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According to the World Health Organization (WHO), Atrial Fibrillation (AF) is emerging as a global epidemic, which has resulted in a need for techniques to accurately diagnose AF and its various subtypes. While the classification of cardiac arrhythmias with AF is common, distinguishing between AF subtypes is not. Accurate classification of AF subtypes is important for making better clinical decisions and for timely management of the disease. AI techniques are increasingly being considered for image classification and detection in various ailments, as they have shown promising results in improving diagnosis and treatment outcomes. This paper reports the development of a custom 2D Convolutional Neural Network (CNN) model with six layers to automatically differentiate Non-Atrial Fibrillation (Non-AF) rhythm from Paroxysmal Atrial Fibrillation (PAF) and Persistent Atrial Fibrillation (PsAF) rhythms from ECG images. ECG signals were obtained from a publicly available database and segmented into 10-second segments. Applying Constant Q-Transform (CQT) to the segmented ECG signals created a time-frequency depiction, yielding 98,966 images for Non-AF, 16,497 images for PAF, and 52,861 images for PsAF. Due to class imbalance in the PAF and PsAF classes, data augmentation techniques were utilized to increase the number of PAF and PsAF images to match the count of Non-AF images. The training, validation, and testing ratios were 0.7, 0.15, and 0.15, respectively. The training set consisted of 207,828 images, whereas the testing and validation set consisted of 44,538 images and 44,532 images, respectively. The proposed model achieved accuracy, precision, sensitivity, specificity, and F 1 score values of 0.98, 0.98, 0.98, 0.97, and 0.98, respectively. This model has the potential to assist physicians in selecting personalized AF treatment and reducing misdiagnosis., (© 2024. Australasian College of Physical Scientists and Engineers in Medicine.)

The present pandemic disease COVID-19 demands an urgent need for more efficient antiviral drugs against SARS-CoV-2. Computational drug designing and discovery enable us to explore ethnomedicinal plants as a source of various lead molecules that can be used against present and future pathogens. Adiantum latifolium Lam., a common fern, is resistant to pathogens mainly due to the presence of various phytochemicals having antimicrobial properties. In our previous study, 3β-acetoxy-21α-H-hop-22(29)ene, a terpenoid has been characterized from the methanol extract of leaves of A. latifolium . The manuscript evaluates the antiviral potency of the compound against SARS-CoV-2 through molecular docking method. Proteins essential for SARS-CoV-2 multiplication in host cells are the target sites. The study revealed strong binding affinity of the compound for all the ten proteins selected, including seven nonstructural proteins, two structural proteins and one receptor protein, with a binding energy of -4.67 to -8.76 kcal/mol. MDS and MMPBSA analysis of the best ranked complex further confirmed the results. The multitargeted compound can be considered as a natural lead molecule in drug designing against COVID-19, but requires wet-lab experimentation and clinical trials.Communicated by Ramaswamy H. Sarma.

The present pandemic disease COVID-19 demands an urgent need for more efficient antiviral drugs against SARS-CoV-2. 22-Hydroxyhopane is a bioactive triterpenoid compound with antibacterial activity, present in the leaves of Adiantum latifolium . In this study, molecular docking method revealed strong binding affinity of the compound for ten proteins essential for SARS-CoV-2 multiplication in host cells, including seven nonstructural proteins, two structural proteins and one receptor protein, with a binding energy of -7.61 to -9.82 kcal/mol and inhibition constant <1 μM. MDS and MM-PBSA analysis of the best ranked complex further confirmed the results. The targets selected include six enzymes, RNA binding protein, spike protein, membrane protein and ACE2 receptor of SARS-CoV-2. It is the first report of a natural compound from A. latifolium having multitargeted activity against SARS-CoV-2. We conclude that 22-hydroxyhopane may be used as a best source for the development of novel therapeutic drugs for COVID-19, but requires further evaluations.

Introduction: Smoked, and especially smokeless, tobacco are major causes of oral cancer globally. Here, we examine the oral bacteriome of smokers and of smokeless tobacco users, in comparison to healthy controls, using 16S rRNA gene sequencing., Methods: Oral swab samples were collected from smokers, smokeless tobacco users, and healthy controls (n = 44). Microbial DNA was extracted and the 16S rRNA gene profiled using the Illumina MiSeq platform. Sequencing reads were processed using DADA2, and taxonomical classification was performed using the phylogenetic placement method. Differentially abundant taxa were identified using DESeq2, while functional metagenomes based on KEGG orthology abundance were inferred using LIMMA., Results: A significantly higher microbial diversity was observed in smokeless tobacco users and smokers relative to controls (P < 0.05). Compositional differences in microbial communities were observed in all comparisons with healthy controls (PERMANOVA P < 0.05) but not between smokers and smokeless tobacco users. Levels of Fusobacterium spp., Saccharibacterium spp., and members of Shuttleworthia were elevated in smokers when compared to controls (BH adj P < 0.01). In addition, the relative abundance of three bacterial taxa belonging to genera Fusobacterium spp., Catonella, and Fretibacterium spp. was significantly increased in smokeless tobacco users relative to controls (BH adj P < 0.01). Major functional pathways significantly increased in smokeless tobacco users relative to both controls, and smokers were similar and involved amino acid metabolism including glutamate and aspartate biosynthesis and degradation (log FC > 1.5; BH adj P < 0.01)., Conclusions: A distinct taxonomic and functional profile of oral microbiome in smokers and smokeless tobacco users as compared to healthy controls implicates a significant role of microbes and their metabolites in diseases associated with tobacco use including oral cancer., Clinical Relevance: Future efforts in preventive, diagnostic, curative, and prognostic strategies for diseases associated with tobacco use in smokers and smokeless tobacco users could incorporate the oral microbiome., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background and Aim: The impact of oral health related disease and treatment on the patient's overall well-being and functioning is a topic of growing interest in clinical research and practice. Research shows that there is a significant reduction in the quality of life for the patients throughout the treatment of head and neck cancer. Therefore, the aim of the study is to assess the quality of life among treated head and neck cancer patients., Materials and Method: The cross sectional study was conducted among 225 head and neck cancer patients. The European Organization for Research and Treatment of Cancer (EORTC QLQ C-30), Quality Of Life Head and Neck35" (QLQ-HN35) instruments were used to assess their quality of life. The study population was divided into three groups based on the treatment done: Group I (Surgery), Group II (Surgery and Radiotherapy) and Group III (Surgery, Radiotherapy and Chemotherapy). Independent t-test and one way ANOVA test were done to analyze the data., Results: Trouble with opening mouth (34.66 ​± ​30.58) was one of the highest rated symptoms among the study population. Salivary dysfunction leading to dry mouth (33.33 ​± ​34.06), sticky saliva (33.33 ​± ​26.72) were also found to be severe. Among the three groups, the Global Health Status, Symptom Scale mean scores were more high in Group I, Functional Scale and H&N35 symptoms mean scores was high in Group III however no statistical significance was observed (p ​> ​0.05)., Conclusion: Head and neck cancer has severe effects on the quality of life. As observed from the findings of the current study, Global Health Status indicated a healthy level of living among patients who have undergone surgery alone; head and neck symptoms were more severe and problematic among patients who had surgery and radiotherapy. Therefore, assessing health related quality of life can be a factor that is weighed against treatment burden, toxicity, survival benefit. It can be more integral to treatment planning, refining treatment protocols and a better post-operative care and support., (© 2021 Craniofacial Research Foundation. Published by Elsevier B.V. All rights reserved.)

Introduction: Dental caries is the most common chronic disease of childhood that interferes with normal nutrition intake, speech, and daily routine activities. Dental caries affects people of all ages with the highest priority risk group being school-going children. Hence, this cross-sectional study helps to determine the prevalence and to compare the dental caries experience among 5- to 12-year-old school-going children of Chandigarh using dft/DMFT and SiC index., Materials and Methods: The present study was conducted among 3354 school children in the age group of 5 to 12 years. The subjects were selected from four randomly selected schools in Chandigarh. Independent t -test and one-way analysis of variance were used to compare the mean difference at 5% significance level ( P < 0.05)., Results: The prevalence of dental caries was found to be 46.9% with a mean dft and DMFT score of 1.36 ± 2.16 and 0.28 ± 0.80, respectively. The SiC index score for primary and permanent dentition were 3.53 ± 2.53 and 0.85 ± 1.20, respectively. The dft scores declined progressively as the age advanced whereas the DMFT scores increased from 5 to 12 years., Conclusion: Caries prevalence was high in primary than permanent dentition. Comparison between dft/DMFT and SiC indices indicated there is a subgroup that presented with a higher caries rate., Competing Interests: There are no conflicts of interest., (Copyright: © Journal of Family Medicine and Primary Care.)

Introduction: Oral cavity harbors wide variety of microorganisms; these are considered crucial for the dental caries initiation and progression. Plaque-induced caries is a local disease; therefore, dentifrices are the most ideal vehicle for the daily delivery of antibacterial agents. In recent years, alternatives to fluorides such as green tea, probiotic, and chlorhexidine (CHX) toothpastes have been proposed to possess antiplaque and anticariogenic properties., Aim: To compare the effectiveness of probiotic, green tea, and CHX- and fluoride-containing dentifrices on oral microbial flora., Materials and Methods: A double-blinded, parallel group, randomized controlled clinical trial was conducted among healthy adults. Fifty-two individuals were randomly allocated to four groups ( n = 13): Group I - green tea dentifrice, Group II - fluoridated dentifrice, Group III - CHX dentifrice, and Group IV - probiotic dentifrice. Plaque and saliva samples were evaluated for Streptococcus mutans and Lactobacillus at baseline and 15 th and 30 th days of follow-up. Paired t -test and one-way ANOVA were used to compare the mean differences of plaque and salivary S. mutans counts at two and three time periods. Wilcoxon signed-rank and Kruskal-Wallis tests were used to compare the mean Lactobacillus count in plaque and saliva samples at two and three time periods, respectively., Results: The mean S. mutans and Lactobacillus counts in plaque and saliva samples were significantly reduced by all the treatment groups at the 30 th day of follow-up. However, Group III showed the highest reduction and was found to be statistically significant ( P < 0.05)., Conclusion: All the four groups exhibited antimicrobial activity by bringing about a significant reduction in the mean S. mutans and Lactobacillus colony counts at the 30 th day of follow-up. Among all the preventive modalities, Group III (CHX dentifrice) showed better results compared to other groups., Competing Interests: There are no conflicts of interest., (Copyright: © 2019 Contemporary Clinical Dentistry.)

Introduction: Pit and fissures are approximately eight times vulnerable than the smooth surface caries lesion. Sealants are effective in preventing, arresting, and progression of pit-and-fissure occlusal caries lesions. The failure of sealant resin-based retention is mainly attributed to the moisture contamination. To overcome this drawback, UltraSeal XT ® hydro, a moisture-friendly sealant, has been introduced., Aim: This study aimed to compare and evaluate the retention, cariostatic effect, and discoloration of conventional Clinpro™ 3M™ ESPE™ and hydrophilic UltraSeal XT ® sealants among 12 to 15-year-old schoolchildren for 3 months., Materials and Methods: A single-blinded, randomized, split-mouth clinical trial was conducted among thirty schoolchildren aged 12-15 years. Sealants used in the present study were Group I - Clinpro™ and Group II - UltraSeal XT ® hydro. Sealants were provided in the school by two operators based on the computer-generated random sequence and the study participants were evaluated after 3 months for sealant coverage, caries incidence, and discoloration using Color, Coverage and Caries sealant evaluation system. Sealant coverage between the two sealants was compared using Mann-Whitney U-test and Z-test for proportions., Results: A total of 47 teeth (78.3%) with UltraSeal XT ® Hydro had the sealant covering in all the fissures compared to Clinpro™ 3M™ ESPE™ which was 46.7% (28 teeth) and the difference was observed to be statistically significant., Conclusion: Hydrophilic UltraSeal XT ® Hydro yielded better sealant coverage (retention) compared to the conventional Clinpro™ 3M™ ESPE™. No difference was observed with regard to cariostatic effect and discoloration., Competing Interests: There are no conflicts of interest.

Background: The World Health Organization considers sealing the pit and fissures as a primary preventive measure and is one of the most effective, least invasive means to ensure the complete protection of the occlusal surface from the carious phenomenon. In vitro tests play a vital role in providing the necessary information regarding the efficacy of newer brands of sealants in a short period. Therefore, the aim of the present study was to evaluate and compare the viscosity and length of resin tag of conventional and hydrophilic sealant on permanent molars., Materials and Methods: Twenty extracted third molars were randomly divided into two groups: Group I: Conventional sealant (Clinpro 3M ESPE) and Group II: Hydrophilic sealant (UltraSeal XT Hydro). Occlusal surfaces of each tooth were pretreated with the acid etchant, and the respective sealants were placed. Both the groups were then subjected to thermocycling and sectioned longitudinally. The sectioned tooth specimens were examined under scanning electron microscope for resin tag length measurements. Viscosities were evaluated using an Anton Paar viscometer. Independent t -test was used to compare the difference in mean resin tag length of Group I and Group II sealants., Results: Viscosity measurements of Group I and Group II were found to be 0.9 mega Pascal (MPa) and 0.7 MPa and the mean resin tag length of Group II (10.03 ± 1.00 μm) was found to be higher than Group I (7.46 ± 0.95 μm) and was found to be significant statistically ( P = 0.001)., Conclusion: Based on the results of the present study, it can be concluded that Group II sealant exhibited lower viscosity and formed resin tag of sufficient length than that of Group I sealants. Therefore, hydrophilic sealant showed better results as compared to a conventional sealant., Competing Interests: There are no conflicts of interest.

Background: Naringenin (NAR) was found to display strong pharmacological properties. Since the clinical relevance of NAR is limited by its low bioavailability, we effectively synthesized and characterized a novel PVP-coated NAR nanoparticle (NAR NP) to enhance the therapeutic efficacy of NAR. The present study was designed to investigate the effects of NAR NP on lipopolysaccharide (LPS) induced inflammatory response in RAW 264.7 macrophage cells., Methods: In vitro cell culture studies of LPS stimulated RAW 264.7 macrophage cells were used as experimental model., Results: Cytotoxicity studies revealed that NAR NP is safe even at maximum tested concentration of 200μg/ml. Initial dose fixation study in LPS induced RAW 264.7 cells, revealed the minimum optimal concentration required for anti inflammatory effect as 25μg/ml. mRNA expression studies showed that NAR NP significantly down regulated the expressions of NF-κB and P38MAPK, which is paralleled with the inhibition of the nuclear translocation of NF-κB. This in turn led to the blockade of iNOS and COX-2, thereby inhibiting the production of nitric oxide and pro inflammatory cytokines such as TNF-α, IL-6, MCP-1 and IL-1β. NAR NP was found to be more efficient, when compared with NAR., Conclusions: Anti-inflammatory effects of NAR NP may be allocated to the down-regulation of COX -2 and iNOS via the suppression of NF-κB and MAPK signaling pathway in RAW 264.7 macrophages. The data suggests that NAR NP can be used as a potent candidate for the treatments of inflammatory diseases by exploiting the nanoscale properties and targeting efficacy., (Copyright © 2017 Institute of Pharmacology, Polish Academy of Sciences. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.)

Naringenin (NAR) is one of the naturally occurring flavonoids found in citrus fruits and exerts a wide variety of pharmacological activities. The clinical relevance of naringenin is limited by its low solubility and minimal bioavailability, owing to its largely hydrophobic ring structure. The aim of the present study is to develop a novel naringenin nanoparticle system (NAR NP) using simple nanoprecipitation technique with polyvinylpyrrolidone (PVP) as the hydrophilic carrier. The synthesized nanoparticles were characterized using XRD, FTIR, SEM and EDX. The characterization study revealed the nanoscale properties and the interactions between NAR and PVP. In vivo toxicological evaluations were carried out at various doses (1, 5, 10 & 50 mg/kg body wt) in male Sprague-Dawley rats in comparison with silver nanoparticle (AgNP) at toxic concentration (50 mg/kg body wt). The altered hepatotoxicity markers, hematology parameters and antioxidant defense system were observed in AgNP- treated rats. But NAR NP - treated rats did not show any biochemical alterations and improved the antioxidant defense indices when compared to control group, by virtue of the pharmacological properties exerted by NAR. The modulatory effect of NAR NP over inflammatory and stress signaling cascades were confirmed by the normalized mRNA expressions of NF-κB, TNF-α and IL-6. The histopathological analysis of liver, kidney and heart reinforce our findings. These studies provide preliminary answers to some of the key biological issues raised over the use and safety of nanoparticles for diagnostic and therapeutic applications. Consequently, we suggest that the safe NAR NP can be used to reduce the dosage of NAR, improve its bioavailability and merits further investigation for therapeutic applications., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Aim: The aim of this study was to evaluate whether the flexural strength of a commercially available, heat polymerized acrylic denture base material could be improved using reinforcements., Materials and Methods: A total of 30 specimens (65 mm × 10 mm × 3 mm) were fabricated; the specimens were divided into three groups with 10 specimens each. They were Group 1 - conventional denture base resins, Group 2 - high impact denture base resins, and Group 3 - glass reinforced denture base resins. The specimens were loaded until failure on a three-point bending test machine. An one-way analysis of variance was used to determine statistical differences among the flexural strength of three groups. Data were analyzed by SPSS software version 21.0© (IBM Corporation, Armonk, NY, USA) and the results were obtained., Results: The flexural strength values showed statistically significant differences among experimental groups (P < 0.005)., Conclusion: Within the limitations of the study polymethyl methacrylate (PMMA) reinforced with glass fibers showed the highest flexural strength values this was followed by PMMA reinforced with butadiene styrene, and the least strength was observed in the conventional denture base resins.

A continuous exposure or contact to latex products may sensitize the human body by causing mild to fatal reactions. Despite the availability of the literature, medical personnel are still unaware of the implications of the use of latex materials. The increased awareness to prevent the transmission of infectious blood borne pathogens has lead to increased usage of medical gloves among health care workers. This increased usage of medical gloves, along with improved methods in diagnosing latex allergy, has been the reason for the rise in the number of reported cases. This has lead to recognition of latex allergy as a serious medical concern. Patients in high-risk groups must be assessed carefully, so that appropriate protocols can be used to protect them from contact with latex.

Highly basic MgO nanoparticles with different sizes have been successfully immobilized over mesoporous carbon with different pore diameters by a simple wet-impregnation method. The prepared catalysts have been characterized by various sophisticated techniques, such as XRD, nitrogen adsorption, electron energy loss spectroscopy, high-resolution TEM, X-ray photoelectron spectroscopy, and the temperature-programmed desorption of CO(2). XRD results reveal that the mesostructure of the support is retained even after the huge loading of MgO nanoparticles inside the mesochannels of the support. It is also demonstrated that the particle size and dispersion of the MgO nanoparticles on the support can be finely controlled by the simple adjustment of the textural parameters of the supports. Among the support materials studied, mesoporous carbon with the largest pore diameter and large pore volume offered highly crystalline small-size cubic-phase MgO nanoparticles with a high dispersion. The basicity of the MgO-supported mesoporous carbons can also be controlled by simply changing the loading of the MgO and the pore diameter of the support. These materials have been employed as heterogeneous catalysts for the first time in the selective synthesis of sulfinamides. Among the catalysts investigated, the support with the large pore diameter and high loading of MgO showed the highest activity with an excellent yield of sulfinamides. The catalyst also showed much higher activity than the pristine MgO nanoparticles. The effects of the reaction parameters, including the solvents and reaction temperature, and textural parameters of the supports in the activity of the catalyst have also been demonstrated. Most importantly, the catalyst was found to be highly stable, showing excellent activity even after the third cycle of reaction., (Copyright © 2011 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

The preparation of needle-shaped SnO(2) nanocrystals doped with different concentration of nickel by a simple sol-gel chemical precipitation method is demonstrated. By varying the Ni-dopant concentration from 0 to 5 wt%, the phase purity and morphology of the SnO(2) nanocrystals are significantly changed. Powder XRD results reveal that the SnO(2) doped with a nickel concentration of up to 1 wt% shows a single crystalline tetragonal rutile phase, whereas a slight change in the crystallite structure is observed for samples with nickel above 1wt%. High resolution scanning electron microscopy (HRSEM) results reveal the change in morphology of the materials from spherical, for SnO(2), to very fine needle-like nanocrystals, for Ni-doped SnO(2), annealed at different temperatures. The gas sensing properties of the SnO(2) nanocrystals are significantly enhanced after the nickel doping.

Herbal drugs are frequently considered to be less toxic and also free from side effects, than synthetic ones. Hence, the present study was designed to investigate one such combination of herbal drugs, Asystasia gangetica and Morus indica for their antidiabetic and antioxidant potential against alloxan-induced diabetes in albino rats. The effect of both individual and a combination of Asystasia gangetica and Morus indica on blood glucose and liver glycogen were studied in the diabetic rats. The study also assessed for the effect of selected plant extracts for their effect on Superoxide dismutase (SOD), catalase (CAT), reduced glutathione (GSH) and Lipid peroxidation (LPO) in the homogenates of the pancreas. The results of the present study attests significant antidiabetic and antioxidant potential for the selected plants individually and also in combination as a prominent decrease in blood glucose and liver glycogen was observed in the rats treated with the extracts of the selected plants. Similarly, the levels of the protective antioxidant enzymes like SOD, CAT and GSH were increased along with decrease in the LPO levels. The present study provides a scientific evidence for antidiabetic and antioxidant potential of Asystasia gangetica and Morus indica. Further studies to isolate bioactive compounds will pave the way to identify potential lead compounds for developing safe and efficacious antidiabetic agents.

Background: Long-term follow-up of patients who underwent arterial switch operation for complete transposition of great arteries with anatomic left ventricular outflow tract obstruction (LVOTO) has rarely been brought into the focus., Methods: Of 299 patients who underwent an arterial switch operation between January 1991 and January 2001, 23 patients had anatomic LVOTO. Age ranged from 4 days to 18 years (median 90 days) and weight ranged from 2.6 to 35 kg (median 4.3 kg). Surgical management included arterial switch operation, closure of ventricular septal defect wherever indicated, and excision of LVOTO., Results: Among patients with preoperative LVOTO there were 2 early deaths and 8 patients had mild neoaortic regurgitation at the time of discharge. Follow-up ranged from 8 months to 9 years (mean 60 +/- 12 months). In 4 patients who had mild neoaortic regurgitation at discharge, the regurgitation progressed to moderate or severe degree after a follow-up of 22 to 72 months. In 1 patient mild mitral regurgitation present at the time of discharge progressed to severe mitral regurgitation. This patient subsequently underwent double valve replacement., Conclusions: Presence of preoperative anatomical LVOTO in patients undergoing arterial switch operation predicts high incidence of postoperative neoaortic regurgitation.

Background: Arterial level repair is considered the most appropriate procedure for transposition of the great arteries. This report describes our experience with the arterial switch operation over the past decade., Methods and Results: From January 1991 to January 2001, a total of 299 patients underwent an arterial switch operation for transposition of the great arteries or double-outlet right ventricle. Group I (n=169, 56.5%) comprised patients with transposition of the great arteries in whom the ventricular septum was essentially intact. Group II patients (n=130, 43.5%) had transposition of the great arteries with an additional significant ventricular septal defect or had double-outlet right ventricle with a subpulmonic ventricular septal defect. Of the total, 245 (82%) were males and 54 (18%) were females. In group I, the ages ranged from 2 days to 18 years (median 19 days) and weight ranged from 1.7 to 68 kg (median 2.5 kg). In group II, the ages ranged from 4 days to 4 years (median 90 days) and weight ranged from 2.5 to 17 kg (median 4 kg). Fifteen percent of the patients (25/169) in group I and 30% of the patients (39/130) in group II had features of bacteriologic infection. Arterial switch operation was performed on standard lines. In group I, 141 patients (83.4%) had a primary arterial switch operation while 28 (16.6%) underwent a rapid two-stage repair. Twenty-three patients required concomitant relief of associated anatomic left ventricular outflow tract obstruction. Operative mortality was 8.8% (15/169) in group I and 33% (44/130) in group II with an overall mortality of 19% (59/299). The major causes of operative mortality included pulmonary arterial hypertensive crisis (n=21), sepsis and related complications (n=16), and left ventricular failure (n=8). Coexisting arch anomalies, longer cross-clamp time, late presentation, and preoperative bacteriologic infections were incremental risk factors. Follow-up ranged from 1 to 10 years and was 87% complete. On follow-up, 91% of the patients were asymptomatic and off all medications. There were 3 late deaths and 5 patients required reoperation., Conclusions: Excellent long-term results are obtained in operative survivors following the arterial switch operation. However. operative mortality remains a concern in our set-up.