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Objective: To systematically compare outcomes between patients with asymptomatic carotid artery diseases (>80% stenosis) that had undergone staged carotid endarterectomy (CEA) before coronary artery bypass grafting (CABG) vs simultaneous CEA and CABG. Methods: A comprehensive electronic search of MEDLINE, Scopus, EMBASE, and Ovid from their inception up till August 2018 was performed to identify all studies comparing staged CEA followed by CABG to simultaneous CEA and CABG. Primary outcome measure was postoperative stroke, and secondary measures were myocardial infarction (MI) and 30‐day mortality rates. Results: A total of 67 953 patients were analyzed from 11 articles. There was higher rate of previous stroke in the staged cohort (2.64% vs 2.32%; odds ratio [OR], 0.81; 95% confidence interval [CI; 0.66, 0.99]; P = .040). There was no difference in previous MI (P = .57) or unstable angina (P = .08) among both cohorts. Postoperatively, there were higher stroke rates (3.64% vs 2.83%; OR, 0.72; 95% CI [0.62‐0.89]; P < .0001), operative mortality (4.32% vs 3.58%; OR, 0.90; 95% CI [0.83‐0.98]; P = .02), and 30‐day mortality (4.40% vs 3.58%; OR, 0.86; 95% CI [0.78‐0.96]; P = .006) in the simultaneous cohort. However, length of stay was significantly shorter in the simultaneous cohort (11.9 days vs 12.6 days; weighted mean difference 3.14 [0.77‐5.51]; P = .009). There were no significant differences in 1‐year mortality (P = .33), MI rates (P = .08), and rates of transient neurological deficits (P = .06). Conclusion: The results from this study favors staged CEA with CABG with lower incidence of postoperative stroke, operative, and 30‐day mortality. A larger study, ideally a randomized controlled trial, is required to address the superiority of each technique.

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Water -a critical input for sustained crop production -is becoming limiting both under rainfed and irrigated condition. It calls for an effective on-farm management of water in field crops through microirrigation (drip-fertigation) that could take care of both drainage during rainy months and supplementary life saving irrigation thereafter. Therefore, the present field study involving three planting configurations and five drip-fertigation schedules were taken up in pigeonpea (long duration) during 2010-12 under Eastern Indo-Gangetic Plains at Kanpur, Uttar Pradesh, India. Significant grain yield advantage (19.6%) was with single drip-fertigation with half of N + K fertilizer at branching over farmers' practice (rainfed pigeonpea, 2858 kg/ha). Drip-fertigation at both branch and pod development also out-yielded (3468 kg/ha) over improved practice (furrow irrigation, 3262 kg/ha). These yield levels realized were close to potential yield (2.5-3.0 t/ha). Twice drip-fertigated plots also had higher yield attributes (pods/plant, 100 seed weight and harvest index), lower water use, greater soil profile water content and water use efficiency (65.1 kg/hacm), higher plant nutrient (N, P and K) uptake with improved soil nutrient availability and greater net return (INR 9650/ha) over farmers' practice. A case study on a micro-scale was also given which could explore the possibility of out-scaling the technology.

Emphysematous pyelonephritis (EPN) is a rare, life-threatening infection, and misdiagnosis as uncomplicated pyelonephritis is potentially fatal. Point-of-care ultrasound (POCUS) is a valuable tool for evaluation of the kidneys in patients with septic shock and pyelonephritis. While used primarily to assess for the complication of obstruction and hydronephrosis, POCUS may also detect signs of EPN and prompt surgical consultation for nephrectomy. We present a case in which the emergency physician diagnosed EPN by POCUS in a patient with septic shock and pyelonephritis.