Factors Responsible for Worse Outcomes in STEMI Patients With Early vs Delayed Treatment Presenting in a Tertiary Care Center in a Third World Country.

The aim of the study is to compare the outcomes among ST-segment elevation myocardial infarction (STEMI) cases with early treatment vs delayed treatment. It was a prospective comparative study on 186 patients with consecutive (nonprobability) sampling. Two groups of cases were made as per their time to get admitted to the hospital (ie, within 2 hours of symptom onset = Group A; after 2 hours of symptom onset = Group B). Patients were asked for factors causing a delay in treatment after the onset of symptoms and were monitored for STEMI outcomes. The mean age of all patients was 46.62 ± 9.76 years and there were 140 (75.27%) male and 46 (24.73%) female, and male to female ratio 3:1.Factors significant for delayed treatment vs nondelayed treatment were poor social economic status (65.6% vs 20.4%), history of chronic stable angina (33.3% vs 11.8%), delayed response in the emergency room (20.4% vs 8.6%), delayed ECG acquisition (26.9% vs 8.6%), delayed ECG interpretation (25.8% vs 4.3%), pain at night 12:00-6:00 AM (21.5% vs 9.7%) and belief that the chest pain is noncardiac (26.9% vs 3.2%). Acute heart failure was significantly greater in group B (9.7%) in comparison with group A (2.2%), re-infarction was 18.3% in group B in comparison with 7.5% group A. Similarly sustained ventricular tachycardia and ventricular fibrillation and in-hospital mortality were higher in group B (12.9%, 14%, and 12.9% respectively). Due to delayed treatment patients had higher hospital stays, and complications, like acute heart failure, re-infarction, ventricular fibrillation, and in-hospital mortality.

Is there an EKC between economic growth and air pollutant emissions in SAARC countries? Evidence from disaggregated analysis.

The manufacturing and construction (M&C) sector not only plays a vital role in promoting economic growth, but is also a significant contributor to global air pollution. Growing concerns regarding air pollutant emissions necessitate a more disaggregated (i.e., sectoral) investigation in order to identify the major contributors. This study employs aggregated and disaggregated data to determine the fundamental effects of economic growth (i.e., overall growth and sectoral growth) on air pollutant emissions (APE) (specifically, PM2.5 and PM10 released by the M&C sector) in SAARC economies between 1995 and 2018. It assesses the environmental Kuznets curve (i.e., inverted U-shaped and N-shaped) using the feasible generalized least squares (FGLS), panel-corrected standard errors (PCSE), and generalized method of moments (GMM) techniques. The sectoral analysis reveals the presence of an N-shaped EKC while the overall analysis indicates an inverted U-shaped EKC. Population, financial development (FD), and merchandise exports (MX) have no influence on the estimates. Population and FD increase APE in all models, whereas the effects of MX vary between models. As SAARC economies are capital-deficient, these economies can adopt unbalanced environmental protection policies. First, focus on major contributing sectors (e.g., M&C sector) to curb APE, then focus on less emitting sectors in turn. By implementing pollution reduction strategies on M&C sector activities, governments may reach their threshold (peak) points earlier than expected. A reduction in APE is impossible without rigorous monitoring and application. Being capital-deficient nations and given the collective nature of the problem, a Transboundary Haze/Pollution agreement is required to solve this issue.