Factors Associated with Delayed Hospital Arrival of Patients Presenting with Acute Myocardial Infarction: A Cross-Sectional Study in Bangladesh.

Delay in seeking medical care of the patients with acute myocardial infarction (AMI) could affect the outcome. Therefore, it is important to recognize and reduce pre-hospital in initiating treatment of these patients. The objective of the study was to evaluate the factors associated with delayed hospital arrival of patients with AMI. This cross-sectional study was carried out among 385 patients with AMI attended in the Department of Cardiology, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh. The delay in arrival to the hospital was recorded along with socio-demographic data, conditions of the patients during onset and other relevant data. The mean age of the patients 59.7±9.9 years with a male-female ratio of 2.4:1. About 22% of patients with AMI arrived at the hospital within 6 hours of symptoms onset and only around 13% arrived within 2 hours of onset of symptoms. Comparatively younger (p=0.037), unmarried (p=0.008) and Muslim (p=0.008) patients were more likely to present for hospital care sooner (p=0.037). Patients coming from upper middle class of socioeconomic status (p<0.001) and those with college or post college level of education (p<0.001) were more likely to present earlier for hospital care. Prehospital delay was larger in non-manual worker patients (p<0.001) as well as in patients with onset of chest pain during rest period (p<0.001) and while at home (p<0.001). Pre-hospital delay was shorter in patients with onset of chest pain from 12am to 6am and 6am to 12pm (p<0.001). Lack of awareness of AMI symptoms and benefits of its early treatment, long distance and mode of transport were shown as the most common causes of delayed arrival of patients at hospital (p<0.001). This study has identified the factors associated with AMI in context of Bangladesh. Effective measures including increasing awareness of AMI symptoms should be taken for better outcome of the patients.

Leaching and runoff potential of nutrient and water losses in rice field as affected by alternate wetting and drying irrigation.

Inefficient water management in rice paddy is responsible for a large quantity of water and nutrient loss, which causes tremendous economic and environmental costs. Yet, quantified data on the water and nutrient losses are limited. A study was conducted during 2018-2019 with an Aman (wet)-Boro (dry)-Aman (wet) rice rotation to evaluate the effect of water management on water and nutrient losses through different pathways. The treatments in 2018 Aman season were: (i) rainfed, (ii) I6D (irrigation after six days of ponded water disappearance), and (iii) I3D. In 2019, the Boro season had (i) I6D and (ii) I3D, and the Aman season had (i) rainfed, (ii) I9D, and (iii) I1D treatments. The water input and output from the studied lysimeters were measured daily, and samples from the leachates, ponded water, and topsoil were routinely analyzed for nutrient content. In both Aman seasons, the rainfed cultivation had lower percolation losses (38-44 % of total input) than other treatments (45-70 %). Evapotranspiration in the Boro season (5.4-5.9 mm/day) was higher than that in the Aman seasons (4.2-4.6 mm/day) because of the drier Boro season. Ammonium (NH4⁺-N) leached at 0.6-6.7 mg/L and nitrate (NO3⁻-N) 0.6-5.6 mg/L in these rice seasons. Phosphorus concentration ranged 0.04-0.37 mg/L in the leachates and 0.04-0.51 mg/L in the ponded water. The rainfed and I9D exerted higher nutrient leaching concentration in some events and less so for the I6D treatment than the I3D and I1D, possibly because of the better nitrification and preferential flow paths induced by the prolonged drying processes. However, the rainfed, I9D, and I6D had less leaching load than the I3D and I1D because the latter had larger percolation volume. For example, the I6D treatment in the Boro season reduced the N leaching load by 44 % and P load by 39 % compared with the I3D, and the I9D in 2019 Aman season had 42 and 13 % less N and P leaching load, respectively, than the I1D treatment. The findings will contribute to the effort of developing a sustainable and climate-resilient rice production system.

Addressing the spatial disconnect between national-scale total maximum daily loads and localized land management decisions.

Regulatory watershed mitigation programs typically emphasize widespread adoption of best management practices (BMPs) to meet total maximum daily load (TMDL) goals. To comply with the Chesapeake Bay TMDL, jurisdictions must develop watershed implementation plans (WIPs) to determine the number and type of BMPs to implement. However, the spatial resolution of the bay-level model used to determine these load reduction goals is so coarse that the regulatory plan cannot consider heterogeneity in local conditions, which affects BMP effectiveness. Using the Topo-SWAT modification of the Soil and Water Assessment Tool (SWAT), we simulated two BMP adoption scenarios in the Spring Creek watershed in central Pennsylvania to determine if leveraging fine-scale spatial heterogeneity to place BMPs could achieve the same (or better) nutrient and sediment reduction at a lower cost than the state-level WIP BMP adoption recommendations. Topo-SWAT was initialized with detailed land use and management practice information, systematically calibrated, and validated against 12 yr of observed data. After determining individual BMP cost effectiveness, results were ranked to design a cost-effective BMP adoption scenario that achieved equal or greater load reduction as the WIP scenario for 74% of the cost using eight management-based BMPs: no-till, manure injection, cover cropping, riparian buffers, land retirement, manure application timing, wetland restoration, and nitrogen management (15% less N input). Because watersheds of this size typically represent the smallest modeling unit in the Chesapeake Bay Model, results demonstrate the potential to use watershed models with finer inference scales to improve recommendations for BMP implementation under the Chesapeake Bay TMDL.

Protein C Deficiency Causing Recurrent Myocardial Infarction in a Young Male.

Protein C is one of the most important factors that prevent blood from clotting. Protein C deficiency usually leads to venous thrombosis. We intend to report a male of 38 years admitted in coronary care unit of Dhaka Medical College Hospital, who suffered recurrent episodes of myocardial infarction, whose traditional risk factors were well controlled. Ultimately he was diagnosed with protein C deficiency, which is not commonly implicated in arterial thrombosis. Protein C deficiency can rarely cause severe life threatening arterial thrombosis, like myocardial infarction. Many more cases are reported in recent literature. It can happen sporadically. A high degree of suspicion should be maintained if traditional risk factors are absent in instances of arterial thrombosis, to look for protein C deficiency.

Influence of soil structure on contaminant leaching from injected slurry.

Animal manure application to agricultural land provides beneficial organic matter and nutrients but can spread harmful contaminants to the environment. Contamination of fresh produce, surface water and shallow groundwater with the manure-borne pollutants can be a critical concern. Leaching and persistence of nitrogen, microorganisms (bacteriophage, E. coli, and Enterococcus) and a group of steroid hormone (estrogens) were investigated after injection of swine slurry into either intact (structured) or disturbed (homogeneous repacked) soil. The slurry was injected into hexaplicate soil columns at a rate of 50 t ha-1 and followed with four irrigation events: 3.5-h period at 10 mm h-1 after 1, 2, 3, and 4 weeks. The disturbed columns delayed the leaching of a conservative tracer and microorganisms in the first irrigation event compared to the intact columns due to the effect of disturbed macropore flow paths. The slurry constituents that ended up in or near the macropore flow paths of the intact soil were presumably washed out relatively quickly in the first event. For the last three events the intact soil leached fewer microorganisms than the disturbed soil due to the bypassing effect of water through the macropore flow path in the intact soil. Estrogen leached from the intact soil in the first event only, but for the disturbed soil it was detected in the leachates of last two events also. Leaching from the later events was attributed to higher colloid transport from the disturbed soils. In contrast, NO3-N leaching from the intact soil was higher for all events except the first event, probably due to a lower nitrification rate in the disturbed soil. A week after the last irrigation event, the redistribution of all slurry constituents except NO3-N in most of the sections of the soil column was higher for the disturbed soil. Total recovery of E. coli was significantly higher from the disturbed soil and total leaching of mineral nitrogen was significantly lower from the disturbed soil. Results demonstrate how manure-borne constituents injected into undisturbed soil columns respond more as expected in the field, in terms of leaching and persistence, than do the same constituents injected into typically constructed columns of disturbed soil.

Echocardiographic comparison of regional wall motion abnormality between patients with acute anteroseptal and acute extensive anteior ST segment elevation myocardial infarction.

Post myocardial infarction (MI) short and long-term clinical outcome is largely determined by the size of the infarcted area. It is generally assumed that as the lead involvement in electrocardiography (ECG) is less in anteroseptal ST segment elevation myocardial infarction (AS-STEMI), where ST segment elevation (STE) is limited to leads V1 to V3, myocardial damage is likely to be less; and in extensive anterior STEMI (EA-STEMI), as the STE extends further upto V6, the myocardial damage is likely to be more. This study was intended to compare regional wall motion abnormality (RWMA) between acute anteroseptal STEMI and acute extensive anterior STEMI patients. 90 patients with AS-STEMI and 106 patients with EA-STEMI, admitted in between October 2012 and September 2013, were included. For each patient, a transthoracic echocardiogram (TTE) was performed within 24-48 hours of MI and was interpreted by an independent investigator blinded to the patient's ECG data. No differences were observed between the two groups in baseline characteristics; except AS-STEMI group had more patients with diabetes and EA-STEMI group had more patients with family history of coronary artery disease. Distribution, extent of wall motion abnormalities and mean number of total involved segments were similar between patients with AS-STEMI and those with EA-STEMI (p > 0.05). Regarding regional dysfunction, the apical septal (99.1% vs. 92.2%, p < 0.05) and apical (76.4% vs. 60.0%, p < 0.05) segments were the only two segments that were affected significantly more in patients with EA-STEMI than in patients with AS-STEMI. So, the term AS-STEMI may be a misnomer, as it implies that only the anteroseptal segments of the left ventricle are involved. This study shows that regional dysfunction in patients with AS-STEMI extends beyond the anteroseptal region. So, any patients with anterior wall involvement, either anteroseptal or extensive anterior STEMI, should be treated with equal importance.

Redistribution and persistence of microorganisms and steroid hormones after soil-injection of swine slurry.

The redistribution and fate of contaminants in pig slurry after direct injection were investigated at two field sites, Silstrup (sandy clay loam) and Estrup (sandy loam), in Denmark. Intact soil samples were collected for up to seven weeks after slurry injection and concentrations of Salmonella Typhimurium Bacteriophage 28B (phage 28B), Escherichia coli, steroid hormones and other slurry components (water, volatile solids, chloride and mineral N) determined in and around the injection slit. The two experiments at Silstrup and Estrup differed with respect to slurry solid content (6.3 vs. 0.8%), as well as soil clay content (27 vs. 15%) and differed considerably with respect to the initial redistribution of slurry-borne contaminants in soil. The transport of microorganisms from the slurry injection slit to the surrounding soil was much lower than that of mineral N and chloride due to attachment and entrapment. The redistribution of E. coli was more affected by site-specific conditions compared to phage 28B, possibly due to the larger cell size of E. coli. The overall recovery of phage 28B was 0.8-4%, and of E. coli 0.0-1.3% in different samples, by the end of the study. Nine different steroid hormones were detected in the slurry slit, and a slow redistribution to the surrounding soil was observed. Overall recovery of estrogens was 0.0 to 6.6% in different samples. The study showed that the combination of soil and slurry properties determined the initial spreading of contaminants, and hence the potential for subsequent leaching.

Persistence and leaching potential of microorganisms and mineral N in animal manure applied to intact soil columns.

Pathogens may reach agricultural soils through application of animal manure and thereby pose a risk of contaminating crops as well as surface and groundwater. Treatment and handling of manure for improved nutrient and odor management may also influence the amount and fate of manure-borne pathogens in the soil. A study was conducted to investigate the leaching potentials of a phage (Salmonella enterica serovar Typhimurium bacteriophage 28B) and two bacteria, Escherichia coli and Enterococcus species, in a liquid fraction of raw pig slurry obtained by solid-liquid separation of this slurry and in this liquid fraction after ozonation, when applied to intact soil columns by subsurface injection. We also compared leaching potentials of surface-applied and subsurface-injected raw slurry. The columns were exposed to irrigation events (3.5-h period at 10 mm h(-1)) after 1, 2, 3, and 4 weeks of incubation with collection of leachate. By the end of incubation, the distribution and survival of microorganisms in the soil of each treatment and in nonirrigated columns with injected raw slurry or liquid fraction were determined. E. coli in the leachates was quantified by both plate counts and quantitative PCR (qPCR) to assess the proportions of culturable and nonculturable (viable and nonviable) cells. Solid-liquid separation of slurry increased the redistribution in soil of contaminants in the liquid fraction compared to raw slurry, and the percent recovery of E. coli and Enterococcus species was higher for the liquid fraction than for raw slurry after the four leaching events. The liquid fraction also resulted in more leaching of all contaminants except Enterococcus species than did raw slurry. Ozonation reduced E. coli leaching only. Injection enhanced the leaching potential of the microorganisms investigated compared to surface application, probably because of a better survival with subsurface injection and a shorter leaching path.

Transport of Cryptosporidium parvum oocysts in soil columns following applications of raw and separated liquid slurries.

The potential for the transport of viable Cryptosporidium parvum oocysts through soil to land drains and groundwater was studied using simulated rainfall and intact soil columns which were applied raw slurry or separated liquid slurry. Following irrigation and weekly samplings over a 4-week period, C. parvum oocysts were detected from all soil columns regardless of slurry type and application method, although recovery rates were low (<1%). Soil columns with injected liquid slurry leached 73 and 90% more oocysts compared to columns with injected and surface-applied raw slurries, respectively. Among leachate samples containing oocysts, 44/72 samples yielded viable oocysts as determined by a dye permeability assay (DAPI [4',6'-diamidino-2-phenylindole]/propidium iodide) with the majority (41%) of viable oocysts found in leachate from soil columns with added liquid slurry. The number of viable oocysts was positively correlated (r = 0.63) with the total number of oocysts found. Destructively sampling of the soil columns showed that type of slurry and irrigation played a role in the vertical distribution of oocysts, with more oocysts recovered from soil columns added liquid slurry irrespective of the irrigation status. Further studies are needed to determine the effectiveness of different slurry separation technologies to remove oocysts and other pathogens, as well as whether the application of separated liquid slurry to agricultural land may represent higher risks for groundwater contamination compared to application of raw slurry.

Elevated serum homocysteine level has a positive correlation with serum cardiac troponin I in patients with acute myocardial infarction.

The objective of the present study is to find out whether the increased serum homocysteine level is associated with the increased serum troponin I as a surrogate marker of extent of myocardial injury in acute myocardial infarction patients. Elevated homocysteine levels are associated with increased thrombosis. In patients presenting with Acute Coronary Syndrome (ACS), it is not known whether this association is reflected in the degree of myocardial injury. This was a cross sectional study conducted among the patients with acute myocardial infarction in the Department of Cardiology, Dhaka Medical College Hospital during the period of October 2009 to September 2010 and which included 194 consecutive patients with acute myocardial infarction. The mean (+/- SD) serum homocysteine level was 20.2 +/- 14.3 micromol/L with range from 7.4 to 129.1 micromol/L. Mean serum troponin-I level was classified according to normal (<15 micromol/L) and high (> or = 15 micromol/L) levels of serum homocysteine values. The mean serum troponin-I level was 8.9 +/- 8.6 ng/ml in the patients having normal serum homocysteine level and 18.4 +/- 6.5 ng/ml in the patients having high serum homocysteine level. A significant positive correlation (r=0.273; p<0.001) was found between serum troponin-I level with homocysteine level. Patients with moderate hyperhomocysteinemia (> or = 15 micromol/L) was found to be 7.09 times more likely to have increased serum troponin-I (a surrogate marker of extent of myocardial injury). The main observation of the present study was that elevated serum homocysteine level has a positive correlation with serum cardiac troponin-I in patients with acute myocardial infarction. So serum homocysteine is associated with increased extent of myocardial injury as measured by serum cardiac troponin-I level, a surrogate marker in patients with acute myocardial infarction.

Sorption of 17ß-estradiol to pig slurry separates and soil in the soil-slurry environment.

Contamination of freshwater by estrogens from manure applied to agricultural land is of grave concern because of the potentially harmful effects on aquatic life and human health. Recent developments in liquid manure (slurry) management include partial removal of particulate slurry dry matter (PSDM) by separation technologies, which may also remove parts of the estrogens and enhance infiltration of the slurry on field application and hence the interaction between estrogens and the soil matrix. This study investigated how 17ß-estradiol (E2), a natural estrogen commonly found in pig manure, sorbs to agricultural soils, to different size fractions of pig slurry separates, and to soils amended with each size fraction to simulate conditions in the soil-slurry environment. A crude fiber fraction (SS1) was prepared by sieving (<500 µm) the solids removed by an on-farm separation process. Three other size fractions (SS2 > SS3 > SS4) were prepared from the liquid fraction of the separated slurry by sedimentation and centrifugation. Sorption experiments were conducted in 0.01 mol L(-1) CaCl(2) and in natural pig urine matrix. Sorption in 0.01 mol L(-1) CaCl(2) was higher than that in pig urine for all solids used. Sorption of E2 to soil increased with its organic carbon content for both liquid phases. The solid-liquid partition coefficients of slurry separates were 10 to 30 times higher than those of soils, but the organoic carbon normalized partition coefficient values, reflecting sorption per unit organic carbon, were lower for slurry separates. Mixing slurry separates with soil increased the sorption of E2 to the solid phase significantly in the order: SS1 < SS3 < SS2 for both liquid phases. In contrast, SS4 reduced the sorption of E2 to the solid phase by increasing the sorption to suspended or dissolved organic matter. The study suggested that potentially 50 to 75% of E2 in slurry can be removed from the liquid fraction of slurry by physical separation.