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Obesity is a modifiable, independent risk factor for mortality and morbidity after cardiovascular surgery in adults. Our objective was to evaluate the impact of obesity on short-term outcomes in adolescents undergoing surgery for congenital heart disease (CHD).
This retrospective chart review included patients 10–18 years of age who underwent CHD surgery. Our exclusion criteria were patients with a known genetic syndrome, heart transplantation, and patients with incomplete medical records. The clinical data collected included baseline demographics and multiple perioperative variables. Charting the body mass index in the Centers for Disease Control and Prevention growth curves, the entire cohort was divided into three categories: obese (>95th percentile), overweight (85th–95th percentile), and normal weight (<85th percentile). The composite outcome included survival, arrhythmias, surgical wound infection, acute neurologic injury, and acute kidney injury.
The study cohort (n = 149) had a mean standard deviation (SD), body mass index (BMI) of 22.6 ± 6.5 g/m2, and 65% were male. There were 27 obese (18.1%), 24 overweight (16.1%), and 98 normal weight (65.8%) patients. Twenty-seven (18%) patients had composite adverse outcomes. Overweight and obese patients had significantly higher adverse outcomes compared with normal weight patients (odds ratio (OR): 2.9; confidence interval (CI): 1–8.5, p = 0.04 and OR: 3; CI: 1–8.5, p = 0.03, respectively). In multivariate analysis, obesity was an independent predictor of adverse outcome in our cohort (p = 0.04).
Obesity is associated with short-term adverse outcome and increased health resource utilisation in adolescents following surgery for CHD. Further studies should evaluate if intervention in the preoperative period can improve outcomes in this population.
Self-focusing of Gaussian laser beam has been investigated in quantum plasma under the effect of applied axial magnetic field. The nonlinear differential equation has been derived for studying the variations in the beam-width parameter. The effect of initial plasma electron temperature and the axial magnetic field on self-focusing and normalized intensity are studied. Our investigation reveals that normalized intensity increases to tenfolds where quantum effects are dominant. The normalized intensity further increases to twelvefolds on increasing the magnetic field.
Anthracycline-associated cardiotoxicity in childhood cancer survivors may relate to global or segmental left ventricular abnormalities from associated thromboembolic events and myocardial microinfarcts. We characterized left ventricular segmental changes by two-dimensional speckle-tracking echocardiography in anthracycline-treated asymptomatic childhood cancer survivors.
Methods and Results:
Childhood cancer survivors’ echocardiograms with normal left ventricular fractional shortening >1 year after anthracycline chemotherapy were studied. Cancer-free control children had normal echocardiograms. Apical two-, three-, and four-chamber peak systolic left ventricular longitudinal and global longitudinal strain, and peak systolic left ventricular radial and circumferential strain at papillary muscle levels were analyzed. The mean (standard deviation) age was 12.7 (3.8) years in 41 childhood cancer survivors. The median (interquartile range) follow-up after anthracycline chemotherapy was 4.73 (2.15–8) years. The median (range) cumulative anthracycline dose was 160.2 (60–396.9) mg/m2. In childhood cancer survivors, the mean (standard deviation) left ventricular longitudinal strain was lower in two- (−18.6 [3.2] versus −21.3 [2.5], p < 0.001), three- (−16.3 [6.0] versus −21.7 [3.0], p < 0.001), and four- (−17.6 [2.7] versus −20.8 [2.0], p < 0.001) chamber views compared to controls. The left ventricular global longitudinal strain (−17.6 [2.7] versus −21.3 [2.0]) and circumferential strain (−20.8 [4.3] versus −23.5 [2.6], p < 0.001) were lower in childhood cancer survivors. Among childhood cancer survivors, 12 out of 16 left ventricular segments had significantly lower longitudinal strain than controls.
Asymptomatic anthracycline-treated childhood cancer survivors with normal left ventricular fractional shortening had lower global longitudinal and circumferential strain. The left ventricular longitudinal strain was lower in majority of the segments, suggesting that anthracycline cardiotoxicity is more global than regional.
This chapter presents original translations on the classification and symptom manifestations of neuropsychiatric disorders from Abūl-Hasan ‘Alī ibn Sahl at-Tabarī’s Arabic text Firdaus al-Hikma (The Paradise of Wisdom), the first original composition in the Islamic medical tradition. Arabic medicine has been characterised as a corpus of scientific texts translated into Arabic, mostly from Greek sources, starting from the eighth century . It inherited the Galenic system of pathology, understood as the disturbed equilibrium of the four humours (blood, mucus, yellow bile and black bile ) and acquired an Islamic character with the spread of Islam in 622 CE beyond the Arabian peninsula . Greek scientific texts from the Hellenistic, Roman and late Antiquity eras were translated into Arabic in an ambitious state project sponsored by the Abbasid caliphate in Baghdad from the eighth to tenth centuries . For example, the ninth-century Abbasid caliph al-Mutawakkil employed as his court physician a Nestorian Christian named Hunayn ibn Ishāq whose team translated the medical compendia of Hippocrates and Galen, the philosophical treatises of Plato and Aristotle, and mathematical works of Euclid and Archimedes . The caliph Harūn ar-Rashīd established a hospital in Baghdad in 805 CE, and 34 more hospitals arose throughout his dominion within two decades . As Islam spread into the Iberian peninsula, Arabic became the language of science into which Greek and Syriac texts were translated in academic centres at Toledo and Córdoba for eventual diffusion into Europe .
Resistance to colistin, a last resort antibiotic, has emerged in India. We investigated colistin-resistant Klebsiella pneumoniae(ColR-KP) in a hospital in India to describe infections, characterize resistance of isolates, compare concordance of detection methods, and identify transmission events.
Retrospective observational study.
Case-patients were defined as individuals from whom ColR-KP was isolated from a clinical specimen between January 2016 and October 2017. Isolates resistant to colistin by Vitek 2 were confirmed by broth microdilution (BMD). Isolates underwent colistin susceptibility testing by disk diffusion and whole-genome sequencing. Medical records were reviewed.
Of 846 K. pneumoniae isolates, 34 (4%) were colistin resistant. In total, 22 case-patients were identified. Most (90%) were male; their median age was 33 years. Half were transferred from another hospital; 45% died. Case-patients were admitted for a median of 14 days before detection of ColR-KP. Also, 7 case-patients (32%) received colistin before detection of ColR-KP. All isolates were resistant to carbapenems and susceptible to tigecycline. Isolates resistant to colistin by Vitek 2 were also resistant by BMD; 2 ColR-KP isolates were resistant by disk diffusion. Moreover, 8 multilocus sequence types were identified. Isolates were negative for mobile colistin resistance (mcr) genes. Based on sequencing analysis, in-hospital transmission may have occurred with 8 case-patients (38%).
Multiple infections caused by highly resistant, mcr-negative ColR-KP with substantial mortality were identified. Disk diffusion correlated poorly with Vitek 2 and BMD for detection of ColR-KP. Sequencing indicated multiple importation and in-hospital transmission events. Enhanced detection for ColR-KP may be warranted in India.
Sheath blight caused by soil borne necrotrophic fungus Rhizoctonia solani [teleomorph-Thanatephorus cucumeris (Frank) Donk.] is a major disease of rice. The disease is increasing over the year in India and cause up to 69% yield loss under favourable conditions. A total of 67 accessions of Oryza nivara were screened to identify resistance against sheath blight during 2015. Out of these, 16 accessions were found moderately resistant (MR) which were further evaluated during the year 2016 and 2017. After three years of screening, 12 of them were found to have a consistent moderate resistant reaction whereas four of the O. nivara accessions namely, IRGC81941, IRGC102463C, CR100097 and CR100110A have shown moderately susceptible to susceptible reaction against sheath blight. A correlation study revealed that different disease variables measured were significantly (P < 0.05) correlated. All the genotypes and genotype × environment interaction had a significant (P < 0.001) effect on all the disease variables. Cluster analysis showed that all the accessions were clustered into four groups which showed resistant, MR, moderately susceptible and susceptible reactions. Among all the O. nivara accessions IRGC81941A showed the maximum potential against sheath blight due to a least relative lesion height of 22.80%. None of the accession had complete resistance to the disease. The identified promising accessions such as IRGC81835, IRGC81941A, CR100008 and CR100111B can be utilized in a sheath blight resistance breeding program.
This chapter focuses on traditional cash welfare. It provides background on federal cash assistance to poor families, explains current TANF policy, and proposes that antipoverty scholars turn their attention to a fundamental precondition of democratic experimentalism: the presence of meaningful and well-functioning democracy that includes the poor. A democratic structure that operates nondemocratically by weakening the political voices of poor people is an insufficient environment for a just approach to welfare. Instead of laboratories of democracy, states in this domain often function as laboratories of suffering –political entities that experiment upon poor people without robust informed consent. While some democratic deficits are likely inevitable in any system, in welfare, we see a governance structure in which the sole direct beneficiaries of the regime are largely shut out of the democratic processes that structure that regime.
New farming systems and management options are needed in South Asia as the intensive rice–wheat production system is set to become increasingly unsustainable under climate change. In the current study, six cropping systems options/treatments varying in tillage, crop establishment method, residue management, crop sequence and fertilizer and water management were evaluated using a cropping systems model under current (1980–2009) and future (2030 and 2050) climate scenarios in the state of Bihar, India. The treatments were current farmers' practice (CP), best fertilizer and water management practices, zero tillage (ZT) with no crop residue retention, ZT with partial crop residue retention (ZTPR), future conservation agriculture-based rice–wheat intensive cropping system (FCS-1) and future conservation agriculture-based maize–wheat intensive cropping system (FCS-2). The results indicate that climate change is likely to reduce rice–wheat system productivity under CP by 4% across Bihar. All the crop management options studied increased yield, water productivity and net returns over that of the CP under the current and future climate scenarios. However, the ZTPR treatment gave significantly higher relative yield, lower annual yield variability and a higher benefit-cost-ratio than the other treatments across cropping system components and climate periods. Although all the new cropping system treatments had a positive yield implication under the current climate (compared to CP), they did not contribute to adaptation under the future climate except FCS-2 in wheat. It is concluded that adaptation to future climate must integrate both cropping system innovations, and genetic improvements in stress tolerance.
Paediatric pulmonary hypertension has been described as a secondary complication of multiple diseases and their treatment. Limited information exists about the relationship between pulmonary hypertension and cancer in children. A review of charts was performed in all patients treated for cancer and developed pulmonary hypertension. A total of four patients developed pulmonary hypertension during treatment of cancer. All patients had solid tumors, had echocardiographic evidence of elevated right ventricular pressures, and required intensive care stays. Treatment courses included inhaled and oral pulmonary vasodilators along with systemic steroids. Each had normalisation of echocardiograms and resolution of pulmonary symptoms. Prompt diagnosis of pulmonary hypertension and treatment with pulmonary vasodilators and steroids are considered important measures followed by chemotherapy and radiation regimens.
Congenital complete tracheal rings are usually associated with pulmonary slings. We report a rare association of congenital complete tracheal rings with hypoplastic left heart variant. A term infant with diagnosis of a mildly hypoplastic mitral valve, unicuspid aortic valve, and moderately hypoplastic aortic arch with severe coarctation underwent a hybrid procedure initially. Upon failing extubation attempts, complete tracheal rings were seen on direct laryngoscopy. The combination of the lesions resulted in a poor outcome. In patients with failure of extubation post-cardiac surgery, a diagnosis of complete tracheal rings should be included in the differential and a direct laryngoscopy should be considered.
The aim of this Research Communication was to contribute to the knowledge of milk sialic acid concentration of bovines with specific focus on India. Sialic acids (SA) are important constituents of mammalian milks. Buffaloes are the main milk producing species in India, therefore, our research focused on both cow and buffalo. Two Indian cattle (Bos indicus) breeds (Sahiwal, Tharparkar), one cross bred cattle – Karan Fries (Tharparkar × Holstein Friesian) and a buffalo breed (Murrah) were selected. Systematic comparisons of the total, free and bound form of SA and also its distribution over the course of lactation- colostrums and mature milk (120–140 d) was generated. Animal management, sample collection and methodology of SA estimation were identical for the different groups. Colostrum had the highest concentration of SA, which declined with the progress of lactation in all the groups. Majority of the SA existed in bound form. No significant (P < 0.05) difference was recorded in the total, bound or free SA across all the groups. However, differences were obvious in the total and bound SA level in the mature milk. Indian cattle, Sahiwal and Tharparkar were equivalent, but had higher concentration of total and bound SA than crossbred cattle. Milk of buffalo had SA equivalent to that of crossbred cattle. The mean (se) levels of total SA was 23.4 (0.8), 25.8 (2.4), 20.3 (0.6) and 20.2 (1.2) in Sahiwal, Tharparkar, cross bred and Murrah buffalo, respectively. The findings suggested that milk of indigenous cattle may be a potential source of SA, a bioactive compound with beneficial effect on human health and a potential functional ingredient in foods. Results add value to the currently declining indigenous cattle of India.
This paper presents an investigation on the self-focusing of a cosh-Gaussian laser beam in the thermal quantum plasma (TQP) by taking into account the effects of relativistic nonlinearity. An appropriate nonlinear Schrödinger equation has been solved analytically by applying the variational approach. The self-focusing and the self-phase modulation are examined under a variety of parameters. The self-trapping of a cosh-Gaussian laser beam is further studied at various values of the decentered parameter, b with different absorption levels,
. Numerical analysis shows that these parameters play a vital role in propagation characteristics. The significant contribution of the quantum effects to enhance the self-focusing and minimize the longitudinal phase has been observed. Further, a comparison has been made with the classical relativistic (CR), the relativistic cold quantum (RCQ), and the thermal quantum (TQ) regimes. The self-focusing is found to occur earlier and is strongest for the case of TQP in the present analysis.
In the present paper, we have investigated self-focusing of the quadruple Gaussian laser beam in underdense cold quantum plasma. The non-linearity chosen is associated with the relativistic mass effect that arises due to quiver motion of electron and electron density perturbation caused by ponderomotive force. The non-linearity modifies the plasma frequency in the dielectric function and hence the refractive index of the medium. The focusing/defocusing of the quadruple laser depends on the refractive index of the medium. We have set up non-linear differential equation that controls the beam width parameter by using well-known paraxial ray approximation and Wentzel–Krammers–Brillouin approximation. The effect of intensity parameter and electron temperature is observed on laser beam self-focusing in the presence of cold quantum plasma. From the results, it is revealed that electron temperature and the initial intensity of the laser beam control the profile dynamics of the laser beam.
The paper presents an investigation on self-focusing of cosh-Gaussian (ChG) laser beam in a relativistic–ponderomotive non-uniform plasma. It is observed numerically that the selection of decentered parameter and initial beam radius determines the focusing/defocusing of ChG laser beam. For given value of these parameters, the plasma density ramp of suitable length can avoid defocusing and enhance focusing effect significantly. Focusing length and extent of focusing may also be controlled by varying slope of the ramp density. A comparison with Gaussian beam has also been attempted for optimized set of parameters. The results establish that ChG beam focuses earlier and sharper relative to Gaussian beam. We have setup the non-linear differential equation for the beam width parameter using Wentzel–Kramers–Brillouin and paraxial ray approximation and solved it numerically using Runge–Kutta method.
This paper presents an overview of the importance of oral health in complex emergencies. It highlights the importance of maintaining general and oral health in the acute, intermediate and long-term phases of such events which are increasing in frequency. The importance of oral health as an early warning sign for systemic disease and deprivation is also explored along with the crucial role of oral health in maintaining quality of life through adequate nutrition and speech. The overview of oral health in these situations identifies the need for training dental personnel as members of rehabilitation teams that set out to manage these disasters. They can quickly help in improving quality of life for victims by extracting carious and painful teeth as necessary, and also form part of an oral health education program for aid agencies. They can also be the first to identify systemic diseases like HIV and may also play a role in identifying victims of abuse, as non-accidental injuries can frequently present in the oro-facial region. The oral health overview concludes by describing the contents of innovative oral health packs that are tailored to prevention of dental diseases and that can be readily incorporated as part of food packs distributed by aid agencies. (Disaster Med Public Health Prepardness. 2018;12:772-777)
Information and communication technologies (ICTs) have become an element of strategic importance to all countries. Researchers argue that ICTs may open up new avenues for economic growth, competitiveness and human development. It is widely recognised that ICTs have the potential of overcoming many of the barriers faced by people with visual impairment (VI). Based on an interpretive study using the narrative interview method, this article contributes to this literature by presenting perceptions and understandings of how the use of ICTs can be used to promote the ‘development’ of people with VI in Bangladesh. We approached this study through the economist and Nobel Laureate Amartya Sen’s work on ‘development as freedom’ that focuses on, among other themes, five dimensions of freedom — social, economic, protective, political and transparency. We collected stories from 18 people with VI who had received ICTs training and support from resource centres, and from some disability rights activists and leaders who use ICTs. Our findings suggest that ICTs can be used as tools for improving the wellbeing of people with VI by enhancing different aspects of freedom suggested by Sen. ICTs tools assist people with VI by providing them with educational and work opportunities, and thus increase the potential for social inclusion and economic development. We conclude that governments, nongovernment organisations and development partners in countries such as Bangladesh may use ICTs to expand different types of ‘freedom’ for marginalised groups such as people with VI and persons with disabilities in general.
In this study, we report a patient with pulmonary atresia with intact ventricular septum (PA/IVS), confluent pulmonary arteries supplied by an arterial duct, and chromosome 22q11.2 microdeletion. The 22q11.2 deletion syndrome has been associated with anomalies of the outflow tracts, such as tetralogy of Fallot with either pulmonary stenosis or atresia, but we are aware of a solitary case described with pulmonary atresia when the ventricular septum is intact. The presence of genetic malformations can have long-term co-morbidities. By describing our patient, we aim to create awareness of this rare association.
In the present paper, we have studied self-focusing of Gaussian laser beam in weakly relativistic magnetized cold quantum plasma. When interparticle distance is comparable to the de Broglie wavelength of charged particles, we cannot neglect the quantum contribution of plasma constituents. Therefore, propagation characteristics are studied by taking in to account quantum contribution in the presence of static magnetic field applied along the beam propagation. Our results show that the magnetic field plays a key role in achieving additional focusing, it modifies the quiver motion of electrons by adding cyclotron frequency to the natural frequency of oscillating electrons during laser beam propagation. The results are compared with those of weakly relativistic quantum plasma and weakly relativistic magnetized plasma. The self-focusing is found to be more pronounced when axial magnetic field is increased in the present model. We have setup the non-linear differential equation for the evolution of beam-width parameter by well-known paraxial ray approximation and solved it with the help of computational technique.
Parents may experience anxiety and stress when their children undergo cardiac catheterisation. The goal of this study was to assess the level of anxiety in parents of children undergoing cardiac catheterisation and to identify factors that were associated with level of anxiety.
This was a cross-sectional survey of parents of children who underwent cardiac catheterisation. Anxiety levels were measured using a validated self-report questionnaire – State-Trait Anxiety Inventory, which generates state anxiety scores on the current state of anxiety and trait anxiety scores on the stable aspects of anxiety proneness. One sample t-test was used to compare the data with normative data. Multiple linear regression was used to assess the factors associated with the state score.
A total of 113 parents completed the survey. The mean age of parents was 34.0±7.7 years and the mean age of children undergoing catheterisation was 6.7±5.7 years. Compared with normative data, mean state score was significantly higher in our cohort (p<0.05) despite no difference in the trait score. Final multivariate model showed that the state score was significantly associated with child age group (<1 year [coefficient β 7.2] and 10–18 years [6.3], compared to 1 to <10 years of age [reference]) and history of previous catheterisation (−5.2) (p<0.05).
Concurrent state anxiety level was high among parents of children undergoing cardiac catheterisation, whereas trait anxiety level was not. Higher anxiety was experienced by parents of infants and adolescents without a history of previous catheterisation.