedade na modernidade?
Genomic diversity of Escherichia coli from healthy children in rural Gambia
Authors: Foster-Nyarko Ebenezer , Alikhan Nabil-Fareed , Ikumapayi Usman N. , Sarwar Golam , Okoi Catherine , Tientcheu Peggy-Estelle Maguiagueu , Defernez Marianne , O’Grady Justin , Antonio Martin , Pallen Mark J. 
Published: January 2021

Little is known about the genomic diversity of Escherichia coli in healthy children from sub-Saharan Africa, even though this is pertinent to understanding bacterial evolution and ecology and their role in infection. We isolated and whole-genome sequenced up to five colonies of faecal E. coli from 66 asymptomatic children aged three-to-five years in rural Gambia (n = 88 isolates from 21 positive stools). We identified 56 genotypes, with an average of 2.7 genotypes per host. These were spread over 37 seven-allele sequence types and the E. coli phylogroups A, B1, B2, C, D, E, F and Escherichia cryptic clade I. Immigration events accounted for three-quarters of the diversity within our study population, while one-quarter of variants appeared to have arisen from within-host evolution. Several isolates encode putative virulence factors commonly found in Enteropathogenic and Enteroaggregative E. coli, and 53% of the isolates encode resistance to three or more classes of antimicrobials. Thus, resident E. coli in these children may constitute reservoirs of virulence- and resistance-associated genes. Moreover, several study strains were closely related to isolates that caused disease in humans or originated from livestock. Our results suggest that within-host evolution plays a minor role in the generation of diversity compared to independent immigration and the establishment of strains among our study population. Also, this study adds significantly to the number of commensal E. coli genomes, a group that has been traditionally underrepresented in the sequencing of this species.