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There are limited outcome data in adults with tetralogy of Fallot and pulmonary atresia. The purpose of this study was to describe re-operations and all-cause mortality in adults with tetralogy of Fallot and pulmonary atresia.
Retrospective review of adults with repaired tetralogy of Fallot and pulmonary atresia who received care at the Mayo Adult Congenital Heart Disease Clinic, 1990–2016. All-cause mortality was calculated as events per 100 patient-years from the time of first presentation to the Adult Congenital Heart Disease Clinic.
Of the 221 patients, the age at initial tetralogy of Fallot repair was 6 (5–13) years, and the age at first presentation to the clinic was 27 – 8 years. All patients had at least one right ventricular to pulmonary artery conduit re-operation. There were 31 deaths (14%) at mean age of 41 – 14 years. The causes of death were end-stage heart failure (n = 17), sudden cardiac death (n=9), post-operative death after cardiac surgery (n = 2), sepsis with multi-system organ failure (n = 2), and unknown (n = 1). All-cause mortality rate was 1.7 per 100 patient-years. The risk factors for all-cause mortality were older age (>12 years) at the time of repair (hazard ratio 1.41, 95 confidence interval 1.06–2.02, p = 0.033), non-sustained ventricular tachycardia (hazard ratio 1.36, 95 confidence interval 1.17–2.47, p = 0.015), and left ventricular ejection fraction <50% (hazard ratio 1.39, 95 confidence interval 1.08–2.31, p = 0.031).
Based on a review of 221 adults with repaired tetralogy of Fallot and pulmonary atresia, all patients had re-operations and all-cause mortality rate was 1.7 events per 100 patient-years. The current study provides important outcomes data for risk stratification in adults with tetralogy of Fallot and pulmonary atresia.
To investigate a Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak event involving multiple healthcare facilities in Riyadh, Saudi Arabia; to characterize transmission; and to explore infection control implications.
Cases presented in 4 healthcare facilities in Riyadh, Saudi Arabia: a tertiary-care hospital, a specialty pulmonary hospital, an outpatient clinic, and an outpatient dialysis unit.
Contact tracing and testing were performed following reports of cases at 2 hospitals. Laboratory results were confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) and/or genome sequencing. We assessed exposures and determined seropositivity among available healthcare personnel (HCP) cases and HCP contacts of cases.
In total, 48 cases were identified, involving patients, HCP, and family members across 2 hospitals, an outpatient clinic, and a dialysis clinic. At each hospital, transmission was linked to a unique index case. Moreover, 4 cases were associated with superspreading events (any interaction where a case patient transmitted to ≥5 subsequent case patients). All 4 of these patients were severely ill, were initially not recognized as MERS-CoV cases, and subsequently died. Genomic sequences clustered separately, suggesting 2 distinct outbreaks. Overall, 4 (24%) of 17 HCP cases and 3 (3%) of 114 HCP contacts of cases were seropositive.
We describe 2 distinct healthcare-associated outbreaks, each initiated by a unique index case and characterized by multiple superspreading events. Delays in recognition and in subsequent implementation of control measures contributed to secondary transmission. Prompt contact tracing, repeated testing, HCP furloughing, and implementation of recommended transmission-based precautions for suspected cases ultimately halted transmission.
In Iran, the availability of high quality forages is restricted. The use of wheat straw, which is accessible in a huge amount, is limited due to its low nutritional value. Recently, biological method using white-rot fungi to improve the nutritional value of straw have been reported (Zadrazil 1997). However, the data available have been obtained from in vitro works. Additionally, little information is available on the utilization of fungal treated straw fed to dairy cow. Therefore, this experiment was carried out to assess the effect of fungal treated wheat straw on the performance of lactating cows.
Thinning and rupture of a thin film of a power-law fluid on a solid substrate under the balance between destabilizing van der Waals pressure and stabilizing capillary pressure is analysed. In a power-law fluid, viscosity is not constant but is proportional to the deformation rate raised to the
is the power-law exponent (
for a Newtonian fluid). In the first part of the paper, use is made of the slenderness of the film and the lubrication approximation is applied to the equations of motion to derive a spatially one-dimensional nonlinear evolution equation for film thickness. The variation with time remaining until rupture of the film thickness, the lateral length scale, fluid velocity and viscosity is determined analytically and confirmed by numerical simulations for both line rupture and point rupture. The self-similarity of the numerically computed film profiles in the vicinity of the location where the film thickness is a minimum is demonstrated by rescaling of the transient profiles with the scales deduced from theory. It is then shown that, in contrast to films of Newtonian fluids undergoing rupture for which inertia is always negligible, inertia can become important during thinning of films of power-law fluids in certain situations. The critical conditions for which inertia becomes important and the lubrication approximation is no longer valid are determined analytically. In the second part of the paper, thinning and rupture of thin films of power-law fluids in situations when inertia is important are simulated by solving numerically the spatially two-dimensional, transient Cauchy momentum and continuity equations. It is shown that as such films continue to thin, a change of scaling occurs from a regime in which van der Waals, capillary and viscous forces are important to one where the dominant balance of forces is between van der Waals, capillary and inertial forces while viscous force is negligible.
NGC 581 was studied using new plates taken by the Kottamia 74′ telescope and measured by the Helwan Iris photometer. A mean value of 3.13×107 years and 2334 pcs were found for the age and distance of the cluster respectively. The cluster has an evolved giant branch.
Applying career construction theory, this study develops and tests a research model that investigates whether career adaptability mediates the effect of work social support on career satisfaction and turnover intentions. Data obtained from frontline hotel employees with a 2-week time lag in three waves in Nigeria were used to assess the previously mentioned relationships. The results from structural equation modeling suggest that work social support boosts career adaptability and career satisfaction, while it mitigates turnover intentions. Surprisingly, the results suggest that career adaptability triggers turnover intentions, while it has no bearing on career satisfaction. The results further suggest that career adaptability partially mediates the relationship between work social support and turnover intentions.
Morphology of the nuclear region of the component NGC 7770 indicates that it has a complicated structure in the B-band, while the V-band shows a double nuclear structure. The brightness and color of the nuclear condensations are given. Detailed photometric analysis of this component including luminosity profiles along major and minor scans as well as position angle and ellipticity curves is obtained. Integration and decomposition of the luminosity profiles are also performed. The color distribution and integrated color are also studied taking into account that the blue color together with the unusual color distribution are characteristics relevant to UV-excess galaxies. The integrated photometric parameters are also given.
The state of interaction between the components of the pair is also investigated. The peculiar features appearing in the isophotal maps, the truncation of the luminosity profile along the side of interaction and the unusual appearance of the structural profiles are discussed and considered as strong evidence for the real state of interaction between the components of the pair. A lower limit of the total orbital mass of the system is found to be Mt=1.36 × 1010 M⊙, and the total mass-to-luminosity ratio is f=0.63 f⊙.
The Kottamia 1.88-m reflecting telescope in Egypt is the largest in the Middle East and North Africa. An extensive upgrading programe has been undertaken for this telescope to increase its efficiency. A new Zerodur optical system has been delivered by Carl Zeiss, Germany, and a new CCD system including an acquisition Camera Tek 1024 x 1024 pixels, with pixel size 24 x 24 micron and LN cooling, and an offset guiding camera Kodak 1080 x 1024 pixels with pixel size 16 xl6 micron and thermoelectric cooling. This CCD system has been attached to the Newtonian focus for direct imaging with scale 22.5 arcsec mm-1. The aluminizing plant has also been refurbished by Balzer, the new pumping system can accommodate mirrors up to 2m. The unit is supplied with a microprocessor, which controls and checks all recoating steps, closes all valves and stops the operation in any emergency. A Cassegrain spectrograph (donation from Okayama Astrophysical Observatory, Japan) will be attached to the telescope, after modification, for use with a CCD camera instead of the image-intensifier used before. This spectrograph will be used to obtain medium-dispersion and low dispersion spectra for faint stars and galaxies down to 15th magnitude.
Promotion of astronomy in Arab countries is facing many scientific and technical problems. Teaching astronomy starts very late in schools, with very simple and limited courses. Many teachers lack a suitable astronomical background, which can lead to incorrect understanding by students of many astronomical ideas and phenomena. Teaching astronomy at higher levels is also very limited, for example: aomng the 16 universities in Egypt, astronomy is taught in only two faculties of science, just for two years. Graduate students find many difficulties in obtaining jobs related to astronomical activities and this is a serious limitation on the attraction of the study of astronomy. On the other hand, astronomical institutions are suffering from a serious lack of the new sophisticated equipment, while the budget allotted for maintenance is very small, and there is a serious shortage of technical staff. The training of astronomers and technicians is badly needed, since good research work depends on modern technological equipment and the complicated software packages used in controlling such equipment and in data analysis. Good libraries are needed for promotion of astronomy especially, the Internet facilities available for the staff is very limited. The effects of culture are very clear; many authorities in developing countries believe that astronomy is a luxury. Finally, most of astronomers are engaged with a lot of administration for all matters, so the free time left for science is very limited.
Mirtazapine is indicated in the treatment of major depressive disorder particularly in selective serotonin re-uptake inhibitors resistance. Its effect on hair loss is rare with no previous documented effect on hair colour.
Review of relevant literature and description of a case report of a 54-year-old male patient who developed alopecia and hair discoloration after initiation of mirtazapine treatment.
Upon cessation of mirtazapine treatment full restoration of hair colour and regrowth of hair was attained within 10 weeks.
There was clear temporal relationship between experiencing hair loss and commencing mirtazapine treatment. No other more likely medical reason to explain such experience was established. A noticeable restoration of the hair colour occurred following mirtazapine cessation.
Mirtazapine is associated with hair discoloration and hair loss. The possibility of such distressing adverse effects needs to be conveyed to patients by clinicians and to be further explored by researchers.
Palm oil comprises mainly triacylglycerols (TAG) that account for about 0·95 of its composition. Lipolysis of TAG releases free fatty acids that are then oxidized, impairing oil quality. Lower endogenous lipase activity is therefore desirable for better quality oil. Identifying genotypes for this should allow production of oils with improved shelf-life. A novel non-radioactive cold-activation titration assay was used to assay for lipase activity in 49 randomly selected Elaeis guineensis palms using the novel method as well as the traditional radioactive method. The results confirmed significant correlation between the radioactive and novel non-radioactive methods. A total of 148 E. guineensis palms originating from Angola, Cameroon, Guinea Conarky, Nigeria, Senagal, Sierra Leone, Tanzania and Zaire were then screened for lipase activity using the novel non-radioactive method. The analysis revealed genotypes with significantly different lipase activities, indicating that the activity is genotype-dependent. Quantitative polymerase chain reaction indicated similarity in pattern between gene expression and lipase activity determined by the novel assay. Several low and high lipase genotypes were identified. The findings pave the way for selection and breeding for low lipase genotypes. They are also relevant to genetic marker development for oil quality. Evidence is presented for the presence of at least two different lipases that determine oil quality in the oil palm mesocarp.
In this case report we attempt to emphasize the unfamiliar link between trazodone and relapse of psychotic symptoms.
Case report and literature review of relevant papers.
We report a case of a 78-year-old woman with an established diagnosis of paranoid schizophrenia who has experienced an exacerbation of positive psychotic symptoms following initiation of 50 mg dailydose of trazodone. We noted that psychotic symptoms abated following discontinuation of trazodone.
Trazodone use in patients in remission from schizophrenia may be associated with relapse of psychotic symptoms and caution is required.
Pregabalin is a γ-aminobutyric acid analogue that is primarily prescribed in psychiatry for management of generalized anxiety disorder. The belief in its low potential for abuse has placed it in a superior position to other anxiolytic agents. However, more recent, concerns have been raised about the addictive potential of pregabalin. This problem has not received much attention nor has the mechanism of its development. There is also a lack of understanding of the difference in the experience of abusing pregabalin in contrast to abusing other illicit drugs. We report the case of a 55-year-old patient with a background history of multiple psychoactive substances misuse who elaborated on his own personal experience of pregabalin abuse. He consumed a month’s supply of this medication over 2 days and realized an enhancement in sexual desire and excitement. This effect should be considered when prescribing pregabalin.
Heart failure (HF) is common among long-term care (LTC) residents, and may account for 40 per cent of acute-care transfers. Canadian Cardiovascular Society HF guidelines endorse standard therapies; yet LTC residents are less likely to receive treatment. This qualitative study employed focus groups to explore perceptions, from 18 physicians and nurse practitioners in three Ontario homes, on HF care practices and challenges. For example, participants reported challenges with HF diagnostic skills and procedural knowledge. They also identified the need for interprofessional collaboration and role clarification to improve HF care and outcomes. To address these challenges, multimodal interventions and bedside teaching are required. Leadership was viewed as essential to improve HF care. Several concerns arose regarding knowledge gaps and clinical deficits among primary-care providers who manage heart failure in LTC residents. Multimodal, clinically focused educational and interprofessional solutions are needed to improve HF care in long-term care.
We review clinical, neuroimaging, and genetic information on six individuals with isolated sulfite oxidase deficiency (ISOD).
All patients were examined, and clinical records, biochemistry, neuroimaging, and sulfite oxidase gene (SUOX) sequencing were reviewed.
Data was available on six individuals from four nuclear families affected by ISOD. Each individual began to seize within the first week of life. neurologic development was arrested at brainstem reflexes, and severe microcephaly developed rapidly. neuroimaging within days of birth revealed hypoplasia of the cerebellum and corpus callosum and damage to the supratentorial brain looking like severe hypoxic-ischemic injury that evolved into cystic hemispheric white matter changes. Affected individuals all had elevated urinary S-sulfocysteine and normal urinary xanthine and hypoxanthine levels diagnostic of ISOD. Genetic studies confirmed SUOX mutations in four patients.
ISOD impairs systemic sulfite metabolism, and yet this genetic disease affects only the brain with damage that is commonly confused with the clinical and radiologic features of severe hypoxic-ischemic encephalopathy.
Micronutrient deficiencies and suboptimal energy intake are widespread in rural Kenya, with detrimental effects on child growth and development. Sporadic school feeding programmes rarely include animal source foods (ASF). In the present study, a cluster-randomised feeding trial was undertaken to determine the impact of snacks containing ASF on district-wide, end-term standardised school test scores and nutrient intake. A total of twelve primary schools were randomly assigned to one of three isoenergetic feeding groups (a local plant-based stew (githeri) with meat, githeri plus whole milk or githeri with added oil) or a control group receiving no intervention feeding. After the initial term that served as baseline, children were fed at school for five consecutive terms over two school years from 1999 to 2001. Longitudinal analysis was used controlling for average energy intake, school attendance, and baseline socio-economic status, age, sex and maternal literacy. Children in the Meat group showed significantly greater improvements in test scores than those in all the other groups, and the Milk group showed significantly greater improvements in test scores than the Plain Githeri (githeri+oil) and Control groups. Compared with the Control group, the Meat group showed significant improvements in test scores in Arithmetic, English, Kiembu, Kiswahili and Geography. The Milk group showed significant improvements compared with the Control group in test scores in English, Kiswahili, Geography and Science. Folate, Fe, available Fe, energy per body weight, vitamin B12, Zn and riboflavin intake were significant contributors to the change in test scores. The greater improvements in test scores of children receiving ASF indicate improved academic performance, which can result in greater academic achievement.
Eighty-two hospitals of 66 cities in 30 countries (Argentina, Brazil, Colombia, Cuba, Dominican Republic, Egypt, Greece, India, Kosovo, Lebanon, Lithuania, Macedonia, Malaysia, Mexico, Morocco, Pakistan, Panama, Peru, Philippines, Poland, Salvador, Saudi Arabia, Serbia, Singapore, Slovakia, Sudan, Thailand, Turkey, Uruguay, and Vietnam) from 4 continents (America, Asia, Africa, and Europe).
Patients undergoing surgical procedures (SPs) from January 2005 to December 2010.
Data were gathered and recorded from patients hospitalized in INICC member hospitals by using the methods and definitions of the Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) for SSI. SPs were classified into 31 types according to International Classification of Diseases, Ninth Revision, criteria.
We gathered data from 7,523 SSIs associated with 260,973 SPs. SSI rates were significantly higher for most SPs in INICC hospitals compared with CDC-NHSN data, including the rates of SSI after hip prosthesis (2.6% vs 1.3%; relative risk [RR], 2.06 [95% confidence interval (CI), 1.8–2.4]; P<.001), coronary bypass with chest and donor incision (4.5% vs 2.9%; RR, 1.52 [95% CI, 1.4–1.6]; P<.001); abdominal hysterectomy (2.7% vs 1.6%; RR, 1.66 [95% CI, 1.4–2.0]; P<.001); exploratory abdominal surgery (4.1 % vs 2.0%; RR, 2.05 [95% CI, 1.6–2.6]; P<.001); ventricular shunt, 12.9% vs 5.6% (RR, 2.3 [95% CI, 1.9–2.6]; P<.001), and others.
SSI rates were higher for most SPs in INICC hospitals compared with CDC-NHSN data.