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Cardiovascular disease is the primary cause of mortality in the United States, and cardiac arrhythmias are a common cause of hospital admission with significant mortality and morbidity. Cardiovascular diseases significantly burden the healthcare system, with high costs associated with hospitalization, medication, and ongoing management. By finding cost-effective methods to prevent and treat cardiovascular diseases, healthcare resources can be allocated more efficiently, ultimately improving health outcomes and reducing the burden on the healthcare system. Exercise therapy is a low-cost intervention that can be done without expensive equipment or medical procedures. Exercise therapy can help decrease risk factors for heart disease, including high blood pressure, obesity, and high cholesterol, by improving overall fitness and reducing chronic inflammation. Over time, there have been concerns about exercise-induced arrhythmia because it can reduce physical activity among patients with arrhythmia. In this review, we emphasized the beneficial effects of physical activity on arrhythmia patients. [ABSTRACT FROM AUTHOR]

A survey was conducted to ascertain the current situation of early--mid-career pediatric cardiologists (<20 years of experience) practicing in India. A formatted questionnaire was sent as a Google Form through email and WhatsApp link. Out of 275 eligible participants, 138 responses were received. Two pediatric cardiologists independently analyzed the data and responses are presented. Results showed pediatric cardiology is not considered a lucrative career option by most of the surveyed Indian pediatric cardiologists. Urgent remedial measures are needed to maintain the recently found momentum in the field in the country. [ABSTRACT FROM AUTHOR]

Background: Outcome data of children with heart disease who acquired COVID-19 infection are limited. Aims : We sought to analyze outcome data and identify risk factors associated with mortality in children with heart disease and grown-ups with congenital heart disease (GUCH) who had a laboratory-confirmed COVID-19 infection. Settings and Design: This is a retrospective, multicentric, observational study. Materials and Methods: The study included children with heart disease and GUCH population, who presented with either symptomatic or asymptomatic COVID-19 infection to any of the participating centers. COVID-19-negative patients admitted to these centers constituted the control group. Results: From 24 pediatric cardiac centers across India, we included 94 patients with a median age of 12.5 (interquartile range 3-96) months and 49 (52.1%) patients were males. Majority (83 patients, 88.3%) were children. One-third of the patients (n = 31, 33.0%) had acyanotic congenital heart disease, and 41.5% (n = 39) were cyanotic, with > 80% of the patients being unoperated. Only 30 (31.9%) patients were symptomatic for COVID-19 infection, while the rest were incidentally detected positive on screening. A total of 13 patients died (case fatality rate: 13.8%). The in-hospital mortality rate among hospitalized patients was significantly higher among COVID-19-positive cases (13 of 48; 27.1%) as compared to COVID-negative admissions (9.2%) during the study period (P < 0.001). On multivariate analysis, the independent predictors of mortality among COVID-19-positive cases were severity of illness at admission (odds ratio [OR]: 535.7, 95% confidence interval [CI]: 6.9-41,605, P = 0.005) and lower socioeconomic class (OR: 29.5, 95% CI: 1.1-814.7, P = 0.046). Conclusions: Children with heart disease are at a higher risk of death when they acquire COVID-19 infection. Systematic preventive measures and management strategies are needed for improving the outcomes. [ABSTRACT FROM AUTHOR]

Background: COVID-19 pandemic has disrupted pediatric cardiac services across the globe. Limited data are available on the impact of COVID-19 on pediatric cardiac care in India. Aims: The aims are to study the impact of COVID-19 pandemic on the care of children with heart disease in India in terms of number of outpatient visits, hospitalizations, catheter-based interventions, and cardiac surgeries. Settings and Design: This is a retrospective, multicentric, observational study. Methods: We collected monthly data on the number and characteristics of outpatient visits, hospitalizations, catheter-based interventions, and cardiac surgeries and major hospital statistics, over a period of 5 months (April to August 2020), which coincided with the first wave of COVID-19 pandemic in India and compared it with data from the corresponding months in 2019. Results : The outpatient visits across the 24 participating pediatric cardiac centers decreased by 74.5% in 2020 (n = 13,878) as compared to the corresponding period in 2019 (n = 54,213). The reduction in the number of hospitalizations, cardiac surgeries, and catheterization procedures was 66.8%, 73.0%, and 74.3%, respectively. The reduction in hospitalization was relatively less pronounced among neonates as compared to infants/children (47.6% vs. 70.1% reduction) and for emergency surgeries as compared to elective indications (27.8% vs. 79.2%). The overall in-hospital mortality was higher in 2020 (8.1%) as compared to 2019 (4.8%), with a higher postoperative mortality (9.1% vs. 4.3%). Conclusions: The current COVID-19 pandemic significantly impacted the delivery of pediatric cardiac care across India with two-third reduction in hospitalizations and cardiac surgeries. In an already resource-constrained environment, the impact of such a massive reduction in the number of surgeries could be significant over the coming years. These findings may prove useful in formulating strategy to manage subsequent waves of ongoing COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

GLO:Q0U/01aug21:jocs15587-fig-0001.jpg PHOTO (COLOR): 1 CT-VRT images show the large atrial septal defect (marked by the dashed line in A), muscular tricuspid atresia, hypoplastic right ventricle (RV), and a common opening of pulmonary venous confluence (marked by *) draining into the left atrium (LA) (A). Keywords: common arterial trunk; discontinuous pulmonary arteries; tricuspid atresia EN common arterial trunk discontinuous pulmonary arteries tricuspid atresia 2941 2943 3 07/13/21 20210801 NES 210801 A 1-month-old cyanotic male child with anorectal malformation had an oxygen saturation of 90% on routine preoperative workup. The echocardiography revealed tricuspid atresia (TA) with common arterial trunk with unclear right pulmonary artery (RPA) and was referred to computed tomography (CT) angiography for further evaluation. [Extracted from the article]

Folger's pouch is a right ventricular outflow pouch arising from the distal low-pressure chamber in double-chambered right ventricle. It is rarely described on echocardiogram due to difficult visualization and lack of knowledge of its existence. Retrospective assessment of echocardiogram after an angiocardiographic evaluation demonstrates the pouch in a modified high parasternal view. [ABSTRACT FROM AUTHOR]

We report two cases of agenesis of the right pulmonary veins (PVs) associated with sequestration of the right lung with systemic to pulmonary collateral. Both the children were referred for evaluation of recurrent lower respiratory tract infections. Transthoracic echocardiographic evaluation showed reversal of flow in the right pulmonary artery (PA) and absent right PVs. Cardiac catheterization confirmed the diagnosis of agenesis of the right PVs. Transcatheter closure of collaterals was performed in view of significant shunt from systemic to PA. Both the patients are asymptomatic on follow-up. [ABSTRACT FROM AUTHOR]

Objective: To compare the performance of mid-upper arm circumference (MUAC) against weight-for-height Z-score (WHZ) for predicting inpatient deaths in children under 5 years of age.Design: Diagnostic test accuracy study.Setting: Paediatric emergency department of a tertiary care hospital catering to semi-urban and rural population in Delhi, India.Subjects: Hospitalized children (n 1663) aged 6 months to 5 years, for whom discharge outcome was available, were consecutively recruited over 14 months. MUAC (cm), weight (kg) height (cm), clinical details and the outcome were recorded. MUAC (index test) was compared with WHZ based on the WHO growth standards (reference test) for predicting the outcome.Results: One hundred and twenty-four (7 %) children died during hospital stay. Both MUAC < 11·5 cm (adjusted OR (95 % CI): 3·7 (2·43, 5·60), P<0·001) and WHZ<-3 (2·0 (1·37, 2·99), P<0·001) served as independent predictors of inpatient mortality. However, MUAC was a significantly better predictor of mortality compared with WHZ in terms of area under the receiver-operating characteristic curve (MUAC=0·698, WHZ=0·541, P<0·001). MUAC<11·5 cm had the best trade-off of sensitivity and specificity for predicting inpatient mortality. A combination of WHZ<-3 and/or MUAC<11·5 cm did not significantly improve the predictive value over that of MUAC/WHZ, assessed individually.Conclusion: MUAC<11·5 cm is a better predictor of mortality in hospitalized under-5 children, as compared with WHZ<-3. It should be measured in all emergency settings to identify the children at higher risk of death. [ABSTRACT FROM AUTHOR]

A Mobile ad hoc network is a collection of mobile devices where each device participates in routing by forwarding data to other nodes. MANETs can be employed in various situations ranging from emergency operations and disaster relief to military service and task forces, so security is an essential component for protected communication between nodes. There are a number of challenges in security design as ad hoc network is a decentralized network and vulnerable to various internal and external attacks. In this paper, we discuss about various attacks affecting normal routing procedure, their countermeasures and defense mechanisms and comparison between these defense mechanisms. [ABSTRACT FROM AUTHOR]

A reliable credit rating provides creditworthiness and financial strength to a firm. Any revision to credit rating may provide signal to volatility in returns of that firm. We study the relationship between credit rating and its security return. Banks being the back bone to any economy, bonds rating provides information how many the banks are reliable and credit worthy to the investors. Using event study framework with E-Grach application, results suggest that credit rating does affect the volatility of stocks. And the effect during downgrade in credit rating is more than the effect during upgrade. Also, the banks with higher market share shows more positive returns than the banks with lower market share in case of credit rating upgrade, and vice versa trend follows in case of downgrade. This suggests that credit rating can give some abnormal returns in a specific window. [ABSTRACT FROM AUTHOR]

Abstract: The main goal of the authors is to present an overview of adenosine and its receptors, which are G-protein coupled receptors. The four known adenosine receptor subtypes are discussed along with the therapeutic potential indicating that these receptors can serve as targets for various dreadful diseases. [Copyright &y& Elsevier]

Deterioration following a successful balloon atrial septostomy (BAS) is not common. We report an unusual cause for the same. A thrombus in transit has not been previously reported following BAS. [ABSTRACT FROM AUTHOR]

A circumflex retroesophageal left aortic arch with a right-sided ductus is an extremely rare cause of a complete vascular ring, which may result in severe tracheobronchial compression, leading to respiratory compromise, especially in children. We present a case of a 6-month-old female child with stridor and feeding difficulties since birth with interspersed self-resolving episodes of cyanosis and apnea, secondary to the presence of the above-mentioned vascular ring. [ABSTRACT FROM AUTHOR]

Competing Interests: The authors have no funding or conflicts of interest to disclose.

An isolated carotid artery is a rare aortic arch anomaly. Instead of connecting to the aorta, the isolated carotid artery connects anomalously to the pulmonary artery. Chronically altered cerebral circulation poses the risk of cerebral hyperaemia following surgical reimplantation. We describe successful reimplantation of the isolated left common carotid artery in a child, highlighting the importance of a multidisciplinary approach for good clinical and neurological outcomes. We also briefly discuss the embryologic basis of this rare arch anomaly.