Maize, wheat, and soybean root traits depend upon soil phosphorus fertility and mycorrhizal status.

Strong effects of plant identity, soil nutrient availability or mycorrhizal fungi on root traits have been well documented, but their interactive influences on root traits are still poorly understood. Here, three crop species (maize, wheat and soybean) were grown under four phosphorus (P) addition levels (0, 20, 40 and 60 mg P kg-1 dry soil), and plants were inoculated with or without five combined arbuscular mycorrhizal fungal (AMF) species. Plant biomass, nutrient contents, root traits (including total root length, average root diameter, specific root length and root tissue density) and plants' mycorrhizal responses were measured. Crop species, P level, AMF, and their interactions strongly affected plant biomass and root traits. P fertilization promoted plant growth but reduced mycorrhizal benefits on plant biomass and nutrient uptake. Root traits of maize were sensitive to P addition only under the non-mycorrhizal condition, whilst most root traits of soybean and wheat plants were responsive to mycorrhizal inoculation but not P addition. Mycorrhizal colonization reduced the root plasticity in response to P fertility for maize but not for wheat or soybean. This study highlights the importance of soil nutrient fertility and mycorrhizal symbiosis in influencing root traits.

Entropy Generation on Nanofluid Thin Film Flow of Eyring-Powell Fluid with Thermal Radiation and MHD Effect on an Unsteady Porous Stretching Sheet.

This research paper investigates entropy generation analysis on two-dimensional nanofluid film flow of Eyring-Powell fluid with heat amd mass transmission over an unsteady porous stretching sheet in the existence of uniform magnetic field (MHD). The flow of liquid films are taken under the impact of thermal radiation. The basic time dependent equations of heat transfer, momentum and mass transfer are modeled and converted to a system of differential equations by employing appropriate similarity transformation with unsteady dimensionless parameters. Entropy analysis is the main focus in this work and the impact of physical parameters on the entropy profile are discussed in detail. The influence of thermophoresis and Brownian motion has been taken in the nanofluids model. An optima approach has been applied to acquire the solution of modeled problem. The convergence of the HAM (Homotopy Analysis Method) has been presented numerically. The disparity of the Nusslet number, Skin friction, Sherwood number and their influence on the velocity, heat and concentration fields has been scrutinized. Moreover, for comprehension, the physical presentation of the embedded parameters are explored analytically for entropy generation and discussed.

Hypocholestrolic effect of spent black tea leaves replaced with wheat bran in broiler ration.

Black tea leaves (Camellia sinensis) have been known for many years in lowering cholesterol level. The purpose of the present study was to find the effects of spent black tea leaves as a substitute of wheat bran on cholesterol reduction in broiler chicks. For this purpose a total of hundred & fifty (150), day old broiler poultry chicks were purchased from the local market. The spent black tea leaves were collected from tea stalls. Chicks were randomly distributed into 5 main groups according to spent black tea leaves and wheat bran supplementation. Group R0 was kept as control, containing 120 g/kg wheat bran but no spent black tea leaves supplementation; group R30 received spent black tea leaves supplemented feed at the rate of 30 g/kg plus 90 g/kg wheat bran; group R60 received spent black tea leaves supplemented feed at the rate of 60 g/kg plus 60 g/kg wheat bran, group R90 received spent black tea leaves supplemented feed at the rate of 90 g/kg plus 30 g/kg wheat bran and group R120 received the spent black tea leaves supplemented feed at the rate of 120 g/kg plus 0 g/kg wheat bran respectively. Each group was carrying three replicate (10 chicks/replicate). The data was statistically analyzed, using completely randomized design. Mean liver cholesterol per chick on diet R30, R60, R90, and R120 was 102.22, 93.55, 76.22, 60.78 and 51.55 mg/100 g. Breast cholesterol per chick on diet R30, R60, R90, and R120 was 61.89, 51.33, 44.78, 37 and 32.77 mg/100 g. It was concluded that the addition of spent black tea leaves at the rate of 120 g/kg has significant effect on cholesterol reduction and over all performance of broiler chicks and recommended that expensive wheat bran can be effectively replaced by these spent black tea leaves in broiler poultry ration.

Retrieval of gallbladder through epigastric port as compared to umbilical port after laparoscopic cholecystectomy.

This comparative prospective study was conducted at the Ghulam Muhammad Mahar Medical College Hospital and Red Crescent General Hospital, Sukkur, Pakistan, for a period of two years from July 2012 to June 2014. The study included 1800 patients who underwent laparoscopic cholecystectomy for symptomatic cholethiasis. These patients were divided in to two groups. Group I included 900 patients, who underwent conventional laparoscopic cholecystectomy with the four port technique. In these patients, the gall-bladder was retrieved through umbilical port by a sterile surgical hand glove (size 6 ½ or 7 inches) endobag. The fascial defect of 10 mm umbilical port was closed by vicryl "0" with J-shaped needle, while three 5 mm ports closed by applying steri strips. Group-II also included 900 patients. In these patients laparoscopic cholecystectomy was done by using three ports, 10 mm epigastric working port, 5 mm umbilical port for 5 mm telescope and lateral 5 mm port for assistant. The gall-bladder was retrieved through epigastric port without endobag. The results of both these techniques were collected and analyzed on SPSS version 14. The mean age of patients was 45 years. The male to female ratio was 1:3. In group-I, after laparoscopic cholecystectomy, gall-bladder was retrieved safely through 10 mm umbilical port in surgical glove endobag. In acutely inflamed cases, the gall-bladder was opened at the umbilical port site inside the endobag and decompressed before retrieval. In this group, wound infection of umbilical port occurred in 5.11% patients, port-site hernia in 3.66%, port-site bleeding in 1.33% while difficulty in retrieval of gall-bladder in acutely inflamed cases in 1.88% patients. In group-II, wound infection in epigastric port was found in 1.55% patients, port-site hernia in 0.11%, port-site bleeding in 4%, difficulty in retrieval of gall-bladder in 5.33% while leakage /perforation of gall-bladder in 4.11% patients. The serious complications like wound infection and port-site hernia are more frequently found in group-I patients as compared to group-II.

Lumbar disc herniation in patients with chronic backache.

BACKGROUND: Low back pain with or without lower extremity pain is the most common problem among chronic pain disorders with significant economic, social, and health impact. This study was conducted to determine the frequency of lumbar disc herniation and its different levels, among patients with chronic backache. METHODS: This cross sectional study was conducted in the department of Neurosurgery, Ayub Medical College Abbottabad from January 2011 to January 2013. All the patients presenting with chronic low backache of either gender above the age 14 years were included in the study. Magnetic resonance imaging (MRI) was done in all the patients included in the study to look for lumbar disc herniation. RESULTS: A total of 477 patients with chronic low backache were included in the study out of which 274 (57.4%) were males. Age of the patients ranged from 19 to 75 (39.92 +/- 12.31) years. Out of 477 patients 38 (7.9%) had significant radiological evidence of disc prolapse at lumbar vertebral levels, with 26 (9.5%) males and 12 (5.9%) females. Among these 38 patients with inter-vertebral disc, 20 (52.6%) of patients had disc herniation at L5-S1, 15 (39.5%) at L4-L5, 2 (5.26%) cases at L3-L4 level and only one case (2.6%) had the involvement of L2-L3 level. No cases of L1-L2 disc prolapse were found. CONCLUSION: Patients with chronic backache can have inter-vertebral lumbar disc prolapsed disease. Middle age group are more affected by lumbar disc disease especially at the lower lumbar regions.

Conservative Management of Splenic Injury in Blunt Abdominal Trauma: A Single Center Experience.

BACKGROUND: Road traffic accidents are the greatest cause of death worldwide. Most intra-abdominal injuries caused by blunt abdominal trauma have been treated surgically for a very long period. Over the past few decades, conservative care has gained in popularity and effectiveness as a treatment choice for blunt abdominal trauma. OBJECTIVE: To determine the efficacy of conservative management in patients suffering from splenic injury in blunt abdominal trauma. METHODS: The study included 62 cases of blunt abdominal trauma treated non-operatively in the general surgery department of the Hayatabad Medical Complex Peshawar between June 2021 and December 2022. RESULTS: Minimal hemoperitoneum was observed in 47 (75.8%) cases, moderate hemoperitoneum was noted in 11 (17.7%) cases, and 4 (6.4%) patients didn't have free fluid in the abdomen. There was no massive hemoperitoneum among the study patients. No major complications were observed during the study period. Only 7 (11.3%) cases develop minimal pleural effusion while 2 (3.2%) patients developed splenic abscess. Mortality was observed in only 1 (1.6%) case. CONCLUSIONS: Conservative management is a safe and efficient strategy and should be considered as a first line of treatment for all hemodynamically stable patients who suffered blunt splenic injury.

Nickel exposure induces gut microbiome disorder and serum uric acid elevation.

Serum uric acid elevation has been found in long-term nickel (Ni) exposure occupational workers, but the mechanism is unclear. In this study, the relationship between Ni exposure and uric acid elevation was explored in a cohort of 109 participants composed of a Ni-exposed workers group and a control group. The results showed that Ni concentration (5.70 ± 3.21 µg/L) and uric acid level (355.95 ± 67.87 µmol/L) in the serum were increased in the exposure group with a significant positive correlation (r = 0.413, p < 0.0001). The composition of gut microbiota and metabolome revealed that the abundance of uric acid-lowering bacteria, such as Lactobacillus, Lachnospiraceae_Unclassfied and Blautia were reduced while pathogenic bacteria including Parabacteriadies and Escherichia-Shigella were enriched in Ni group, accompanied by impaired intestinal degradation of purines and upregulated biosynthesis of primary bile acids. Consistent with human results, the mice experiments showed that Ni treatment significantly promotes uric acid elevation and systemic inflammation. Lactobacillus and Blautia in gut microbiota were reduced and inflammation-related taxa Alistipes and Mycoplasma were enriched in the Ni treatment. In addition, LC-MS/MS metabolomic analysis indicated that purine nucleosides were accumulated in mice feces, which increased purine absorption and uric acid elevation in the serum. In summary, this study provides evidence that UA elevation was correlated with heavy metals exposure and highlighted the role of gut microbiota in intestinal purine catabolism and in the pathogenesis of heavy metal-induced hyperuricemia.

Study protocol of DIVERGE, the first genetic epidemiological study of major depressive disorder in Pakistan.

INTRODUCTION: Globally, 80% of the burdenof major depressive disorder (MDD) pertains to low- and middle-income countries. Research into genetic and environmental risk factors has the potential to uncover disease mechanisms that may contribute to better diagnosis and treatment of mental illness, yet has so far been largely limited to participants with European ancestry from high-income countries. The DIVERGE study was established to help overcome this gap and investigate genetic and environmental risk factors for MDD in Pakistan. METHODS: DIVERGE aims to enrol 9000 cases and 4000 controls in hospitals across the country. Here, we provide the rationale for DIVERGE, describe the study protocol and characterise the sample using data from the first 500 cases. Exploratory data analysis is performed to describe demographics, socioeconomic status, environmental risk factors, family history of mental illness and psychopathology. RESULTS AND DISCUSSION: Many participants had severe depression with 74% of patients who experienced multiple depressive episodes. It was a common practice to seek help for mental health struggles from faith healers and religious leaders. Socioeconomic variables reflected the local context with a large proportion of women not having access to any education and the majority of participants reporting no savings. CONCLUSION: DIVERGE is a carefully designed case-control study of MDD in Pakistan that captures diverse risk factors. As the largest genetic study in Pakistan, DIVERGE helps address the severe underrepresentation of people from South Asian countries in genetic as well as psychiatric research.

The role of nutrition in harnessing the immune system: a potential approach to prevent cancer.

Cancer is a vital barrier to increase the life expectancy and the foremost cause of death globally. The initial diagnosis and proper management of cancer can expand the survival rate of individuals. This review provides an in-depth investigation of cancer causes symptoms, types of cancer, and worldwide distribution of cancer. The relation between nutrition (i.e., various food items) and cancer is also emphasized to offer a framework of nutrition management in different cancer types. The microbiota is closely associated with the occurrence of cancer. Thus, genomics of intestinal microbes and nutrigenomics have been discussed based on the reported meta-analysis studies. A dramatic increase in cancer rates has been observed due to intake of alcohol, microbial infections, and deficiency of nutrition. Malnutrition is a substantial problem in cancer patients linked with improper treatment and increased morbidity. The detail studies of cancer and nutrigenomics are an eminent approach to comprehend the relation between microbes and the consumption of certain food types which can further reduce the cancer risk. The incorporation of specific nutrients and probiotics improved the gut microbial health, increased life expectancy, and also decreased the incidence of tumorigenesis in individuals.

Wood carbon electrode in microbial fuel cell enhances chromium reduction and bioelectricity generation.

Microbial fuel cell (MFC) is a recommended treatment to remediate hexavalent chromium (Cr(VI)) in wastewater. In this study, a wood carbon (WC) electrode was introduced in MFC to enhance the Cr(VI) removal efficiency. WC electrode in MFC completely removed Cr(VI) as compared to the carbon cloth (31.12%) and carbon felt (34.83) within 48 h of operation at 20 mg L-1 of Cr(VI) concentration. The maximum power density of WC electrode was 62.59 mW m-2 higher than 0.115 and 3.154 mW m-2 of carbon cloth and felt respectively. The specific surface area of WC increased to 158.47 m-2 g-1 after high-temperature carbonization, and electrochemical tests indicate it has higher electrocatalytic ability. Therefore, WC might be a good electrode material to effectively remove Cr(VI) and generate bioelectricity simultaneously.

Quantum-dot sensitized hierarchical NiO p-n heterojunction for effective photocatalytic performance.

A facile and low-cost pseudo successive ionic layer adsorption and reaction technique was used to deposit cadmium sulfide quantum dots (CdS QDs) on hierarchical nanoflower NiO to form an effective and intimate NiO/CdS p-n heterojunction system. The synthesized hierarchical p-n heterojunctions demonstrated effective photocatalytic activity due to the enhanced separation and transport of photogenerated charge carriers compared to standalone NiO. The dye degradation efficiency of optimized CdS QDs that form p-n heterojunctions was examined by rhodamine B and methylene blue dyes under UV-vis irradiation. The improved photocatalytic performance can be accredited to a large morphological surface, and the successful deposition of CdS QDs to form an active p-n junction for efficient charge separation and migration. The morphological, structural, optical, charge transfer and photocatalytic characteristics of synthesized hierarchical p-n junction photocatalyst were studied by scanning electron microscopy, UV-visible absorbance, X-ray diffraction, photoluminescence spectroscopy, electrochemical spectroscopy, and Fourier transform infrared spectra. Additionally, scavenging experiments were performed to find out the energetic species taking part in dye-degradation, and a rational reaction mechanism has been proposed.

The outcome of Newtonian heating on Couette flow of viscoelastic dusty fluid along with the heat transfer in a rotating frame: second law analysis.

The outcome of Newtonian heating on the viscoelastic fluid plays a vital role in daily life applications such as conjugate heat transfer around fins, heat exchanger, solar radiation, petroleum industry, etc. Also, rotation of viscoelastic fluid has various importance in product-making industries and engineering. Viscoelastic dusty fluids and Newtonian heating are applicable in nuclear reactors, gas cooling systems, control temperature of the system and centrifugal separators, etc. Therefore, based on this motivation, the present study presents the Newtonian heating effect on the dusty viscoelastic fluid. Additionally, a free convective heat transfer is taken for Couette flow in a rotating frame along with a uniform applied magnetic field. The dust particles possess complex velocities due to rotation and therefore it is the combination of the primary and secondary velocities. For the specified flow, the entropy generation and Bejan number are also computed. Poincare-Light Hill technique has been used for the solution of the system of partial differential equations. The velocity profile for dust particles and fluid are discussed in this article. The influence of different parameters on the Nusselt number, temperature profile, velocity of fluid and dust particle is discussed thoroughly.

Role of 25-hydroxyvitamin D in irritable bowel syndrome patients.

We conducted this study on patients diagnosed with irritable bowel syndrome without identifiable stressors and replaced them with vitamin D supplements for 3 months. Almost 97 cases have repeated the vitamin D status that appeared to be sufficient, while 14 patients were missing data for follow-up. The advised option was intramuscular injection replacement but 34 out of 97 were taken oral route for replacement of Vitamin D and incidental finding is noted that serum vitamin D levels rise less in the oral group than in the intramuscular group. Mean age of our subjects was 35.97 ± 9.89 years, comprising 54% males (n = 60) and 46% females (n = 51). In the outcomes of our study, 56.7% of individuals showed complete relief from IBS symptoms after vitamin D replacement, while 36.1% reported considerable improvement. Another 6.2% had exhibited moderate relief with about 14 individuals lost to follow-up.

Chitooligosaccharides production from shrimp chaff in chitosanase cell surface display system.

Chitin refers to a natural biopolymer, which is economically significant to next-generation biorefineries. In this study, a novel high-yield method with cell surface-display chitosanase (CHI-1) was built to produce chitooligosaccharides (COS) from shrimp chaff through the co-fermentation in the presence of Bacillus subtilis and Acetobacter sp. Under the optimized co-fermentation conditions (5 g/L yeast extracts, 10 g/L KH2PO4, 6% ethanol, 50 g/L glucose), the final deproteinization (DP) and demineralization (DM) efficiency and the chitin yield were achieved as 94, 92 and 18%, respectively. The engineered E. coli BL21-pET23b(+)-NICHI maintained 81% of the initial enzyme activity after 40 days at room temperature. The crude CHI-1 was inactivated after one-day interacting with prepared chitosan. Moreover, E. coli BL21-pET23b(+)-NICHI still maintained excellent hydrolysis ability in 7 days, and the COS yield reached 41%. Accordingly, the proposed method exhibited excellent stability and a high hydrolysis efficiency to produce COS with whole engineered cells.

Prevalence and predictors of thyroid dysfunction amongst patients with Type 2 diabetes mellitus in Pakistan.

Introduction: Diabetes and thyroid disorders are the two most common disorders amongst endocrine diseases. Uncontrolled diabetes mellitus (DM) may disturb thyroid metabolism by disturbing the levels of thyroid hormones in the plasma. This study was undertaken to determine the prevalence and thyroid dysfunction in type 2 diabetic population presenting in a public sector tertiary care teaching hospital. Materials and Methods: This descriptive cross-sectional study was conducted in Civil Hospital Karachi (CHK) in the department of medicine from October 01, 2018, to March 31, 2019. The study population consisted of 317 patients diagnosed with DM type 2 based on American Diabetes Association (ADA) criteria. Patients with fasting blood sugar ≥ 126 mg/dL, or HbA1c >6.5 (%), and 2 h postprandial blood glucose levels >200 mg/dL were included. After a minimum of 8 h of fasting, plasma samples of patients were collected and sent for fasting blood glucose, HbA1c, FT3, FT4, and thyroid-stimulating hormone (TSH). Descriptive statistics were calculated. Post-stratification Chi-squared test was applied, and a P value of ≤ 0.05 was considered significant. Results: Among all enrolled DM type 2 patients, 207 (65.3%) were male with a mean age of 46.54 ± 8.72 years. Mean fasting blood sugar (FBS), random blood sugar (RBS), and HbA1c were 212.76 ± 26.91 (mg/dL), 328.89 ± 52.89 (mg/dL), and 9.43 ± 2.47 (%), respectively. The mean duration of DM was 7.81 ± 3.15 years. Mean FT3, FT4, and TSH were 113.13 ± 44.40 (ng/dL), 7.63 ± 3.11 (mg/dL) and 2.64 ± 2.57 (mIU/mL), respectively. In the present study, 55 (17.4%) patients had subclinical hypothyroidism, 27 (8.5%) had hypothyroidism, 19 (6.0%) had hyperthyroidism, and 16 (5.0%) had subclinical hyperthyroidism. Significant association of thyroid dysfunction was established with age group, female gender, and family history of thyroid dysfunction (P =< 0.001). Conclusion: The prevalence of thyroid dysfunction is higher among patients with type 2 diabetes mellitus (T2DM), in which hypothyroidism was the most common dysfunction with more prevalence among female patients.

Theoretical and numerical analysis of novel COVID-19 via fractional order mathematical model.

In the work, author's presents a very significant and important issues related to the health of mankind's. Which is extremely important to realize the complex dynamic of inflected disease. With the help of Caputo fractional derivative, We capture the epidemiological system for the transmission of Novel Coronavirus-19 Infectious Disease (nCOVID-19). We constructed the model in four compartments susceptible, exposed, infected and recovered. We obtained the conditions for existence and Ulam's type stability for proposed system by using the tools of non-linear analysis. The author's thoroughly discussed the local and global asymptotical stabilities of underling model upon the disease free, endemic equilibrium and reproductive number. We used the techniques of Laplace Adomian decomposition method for the approximate solution of consider system. Furthermore, author's interpret the dynamics of proposed system graphically via Mathematica, from which we observed that disease can be either controlled to a large extent or eliminate, if transmission rate is reduced and increase the rate of treatment.

Biomethanation and microbial community response during agricultural biomass and shrimp chaff digestion.

Anaerobic digestion, a promising technology for waste utilization and bioenergy generation, is a suitable approach to convert the shrimp waste to biomethane, reducing its environmental impact. In this study, shrimp chaff (SC) was co-digested corn straw (CS), wheat straw (WS), and sugarcane bagasse (SB). In co-digestion, SC enhanced biomethane production of CS by 8.47-fold, followed by SC + WS (5.67-folds), and SC + SB (3.37-folds). SC addition to agricultural biomass digestion also promoted the volatile solids removal up to 85%. Microbial community analysis of SC and CS co-digestion presented the dominance of phylum Bacteroidetes, Firmicutes, Proteobacteria, and Euryarchaeota. Proteolytic bacteria were dominant (18.02%) during co-digestion of SC and CS, with Proteiniphilum as major bacterial genera (14%) that converts complex proteinaceous substrates to organic acids. Among the archaeal community, Methanosarcina responsible for conversion of acetate and hydrogen to biomethane, increased up to 70.77% in SC and CS digestion. Addition of SC to the digestion of agricultural wastes can significantly improve the biomethane production along with its effective management to reduce environmental risks.

Feed-additive of bioengineering strain with surface-displayed laccase degrades sulfadiazine in broiler manure and maintains intestinal flora structure.

Sulfonamide antibiotics (SAs) are excreted into the ecosystem unchanged through feces and urine because of their low adsorption and degradation in the guts of humans and animals. In this study, a novel whole-cell biocatalyst with fungal laccase on the cell surface of Escherichia coli Nissle 1917 was developed to degrade sulfadiazine (SDZ). Engineered strain EcN-IL showed laccase enzyme activity of 2 ± 1 U/mg dry weight of cell and degraded 37 ± 1% of SDZ at temperature 40 °C and pH 5 within 3 h in vitro. Strain EcN-IL with 500 mg/kg of SDZ was employed as a food supplement to feed chicken broilers, which can reduce the residue of SDZ in broiler manure by 58 ± 2% and also reduced dysbiosis of the gut microbiota due to overuse of antibiotics. The genetically engineered EcN-IL has laid a foundation for degrading SDZ in broilers and their manure.

Surgical Outcome Of Intradural Spinal Tumours.

BACKGROUND: This study was conducted to determine the short-term outcome of surgical procedure in patients having spinal intradural tumours. METHODS: This cross-sectional study was conducted from 26 April 2016 to 25 March 2019 on 56 patients after approval from hospitals ethical and research committee. MRI spine were studied in detail for all patients to know about the site, size, shape, extent and nature of the tumour. History, examination, pre-operative MRI findings, post-operative findings were documented in patient's pro forma. Short term as well as long term post-operative results were documented after surgery, during stay at hospital and followup visits till 6 months. RESULTS: In this study, 56 patients with spinal intradural tumours were observed. Male to female ratio was 1.33:1. Age ranged from 5-65 years (32.5±14.6). Paraparesis, hypesthesia, sphincter dysfunction were the presenting symptoms in most of the patients. 47% (21) patients improved according to MRC Grading system 46% (20) patients remained static 7% (3) patients deteriorated. Wound infection was found in 7 (12.5%) patients, followed by Neurological Deficit in 5 (8.9%) cases, Meningitis was found in 2 (3.57%), CSF leak was noted in 4 (7.14%) patients and mortality in 1 (1.7%) of the case. CONCLUSIONS: Surgery of the intradural spinal tumours carry good neurological outcome with acceptable complication rates.

Coronary endarterectomy for severe diffuse coronary artery disease.

OBJECTIVE: To determine the outcome of Coronary Endarterectomy (CE) in patients undergoing Coronary Artery Bypass Graft (CABG) surgery for diffuse Coronary Artery Disease (CAD), in terms of postoperative mortality and morbidity, relief from angina and survival at one year. STUDY DESIGN: A case series. PLACE AND DURATION OF STUDY: Department of Cardiac Surgery, Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, from January 2003 to November 2005. METHODOLOGY: Included in the study were all patients with such diffuse CAD that conventional bypass grafting was not possible. Those with the diseased coronary artery supplying an akinetic myocardium and a fixed perfusion defect on perfusion scan, or with poor left ventricular function (ejection fraction<30%) in association with severe chronic hepatic disease and deranged liver function tests, permanent severe immune deficiency state, or poor results at lung function tests were excluded. Cardiopulmonary Bypass (CPB) was used in all patients. All patients were followed up for a mean time of one year, for assessment of postoperative mortality and morbidity, relief from angina and survival. RESULTS: Fifty five patients (3.2%) underwent CE of at least one major coronary artery for severe diffuse atheromatous disease. The mean age was 53.9+/-9.5 years. Twenty six (47.3%) had previous Myocardial Infarction (MI), 16 (29.1%) had unstable angina, 12 (21.8%) had poor Left Ventricular (LV) function, 5 (9.1%) underwent emergency CABG surgery for impending infarction, 39 (70.9%) had angina Canadian Cardiovascular Society (CCS) class II/III, 11 (20%) had critical left main stem disease and 12 (21.8%) required Intra-Aortic Balloon Pump (IABP) for hemodynamic support. There were 2 (3.6%) early deaths and 2 (3.6%) cases of non-fatal infarctions. Three (5.4%) patients had low Cardiac Output (CO) after operation. At one year follow-up, there were no late deaths and 43 patients (91.5% of those reporting for follow-up) did not have angina. CONCLUSION: CE acted as an adjunct to CABG surgery with acceptable operative risks and satisfactory results at one year in terms of mortality and angina relief.