BackgroundThe time‐sensitive hazard of perioperative cardiac troponin T (cTnT) elevation and whether long‐term mortality differs by mechanism of myocardial injury are poorly understood.Methods and ResultsIn this observational study of 12 882 patients who underwent noncardiac vascular surgery, patients were assessed for cTnT sampling within 96 hours postoperatively. Mortality out to 5‐years was stratified by cTnT level and mechanism of myocardial injury. During a median follow‐up of 26.9 months, there were 2149 (16.7%) deaths. By multivariable Cox proportional hazards analysis, there was a graded increase in mortality with any detectable cTnT compared to <0.01 ng/mL; cTnT 0.01 to 0.029 ng/mL hazard ratio (HR) 1.54 (95% CI 1.18–2.00, P=0.002), 0.03 to 0.099 ng/mL HR 1.86 (95% CI 1.49–2.31, P<0.001), 0.10 to 0.399 ng/mL HR 1.83 (95% CI 1.46–2.31, P<0.001), ≥0.40 ng/mL HR 2.62 (95% CI 2.06–3.32, P<0.001). Mortality for each mechanism of injury was greater than for patients with normal cTnT; baseline cTnT elevation HR 1.71 (95% CI 1.31–2.24; P<0.001), Type 2 myocardial infarction HR 1.88 (95% CI 1.57–2.24; P<0.001), Type 1 MI HR 2.56 (95% CI 2.56, 1.82–3.60; P<0.001). On Kaplan–Meier analysis, long‐term survival did not differ between mechanisms. The hazard of mortality was greatest within the first 10 months postsurgery. Consistent results were obtained in confirmatory propensity‐score matched analyses.ConclusionsAny detectable cTnT ≥0.01 ng/mL is associated with increased long‐term mortality after vascular surgery. This risk is greatest within the first 10 months postoperatively. While short‐term mortality is greatest with Type 1 myocardial infarction, long‐term mortality appears independent of the mechanism of injury.

BackgroundThe significance of hospital readmission after endovascular therapy for critical limb ischemia (CLI) is not well established. We sought to investigate the incidence, timing, and causes of readmissions after endovascular therapy for CLI and whether readmission is associated with major adverse limb events (MALE) or mortality.Methods and ResultsThis was a retrospective study of 252 patients treated with endovascular therapy for CLI. During median follow‐up of 381 days (interquartile range [IQR], 115–718), 140 (56%) were readmitted, with median time to readmission of 83 days (IQR, 33–190). Readmission within 30 days occurred in 14% of patients (n=35; 25% of readmissions). Most readmissions occurred between 30 and 180 days (n=67; 48% of readmissions). The most frequent reason for readmission was unhealed wounds (n=63; 45% of readmissions). Independent predictors of readmission by Cox proportional hazards analysis were unhealed wounds, presence of multiple wounds, age ≥70, female sex, hemodialysis, and history of heart failure (P<0.05 for each). By Kaplan–Meier analysis, readmission was greatest in patients with unhealed wounds, followed by patients who never had a wound, and lowest in patients whose wounds completely healed (P<0.0001 overall, and P<0.01 between groups). After multivariable adjustment, readmission remained an independent predictor of composite MALE (major amputation, bypass, or endarterectomy) or mortality (adjusted hazard ratio, 3.1; 95% CI, 1.5–6.5; P=0.002).ConclusionsMost readmissions occur 30 and 180 days after endovascular therapy for nonprocedural reasons. Unhealed wounds are an independent risk factor for readmission. Readmission is associated with increased MALE and mortality after endovascular therapy for CLI.

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Background: There is conflicting data as to whether diastolic dysfunction (DD) affects the prognosis of patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Methods: Consecutive patients undergoing TAVR underwent assessment of DD with preoperative echocardiography and NT-pro BNP. Long-term survival was ascertained every 6 months by clinic visits or phone. DD was graded according to the new American Society of Echocardiography recommendations. Health status was assessed at baseline and 30 days post-procedure using the KCCQ-12 questionnaire. Long-term survival was displayed using Kaplan-Meier curves according to NT-pro BNP levels and DD grades. Results: We included 222 patients, mean age 78 (±8) years, median STS score 4 (interquartile range = 3-7), median follow-up time 385 days (IQR = 180-640). DD was absent in 25, Grade I in 13, Grade II in 74, Grade III in 24, and indeterminate in 86 patients.Advanced (Grades II-III) DD was associated with higher pre-procedural NT-pro BNP levels (p < .001), worse quality of life (p < .001) but similar surgical risk (p = .43). Advanced and indeterminate DD were associated with increased long-term mortality (25-28% vs. 5%, p = .02) and elevated NT-pro BNP levels (26.4% vs. 9.8%, p = .05). Improvements in quality of life measures were seen in all DD groups (median change in KCCQ score no or Grade I DD:14 [3-21] vs. Grades II-III DD: 15 [16-26; p = .37]).Conclusion: Preoperative NT-pro BNP levels and echocardiographic indices of indeterminate or advanced DD are associated with increased long-term mortality after TAVR but similar improvements in quality of life.

Role of ICT and knowledge among professionals of organizations directly affects the quality of output. In this study the levels of aspect for utilization of ICT resource at workplace among professionals from different organizations in Karachi have assessed. These organizations belong from different sectors including public and private. Data was obtained from the employees of different organizations through online questionnaire. The Survey was conducted from October 15 – December 4, 2015. Questions were asked about its effect on their lives and work. A Sample of 24 employees was responded to the questionnaire and was completed for analysis. A total of 24 employees were assessed for frequency distribution of ICT Knowledge factors and descriptive analysis test was used to see the association of online system, computer exposes organization works, usage of the latest technology, internet, E-commerce and different statistical software's related to ICT knowledge. The study has few recommendations on the basis of data analysis and findings. Although the knowledge of ICT is good but some professionals and organizations are not utilizing the ICT resources completely to achieve the better results. They should improve and enhance their staff skills and knowledge through different trainings and upgrade their systems for fulfillment of their requirements and productive outputs. In addition, the Government of Pakistan has established the Ministry of Information Technology and Telecommunication Division in March 2000. The Ministry of IT is building Pakistan's IT competency to meet the challenges of 21st Century. Similarly, IT Departments are created in all Provinces for taking initiative for development of IT as per requirement of 21st century and promotion of IT education and development. The local institutions and universities do not seem to produce highly skilled people in the field of IT, especially, in certain required fields, such as programming and hardware engineering. The strength of IT education and proper trainings in the relevant field are essential. However, it seems that the focus of our educations institutions is on the quantity of the number of students being awarded degrees each year rather than imparting quality education. Thus, the challenges of the 21st century cannot, undoubtedly, be met with the present human resource. We strongly suggest taking serious measures and reforms in the education system, support IT industry in order to create a good job market, and attract investors from around the globe by providing subsidized business.