Veno-venous ECLS rescue for a heart transplant recipient with COVID-19, a case report

The potential for increased rates of morbidity of SARS-CoV-2 within immunocompromised populations has been of concern since the pandemic's onset. Transplant providers and patients can face particularly challenging situations, in the current settings as data continues to emerge for the prevention and treatment of the immunocompromised subpopulation. This case report details a patient 9-months post orthotopic heart transplant that developed SARS-CoV-2 infection despite two prior doses of the Pfizer-BioNtech COVID-19 vaccine, and had successful rescue from refractory hypoxemia with veno-venous extracorporeal membrane oxygenation (VV ECLS).

PARTIAL PURIFICATION OF GLUTATHIONE PEROXIDASE ENZYME FROM WOMEN WITH BREAST CANCER

The study included the purification of glutathione peroxidase enzyme (GPX) in the serum of women with breast cancer, which involved 60 samples of serum from women with breast cancer, and 30 samples from healthy individuals. The results of the study showed a significant decrease at a probability level of p<0.0001 for the activity of the GPX enzyme in the serum of women with breast cancer. Additionally, the GPX enzyme was purified from the serum of women with breast cancer through precipitation with ammonium sulfate and dialysis, and the use of DEAE-Cellulose ion exchange chromatography and gel filtration chromatography using Sephadex G-100, where a main protein band was separated, which was relied upon in determining the optimal conditions for the partially purified enzyme. The optimal conditions for the partially purified enzyme from the serum of women with breast cancer were determined and the highest activity was for the substrate concentration of 0.1 mM H2O2. The maximum speed Vmax was 3.125IU/L and the Michaelis-Menten constant Km was 0.0179 M using Lineweaver-Burk plot, the optimal pH was at 8.5, temperature at 37°C, and the highest activity time was at 5 minutes.

Knowledge of Hepatitis B Vaccine and Vaccination Status of Theatre Personnel at ATBUTH, Bauchi

BACKGROUND

Hepatitis B virus infection affects millions of people worldwide and is transmitted vertically and through contact with infected blood or body fluids. Frontline Healthcare workers are at increased risk of contracting HBV infection and the HBV vaccine is a crucial preventive measure recommended by WHO to safeguard healthcare workers.

OBJECTIVES

To investigate the awareness and knowledge of hepatitis B virus infection, to evaluate current vaccination status among theatre personnel, and to identify factors influencing vaccine uptake.

METHODOLOGY

This is a cross-sectional study conducted among 85 theatre personnel of ATBUTH Bauchi. Convenience sampling method was used to select participants, each participant gave consent to participate in this study. A structured questionnaire was used to collect data, which was analysed using SPSS version 25.

RESULT

Hepatitis B virus vaccine is safe according to 85% of respondents, 92% agreed that they would recommend the vaccine to other surgical staff and that it should be given as part of workplace safety. However, only 33% of respondents had completed their vaccination, while 31% had not started. The main reasons given for not being vaccinated were because they had no time to attend and did not know about the vaccine or did not have enough information regarding it.

CONCLUSION

The majority of study respondents were aware of and had a good knowledge of HBV and its' vaccine. However, vaccination status is very low among theatre personnel of ATBUTH Bauchi. Healthcare workers should be enlightened about the benefits of the HBV vaccine.

PREVALENCE AND RISK FACTORS OF NEEDLE STICK INJURIES AMONG CLEANERS IN A TERTIARY HEALTH FACILITY IN GOMBE, NORTHEAST, NIGERIA

Introduction

The cleaning staff working in a health facility are at risk of needle stick injuries (NSI) because of the nature of their work which involves the disposal of used needles and sharps. This study aimed to determine the prevalence and risk factors of NSI among cleaning staff at Federal Teaching Hospital Gombe.

Methodology

A cross-sectional study was carried out among 150 cleaning staff, selected using simple random sampling technique. An interviewer-administered questionnaire was used to collect data on the research variables. Data was analyzed using SPSS Version 23. Bivariate analysis was conducted to examine the relationships between sociodemographic factors and the prevalence of injury, while logistic regression was used to determine the predictors of needle stick injuries. Statistical significance was determined at a p-value of ≤0.05.

Result

Majority of the respondents were males (64%) and uneducated (63.3%) with a mean age of 39.9±9 years. The prevalence of NSI among the cleaners was 35.3% with 23.3% having experienced injury at least once. Uneducated individuals were found to have experienced NSI more than those who were educated. Risk factors found to be predictors of NSI were sex, educational level, job duration of > 10 years, and number of hours spent during cleaning activity.

Conclusion

Most of the staff were uneducated with no formal training before the commencement of work. Prevalence of NSI was high and therefore, there is a need for health education on the risks of the job and formal training of staff before commencement of work.

OCCUPATIONAL HEALTH AND SAFETY PRACTICES AMONG WORKERS IN BLOCK/CONCRETE CONSTRUCTION INDUSTRIES IN GOMBE METROPOLIS, GOMBE STATE, NORTHEAST, NIGERIA

Introduction

The block/concrete industry is often seen as a driver of economic growth in developing countries. A wide range of people mainly unskilled form the bulk of workers in these industries. According to the International Labor Organization, about 60,000 fatal accidents occur annually on these construction sites. This study aimed to determine the knowledge of hazards and practices of occupational safety measures among the workers in these industries.

Methodology

A descriptive cross-sectional study was done among 295 respondents selected using a multi-stage sampling technique. A structured, interviewer-administered-electronic questionnaire was used to obtain information from the respondents. Data were analyzed using SPSS version 23. Quantitative variables were summarized using tables and charts. The chi-square test was used to examine the relationship between socio-demographic characteristics and knowledge and practice. Statistical significance was determined at a p-value of ≤0.05.

Results

All the respondents were males, with a mean age of 28.9 ± 6.9 years. Most (70%) of the respondents have good knowledge while 49% have good practices in occupational safety. The age, level of education, and status of the worker were associated with knowledge of occupational hazards and practices. There was a statistically significant relationship between the knowledge of hazards and the practice of occupational safety (p = 0.000).

Conclusion

The knowledge of occupational hazards among the study participants was high while safety practices were not adequate. Therefore, the health authorities should educate workers on safety practices and encourage the management of the factories to provide safety measures to protect the workers.

AWARENESS AND PRACTICES TOWARDS PREVENTION OF MOTHER-TO-CHILD TRANSMISSION OF HIV AMONG MARRIED MEN ATTENDING THE ANTIRETROVIRAL CLINIC IN AMINU KANO TEACHING HOSPITAL, KANO, NIGERIA

Background

The prevention of mother-to-child transmission (PMTCT) of HIV programme was introduced as a comprehensive package of interventions with the aim of reducing mother-to-child transmission (MTCT) of HIV. The programme offers an opportunity to capture pregnant women and their partners in order to prevent the transmission of HIV to the baby. This study is aimed at assessing the awareness and practices of married HIV-positive male partners towards PMTCT.

Methodology

A descriptive cross-sectional study that interviewed 220 HIV-positive male partners using an interviewer-administered questionnaire.

Results

The study revealed that more of the respondents 145 (65.9%) were between the age group of 31 to 40 years. More than half 130 (59%) of the respondents were aware of PMTCT while 135 (61.4%) of the respondents had good practice of PMTCT. Respondents with formal education were 1.5 times more likely to be aware of the PMTCT programme than those having informal education [p=0.03, AOR=1.53, 95%CI=(1.98-4.54)]. Similarly, respondents with formal education were 2.5 times more likely to practice PMTCT programme than those having informal education [p=0.03, AOR=2.53, 95%CI= (1.63-4.54)].In addition, Male partners who were above 30 years of age were 3 times more likely to participate in PMTCT activities compared to those who were less than 30 years [p=0.02, AOR=2.17, 95%CI=(0.01-4.12)].

Conclusion

Raising awareness about the need for male partners' involvement in the PMTCT programme as well as encouraging male partners to partake in PMTCT activities will further increase its uptake.

DIAGNOSIS DISCLOSURE RATE AND ITS ASSOCIATIONS AMONG ADOLESCENTS LIVING WITH HUMAN IMMUNODEFICIENCY VIRUS IN GOMBE METROPOLIS, NIGERIA

Introduction

Disclosure of Human Immunodeficiency Virus (HIV) status is one of the major challenges in the management of children and adolescents living with HIV (CALHIV). With the increasing number of adolescents living with HIV (ALHIV) and the peculiarities of the adolescent stage of development, there is a need for local data on the disclosure of HIV status among adolescents living with HIV in our area of practice.

Objectives

To determine the prevalence of disclosure of HIV status and its associated factors among Adolescents living with HIV in Gombe Metropolis.

Methodology

This was a cross-sectional descriptive study among 130 ALHIV aged 12-18 years, attending Antiretroviral Therapy (ART) clinics in Federal Teaching Hospital and State Specialist Hospital- Gombe who were recruited consecutively over 10 months. Disclosure of HIV status was assessed using a pre-tested semi-structured questionnaire in both the adolescents and their respective caregivers.

Results

The prevalence of HIV status disclosure by caregivers' report and self-report was 66.2% and 63.1% respectively. Older adolescents' age and a higher level of education were significantly associated with disclosure (p value < 0.05). The commonest reason for disclosure was 'increasing curiosity' 23/130(26.7%) while 'being too young' was the commonest reason for non-disclosure 19/44(43.2%). About half 42/86(48.8%) of the disclosures were done by the mothers while 15/86(17.4%) disclosure processes were carried out by healthcare workers.

Conclusion

The disclosure rate was relatively high among ALHIV in the Gombe Metropolis. Caregivers should be encouraged on early disclosure.

Hashimoto's thyroiditis and renal transplant rejection

PURPOSE

Hashimoto's thyroiditis (HT) is a common autoimmune thyroid disorder that can disrupt thyroid function and homeostasis. As HT results from a dysregulated immune system, we hypothesized that these patients might be more susceptible to transplant failure; however, literature on this association is limited. The purpose of this study is to examine the association of HT with the risk of renal transplant failure.

METHODS

We utilized the United States Renal Database System dataset collected from 2005 to 2014 and compared the time from first renal transplant to transplant failure in end-stage renal disease (ESRD) patients with a HT diagnosis to ESRD patients without a HT diagnosis that underwent renal transplant.

RESULTS

A total of 144 ESRD patients had International Classification of Disease-9 claim codes for HT prior to renal transplant, amongst a total cohort of 90,301 renal transplant patients aged 18-100 and meeting criteria. Patients with HT were significantly more likely to be female, white, and to have a diagnosis of cytomegalovirus compared to patients without. ESRD patients with a HT diagnosis that underwent renal transplant had a significantly increased risk of renal transplant failure compared to those ESRD renal transplant patients without an HT diagnosis. There was a significantly increased adjusted hazard ratio for graft failure in patients with a HT diagnosis compared to those without.

CONCLUSION

Thyroid health and HT may play a significant role in the development of the increased risk of renal transplant failure observed in this study. Additional studies are needed to investigate the underlying mechanisms for this association.

Positive donor blood cultures are not associated with worse heart transplant survival

BACKGROUND

Recent evidence has demonstrated that transplantation of hearts with blood culture positive donors (BCPDs) to pediatric recipients is safe and effective. Few studies have analyzed the effect of BCPD on adult heart transplant recipients.

METHODS

The United Network for Organ Sharing (UNOS) database was retrospectively reviewed from September, 1987 to March, 2021. Exclusion criteria included pediatric donors/recipients, donor ejection fraction <10% or >85%, inactive listed recipients, donors missing blood cultures, and recipients missing follow-up time. Outcomes were compared with fully adjusted logistic models. To account for discrepancies in BCPD and non-BCPD covariates, an inverse proportionally weighted model with regression adjustment (IPWRA) was used.

RESULTS

A total of 60 592 donors were non-BCPD, while 4009 were BCPD. 7% of hearts not transplanted were BCPD, while 6% of hearts transplanted were BCPD (p = .001). These rates have been nearly constant since 2005. There were no differences in short term survival between the two groups in the adjusted or IPWRA models (p = .103 and .277, respectively). Additionally, the BCPD group had longer ischemic time (3.24 vs. 3.06 h, p < .001), older donor age (32.73 vs. 31.65 years, p < .001), and older recipient age (52.76 vs. 52.09 years, p = .001). The IPWRA revealed an average additional 3.4 years of overall survival and 2.25 years of graft function for BCPD versus non-BCPD recipients, although these results failed to reach statistical significance (p = .387 and .527, respectively).

CONCLUSIONS

Given the need for more donor hearts, donors with positive blood cultures should be considered. Great care in evaluating such patients is advised to eliminate donors with untreated infections, while carefully selected donors can be considered and used.

Influence of pregnancy and lactation on vitamin D serum levels and antioxidant status in randomized women in Zaria

Pregnancy and lactation are normal physiological conditions that tend to influence numerous biological processes. The aim of this study was to identify the impact of pregnancy and lactation on serum vitamin D level and antioxidant status in some women in Zaria, Nigeria. A cross‑sectional descriptive study conducted at Ahmadu Bello University Teaching Hospital, Zaria for a period of three (3) months. Blood samples were collected, serum catalase, superoxide dismutase, lipid peroxidation and vitamin D, were determined using standard methods. Data were presented as mean ± SD, analysis was performed using one-way ANOVA and Pearson's correlation analysis. Values were considered significant at p ≤ 0.05. There was a significant difference (p < 0.01) serum malondialdehyde level, superoxide dismutase activity and glutathione peroxidase activity during the various trimesters of pregnancy and lactating group. However, the levels of these markers were highest in the lactating group. Furthermore, serum level of vitamin D and catalase activity was highest in the 2nd trimester and lowest in the control and lactating group respectively.  Pregnancy and lactation altered serum level of Vitamin D, CAT, SOD, MDA and GPx suggesting a variation in oxidative stress at different trimester of pregnancy and lactation. Key words: Pregnancy, lactation, oxidative stress, vitamin D.

Pre-emptive intraoperative administration of PCC4 in cardiac surgery patients at high risk of bleeding: A pilot study

BACKGROUND

Four-factor prothrombin complex (PCC4), a concentrate of factors II, VII, IX, and X and proteins C and S, has been used selectively for reversal of oral anticoagulation before surgery. There is data to support PCC4 as opposed to supplemental fresh frozen plasma (FFP) to manage postoperative bleeding following cardiac surgery. The preemptive, intraoperative use of PCC4 in cardiothoracic surgery has not been studied though it may prevent postoperative bleeding, the need for blood transfusion and the risk of transfusion-related acute lung injury, volume overload, and right ventricular (RV) heart failure. The purpose of this study is to evaluate the intraoperative administration of PCC4 to decrease bleeding and lower the rate of blood transfusion.

METHODS

A single institution retrospective chart review was conducted from May 2020 to November 2021 of patients who received PCC4 intraoperatively during cardiothoracic surgery of high-risk variety. Patients were evaluated for the type of surgery, demographics, baseline anticoagulation, PCC4 dose, type and quantity of blood transfusion within 72 hours (h) postoperatively, chest tube output, the incidence of RV failure, hypersensitivity reactions, acute kidney injury (AKI), thrombosis, acute lung injury, and mortality within 45 days of the operative dose of PCC4.

RESULTS

Thirty-five patients received PCC4 at a mean dose of 2920 units (U). Sixty-five percent of cases were left ventricular assist devices (LVADs) or heart transplants. The protocol is to use PCC4 30  units (U)/kg immediately after the completion of protamine administration. Inclusion criteria are cardiothoracic surgery with increased risk of postoperative right heart failure commonly secondary to blood product transfusion, or cardiothoracic surgery associated with increased risk of bleeding, including heart transplant, LVAD implant, aortic dissection, and redo sternotomy (e.g., coronary artery bypass). Total chest tube output was recorded as a mean of 757 ml for 24 h after surgery (32 ml/h). Overall median event rates of FFP and red blood cell (RBC) transfusions were 0 (interquartile range [IQR]: 0-3 U) and 4 (IQR: 2-5 U). Overall, 43% and 89% of cases received FFP and RBC, respectively. There was one occurrence of RV failure, one occurrence of AKI requiring renal replacement therapy, one occurrence of venoarterial extracorporeal membrane oxygenation, one occurrence of venous thromboembolism related to a central venous access line, and one death unrelated to surgery or PCC4 that was attributed to advanced heart failure not amenable to advanced therapies.

CONCLUSION

Overall patients received a low rate of blood transfusion, had minimal chest tube output, and there was a small incidence of right heart failure. Patients did not have an increased risk of adverse effects such as AKI or venous thromboembolism. A randomized controlled clinical trial comparing the observed dose and timing of PCC4 versus routine postoperative bleeding management with blood product transfusion is recommended.

Analysis and remedies for factors responsible for time between overhaul: a case study of Do-228 aircraft starter generator

The starter generator is used for cranking the engine and to produce electricity for the aircraft system after a sustainable speed. A review of relevant literature reveals the time between the overhaul of the Do-228 aircraft starter generator but did not go in-depth to unravel the factors responsible. A survey research method is adopted to elicit information on the factors. Raosoft sample technique calculator: a software that primarily calculates or generates the sample size of a research or survey was used to obtain the minimum sample size from the study population with the nominal rolls of the technicians as the sampling frame. The questionnaire was vetted and validated by a professional focus group discussion team. The result shows that the factors responsible for the time between overhaul of the starter generator are Environmental Factors (10%), Mechanical Factors (20%), Poor Maintenance Factors (17%), Time Due (25%), Usage/Life Cycle (16%) and Aging (12%). 75% overhaul is unscheduled. It is recommended that the overhauling of the aircraft starter generators be done at 900 as against 1000 flight hour intervals to mitigate unscheduled maintenance.

Physiological Changes in Serum Calcium, Phosphate, Vitamin D, Parathyroid Hormone and Calcitonin During Pregnancy and Lactation in Randomised Population of Zaria Women

Pregnancy and lactation are usual but stressful physiological conditions accompanied by changes in calcium and phosphate metabolism and their regulatory hormones which may lead to calcium-related disorders in pregnant women. This study aimed to evaluate the changes in serum levels of calcium, phosphate, vitamin D and their regulatory hormones in pregnant and lactating women in Zaria, Nigeria. A cross‑sectional descriptive study was conducted at Ahmadu Bello University Teaching Hospital, Zaria for three (3) months. Blood samples were collected, anthropometric measurements (weight, height and body mass index) of 179 women were taken. Serum calcium, phosphate, vitamin D, parathyroid hormone and calcitonin were determined using standard methods. Data were presented as mean ± SD, analysis was performed using one-way ANOVA and Pearson's correlation analysis. Values were considered significant at p ≤ 0.05. There was a significant decrease in serum calcium concentration (p < 0.01) during the third trimester of pregnancy and lactation. An increase in serum concentration of vitamin D, parathyroid hormone, and calcitonin in the 2nd trimester and a decrease during the third trimester and lactation although not statistically significant when compared with the control. There was a negative correlation between serum calcium concentration and gestational age (r = 0.255) while no correlation between gestational age and serum phosphate concentration. Changes in serum calcium, vitamin D, parathyroid hormone and calcitonin during pregnancy and lactation has been demonstrated suggesting a relationship between calcium metabolism and these hormones at some stages of pregnancy.

Functional status of heart transplant recipients predicts survival

INTRODUCTION

Recipient functional status prior to transplantation can significantly impact post-transplant survival.

METHODS

The United Network for Organ Sharing database was queried for adult heart transplants including data on functional capacity and from February 1, 2005 to March 1, 2021; there were 32 875 cases included. The four functional categories studied were based on adult daily activities of living and were separated into total assistance required, some assistance required, no assistance required, and near death. Survival outcomes were compared for recipient's pretransplant level of functional status versus those with near death status. These were compared using adjusted logistic regression (odds of death at 30 days and 1 year) and conditional Cox models (overall survival and time until post-transplant rejection). All models were adjusted for donor age, sex, ethnicity, ischemic time, as well as recipient age, sex, ethnicity, length of stay, UNOS region, ventricular assist device, creatinine, days on the waiting list, and status at transplant.

RESULTS

There were 12 953 recipients classified as "near death" or "severely disabled"; 7711 "required total assistance in daily living", 7,328 "needed some", and 4883 "needed none". In adjusted models, the probabilities of death for the lowest functioning groups within 30 days and 1 year were 5% and 10%, respectively. Those "requiring total assistance" had analogous probabilities of 3% (OR = 0.58; p < 0.001) and 9% (OR = 0.81; p < 0.001). Those "requiring some assistance" had probabilities of 3% (OR = 0.56; p < 0.001) and 9% (OR = 0.74; p < 0.001). Lastly, those "requiring no assistance" had probabilities of death of 2% (OR = 0.35; p < 0.001) and 7% (OR = 0.63; p < 0.001).

CONCLUSION

Recipient functional status assessed pre-transplant and recorded in the UNOS database is a strong predictor of post-transplant survival.

Ischemic time and patient outcomes after the 2018 UNOS donor heart allocation system change

BACKGROUND

The allocation system for heart donors in the United States changed on October 18, 2018. The typical distance from donor hospitals to recipient hospitals has increased as has the ischemic time. We investigated patient outcomes with the new allocation system and the differential effects of ischemic time under both the old and new allocation schemas.

METHODS

The United Network for Organ Sharing Registry (UNOS) was queried for data regarding heart transplants occurring from October 1, 1987 to March 1, 2021. In total, 62,301 adult heart transplants were examined. Survival outcomes at 30 days and 1 year and ischemic times were compared via adjusted logistic and Cox models (overall survival and time until post-transplant rejection).

RESULTS

Mean ischemic time was slightly increased in the new system (3.43 h vs. 3.03 h, p < .001). Survival differences between old versus new systems were not observed in adjusted models (p = .818). However, there was evidence to suggest longer ischemic times are more detrimental to long-term survival under the new system (hazard ratio [HR] = 1.15 per hour increase; p = .001) versus the old system (HR = 1.08 per hour increase; p < .001), although this relationship did not reach statistical significance (p = .150).

CONCLUSIONS

Although travel distances have significantly increased under the new allocation system, survival outcomes remain largely unchanged. Ischemic time is an influential factor in recipient survival that should be limited during organ transport. Further studies on the impact of travel distances and ischemic time under the new allocation system are needed.

Durability properties of cement – saw dust ash (SDA) blended self compacting concrete (SCC)

This paper report the durability properties of self-compacting concrete (SCC) modified with Saw dust ash (SDA) exposed to an aggressive media. Saw dust ash (SDA) was used to partially replace OPC in SCC at 0 - 30%. A number of trials mixes were conducted to obtain grade 40 SCC, with a suitable mix proportion varied at 5, 10, 15, 20, 25 and 30 % by weight of the binder as OPC replacement in SCC. Constant water to binder ratio of 0.37 with water reducing admixtures was used in all the mixtures. The research reveals that SDA enhanced the resistance of SCC against Na2SO4 attack at 5% replacement but performed poorly in H2SO4. The water absorption of SCC decreases with an increase in SDA content. The resistance of SDA-SCC to elevated temperature is reduced with an increase in SDA content. The compressive strength of the SDA-SCC decreases with the age of exposure in an aggressive media. The SEM result revealed the presence of crystal like spikes of SDA particles, which may contribute significantly to the high surface area of the ash particles and results in a porous structure at an early age.

Successful recovery with venovenous ECMO for ARDS after LVAD HeartMate 3 implantation: A case report

Acute respiratory distress syndrome (ARDS) following left ventricular assist device (LVAD) implantation is a rare complication. Venovenous (VV) extracorporeal membrane oxygenation (ECMO) is used as a treatment for severe ARDS and pneumonia. We report the successful use of VV ECMO for ARDS Klebsiella pneumonia following urgent LVAD HeartMate 3 implantation.

P329 SEVERE ISOLATED MITRAL STENOSIS: ARE WE FACING DIFFERENT PHENOTYPES?

Introduction

The aim of the study was the evaluate the different characteristics between high gradients (HG) and low gradient (LG) mitral stenosis (MS) and, within the LG group those with high (LG–HF) or low flow (LG–LF). Moreover, we wanted to evaluated if there was any difference in overall complications and atrial fibrillation (AFib) incidence.

Methods

A total of 147 patients with isolated severe MS were retrospectively enrolled from the institutional echo database. Echocardiograms were read off line and clinical information were obtained from patients` records. Patients were divided into a group with HG (31 patients, mean MS gradient &gt; 10 mmHg) and LG (116 patients, mean MS gradient ≤ 10 mmHg). The group of LG was then divided in low flow (Stroke volume index (SVi) ≤ 35 ml/m2, LF–LG: 68 patients) and in high flow (SVi &gt; 35 ml/m2, HF–LG: 48 patients).

Results

The HG group was younger, although the difference did not reach statistical significance, higher percent of males (45% M vs 22% F, p = 0.02), higher heart rate (HR), left atrial volume, higher tricuspid regurgitation velocity and derived pulmonary artery systolic pressure (PASP), right ventricular fractional area changes (RV FAC) but similar RV longitudinal contraction. Moreover, the HG group had more severe MS calculated according to PHT. The group of LG was divided according to SVi: LF–LG compare to HG–MS had higher percent of females (45% F vs 13% M, p &lt; 0.001), similar AFib (43% vs 32%, p=ns) and pre surgical complications (19% vs 16%, p=ns). LF–LG group had smaller LA volumes (LAV systole: 117±51 51 ml vs 148.6±38 ml, p &lt; 0.0001), lower LV–S` (5.3±1.4 vs 6±1.6 cm/s, p = 0.004), lower tricuspid velocity regurgitation (TVR 2.47±0.5 vs 3.24±0.7 m/s, p &lt; 0.0001), higher TAPSE/PASP (0.64±0.3 vs 0.45±0.29, p &lt; 0.001), lower RV S` (9.79±2.01m/s vs 11.25±3.1 m/s, p = 0.01), higher RVFAC (38.5±9.6% vs 30.9±9.2%, p = 0.0005). The group of LG–LF had also less severe MS (1.3±0.6 cm2 vs 1.15±0.3 cm2, p &lt; 0.01). The 3 groups of MS were similar in terms of cardiovascular risk factors.

Conclusion

Patients with HG MS were those with worst left ventricular involvement, higher PASP and lower RV function. However LF–LG MS were older and more females were included and even though they had smaller LA, lower values of PASP they had significantly higher percent of Afib and similar pre surgical complications. It could be speculated that LF–LG severe MS patients could be a different fenotype of the disease.

Performance of millet husk ash in self compacting concrete

In a quest to mitigate the negative effects associated with the use of high cement content in self-compacting concrete (SCC), mineral additive from agricultural waste of millet husk ash (MHA) was explored with a view to partially replace cement in SCC without loss of quality. Several trial mixes were carried out with the aim of achieving grade 40 SCC, using water to binder ratio of 0.35 and plasticizer at 1.05 litre per 100 kg of cement. The adopted mix proportion satisfying the desired strength was used in production of MHA concrete (SCC – MHA) containing 5, 10, 15, 20, 25 and 30 percentages by weight of MHA as a replacement of cement respectively. Slump flow, L-box height ratio and segregation resistance were used to evaluate the fresh properties of the SCC – MHA mixes and compressive, splitting tensile and flexural strengths of the SCC – MHA evaluated at 3, 7, 28, 56 and 90 days curing ages were used to study the effects of the MHA in SCC. The result from the study shows that the slump flow and passing ability of the fresh SCC – MHA reduces with increase in MHA content in SCC but with improvement in the resistance against segregation. In addition, the increase in MHA content in SCC from 10 to 30 % reduces the compressive, splitting tensile and flexural strengths of the SCC – MHA. A microstructure study conducted on some selected specimen using X-Ray diffraction and scanning electron microscopy revealed that the available portlandite in the SCC were gradually consumed in the presence of MHA as the curing age increases. However, the result from the study showed that the MHA is class N pozzolanic material with optimum usage dose of 5 % for improvement of the hardened properties of SCC.