Interaction of mid-latitude systems in the southern Hemisphere with southwest monsoon

The movement of cold fronts with associated westerly waves in the lower troposphere across southern Africa and adjoining southwest Indian Ocean during the months of May to August for the years 1977 to 1981 has been examined in relation to the chief features of southwest monsoon. The deep frontal systems which penetrate north or latitude 25° S cause considerable fluctuations in the intensity of south to north pressure ridge along the east coast of southern Africa and Mascarene high. During the period of movement deep frontal systems from the west coast of South Africa to the Mozambique channel, the pressure index falls leading to decrease in cross equatorial flow. With further eastward movement of the system across Mozambique channel the pressure .index rises and causes increase in cross equatorial flow in Arabian Sea, strengthening equatorial westerlies and .increase in horizontal shear. The study has revealed a definite association between variation of pressure index with onset and various phases of the monsoon circulation. This association could be of help in understanding and forecasting of these monsoon features.

FLOW MEDIATED DILATATION, CAROTID INTIMA MEDIA THICKNESS, ANKLE BRACHIAL PRESSURE INDEX AND PULSE PRESSURE IN YOUNG MALE POST MYOCARDIAL INFARCTION PATIENTS

Introduction:Due to increase in Coronary Artery Disease (CAD) at a younger age, we should try to diagnose atherosclerotic process and population at risk, at the earliest. Flow Mediated Dilatation (FMD), Carotid Intima-Media Thickness (CIMT) and Ankle-Brachial Pressure Index (ABI) are probable markers for early atherosclerosis and may be useful in coronary risk stratification Objectives: To compare and correlate the FMD, CIMT, ABI and Pulse Pressure (PP) in young male patients of Myocardial Infarction (MI) with age and sex matched healthy controls Method50 patients of MI aged ≤45 years, who presented to iccu of Department of Medicine Indira Gandhi medical college Nagpur India, were recruited consecutively for this case control study and same number of age and sex matched healthy controls were also analyzed. 3 days after Myocardial infarction FMD of the brachial artery, intima media thickness of carotid artery, ABPI and PP were measured in the cases and compared with healthy control Results: The FMD was lower among young patients of MI than controls . CIMT was higher among cases than controls . ABI was lower among cases than controls . Compared to controls, PP was higher among cases . In all subjects, a negative correlation between FMD and CIMT and a positive correlation between FMD and ABPI was found. A statistically significant negative correlation was found between endothelial dependent FMD and PP among cases and control groups Conclusion: Biophysical parameters were deranged in young post MI patients. Majority of our young male patients fell in low risk Framingham risk score but still they manifested with CAD. Despite 3 days of treatment among young male patients of MI, various biophysical parameters were stillderanged.

Introducing the new Chronic Oedema Wet Leg Pathway

Reticence to apply compression therapy has been widely observed in clinical practice, compounded by an absence of evidenced-based pathways for application of prompt compression prior to measuring ankle brachial pressure index (ABPI). Importantly, delaying compression therapy for patients with chronic oedema and lymphorrhoea causes many avoidable complications. In 2017, Lymphoedema Network Wales (LNW) developed an evidenced-based pathway to improve the management of chronic oedema and wet legs (lymphorrhoea) for community nurses. During the past 4 years, the Chronic Oedema Wet Leg Pathway has been presented, published and used internationally, as well as being translated into different languages. It is commonly used in community nursing Teams as an evidenced-based document. However, like all documents and guidelines, when more evidence becomes available, the pathway needs updating. Therefore, this clinical focus article will present the new and enhanced Chronic Oedema Wet Leg Pathway, introducing a new level four compression section, which increases the layers of compression bandaging for patients with venous insufficiency or who are morbidly obese.

Space Adequacy Analysis Based on Population Pressure National park Area (Case Study : Putri Betung Sub District, Gayo Lues, Aceh)

The land requirement for Putri Betung Sub District in Gunung Leuser National Park (GLNP) area kept increasing along with the population growth. The population density in the Putri Betung Sub-district was driven by the need for cultivation and residential area along the GLNP conservation boundary. This study aims to analyze the space adequacy for Putri Betung Sub-District in the GLNP area based on the population pressure prediction for 20 years. The research method was conducted by field survey using remote sensing, interviewed the residents, and analyzed the population pressure index using the Soemarwoto formula. The Population Pressure Index (PPI) for the cultivation area was determined from 13 villages in Putri Betung Subdistrict and shows that 12 villages had a PPI 1 value (population pressure was over the land carrying capacity limits). Only one village had PPI 1 (population pressure less than the land carrying capacity. Based on data surveys obtained, the cultivation area set in the Putri Betung area was no longer sufficient for population, resulting from the expansion in the GLNP area of 4,776.97 ha. Meanwhile, predictive analysis on space adequacy for people living decently in Putri Betung Sub District for 20 upcoming years is 6117.15 ha. In conclusion, 12 out of 13 villages in the Putri Betung SubDistrict have PPI 1 value, which is inversely proportional to the land carrying capacity. The PPI values could result in other pressures on the ecology and biodiversity conservation in National Park. It is suggested that the government need to surpass the pressure by making new policy on people’s resettlement, expanding the cultivation area, or shifting people's livelihoods

Surgical 5-year Outcomes of Extra-Anatomical Bypass for Middle Aortic Syndrome: A Case Series

Background Middle aortic syndrome is a rare disease. Several surgical treatments are available; however, the optimal treatment strategy and long-term outcomes remain unelucidated. We herein report the 5-year outcomes of six patients treated with extra-anatomical bypass surgery for middle aortic syndrome. Case presentations Between 2013 and 2016, six patients underwent extra-anatomical bypass for middle aortic syndrome at our institute: three had Takayasu’s arteritis, one had vessel vasculitis, and two had middle aortic hypoplastic syndrome of unknown origin. The patients included five women and one man, with a mean age of 59.7 years. Four patients had uncontrolled hypertension and were receiving antihypertensive medications. The mean ankle–brachial pressure index was .61. The three patients with Takayasu’s arteritis were hospitalized for congestive heart failure. These patients underwent bypass surgery from the descending aorta to the infrarenal abdominal aorta, and one also underwent concomitant heart surgery. The patient with microscopic polyangiitis underwent Y-grafting with an aortic aneurysmectomy. Subsequently, bypass surgery was performed from the descending aorta to the graft via the diaphragm. The two patients with unknown causes underwent bypass surgery from the proximal descending aorta to the distal descending thoracic aorta. There were no early or late deaths at the 5-year follow-up. We did not observe any changes in anastomotic site stenosis or new aneurysmal changes during the follow-up period. The number of antihypertensive medications was reduced in all cases, and critical symptoms, including headache, severe abdominal pain, claudication, and heart failure, improved in all patients. The ankle–brachial pressure index increased to 1.11 and did not change for five years. Renal function remained stable, and the brain natriuretic peptide level decreased from 302.8 to 74.5 pg/mL at follow-up. Conclusion Extra-anatomical bypass for middle aortic syndrome is safe and effective, and can help prevent renal failure, and relieve critical ischemic symptoms.

The Relationship Between Markers Derived From Ambulatory Blood Pressure Monitoring and Preterm Birth and Neonatal Weight in Patients With Preeclampsia

Background: In order to discern the relationship between ambulatory blood pressure monitoring-related indices and preterm birth and newborn weight in patients with preeclampsia. Methods: Sixty-seven patients with preeclampsia were included in the present study. We used logistic regression analysis to determine the relationship between blood pressure index and preterm birth risk, and to find the best threshold to predict preterm birth using an ROC curve. The relationship between the blood pressure index and neonatal weight was best described by linear regression analysis. Results: The main result are as follows. Nocturnal diastolic blood pressure load (OR =1.045, 95% Cl 1.016–1.076, P=0.002) has significant statistical association with preterm birth, but there was no statistical association between other indicators and preterm birth. Nocturnal systolic blood pressure, nocturnal systolic blood pressure load, and nocturnal diastolic blood pressure load each showed a significant negative correlation with neonatal weight. Other indicators were also negatively correlated, but these were not statistically significant. The predictive thresholds for nDBP load, as follows: for nDBP load at 73.8% a sensitivity of 0.78 and specificity of 0.70. Conclusions: In conclusion, in women with preeclampsia, elevated nDBP load has significant positive correlation with the risk of preterm birth, and nSBP, nSBP load and nDBP load has negative correlation with birth weight in newborns.Trial registration: Not applicable

Constraints of Weight Loss as a Marker of Bariatric Surgery Success: An Exploratory Study

PurposeThe aim of this exploratory study was to investigate whether the degree of weight loss properly reflects improvements in cardiometabolic health among patients who underwent Roux-en-Y gastric bypass.MethodsIn this ancillary analysis from a clinical trial, patients were clustered into tertiles according to the magnitude of the percentage weight loss (1st tertile: “higher weight loss”: −37.1 ± 5.8%; 2nd tertile: “moderate weight loss”: −29.7 ± 1.4%; 3rd tertile: “lower weight loss”: −24.2 ± 2.3%). Delta changes (9 months after surgery-baseline) in clustered cardiometabolic risk (i.e., blood pressure index, fasting glucose, high-density lipoprotein [HDL] and triglycerides [TG]), glycated hemoglobin (HbA1c), homeostasis model assessment (HOMA-IR), and C-reactive protein (CRP) were calculated.ResultsA total of 42 patients who had complete bodyweight data (age = 40 ± 8 year; BMI = 47.8 ± 7.1 kg/m2) were included. Surgery led to substantial weight loss (−37.9 ± 11.3 kg, P < 0,001), and clinically significant improvements in blood pressure index (−17.7 ± 8.2 mmHg, P < 0.001), fasting glucose (−36.6 ± 52.5 mg/dL, P < 0.001), HDL (9.4 ± 7.1 mg/dL, P < 0.001), TG (−35.8 ± 44.1 mg/dL P < 0,001), HbA1c (−1.2 ± 1.6%, P < 0.001), HOMA-IR (−4.7 ± 3.9 mg/dL, P < 0.001) and CRP (−8.5 ± 6.7 μg/mL P < 0.001). Comparisons across tertiles revealed no differences for cardiometabolic risk score, fasting glucose, HbAc1, HOMA-IR, blood pressure index, CRP, HDL, and TG (P > 0.05 for all). Individual variable analysis confirmed cardiometabolic improvements across the spectrum on weight-loss. There were no associations between weight loss and any dependent variable.ConclusionWeight loss following bariatric surgery does not correlate with improvements in cardiovascular risk factors. These findings suggest that weight loss alone may be insufficient to assess the cardiometabolic success of bariatric surgery, and the search for alternate proxies that better predict surgery success are needed.