Background and Purpose-Hemodynamic instability can occur acutely after carotid angioplasty and stent placement (CAS). We performed this study to determine the frequency of hemodynamic instability in a series of patients who underwent CAS and to analyze factors associated with development of postprocedural hemodynamic events. Methods-We reviewed medical records and angiograms in a series of 51 patients (mean age 68.3Ϯ8.9 years) who underwent CAS for symptomatic (nϭ29) or asymptomatic (nϭ22) carotid artery stenosis. Any episodes of hypotension (systolic blood pressure Ͻ90 mm Hg), hypertension (systolic blood pressure Ͼ160 mm Hg), or bradycardia (heart rate Ͻ60 bpm) that occurred in the acute postprocedural period were recorded.

Embolization of intracranial aneurysms performed using GDCs in the awake patient appears to be safe and feasible and allows intraprocedural evaluation of the patient. Potential advantages, including decreased cardiopulmonary morbidity rates, shorter hospital stay, and lower hospital costs, still require confirmation by a direct comparison with other anesthetic procedures.

A reproducible model of ICH in rabbits is described. At 24 hrs, the perihematoma region contains relatively large proportions of morphologically intact or reversibly injured (swollen) cells, suggesting the possibility of an extended window for therapeutic intervention.

Summary Background COBRA-BPS (Control of Blood Pressure and Risk Attenuation-Bangladesh, Pakistan, Sri Lanka), a multi-component hypertension management programme that is led by community health workers, has been shown to be efficacious at reducing systolic blood pressure in rural communities in Bangladesh, Pakistan, and Sri Lanka. In this study, we aimed to assess the budget required to scale up the programme and the incremental cost-effectiveness ratios. Methods In a cluster-randomised trial of COBRA-BPS, individuals aged 40 years or older with hypertension who lived in 30 rural communities in Bangladesh, Pakistan, and Sri Lanka were deemed eligible for inclusion. Costs were quantified prospectively at baseline and during 2 years of the trial. All costs, including labour, rental, materials and supplies, and contracted services were recorded, stratified by programme activity. Incremental costs of scaling up COBRA-BPS to all eligible adults in areas covered by community health workers were estimated from the health ministry (public payer) perspective. Findings Between April 1, 2016, and Feb 28, 2017, 11 510 individuals were screened and 2645 were enrolled and included in the study. Participants were examined between May 8, 2016, and March 31, 2019. The first-year per-participant costs for COBRA-BPS were US$10·65 for Bangladesh, $10·25 for Pakistan, and $6·42 for Sri Lanka. Per-capita costs were $0·63 for Bangladesh, $0·29 for Pakistan, and $1·03 for Sri Lanka. Incremental cost-effectiveness ratios were $3430 for Bangladesh, $2270 for Pakistan, and $4080 for Sri Lanka, per cardiovascular disability-adjusted life year averted, which showed COBRA-BPS to be cost-effective in all three countries relative to the WHO-CHOICE threshold of three times gross domestic product per capita in each country. Using this threshold, the cost-effectiveness acceptability curves predicted that the probability of COBRA-BPS being cost-effective is 79·3% in Bangladesh, 85·2% in Pakistan, and 99·8% in Sri Lanka. Interpretation The low cost of scale-up and the cost-effectiveness of COBRA-BPS suggest that this programme is a viable strategy for responding to the growing cardiovascular disease epidemic in rural communities in low-income and middle-income countries where community health workers are present, and that it should qualify as a priority intervention across rural settings in south Asia and in other countries with similar demographics and health systems to those examined in this study. Funding The UK Department of Health and Social Care, the UK Department for International Development, the Global Challenges Research Fund, the UK Medical Research Council, Wellcome Trust.

We observed a low frequency of neurological events in high-risk patients undergoing angioplasty with or without stent placement. Abciximab seems to be a relatively safe adjunct for carotid or vertebrobasilar endovascular intervention either alone or in combination with low-dose thrombolytics. Partial reversal of intraprocedural heparin should be considered to reduce the risk of postprocedural bleeding.

Background: Burn related injuries (BRIs) are relatively common, mostly accidental, and highly preventable forms of injury. First aid management of BRIs can have a significant impact on the outcome and morbidity of these injuries, yet there seems to be an inadequacy in the knowledge related to burn management worldwide. Hence, our study aimed to delineate the level of knowledge and awareness of burn first aid treatment (BFAT) amongst undergraduate students, and the impact training courses had on that knowledge. Methods: A cross-sectional study was conducted by employing undergraduate medical and nonmedical students from various universities of Karachi, Pakistan. By means of convenience sampling, 400 students were sent online, structured questionnaires. The analysis was conducted using Statistical Package for Social Sciences (SPSS version 23.0, IBM Corp., Armonk, NY, US), and associations calculated through t-tests. A mean knowledge score was calculated to assess the participant's adequacy of knowledge regarding BFAT.Results: Medical students had a better knowledge score than their non-medical counterparts (5.8 ± 1.6 versus 3.6 ± 1.5, P < 0.01), however, overall knowledge of BFAT remained inadequate amongst participants. Students who received formal training scored a higher mean knowledge score than the majority of students with no training (P < 0.01). Conclusion:The majority of students had insufficient overall knowledge about BFAT, highlighting the need for integrating this topic into the curriculum. In addition, education of the masses via multimedia and conducting formal training courses, are both imperative in raising awareness and reducing the occurrence of BRIs.

It is said that Naturopathy, a drugless system of therapy, is the best method of retaining health and vigour. It makes use of physical forces such as air, light, water, heat, exercise, massage and regulation of diet. The role of a properly balanced diet for sound body and mind is well established. The fact that it can also be a curative tool is little known. The common vegetables, which form part of our daily meals, are attributed with .various medicinal properties. Review of literature on the subject yielded thrilling findings. An outline of these,is being presented in this article. The objective is not to give an exhaustive list. The examples mentioned, however, are intended to stress the importance of commdnplace and apparently inconspicous gifts of Nature. Alliurn cepa L.

Investigating water-land-climate interactions is critical for urban development and watershed management. This study examined this nexus by elasticity and statistical approaches through the lens of three watersheds: The Yukon, Mekong and Murray. Here, this study reports the fundamental characteristics, explanations and ecological and management implications of terrestrial determinant influence on the response of water quality to climate drivers. The stability of the response, measured by climate elasticity of water quality (CEWQ), is highly dependent on terrestrial determinants, with strong impacts from anthropogenic biomes and low impacts from surficial geology. Compared to temperature elasticity, precipitation elasticity of water quality is more unstable due to its possible linkages with many terrestrial determinants. Correlation and linear models were developed for the interaction system, which uncovered many interesting scenarios. The results implied that watersheds with a higher ratio of rangeland biomes have a lower risk of instability as compared to watersheds with a higher proportion of dense settlement, cropland and forested biomes. This study discusses some of the most essential pathways where instability might adversely affect CEWQ parameters and recommends suggestions for policy makers to alleviate the instability impacts to bring sustainability to the water environment.