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Opto-chemical sensors are the most significant type of sensors that are widely used to detect a variety of volatile organic compounds and chemicals. This research work demonstrates the fabrication and characterization of an opto-chemical sensor based on a graphene thin film. A 300 nm graphene thin film was deposited on clean glass with the help of RF magnetron sputtering. The structure, surface and quality of the graphene thin film were characterized using XRD, SEM and Raman spectroscopy. For optical characterization, the thin film was exposed to IPA, acetone and toluene (separately) for five, ten and fifteen minutes. The optical transmission was then observed

Fenestrated grafts form an alternative to open surgery, and are already increasingly being offered as part of the standard spectrum of treatment in developed countries. The past two decades have seen rapid developments in fenestrated endovascular aneurysm repair (fEVAR)/branched (bEVAR) expertise, to the point where the results are striking and can compete with those of conventional surgery. We here report the case of an 82-year male, who was diagnosed with an abdominal aortic aneurysm 10 years ago. Computed tomography showed a large fusiform juxta-renal abdominal aortic aneurysm extending into bilateral common iliac arteries to their bifurcation. Bilateral femoral access was acquired surgically. Fenestrated part of the stent grafted was deployed successfully. Right and left renal arteries and superior mesenteric artery were stented. Celiac artery showed good flow and no stenting was required. Distal stent graft and bilateral iliac grafts were deployed successfully. Follow up computed tomography scan showed 99% patency and no endoleak. Patient remains stable and asymptomatic at 6-month follow-up. To the best of our knowledge, it is the first reported case of successful fEVAR from Pakistan. Key Words: Fenestrated grafts, Abdominal aortic aneurysm, Endovascular.

Extracorporeal membrane oxygenation complications involving vascular injury or intracardiac thrombosis in neonates are rare. We present a series of unique complications and describe their variable treatments.

Bovine mastitis causes severe economic losses to dairy farmers. Staphylococcus aureus, is one of the most important pathogen implicated in etiology of clinical and subclinical mastitis in bovines. In view of increasing antimicrobial resistance alternatives to antibiotic therapy are much needed. The present decade has witnessed a renewed interest in phage based therapeutics and diagnostics. The present study, describes isolation and characterization of two lytic phages SAJK-IND and MSP against Staphylococcus aureus having a potential to be used in therapy against mastitis. SAJK-IND and MSP phages belonged to Myoviridae and Podoviridae families, respectively. TEM imaging of the two phages revealed an iscosahedral head. MSP phage has a short non contractile tail. SAJK-IND and MSP have a burst size of 44 ± 3 and 25 ± 5 PFU/ infected cell, respectively. SAJK-IND and MSP phages revealed ̴ 12 and ̴16 proteins, respectively on SDS-PAGE analysis. The lytic activity of the phages was specific for Staphylococcus aureus. SAJK-IND revealed 100% lytic activity against several strains of Staphylococcus aureus isolated from mastitis milk samples whereas, MSP had only 40% lytic activity. SAJK-IND phage genome was sequenced, assembled and deposited in Genbank under accession no MG010123.

Background Variable patent ductus arteriosus (PDA) morphology and the need to close PDAs in small size patients has led physicians to use Amplatzer Vascular Plugs (AVP) and recently available Amplatzer Duct Occluder II - Additional Sizes (ADO II AS). The purpose of this study was to analyze the safety, efficacy, and complication rates of the ADO II AS and AVPs, specifically AVP II. Methods All patients undergoing PDA closure with an AVP or ADO II AS from 2011 to 2016 were included. Clinical, echocardiographic, and angiographic data were collected and reviewed. Results Four hundred and sixty-nine patients were included. Median age was 27 months (0.75-852) and the median weight was 11.4 kg (1-92). There were 51 patients ≤5 kg. Type A PDA was most common in 48% (n = 225), followed by type E (27.5%, n = 129), type D (13%, n = 61), type C (10.2%, n = 48), and type B (1.3%, n = 6). Devices included AVP II (n = 421), ADO II AS (n = 30), and AVP IV (n = 18), left pulmonary artery stenosis occurred in 4.3% (n = 20). One patient required surgery for severe stenosis; the remaining cases were mild and required no intervention. Device embolization occurred in 3 patients (10%) with the ADO II AS. Successful device closure was achieved in 98.9% of cases. Conclusions The AVP II was highly effective for closing PDAs in smaller babies with varying morphologies and is safe when used in small sized patients with relatively low risk of complications. More studies are warranted to clarify the risks of ADO II AS.

Currently used alum precipitated and oil adjuvant vaccines against HS caused by Pasteurella multocida B:2, have side effects and short-lived immunity, leading to regular catastrophic outbreaks in bovines in Asian subcontinent. The need for the development of an improved vaccine with longer immunity and the ability to differentiate between vaccinated and infected is essential. Pasteurella phage isolated in present study belongs to family Siphoviridae. PMP-GAD-IND phage exhibited lytic activity against vaccine strain (P52) as well as several field strains of P. multocida (B:2), and fowl cholera agent (P. multocida A:1).The phage has a double stranded DNA (dsDNA) with a genome of 46 335 bp. The complete genome sequence of the Pasteurella multocida phage has been deposited in Gen Bank with accession no: KY203335. PMP-GAD-IND being a lytic phage with broad activity range has a potential to be used in therapy against multidrug resistant P. multocida infections. Significance and impact of the study The present work is a part of research for the development of an improved phage lysate marker vaccine and a companion DIVA assay against haemorhagic septicaemia. This study describes the isolation and genome analysis of PMP-GAD-IND a lytic Pasteurella multocida bacteriophage.

Aim The study was conducted to report the occurrence of the Clostridium perfringens in sheep and goats of the Kashmir valley for the 1st time and to characterize them molecularly with respect to toxin genes to determine the prevalence of the various toxinotypes. Materials and methods A total of 177 samples (152 from sheep and 25 from goats) collected from healthy, diarrheic animals, and morbid material of animals suspected to have died of enterotoxaemia were screened for C. perfringens toxinotypes. The presumptive positive isolates were confirmed using 16S rRNA gene-based polymerase chain reaction (PCR). All the confirmed isolates were screened for six toxin genes, namely; cpa, cpb, etx, cpi, cpb2, and cpe using a multiplex PCR. Results The PCR amplification of 16S rRNA gene revealed that out of 177 samples collected, 125 (70.62%) were found positive for C. perfringens, of which 110 (72.36%) were from sheep and 15 (60%) were from goats. The highest prevalence of C. perfringens toxinotype D was observed in lambs (56.16%) and kids (46.16%) followed by 3.84% in adult sheep while it was absent in samples obtained from adult goats. The multiplex PCR revealed that 67 (60.90%) isolates from sheep and 8 (53.33%) isolates from goats belonged to toxinotype A, while 43 (39.09%) isolates from sheep and 7 (46.66%) isolates from goats were detected as toxinotype D. None of the isolates was found to be toxinotype B, C, or E. All the C. perfringens toxinotype A isolates from sheep were negative for both cpb2 and cpe genes, however, 27.90% toxinotype D isolates from sheep carried cpb2 gene, and 6.97% possessed cpe gene. In contrast, 12.50% C. perfringens toxinotype A isolates from goats harbored cpb2 and cpe genes while 14.28% isolates belonging to toxinotype D carried cpb2 and cpe genes, respectively. Conclusion The high prevalence of C. perfringens was observed, even in day-old lambs. The toxinotypes A and D are prevalent in both sheep and goats. The severity of disease and mortality may be associated with the presence of minor toxins in both the detected toxinotypes.

Traumatic aortic injury (TAI) or aortic transection is the second most common cause of death after blunt trauma. The conventional management approach towards a thoracic aortic injury is open thoracotomy and surgical repair; however, there is a recent increase in the trend towards the use of endovascular approach in this regard, particularly in the developed countries. We here report the cases of two young healthy male patients presenting in emergency department with thoracic aortic injury, following a road traffic accident (RTA). Thoracic endovascular aortic repair (TEVAR) was planned for both patients, as open repair was risky owing to other systemic injuries. Aortic stent graft was deployed just below the origin of the left subclavian artery in one patient, while it partially covered the left subclavian in the other. End runs showed good position of the graft with perfusion of aortic branches and exclusion of flow to the transection. Both patients had an uneventful recovery with no episodes of cerebrovascular accident (CVA) or paraplegia. Our study gives an insight into the recent trends of endovascular aortic repair (EVAR) becoming the mainstay treatment for TAIs. As far as we know this is the first reported successful case series of thoracic endovascular stent graft deployment for blunt thoracic aortic trauma in Pakistan. We recommend education and further teaching of surgeons to acquire expertise in this novel approach.

Percutaneous patent foramen ovale (PFO) closure is an effective treatment for preventing stroke recurrence in patients with a history of cryptogenic stroke. However, comparative data between the two FDA-approved PFO closure devices is limited. This study aims to compare peri-procedural

Objectives To investigate technical approaches for transcatheter closure of coronary artery fistula based on anatomic type of the fistula. Background The variability in coronary artery fistulae (CAF) anatomy that necessitates different transcatheter closure (TCC) approaches has not been well documented. Methods Records of patients with CAF who underwent TCC at 2 centers were reviewed for technical details and procedural outcome. CAF were classified as proximal and distal. TCC approaches employed were arterio-venous or arterio-arterial loop, retrograde arterial, and antegrade venous. Results Eighteen patients with CAF, mean age 12.6 years (0.07–60), 11 male (61%), underwent TCC. All CAF drained predominantly into the right side of the heart. Types of CAF were proximal in 15 and distal in 3 patients. CAF calibers were large in 7, medium in 9, and small in 2 patients. The arterio-venous loop approach was used in the majority of the cases (11 patients) and the CAF size were medium to large. The retrograde arterial approach was used in 4; of these, 3 patients had small to medium sized CAF. In 2 patients with long tortuous CAF an antegrade venous approach was employed. TCC was successful in 17 of the 18 patients (94.4%). There were no peri-procedural deaths or vascular complications. Conclusions This study documents transcatheter closure approaches for CAF and device selection based on fistula origin. The choices of TCC technique and device selection vary, and are primarily determined by the heterogeneous anatomic characteristics of the fistulae.

Transcatheter pulmonic valve implantation has emerged as a safe and effective alternative to valve surgery in patients with surgically corrected congenital heart disease. In cases where the transcatheter approach has failed, or was thought to be technically challenging, a hybrid approach to pulmonic valve implantation has been described. This approach involves a small subxyphoid incision made by the cardiac surgeon and implantation of the pulmonic valve through the appropriate delivery sheath through this incision. Here we describe a case of a successful implantation of a Melody valve in a 12 kg child with tetralogy of Fallot. To our knowledge this is the smallest child to have undergone this procedure reported. © 2013 Wiley Periodicals, Inc.

Objectives The purpose of this study was to compare the safety and efficacy of surgical, stent, and balloon angioplasty (BA) treatment of native coarctation acutely and at follow-up. Background Controversy surrounds the optimal treatment for native coarctation of the aorta. This is the first multicenter study evaluating acute and follow-up outcomes of these 3 treatment options in children weighing >10 kg. Methods This is a multicenter observational study. Baseline, acute, short-term (3 to 18 months), and intermediate (>18 months) follow-up hemodynamic, imaging data, and complications were recorded. Results Between June 2002 and July 2009, 350 patients from 36 institutions were enrolled: 217 underwent stent, 61 underwent BA, and 72 underwent surgery. All 3 arms showed significant improvement acutely and at follow-up in resting systolic blood pressure and upper to lower extremity systolic blood pressure gradient (ULG). Stent was superior to BA in achieving lower ULG acutely. Surgery and stent were superior to BA at short-term follow-up in achieving lower ULG. Stent patients had shorter hospitalization than surgical patients (2.4 vs. 6.4 days; p Conclusions Stent patients had significantly lower acute complications compared with surgery patients or BA patients, although they were more likely to require a planned reintervention. At short-term and intermediate follow-up, stent and surgical patients achieved superior hemodynamic and integrated aortic arch imaging outcomes compared with BA patients. Because of the nonrandomized nature of this study, these results should be interpreted with caution.

Objective: We describe our medium-term outcomes for peripheral pulmonary artery stenting in adults with congenital heart disease. Background: Improved outcomes in congenital heart disease have lead to the evolution of transcatheter therapies in adults aimed at maintaining normal hemodynamics. Stenting for pulmonary artery narrowing is effective in children, however little is known about outcomes in adults. Methods: Retrospective data analysis and follow-up review of our complete experience with peripheral pulmonary artery stenting in adults. Results: Over a 9-year period we carried out 15 procedures, implanting 23 stents (11—left pulmonary artery) in the pulmonary arteries of 12 adult patients (7 female). Eleven patients had previous cardiac surgery. Median age at implantation was 32.5 years (range, 18.7–56.7 years) with median weight of 71.3 kg (range, 44.5–95 kg). Six patients underwent bilateral pulmonary artery stenting. Median procedure time was 140 minutes (range, 76–263 minutes) and 4 patients had other interventions performed during the same procedure. Median systolic pressure gradient across the narrowing's of 24 mmHg (range, 11–61 mmHg) was reduced to 3 mmHg (range, 0–17 mmHg) postprocedure (P < 0.001). Three patients had acute stent embolization, one of whom required surgical removal. No aneurysm formation or significant stent fractures have been noted on median follow-up of 27.4 months (range, 1–97 months). Two patients required reintervention with further stent implantation. Conclusions: Pulmonary artery stenting provides effective relief of narrowing in adults with congenital heart disease. Bilateral and/or multiple stenting are often required. Stent embolization may occur particularly in patients with associated significant pulmonary regurgitation. (J Interven Cardiol 2011;24:373–377)

The present study has determined the serological diversity, virulence-gene profile and in vitro antibiogram of avian pathogenic Escherichia coli (APEC) isolates from broiler chickens in India suspected to have died of colibacillosis. The virulence-gene profile of APEC was compared with that of the Escherichia coli isolates from faeces of apparently healthy chickens, called avian faecal E. coli (AFEC). In total, 90 representative isolates of APEC and 63 isolates of AFEC were investigated in the present study. The APEC were typed into 19 serogroups, while some isolates were rough and could not be typed. Most prevalent serogroup was O2 (24.44%). Among the eight virulence genes studied, the prevalence of seven genes (iss, iucD, tsh, cva/cvi, irp2, papC and vat) was significantly higher in APEC than in AFEC isolates. However, there was no significant difference between APEC and AFEC isolates for possession of astA gene. The most frequent gene detected among the two groups of organisms was iss, which was present in 98.88% and 44.44% of APEC and AFEC isolates respectively. The in vitro antibiogram showed that the majority (96.6%) of APEC isolates were resistant to tetracycline, while 82.2% were resistant to cephalexin, 78.8% to cotrimoxazole, 68.8% to streptomycin and 63.3% to ampicillin. However, most of them (84.45%) were sensitive to gentamicin. Thus, it is concluded that APEC from the broiler chickens carried putative virulence genes that attributed to their pathogenicity. Furthermore, the majority of APEC isolates were found to be multi-drug resistant, which, in addition to leading treatment failures in poultry, poses a public health threat.

Variable patent ductus arteriosus (PDA) morphology and the desire to close PDA in small size patients (pts) has led physicians to use Amplatzer Vascular Plug (AVP) I - IV and newly available Amplatzer Duct Occluder II - Additional Sizes (ADO II-AS). The purpose of this study was to analyze data

Multiple congenital cardiac defects are usually addressed by cardiac surgery. We present our experience with simultaneous transcatheter treatment of multiple defects in children. Ten children, six females and four males, with multiple defects underwent treatment with interventional technique. The mean age was 4.4 +/- 2.6 years (range, 7 months to 8 years). The cardiac diagnosis was patent ductus arteriosus (PDA) and valvular pulmonary stenosis (PS) in two, atrial septal defect (ASD) and PDA in two, ASD and PS in two, PDA and aortic stenosis (AS) in three (severe left ventricular dysfunction in two), and perimembranous ventricular septal defect (VSD) and valvular PS in one. The ASDs were closed with an Amplatzer septal occluder (mean size, 16 +/- 4 mm), four PDAs were closed with an Amplatzer duct occluder, and three with a Cook's detectable coil. Mean balloon size used to dilate the pulmonary valve was 18 +/- 4 mm, and for the aortic valve this was 12 +/- 2 mm. There was a 70% (+/-15%) postprocedure reduction of gradients across the stenotic valves. The closure rate was 75% for PDAs in the catheterization laboratory, 80% for ASDs, and there was a mild residual intradevice leak in the VSD. In conclusion, interventional technology addressing multiple congenital cardiac defects as a combined procedure in the catheterization laboratory is safe and effective.

A 7.5-lb female neonate was delivered at term, by means of a caesarian section, to a 26-year-old mother (her 2nd pregnancy). The infant had good Apgar scores but was transferred to the neonatal intensive care unit because of respiratory distress. She was treated for transient tachypnea and for bilateral spontaneous pneumothoraces. She improved with minimal respiratory support. Transthoracic echocardiography (TTE) revealed an aneurysmal ductus arteriosus (DA) with a large thrombus (Fig. 1). The patient was observed clinically and was started on 40 mg/d of aspirin. When the infant was 3 weeks old, TTE showed that the DA lumen was almost completely obliterated by the thrombus (Fig. 2). Two weeks later, TTE revealed complete resolution of the DA aneurysm and no thrombus (Fig. 3). The aspirin therapy was discontinued. Fig. 1. Transthoracic echocardiograms (parasternal short-axis views) show A) the pulmonary branch arteries and an aneurysmal ductus arteriosus with an evident thrombus (arrows); B) in color-flow Doppler mode, continuous flow through the ductus arteriosus into ... Fig. 2. Transthoracic echocardiograms. The parasternal short-axis views reveal A) the organization of the thrombus and almost complete obliteration of the ductus arteriosus lumen, and B) the absence of ductal flow, in color-flow Doppler mode. C) The suprasternal ... Fig. 3. Transthoracic echocardiograms. A) The parasternal short-axis view reveals confluent pulmonary branch arteries with unobstructed flow and complete resolution of the ductus arteriosus aneurysm and thrombus. B) The suprasternal view shows a patent aortic ...

To investigate technical approaches for transcatheter closure of coronary artery fistula based on anatomic type of the fistula.The variability in coronary artery fistulae (CAF) anatomy that necessitates different transcatheter closure (TCC) approaches has not been well documented.Records of patients with CAF who underwent TCC at 2 centers were reviewed for technical details and procedural outcome. CAF were classified as proximal and distal. TCC approaches employed were arterio-venous or arterio-arterial loop, retrograde arterial, and antegrade venous.Eighteen patients with CAF, mean age 12.6 years (0.07-60), 11 male (61%), underwent TCC. All CAF drained predominantly into the right side of the heart. Types of CAF were proximal in 15 and distal in 3 patients. CAF calibers were large in 7, medium in 9, and small in 2 patients. The arterio-venous loop approach was used in the majority of the cases (11 patients) and the CAF size were medium to large. The retrograde arterial approach was used in 4; of these, 3 patients had small to medium sized CAF. In 2 patients with long tortuous CAF an antegrade venous approach was employed. TCC was successful in 17 of the 18 patients (94.4%). There were no peri-procedural deaths or vascular complications.This study documents transcatheter closure approaches for CAF and device selection based on fistula origin. The choices of TCC technique and device selection vary, and are primarily determined by the heterogeneous anatomic characteristics of the fistulae.

In a 4.5-year-old child with refractory pulmonary arterial hypertension, we performed atrial septostomy with the application of an Amplatzer fenestrated device designed to maintain patency. Continuous intravenous epoprostenol infusion was started concomitantly. Forty-two months after the procedure, the patient had no recurrent syncope and remained in New York Heart Association functional class II. Fenestration of the atrial septum is feasible in children with pulmonary artery hypertension. No conclusion regarding the patient's need for an atrial septal defect can be drawn since concomitant prostanoid therapy was administered. The long-term patency of the atrial communication needs further confirmation and the optimal timing for its application has to be determined.

Objective Robotic systems allow surgeons to perform minimally invasive cardiac surgery in adults. Experience in the pediatric population, however, is limited. Perventricular closure of muscular ventricular septal defects has been reported in humans but requires a median sternotomy. The objective of this study was to assess the feasibility of robotically assisted closure of perimembranous ventricular septal defects by using the perventricular approach. Methods The procedure was attempted in 7 pigs with naturally occurring perimembranous ventricular septal defects. Echocardiography was performed to confirm the presence and assess the size of the defect. A 3-armed da Vinci system consisting of two 8-mm instrument ports and a 12-mm endoscopy port was used. A pericardiotomy was performed, and the right ventricular free wall was visualized. A spinal needle was advanced into the right ventricular cavity. By using echocardiographic guidance, a glide wire was advanced through the angiocatheter and manipulated through the defect into the left ventricle or the ascending aorta. A delivery sheath was advanced over the wire. An appropriately sized Amplatzer device was deployed through the sheath. Results The procedure was successful in 5 pigs. One device was removed because it was smaller than the defect and an appropriately sized device was not available. The placement failed in the second pig in the series. Four pigs were followed up for 1 to 4 months. Angiograms performed before the pigs were killed documented complete occlusion in 3 and mild-to-moderate shunt in 1. Conclusions Robotically assisted perventricular closure with the Amplatzer Membranous VSD Occluder is feasible. This approach avoids the associated morbidities of cardiopulmonary bypass and median sternotomy. Further investigation and refinements are needed, however, before application of this approach in humans.

OBJECTIVES This phase I study attempted to report the initial safety and efficacy results of transcatheter closure of perimembranous ventricular septal defects (PmVSDs) using the new Amplatzer Membranous VSD Occluder (AGA Medical Corp., Golden Valley, Minnesota) in the U.S. BACKGROUND The most common congenital heart disease is PmVSD. Surgical repair is widely accepted, but still carries a small but definite risk of morbidity and mortality. METHODS Between October 2003 and August 2004, a total of 35 patients with PmVSD underwent an attempt of transcatheter closure under transesophageal and/or intracardiac echocardiographic guidance. The median age was 7.7 years (range, 1.2 to 54.4 years) and median weight was 25 kg (range, 8.3 to 110 kg). The median Qp/Qs ratio was 1.8 (range, 1 to 4), and the median VSD size as assessed by echocardiography was 7 mm (range, 4 to 15 mm). RESULTS The attempt to place a device was successful in 32 patients (91%). The median device size used was 10 mm (range, 6 to 16 mm). The complete closure rates by echocardiography at 10 min (transesophageal/intracardiac), 24 h, 1 month, and 6 months (transthoracic) were 47% (15/32), 63% (20/32), 78% (25/32), and 96% (27/28), respectively. The median fluoroscopy time was 36 min (range, 14 to 191 min), and the median total procedure time was 121 min (range, 67 to 276 min). Three patients (8.6%) had serious adverse events of complete heart block, peri-hepatic bleeding, and rupture of tricuspid valve chordae tendineae. No other patient encountered serious adverse events during the follow-up. CONCLUSIONS Transcatheter closure of a PmVSD is technically feasible and seems safe enough in children over 8 kg in weight to warrant continuation of clinical trials to assess the long-term safety and efficacy.

Noonan Syndrome is an autosomal dominant disorder characterized by short stature, typical facial features and congenital heart defects. Other associated features are webbed neck, chest deformity, mild intellectual deficit, cryptorchidism, bleeding tendency and lymphatic dysplasia. We are reporting a 13 year old boy of Noonan syndrome presenting with lymphoedema of lower limb and genitalia. DOI: http://dx.doi.org/10.3329/jom.v13i2.12771 J Medicine 2012; 13 : 243-245