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Coronary artery anomalies may induce myocardial ischaemia and sudden cardiac death when associated with areas of compression or stenosis. We present a case of transection and reimplantation of an anomalous interarterial right coronary artery arising from a single left main coronary artery. The 18-year-old collegiate athlete had exertional chest pain and haemodynamically significant compromise to coronary blood flow.

Background: Anomalous aortic origin of the left coronary artery with intraseptal course is a rare coronary anomaly associated with an increased risk of myocardial ischaemia. The role and techniques for surgical intervention are evolving, with numerous novel surgical techniques for this challenging anatomy reported in the last 5 years. We report our single-centre experience with surgical repair of intraseptal anomalous left coronary artery in the paediatric population, including clinical presentation, evaluation, and short- to mid-term outcomes. Methods: All patients with coronary anomalies presenting to our institution undergo standardised clinical evaluation. Five patients aged 4 to 17 years underwent surgical intervention for intraseptal anomalous aortic origin of the left coronary artery between 2012 and 2022. Surgical techniques included coronary artery bypass grafting (n = 1), direct reimplantation with limited supra-arterial myotomy via right ventriculotomy (n = 1), and transconal supra-arterial myotomy with right ventricular outflow tract patch reconstruction (n = 3). Results: All patients had evidence of haemodynamically significant coronary compression, and three had evidence of inducible myocardial ischaemia pre-operatively. There were no deaths or major complications. Median follow-up was 6.1 months (range 3.1–33.4 months). Patients who underwent supra-arterial myotomy (with or without reimplantation) had improved coronary flow and perfusion based on stress imaging and catheterisation data. Conclusions: Surgical approaches to intraseptal anomalous left coronary artery with evidence of myocardial ischaemia continue to evolve, with new techniques demonstrating promising improvement in coronary perfusion. Further studies are warranted to determine long-term outcomes and refine indications for repair.

Surgical repair in anomalous aortic origin of a coronary artery aims at mitigating the risk of sudden cardiac death in a subset of patients. The pattern and behavior of electrocardiogram changes in a large cohort of these patients are lacking. We aim to describe postoperative electrocardiogram changes in this population and its clinical implications on follow-up.All patients aged less than 21 years who underwent surgical repair for anomalous aortic origin of a coronary artery between December 2012 and June 2020 at our institution were considered for inclusion. Electrocardiograms were reviewed at 5 defined time intervals, from preoperative to 90-day follow-up, with attention to significant findings of ST-segment changes, abnormal T waves, and pathologic Q waves. The electrocardiogram changes were analyzed for correlation with surgical reintervention and medium-term outcomes.Sixty-two patients met inclusion criteria (median age 13.7 years, 61% male). ST-segment changes in the initial postoperative period were seen in 52 patients (84%), all resolving over time. Abnormal T waves were seen in 19 patients (31%), occurred commonly at the predischarge period, and mostly resolved over time. Pathologic Q waves were observed in only 1 patient and associated with reintervention due to coronary artery stenosis. There was no association between postoperative electrocardiogram changes and inducible myocardial ischemia, ventricular dysfunction, or restriction from exercise at follow-up.ST-segment changes and T-wave abnormalities are commonly seen in the postoperative period after anomalous aortic origin of a coronary artery repair, tend to resolve over time, and are not associated with adverse medium-term outcomes. Pathologic Q waves were associated with the need for early coronary reintervention.

The development of high-performance humidity sensors to cater for a plethora of applications, ranging from agriculture to intelligent medical monitoring systems, calls for the selection of a reliable and ultrasensitive sensing material. A simplistic device architecture, robust quantification of ambient relative humidity (% RH), and compatibility with the contemporary integrated circuit technology make a bimodal (capacitive and resistive) surface-type sensor to be a prominent choice for device fabrication. Herein, we have proposed and demonstrated a facile realization of a 5,10,15,20-tetraphenylporphyrinatonickel (II)-zinc oxide (TPPNi-ZnO) nanocomposite-based bimodal surface-type % RH sensor. The TPPNi macromolecule and ZnO nanoparticles have been synthesized by an eco-benign microwave-assisted technique and a thermal-budget chemical precipitation method, respectively. It is speculated from the morpohological study that specific surface area improvement, via the provision of ZnO nanoparticles on micro-pyramidal structures of TPPNi, may reinforce the sensing properties of the fabricated humidity sensor. The relative humidity sensing capacitive and resistive characteristics of the sensor have been monitored in 40-85% relative humidity (% RH) bandwidth. The fabricated sensor under the biasing conditions of 1 V of applied bias (

Objectives: To determine the common pathogens isolated from DFI to administer appropriate antibiotic treatment, followed by surgical interventions. Methods: A retrospective study was performed on 260 patients who presented with diabetic foot at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from October 2014 to September 2020. All patients underwent swabs and tissue culture for microbiological evaluation. Patient medical records were reviewed to collect demographic and clinical data, including Glycated Hemoglobin (HgA1C), Diabetes Mellitus (DM) type, duration of diabetes, swab, tissue culture, type of surgery, and type of isolated organism. Results: Escherichia coli was the most common organism isolated from the feet of diabetic patients, followed by Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus agalactiae, and Pseudomonas aeruginosa. Amputations were significantly higher in patients who did not have Staphylococcus aureus or Pseudomonas aeruginosa infection, with no significant relationship between amputation and any other isolated organisms. A significant negative correlation between patient age and HgA1C level was discovered, as well as a significant positive correlation between HgA1C and the number of minor amputations. Patients with major and minor amputations had a significantly higher percentage of non-Multidrug Resistance (MDR), whereas patients with MDR had a significantly higher rate of infection with Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, or Staphylococcus aureus. Conclusion: DM is a metabolic syndrome that affects all the body systems and impacts both morbidity and mortality. The most common organism isolated from the feet of diabetic patients was Escherichia coli, followed by Staphylococcus aureus. Ulcer specimens should be collected for culture and identification of causative organisms. Preventive measures such as good glycemic control, appropriate foot care, targeted antibiotic therapy, and patient education can reduce the incidence of amputation.

Opioids are potent analgesics used for the treatment of moderate to severe acute and chronic cancer and non-cancer pain. However, opioid usage may be limited by negative side effects, such as potentially life-threatening respiratory depression.The aim of our study is to investigate the prevalence of opioid-induced respiratory depression (OIRD) and its predictors at King Abdulaziz Medical City in Jeddah (KAMC-JD).This is a retrospective cross-sectional (chart review) study conducted from January 1, 2016, to December 31, 2020.A total of 15,753 patients received opioids during admission to KAMC-JD, and only 144 (0.915%) of them received naloxone from January 1, 2016 to December 31, 2020. Only 91 patients (0.57%) developed opioid-induced respiratory depression (OIRD), which was more frequently reported among young and middle-aged adults. OIRD was significantly associated with receiving a daily morphine milligram equivalent (MME) dose of ≥150 MME and with having a low urea concentration at the baseline and at admission under surgery. Also, fentanyl use remained a significant risk factor for OIRD.In conclusion, monitoring patient receiving opioids with a daily MME dose of ≥150 MME, prescribed Fentanyl, low urea concentration at the baseline, and patients' admissions to the surgery department may mitigate the risk of developing OIRD.

Although established, transcatheter pulmonary valve replacement is in its infancy compared with surgical pulmonary valve replacement. Extended clinical experience and follow-up have identified new challenges; however, careful evaluation of data through clinical trials has facilitated effective evolution of responses to these challenges. The limited patient population has resulted in less interest in new valve design, but having been the older sibling to transcatheter aortic valve replacement, transcatheter pulmonary valve replacement is likely to benefit in the future from design modifications to the more popular and commercially viable transcatheter aortic valve revolution. Improving valve longevity and applying the technology to native outflow tracts remain the short-to-medium term goals.

The most widely accepted treatment for pediatric supracondylar humeral fracture is closed reduction and percutaneous pinning (CRPP). However, there is debate regarding the technique that is utilized, whether crossed or lateral pinning, and the number of pins used.To compare the functional and radiological outcomes of lateral and cross pinning in the management of humeral supracondylar fracture.A retrospective analysis was performed on 101 patients who were surgically managed by either one of the CRPP techniques from 2015 to 2019. Several clinical parameters were taken into account, including pre- and post-intervention Baumann angle, as well as scores for pain, range of motion, function, and stability. Statistical analysis was performed to study the outcomes of the utilized techniques.Amongst our study sample, which included 63 males and 38 females with a mean age of 5.87 years, about one-third of the patients underwent crossed pinning fixation configuration and the remaining two-thirds were managed by lateral pinning configuration. Similar results were obtained in the two groups with no statistical difference regarding Mayo elbow performance scores (MEPS) and Baumann angle. The mean MEPS in the lateral and crossed pinning groups were 93.68 + 8.59 and 93.62 + 9.05, respectively. The mean Baumann angle was 72.5° + 6.46 in the lateral group and 72.3° + 4.70 in the crossed-pinning group (Both lateral pinning and crossed pinning fixation configuration for displaced pediatric supracondylar humeral fractures provide similar functional and radiological outcomes.

In single-ventricle physiology, focus on pulmonary vascular resistance neglects the resistance in the conduit supplying the pulmonary inflow.Conduit length and diameter, which can approximate conduit resistance, are available in the public dataset of Single Ventricle Reconstruction (SVR) trial. Conduit resistance was then calculated for SVR trial participants and the relationship with clinically important variables (death or transplant at 1 year, pulmonary artery size at second-stage palliation, pulmonary-to-systemic blood flow ratio, and supplemental oxygen requirement) was explored. To validate this calculated resistance, calculated resistance was compared with catheterization measurements at a single institution (not included in the SVR trial).In the institutional dataset, calculated and measured resistances had an intraclass correlation of 0.78 for modified Blalock-Taussig shunts (MBTS). Within the SVR trial, transplant-free survivors had a lower MBTS resistance (median, 8.3 Woods Units [WU]. interquartile range [IQR], 6.5-11.1 WU) than patients who died or required transplantation (median, 13.0 WU; IQR, 9.4-16.6 WU,Conduit resistance is associated with important clinical outcomes after Norwood; however, further studies are required to guide conduit resistance optimization.

Molybdenum disulfide (MoS2) is an actively pursuing material of the 2D family due to its semiconducting characteristics, making it a potential candidate for nano and optoelectronics application. MoS2 growth from molybdenum and sulphur precursors by chemical vapor depositions (CVD) is used widely, but molybdates’ conversion into MoS2 via CVD is overlooked previously. Direct growth of MoS2 on the desired pattern not only reduces the interfacial defects but also reduces the complexities in device fabrication. In this work, we combine the wet synthesis and chemical vapor deposition method where sodium molybdate and L-cysteine are used to make a solution. With the dip coating, the mixture is coated on the substrates, and then, chemical vapor deposition is used to convert the chemicals into MoS2. Raman spectroscopy revealed the presence of oxysulphides (peaks number value) other than A 1 g and E 2 g 1 , where heat treatment was performed in the presence of Ar gas flow only. On the other hand, the films reducing in the presence of sulphur and argon gas promote only A 1 g and E 2 g 1 peaks of MoS2, which confirms complete transformation. XRD diffraction showed a very small change in the diffraction peaks and value of strain, whereas SEM imaging showed the flakes formation for MoS2 samples which were heated in the presence of sulphur. X-ray photoelectron spectroscopy is also performed for the chemical composition and to understand the valence state of Mo, S, and O and other species.

Objective. The present study was aimed at investigating the possible antiulcer activities of some natural phytochemicals Aloe perryi leaf extract (APLE) and flower extract (APFE) in addition to the date palm seed extract (DPSE) and the oily samples of DPSE in a pylorus ligation-induced ulcer model using ranitidine as a standard antiulcer drug. Background. Peptic ulcer is a prevalent gastrointestinal disorder due to hypersecretion of gastric acid. It affects four million people worldwide, and 2-10% of these ulcers are perforated and cause bleeding. This increases the risk of morbidity and mortality. So we aimed to introduce a primary study alternatively safe method for treating peptic ulcer. Materials and Methods. Forty-two Wistar Albino rats of either sex were randomly divided into seven groups (6/each). The pylorus ligation was done to induce ulcer in pretreated albino rats. The antiulcer activities of extracts were estimated at different dose levels (250 and 500 mg/kg) using ranitidine as a standard drug (50 mg/kg). Gastric volume, pH, and total and free acidity as well as ulcer index and percentage of ulcer inhibition were measured to elucidate the antiulcerogenic effects. Histological examination of gastric ulcer was also performed. Statistical analysis for the results was done where P < 0.05 was considered statistically significant. Results. Pylorus ligation for 6 h in control rats resulted in gastric ulcer which was indicated by the accumulation of gastric secretion and increased total acidity and decreased pH. The pretreatment of rats with APLE, APFE, and DPSE in addition to the oily samples of DPSE significantly inhibited the ulcers induced by pylorus ligation. These effects were attributed to significant reductions in total and free acidity, ulcer index, and gastric volume while there is a marked decrease in gastric pH (the antisecretory) as well as mucosal strengthening properties of these phytochemicals. Conclusion. These findings give these extracts the potential to be a promising tool for the management of gastric ulcer after performing further clinical and experimental studies. Our study demonstrated the promising antiulcer activity of extracts and oils in pyloric ligation-induced gastric ulcer. To the best of our knowledge, this is the first study to explore the antiulcer activity of these extracts; however, further investigations may be recommended for full details about this antiulcerogenic capacity.

We studied conduit-related risk factors for mortality, conduit reintervention, conduit replacement, and pulmonary artery (PA) reinterventions after truncus repair. Patients who underwent truncus repair at our institution between 1995 and 2019 were studied. Cox proportional hazards modeling evaluated variables for association with mortality, time to conduit reintervention, time to conduit replacement, and time to PA reintervention. Truncus was repaired in 107 patients at median age of 17 days (IQR 9-45). Median follow-up time was 7 years. Aortic homografts were implanted in 57 (53%) patients, pulmonary homograft in 40 (37%), and bovine jugular conduit in 10 (9%). Median conduit size was 11 mm (IQR 10-12) and median conduit Z-score was 1.71 (IQR 1.08-2.34). At 5 years, there was 87% survival, 21% freedom from conduit reinterventions, 37% freedom from conduit replacements, and 55% freedom from PA reinterventions. Conduit size (HR 0.7, 95%CI 0.4-1.4, p=.41) and type (aortic homograft reference; bovine jugular vein graft HR 0.6, 95% CI 0.08-5.2, p=.69; pulmonary homograft HR 0.7, 95% CI 0.2-2.3, p=.58) were not associated with mortality. On multivariate analysis, the hazard for conduit reintervention, conduit replacement, and PA reintervention decreased with increasing conduit Z-score values of 1 to 2.5 (non-linear relationship, p.01), with little additional reduction in hazard beyond this range. Implantation of a larger conduit within Z-score values of 1 and 2.5 is associated with a decreased hazard for conduit reintervention, conduit replacement, and PA reintervention after truncus repair. The type and size of the conduits did not impact mortality.

Background: Rheumatic heart disease is a signicant public health concern. Thirty million people are currently thought to be affected by rheumatic heart disease globally. Despite the decreasing trend, there is still a signicant disease burden, especially in developing nations. Objective: To determine trends in rheumatic heart disease in the western region of Saudi Arabia, in one decade. (2010-2020) Methods: A retrospective study was done in a hospital in Taif region, Saudi Arabia, where 81 patients randomly selected from a population of over 688,693 were included. Data was collected from patients’ les, laboratory results data, and echocardiographic results. Results: The mean age of patients was 47 ± 18 years. The most commonlyreported chronic diseases or surgery were; hypertension 30 (16.4%) and cardiac diseases 24 (13.1%). Almost one-third of the participants presented with a cardiac complication of rheumatic fever in a form of shortness of breath 46 (26.9%). The most common echo nding was mitral valve regurgitation 28 (33.3%). Conclusion: Mitral regurgitation (33.3%) and mitral stenosis (33.3%) were echocardiographic ndings accounting for more than half of cases. The most commonly reported signs of rheumatic heart disease were murmur and atrial fibrillation which goes with international study findings. We recommend raising the level of public awareness about rheumatic heart disease in order to lower the incidence of the disease. Keywords: Heart, Rheumatic Heart Disease, Tertiary Care Centers, Saudi Arabia.

The incidence rates of sepsis and septic shock as a complication have become more common over the past several decades. With this increase, sepsis remains the most common cause of intensive care unit (ICU) admissions and one of the most mortality factors, with a huge burden on healthcare facilities. Septic shock has devastating consequences on patients' lives, including organ failures and other long-term complications. Due to its dynamic clinical presentations, guidelines and tools have been established to improve the diagnosis and management effectively. However, there is still a need for evidence-based standardized procedures for the diagnosis, treatment, and follow-up of sepsis and septic shock patients due to the inconsistency of current guidelines and studies contrasting with each other. The standardization would help physicians better manage sepsis, minimize complications and reduce mortality. Septic shock is usually challenging to manage due to its variety of clinical characteristics and physiologic dynamics, affecting the outcomes. Therefore, this review presented the available data in the literature on septic shock diagnosis, management, and prognosis to have an overview of the updated best practice approach to septic shock.

Cestode infestations in animals are the most important parasite of livestock and humans because most of these parasites are zoonotic causing cysticercosis and hydatidosis in man and it causes economic and production losses in livestock. Diagnosis of Taenia Spp by microscopic observation lack sensitivity and specificity and detection by enzyme-linked immunosorbent assay (ELISA) technique form cross-reaction. The molecular diagnostic can be best to detect in adult and larval stage in definitive and intermediate host based on the amplification of deoxyribonucleic acid (DNA) of target gene with the primer using a different technique of polymerase chain reaction (PCR) such as multiplex PCR. Conventional PCR, real-time PCR, nested PCR, and PCR-restriction fragment length polymorphism (RFLP) are highly sensitive for the diagnosis of cestode and metacestode. Those diagnoses are used for differentiation of Taenia species and differentiation of Taenia and Echinococcus species. As compared to other diagnostic techniques most molecular methods have higher sensitivity and specificity but due to the relatively higher cost, few are commercially available. Most of the molecular diagnostic tests developed to date are generally applicable for laboratory research purposes. The developments in the genomic and proteomic analysis should be used for further understanding of parasite-animal host interaction to find additional targets for diagnosis.

This paper is devoted to a novel Electromagnetic Band Gap (EBG) single-feed circularly polarized microstrip EBG antenna with compact size proposed for C-Band applications. The antenna structure will include eight slits introduced at the boundary and the corners in the radiating square patch with a cross-slot at the center. The provided study will effectively approve the various proposed structures and interest occupied by these types of antennas in the enhancement of output parameters (gain, directivity, radiation efficiency, and bandwidth) without much affecting the operating bandwidth at C-band. At first, the concept and the realization of a directive and circularly polarized antenna using an electromagnetic band gap material whose circular polarization is generated by the structure itself is discussed. The analysis and simulation results are presented for an antenna operating at 6.1 GHz using computer Simulation Technologies (CST). Furthermore, the new compact circular polarized EBG antenna, compared to experimental results, will confirm the pre-studied goal of these kinds of antennas such as radiation efficiency, polarization purity, radiation efficiency, high directivity, and gain.

Background We evaluated the range of prosthetic size-to-weight ratio to optimize valve survival in small children. Methods A single-institution retrospective review of mechanical mitral valve replacements from 1995 to 2019 was performed. Prosthetic valve size-to-weight ratio was calculated as the prosthetic valve diameter divided by the patient’s operative weight in children less than or equal to 35 kg. Patient death or reoperation on the valve was analyzed by size-to-weight ratio. Identifying a U-shaped distribution of events, patients were stratified as being in the nadir of the distribution or on the edges. Results Mechanical mitral valve replacements were performed in 56 (75%) children weighing less than or equal to 35 kg. Median follow-up time was 3.7 (interquartile range, 0.46-12) years. Median size-to-weight ratio was 1.5 (interquartile range, 1.0-2.0). A second replacement was required in 15 (27%) patients. Death occurred in 6 (11%) patients, including 3 after reoperation. The nadir of U-shaped distribution of events by size-to-weight ratio was bounded by a ratio from 1 to 2, which included 29 (52%) patients. A size-to-weight ratio from 1 to 2 provided optimal outcomes regardless of patient age. Reoperation-free survival at 5 years was 96% for patients with a ratio from 1 to 2 and 46% for patients with a ratio less than 1 or greater than 2. Patients with size-to-weight ratio 1 to 2 had longer reoperation-free survival than patients with a ratio less than 1 or greater than 2 (P Conclusions Regardless of patient age, in patients less than or equal to 35 kg, optimal reoperation-free survival after prosthetic mitral valve replacement can be obtained by placing a prosthetic valve whose diameter is between 1 and 2 times the patient’s weight in kilograms.

Electrical energy is very necessary for human life in the modern era. The rising energy prices, depletion of fossil fuels, and instability of the grid are alarming situations. So, it needs a smart solution to ensure the balance between pricing and saving natural resources. Some other issues like environmental change, limitations on installation of new transmission lines, reliability concerns, and considering the expansion in distributed energy generation technologies promise the implementation of distributed generation extensively. The integration of two or more energy supplies in a power system is known as distributed energy resource system. In this study, a university campus is taken as a case study to reduce the energy cost while considering the aforementioned issues. The intelligent source–load–storage coordination scheme is proposed to utilize the available renewable energy resources with storage systems. The proposed linear model is solved in MATLAB using the exact method technique considering the economic parameters. The campus microgrid analysis is not addressed considering the Internet-of-Thing (IoT)-based building, especially in the scenario of Pakistan. The results show the efficacy of the proposed model and can be implemented on the existing campus for source–load–storage coordination as an economical solution.

Transcatheter repair of sinus venosus atrial septal defect (SVASD) has become an alternative option to surgical repair. There are potential significant complications related to stent stability in the superior vena cava (SVC) and potential migration of the stent that need to be addressed. Therefore, the technique is still evolving.To report results of a new modification "the suture technique" that improves safety profile of positioning and securing a covered stent in the SVC.This is a descriptive, single center, retrospective review of patients who underwent SVASD closure using the suture technique at our institution between 02/2020 and 08/2022.Fourteen patients underwent transcatheter repair of SVASD using the suture technique. All procedures were successful. The suture technique allowed precise stent placement in all patients without any migration or complication. Six patients required additional stent placement at the level of the SVC. One patient had an additional covered stent placed to eliminate a tiny residual shunt. Two patients had negligible residual shunts at the time of the procedure. At follow-up, all patients clinically improved and had significant reduction in right heart size on echocardiography and/or magnetic resonance imaging. No arrhythmia was reported in any patient. None required re-intervention after a mean follow-up of 16.5 ± SD 10.5 months.The suture technique appears to be safe modification. Although our study involves small sample size with no comparative group, we believe our technique offers greater control over stent positioning, reducing the risk of stent embolization and residual shunting in transcatheter closure of SVASD.

Arum cyreniacum is an important member of the family of Araceae because of its bio-activities. Hence this work aimed to establish a link between Arum cyreniacum and its uses as bio-control against plant pathogenic fungi which had never hitherto been established. This work was carried out to evaluate the activity of the aqueous extracts of tubers, leaves, and flowers of Arum cyreniacum against three different types of pathogenic fungi, Fusarium solani, Rhizopus microspores and Aspergillus niger. The antifungal activity of the aqueous extracts of Arum cyreniacum was determined by poisoned food technique. The results showed that Arum cyreniacum had an inhibitory effect in a dose-dependent manner on Fusarium solani, Rhizopus microspores, while Aspergillus niger was resistant to all extracts. However, the great inhibition activity against tested fungi was associated with increasing concentrations of the aqueous extracts of Arum cyreniacum. Data in this work indicated that the use of Arum cyreniacum could be a valid alternative for bio-control of plant pathogenic fungi.

Crystalline ZnO offers an excellent host matrix to create a dilute magnetic semiconductor (DMS) owing to its facile Zn-atom substitution with the transition metal dopant atom. The exchange interactions between the spin of the dopant atoms and the carriers in the ZnO matrix results in the room-temperature ferromagnetic order in the entire lattice. In this work, we report on the enhanced solubility (doping) of Fe atoms in ZnO matrix. Zn1-x FexO DMS nanoparticles were synthesized with different doping concentrations (x = 0.01, 0.05, 0.20, 0.22, and 0.25) via a modified version of co-precipitation method, in which the precursors’ solution was heated at 60 ℃ during the stirring process. Only the wurtzite phase was obtained for all Zn1-x FexO samples in X-ray diffraction, and no secondary phase was observed, which supports the idea of an enhanced solubility limit of Fe doping up to 25%. A systematic broadening of the Raman characteristic peak at 525 cm−1 associated with Fe substitution across the entire range of doping accompanied with the suppression of ZnO peak at 371cm−1 and 435 cm−1, supporting the enhanced doping effect further. The bandgap exhibited a systematic trend — it first increased from 3.13 eV for undoped to 3.23 for x = 0.1 and dropped to the value of 2.94 for the highest concentration (x = 0.25) with few in band transitions for high doping. VSM results showed magnetic behavior for all the doped samples at room temperature.

Multiple techniques are available for repair of supracardiac partial anomalous pulmonary venous return (PAPVR); however, most series fail to compare the techniques in contemporary cohorts. This study aimed to describe outcomes of the Warden procedure with a single-patch repair cohort to serve as a control.A retrospective cohort analysis of all patients at a single institution (Texas Children's Hospital, Houston, TX) included patients undergoing either the Warden procedure or single-patch repair from 1996 to 2019 for PAPVR. Reintervention was defined as any catheter or surgical procedure on the superior vena cava (SVC) or pulmonary veins. Subgroup analysis was performed within the Warden cohort to evaluate for association between an SVC patch and reintervention-free survival.In total, 158 patients (122 in the Warden group and 36 in the single-patch group) were identified. The median age at operation was younger for patients in the Warden cohort (5.4 years; interquartile range, 3.3 to 10.2 years) compared with patients in the single-patch cohort (13.3 years; interquartile range, 6.5 to 18.7 years; P.001). One patient in each cohort died. One patient required reoperation after the Warden procedure for dehiscence of the intracardiac patch. Ten patients required transcatheter reinterventions. Reintervention-free survival was not different between patients in the Warden cohort and patients in the single-patch cohort (P = .54) or within the Warden cohort in patients with an SVC patch (P = .27). When controlling for repair type, older age at repair was associated with longer reintervention-free survival (hazard ratio, 0.81; 95% confidence interval, 0.71 to 0.93; P = .002).The Warden procedure is a viable option for younger patients requiring supracardiac PAPVR repair, although these younger patients are likely at greatest risk for reintervention regardless of surgical technique.

Background Multiple techniques exist for the repair of supravalvular aortic stenosis (SVAS), but given the lesion’s rarity, analyses comparing the efficacy of each repair have been limited. Methods A retrospective review of all children at a single institution who underwent repair of SVAS from June 1995 to May 2019 was performed. Anatomic and physiologic measurements across time points were compared between 2 predominant surgical techniques. Time-to-event outcomes were compared using the log-rank test. Results SVAS was repaired in 89 patients, by using a single-patch in 31 (35%) and the Doty repair in 58 (65%). Median age at operation was 2.5 years (interquartile range [IQR], 1.0 to 6.8 years), with median follow-up of 5.8 years (IQR, 1.8 to 10.7 years). Reoperation was required in 8 (9%) patients at a median of 1.5 years postoperatively (IQR, 0.3 to 4.8 years). There was 1 death after multiple reinterventions. The change from the preoperative to the postoperative sinotubular junction z-score was greater for patients after Doty repair (median change +2.5; IQR, 1.5, 4.1) than for patients after single-patch repair (median change +0.8; IQR, −0.1, 2.1; P = .001). Freedom from reoperation was longer for patients after Doty repair than after the single-patch technique (P = .008). Conclusions The Doty repair provides longer freedom from reoperation after supravalvular aortic stenosis repair compared with a single-patch technique, likely through a greater increase in the sinotubular junction at the time of initial operation.

Introduction: Cardiac defects that result in shunting are the most common types of congenital heart anomalies. Although these lesions can be simple, they can cause significant hemodynamic changes a...

BACKGROUND Covered stent correction of sinus venosus ASDs (SVASD) is a relatively new technique. Challenges include anchoring a sufficiently long stent in a nonstenotic superior vena cava (SVC) and expanding the stent at the wider SVC-RA junction without obstructing the anomalous right upper pulmonary vein (RUPV). The 10-zig covered Cheatham-platinum (CCP) stent has the advantage of being available in lengths of 5-11 cm and dilatable to 34 mm in diameter. METHODS An international registry reviewed the outcomes of 10-zig CCP stents in 75 patients aged 11.4-75.9 years (median 45.4) from March 2016. Additional stents were used to anchor the stent in the SVC or close residual shunts in 33/75. An additional stent was placed in 4/5 (80%) with 5/5.5 cm CCPs, 18/29 (62%) with 6 cm CCPs, 5/18 (28%) with 7 cm CCPs, 5/22 (23%) with 7.5/8 cm CCPs and 0/1 with an 11 cm CCP. A "protective" balloon catheter was inflated in the RUPV in 17. RESULTS Early stent embolization in two patients required surgical removal and defect repair and tamponade was drained in one patient. The CT at 3 months showed occlusion of the RUPV in one patient. Follow up is from 2 months to 5.1 years (median 1.8 years). QP:QS has reduced from 2.5 ± 0.5 to 1.2 ± 0.36 (p

INTRODUCTION: The optimal management of scimitar syndrome remains incompletely defined. We (1) evaluated the impact of aortopulmonary collateral (APC) occlusion, (2) compared outcomes according to surgical approach for patients who underwent surgery, and (3) identified anatomic factors associated with longer survival time without scimitar vein repair. METHODS: We conducted a single center, retrospective study of 61 patients diagnosed with scimitar syndrome between 1995 and 2019. Right pulmonary artery to total pulmonary artery cross-sectional area (RPA:PA CSA) quantitatively assessed right pulmonary artery size. Anatomical features were analyzed for association with longer survival time without scimitar vein repair. RESULTS: Median follow-up time was 6 years (Q1-Q3, 2-12), with 96% 5-year survival. Twenty-three patients underwent APC occlusion, which significantly decreased symptoms of overcirculation (100%-46%; p = .001) and systolic pulmonary artery pressure (median, 34-29 mmHg; p = .004). Twenty-three patients underwent scimitar vein repair; 5-year freedom from scimitar vein stenosis was 90% among patients who underwent a reimplantation compared with 42% in patients with baffle repair (p = .1). Three patients underwent surgery before the first year of age, with lower 5-year freedom from scimitar vein stenosis (0% vs. 84%; p < .001). On multivariate analysis, a lower RPA:PA CSA was associated with longer survival time without scimitar vein repair (p = .003). CONCLUSIONS: APC occlusion improves the clinical status of young and hemodynamically unstable patients. Repair at an early age is associated with an increased risk of scimitar vein stenosis. Scimitar vein repair might be avoided in patients with a smaller right pulmonary artery.

Alzheimer’s disease (AD) is a common, progressive, and devastating neurodegenerative disorder that mainly affects the elderly. Microglial dysregulation, amyloid-beta (Aβ) plaques, and intracellular neurofibrillary tangles play crucial roles in the pathogenesis of AD. In the brain, microglia play roles as immune cells to provide protection against virus injuries and diseases. They have significant contributions in the development of the brain, cognition, homeostasis of the brain, and plasticity. Multiple studies have confirmed that uncontrolled microglial function can result in impaired microglial mitophagy, induced Aβ accumulation and tau pathology, and a chronic neuroinflammatory environment. In the brain, most of the genes that are associated with AD risk are highly expressed by microglia. Although it was initially regarded that microglia reaction is incidental and induced by dystrophic neurites and Aβ plaques. Nonetheless, it has been reported by genome-wide association studies that most of the risk loci for AD are located in genes that are occasionally uniquely and highly expressed in microglia. This finding further suggests that microglia play significant roles in early AD stages and they be targeted for the development of novel therapeutics. In this review, we have summarized the molecular pathogenesis of AD, microglial activities in the adult brain, the role of microglia in the aging brain, and the role of microglia in AD. We have also particularly focused on the significance of targeting microglia for the treatment of AD.

Influenza is a highly transmissible respiratory virus. Public awareness about the nature of the disease and how to prevent it must be explored to effectively mitigate the adverse effects of the disease. This study aimed to assess the parents’ knowledge and attitudes towards the influenza and the influenza vaccine in Al-Kharj Governate, Saudi Arabia. A cross-sectional study was performed, and an electronic questionnaire was distributed from December 2020 to the end of April 2021 to parents living in Al-Kharj, Saudi Arabia. Data were collected and analyzed using IBM SPSS version 21. The study had 510 participants, of which 75.1% were mothers. Overall knowledge about the influenza disease was found to be low in 68.6% of participants. In addition, 55.7% of respondents displayed an inadequate level of knowledge of the influenza vaccine. Almost 75% of parents had chosen not to vaccinate their children in the past and of those, only 35.9% were willing to vaccinate their child this year. The most common reason for parents choosing not to vaccinate their children was that they believed the child to be in good health. This demographic studied in Al-Kharj, Saudi Arabia did not demonstrate sufficient knowledge about the influenza disease and vaccine. Study participants were hesitant to vaccinate their children. This should prompt healthcare workers and the Ministry of Health to lead a broad awareness campaign on influenza vaccination that extends to both urban and rural areas.

Given pulmonary artery interventions following the Norwood procedure can recur, the average number of occurrences per patient over time is likely more informative than the crude percentage of patients who required an intervention. Pulmonary artery intervention was defined as any surgical or catheter-based procedure after the Norwood procedure. The number of pulmonary artery interventions for patients with hypoplastic left heart syndrome were compared between patients with modified Blalock-Taussig Shunts (MBTS) and right ventricle-to-pulmonary artery conduits (RVPA) at a single institution from 2011 to 2018. The comparison was replicated using data from the Single Ventricle Reconstruction Trial (SVR), a nonoverlapping dataset. The mean number of pulmonary artery interventions per patient over time (mean cumulative function, MCF) is described using Nelson-Aalen estimates and compared using the pseudo-score test. The number of patients requiring intervention was compared using the chi-square test. Using our institutional dataset, the Norwood operation was performed on 117 patients (59 MBTS, 58 RVPA). In total, 73 patients had a pulmonary artery intervention, including 32 of 58 (55%) after MBTS and 41 of 59 (69%) after RVPA (P= 0.11). The MCF did not vary between cohorts (P = 0.55). Using the SVR trial dataset, 140 of 549 patients required pulmonary artery intervention, including 55 (21%) after MBTS and 85 (30%) after RVPA (P = 0.0090). The MCF did not vary between cohorts (P = 0.067). Although more patients with RVPA than MBTS require pulmonary artery interventions after the Norwood procedure, the MCFs are not different, which may be of greater importance to patients and families.

With the emergence of computation-intensive and delay-sensitive applications, such as face recognition, virtual reality, augmented reality, and Internet of Things (IoT) devices; Mobile Edge Computing (MEC) allows the IoT devices to offload their heavy computation tasks to nearby edge cloud network rather than to compute the tasks locally. Therefore, it helps to reduce the energy consumption and execution delay in the ground mobile users. Flying Unmanned Aerial Vehicles (UAVs) integrated with the MEC server play a key role in 5G and future wireless communication networks to provide spatial coverage and further computational services to the small, battery-powered and energy-constrained devices. The UAV-enabled MEC (U-MEC) system has flexible mobility and more computational capability compared to the terrestrial MEC network. They support line-of-sight (LoS) links with the users offloading their tasks to the UAVs. Hence, users can transmit more data without interference by mitigating small-scale fading and shadowing effects. UAVs resources and flight time are very limited due to size, weight, and power (SWaP) constraints. Therefore, energy-aware communication and computation resources are allocated in order to minimize energy consumption.In this paper, a brief survey on U-MEC networks is presented. It includes the brief introduction regarding UAVs and MEC technology. The basic terminologies and architectures used in U-MEC networks are also defined. Moreover, mobile edge computation offloading working, different access schemes used during computation offloading technique are explained. Resources that are needed to be optimized in U-MEC systems are depicted with different optimization problem, and solution types. Furthermore, to guide future work in this area of research, future research directions are outlined. At the end, challenges and open issues in this domain are also summarized.

Recent reports have suggested that the number of adults with congenital heart disease (CHD) has surpassed pediatric numbers and that approximately 1 in 150 adults has some form of CHD (Marelli et al., Circulation 115:163–172, 2007; Warnes et al., Circulation 118:2395–2451, 2008). Significant rates of intervention and re-intervention are required in this cohort of patients with one report demonstrating 20 % of young adults with CHD requiring cardiovascular surgery (Zomer et al., Circulation 124:2195–201, 2011). Increasingly, transcatheter alternatives to surgery exist in this population particularly in the field of transcatheter pulmonary valve replacement (tPVR), and recommendations for catheter intervention in adults with CHD have been published in the context of overall care of these patients (Warnes et al., Circulation 118:2395–2451, 2008). Case complexity will vary according to the underlying diagnosis ranging from more straightforward interventions such as atrial septal defect closure to complex stenting interventions for interatrial baffle leak in patients following atrial switch surgery for transposition of the great arteries. Many of the more complex patients may have had multiple previous interventions, and detailed review of previous data as well as sensible use of pre-procedural imaging techniques including cardiac CT and MRI is essential. This chapter will outline some of the procedural techniques and the diagnostic imaging tools used to optimize patient selection and procedural success. Outcome data where available will also be discussed in relation to the range of transcatheter interventions seen in this patient group.

Although aortopulmonary collaterals (APCs) frequently develop in patients with single ventricle palliation, there is a lack of understanding of pathophysiology, natural history, and outcomes with no universal guidelines for management and interventional practice. We conducted a study to assess the views held by interventional congenital cardiologists regarding the hemodynamic impact of APCs in patients with single ventricle palliation, and their embolization practice. An electronic survey using the Pediatric Interventional Cardiology Symposium (PICS) mailing list was conducted between February and March 2019 with one reminder sent 2 weeks after initial invitation for participation. Of the 142 interventional cardiologist respondents, 95 (66.9%) reside in North America and 47 (33.1%) worldwide. We elected to exclude the data from interventionalists outside North America in this analysis as it was not representative of worldwide practice. Hypoxemia was considered to be the most common trigger for development of APCs by 56 (58.9%) respondents. After completion of total cavopulmonary connection, 30 (31.6%) respondents reported the APC burden stays the same while 31 (32.6%) feel it decreases. In evaluating the burden of APC flow, only 4 (4.2%) reported measuring oxygen saturation at different pulmonary artery segments, 21 (22.1%) perform segmental aortic angiograms, and 18 (19%) perform selective bilateral subclavian artery angiograms. A majority of respondents, 71 (74.7%), occlude the feeder vessel at different locations, while 10 (10.5%) occlude only the origin of the vessel. Our study demonstrates significant variation in the understanding of the cause and prognosis of APCs in patients with single ventricle palliation. Furthermore, there is variation in the approach for diagnosis and management among interventional cardiologists. Further studies are required to improve understanding of APCs and develop universal management guidelines.

This paper presents a compact multiband microstrip electromagnetic band gap (EBG) patch antenna with partial ground used for the 2nd and 3rd mode excitation, allowing multiple band resonance and control of the resonance frequencies. The electromagnetic band gap elements are inserted to improve obviously output parameters (gain directivity, return loss, maximum radiation Intensity, and radiation efficiency). Simulation and measurement results show a multiband antenna WiMAX, WLAN-band applications that can effectively cover three separated bandwidths (2.12, 3.1 and 5.41 GHz). The proposed compact antenna is grounded on a 1.6 mm-thick FR4 epoxy substrate with overall dimension of 0.305λ × 0.305λ × 0.012λ at lower frequency. The whole size of the proposed antenna with an overall area of 25 × 38 × 1.6 mm3 is maintained, and a low cross-polarization level within the operating frequency range. Electromagnetic Band Gap materials, artificially engineered structures, have the main role to improve the output performance of the patch antennas.

BACKGROUND AND OBJECTIVES: Polymer-based bioresorbable scaffolds (PBBS) have been assessed for coronary revascularization with mixed outcomes. Few studies have targeted pediatric-specific scaffolds. We sought to assess safety, efficacy, and short-term performance of a dedicated drug-free PBBS pediatric scaffold compared to a standard low profile bare metal stent (BMS) in central and peripheral arteries of weaned piglets. METHODS: Forty-two devices (22 Elixir PLLA-based pediatric bioresorbable scaffolds (6x18 mm) and 20 control BMS Cook Formula 418 (6x20 mm)) were implanted in the descending aorta and pulmonary arteries (PA) of 14 female Yucatan piglets. Quantitative measurements were collected on the day of device deployment and 30 and 90 days post implantation to compare device patency and integrity. RESULTS: The bioresorbable scaffold (BRS) has a comparable safety profile to the BMS in the acute setting. Late lumen loss (LLL) and percent diameter stenosis (%DS) were not significantly different between BRS and BMS in the PA at 30 days. LLL and %DS were greater for BRS vs BMS in the aorta at 30 days post implantation (LLL difference: 0.96 ± 0.26; %DS difference: 16.15 ± 4.51; p

Background This single-institution study assessed the midterm outcomes of patients undergoing complete vascular ring (CVR) repair and the need for reintervention. Methods The study included all patients who underwent surgical repair of an isolated CVR from 1996 to 2018 at our institution. Patients who underwent concomitant intracardiac repair were excluded. Data analysis included demographics, type of anomaly, other congenital heart disease, clinical symptomatology, operative technique, perioperative outcomes, reoperation rates, and mortality. Results CVR repair through open thoracotomy was performed in 148 patients (80 boys [54%]), median age, 1.04 years (interquartile range, 0.4-5.2 years), and median weight, 12.8 kg (interquartile range, 7.5-26.5 kg). The cohort included 72 patients with double aortic arch (DAA), 69 with right aortic arch (RAA) with aberrant left subclavian artery and left ligamentum arteriosum (LLA), 5 with RAA with left descending aorta and LLA, and 2 with RAA with mirror-image branching and LLA. There was 1 outpatient perioperative death (0.7%) 15 days postoperatively. Perioperative complications occurred in 20 patients (14%): 18 (12%) with chylothorax (3 required reintervention), 1 pneumothorax, and 1 vocal cord paresis. Two of 36 patients (5.5%) without primary diverticulum resection required reoperation and subclavian reimplantation at 3 and 4 years, and 1 patient required aortic translocation 9 years later for persistent symptoms. Conclusions Freedom from reoperation after CVR repair was 93% at 5 years and 86% at 10 years. A small proportion of patients who do not undergo diverticulum resection and aberrant left subclavian artery reimplantation at the time of CVR repair will require reintervention in the future.

Background: SARS-CoV-2 emerged in late 2019 and caused COVID-19. Patients treated with Zyesami were found to have a 3-fold decrease in respiratory failure and improved clinical outcomes. It was reported that Zyesami inhibits RNA replication of SARS-CoV-2, including several non-structural proteins essential in viral RNA replication. SARS-CoV-2 is a distinctive virus that requires nsp10 and nsp16 for its methyltransferases activity which is crucial for RNA stability and protein synthesis. Objective: We aimed the in silico determination of inhibitory consequences of Zyesami on the SARS-CoV-2 nsp10/nsp16 complex. Targeting SARS-CoV-2 nsp10/ nsp16 protein complex may be used to develop a drug against COVID-19. Methods: I-TASSER was used for secondary structure prediction of Zyesami. CABS-dock was used to model Zyesami with SARS-CoV-2 nsp16 interaction. The docked complex was visualized using PyMol. The quality of the docking model was checked by using ProQdock. Results: The 3D structure of SARS-CoV 2, nsp10/nsp16 showed that essential interactions exist between nsp10 and nsp16. Significant contact areas of Zyesami exist across amino acid residues of nsp10; Asn40-Thr47, Val57-Pro59, Gly69-Ser72, Cys77-Pro84, Lys93-Tyr96. In addition, polar contacts between nsp16 and Zyesami are Asn299-Ser440, Val297-Asn443, Gly149-Tyr437, Gln159-Lys430, Asn178- Arg429, Ser146-Arg429, Ser146-Arg429, Lys147-Arg429, Asr221-Thr422, Lys183-Asp423, Lys183-Asp423, and Gln219-Asp423 the residues are shown of nsp16 and Zyesami respectively. Conclusion: The structural bioinformatics analyses have indicated the potential binding specificity of Zyesami and nsp16. Data predict how the initial binding of Zyesami with nsp10 and nsp16 may occur. Moreover, this binding could significantly inhibit the 2 -O-MTase activity of the SARSCoV nsp10/16 complex.

Propionic acidemia is a rare autosomal recessive inborn error of metabolism. It is relatively common in Middle East. Dilated cardiomyopathy is one of the leading causes of morbidity and mortality for patients with propionic acidemia. Liver transplantation has been used for patient with frequent metabolic decompensations and was shown to be beneficial in propionic acidemia-related dilated cardiomyopathy. Up to our knowledge, there has been one reported case of recurrent dilated cardiomyopathy 3 years after liver transplantation. We report the first case, from Middle East, of recurrent dilated cardiomyopathy, 6 years after liver transplantation.

Over the last decade, researchers have discovered that a group of apparently unrelated neurodegenerative disorders, such as Parkinson's disease, have remarkable cellular and molecular biology similarities. Protein misfolding and aggregation are involved in all of the neurodegenerative conditions; as a result, inclusion bodies aggregation starts in the cells. Chaperone proteins and ubiquitin (26S proteasome's proteolysis signal), which aid in refolding misfolded proteins, are frequently found in these aggregates. The discovery of disease-causing gene alterations that code for multiple ubiquitin-proteasome pathway proteins in Parkinson's disease has strengthened the relationship between the ubiquitin-proteasome system and neurodegeneration. The specific molecular linkages between these systems and pathogenesis, on the other hand, are unknown and controversial. We outline the current level of knowledge in this article, focusing on important unanswered problems.