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Objective: To study the incidence of postoperative cardiac arrhythmias in children undergoing cardiac surgery and to evaluate the risk factors and outcome of these patients. Materials and Methods: This retrospective observational study was conducted in the cardiac pediatric intensive care unit and included children <18 years of age. Children were monitored in the early postoperative period (72 h) for any sustained rhythm abnormality and were classified using standard definition. Details of treatment and their response were assessed. Risk factors for arrhythmias were evaluated using multivariate logistic regression analysis. Results: Five hundred and thirty-six children were included and the prevalence of arrhythmia was 14.4% (n = 77). The most common arrhythmia was complete heart block (CHB) (n = 28; 5.2%), followed by junctional ectopic tachycardia (JET) (n = 25; 4.7%), junctional escape rhythm (n = 13; 2.4%), supraventricular tachycardia (SVT) (n = 8; 1.5%), and ventricular tachycardia (VT) (n = 3; 0.6%). Cardiac pacing was required in all CHB; 8 (28.6%) required a permanent pacemaker. Six (24%) patients with JET responded to conventional measures; 19 (76.0%) patients required amiodarone and 5 (20%) required cooling to 34°C or cardiac pacing. Temporary cardiac pacing was required in 9 (69.2%) cases of junctional escape rhythm. Seven (87.5%) events of SVT responded to adenosine and 1 (12.5%) required cardioversion. Two (66.7%) of VT responded to cardioversion while 1 (33.3%) was refractory. Five (6.5%) patients with arrhythmia died. In the multivariate logistic regression analysis, age <1 year, risk adjustment for congenital heart surgery category ≥3, and cross-clamp time >67 min were independent risk factors. Conclusion: Early postoperative period following cardiac surgery is extremely vulnerable to cardiac arrhythmias. Although majority are self-limiting, some can be life-threatening. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to evaluate vasoactive-ventilation-renal (VVR) score to predict outcome postcardiac surgery in children and establish the time at which the score is best to predict outcome. Materials and Methods: This prospective cohort included children =18 years recovering from cardiac surgery for congenital heart disease. Data were collected from the Intensive Care Unit (ICU) and vasoactive-inotropic score (VIS) and VVR scores calculated at admission, 24 h, and 48 h postoperatively. Outcome of interest was prolonged length of ICU stay (defined as length of stay [LOS] in the upper 25th percentile) and ICU mortality. Correlation between the outcome and scores was obtained and receiver operating characteristic (ROC) curves generated. Independent association of the scores with the outcome was also established. Results: One thousand ninety-seven patients were enrolled with a median age of 24 months (range: 2 days-18 years) including 14.6% with single ventricle physiology. Pediatric ICU LOS >89 h was considered prolonged, and mortality was 2.2%. VVR score correlated better with outcome and had greater area under the curve (AUC) for ROC curve than the corresponding VIS at each study time point. The AUC of ROC curve for VVR score was greatest at 48 h for predicting both prolonged LOS (0.87) and mortality (0.92). VVR score at 48 h remains strongly associated with both prolonged LOS (odds ratio [OR] - 1.24; P = 0.000) and mortality (OR - 1.16; P = 0.000). Conclusion: VVR score is effective and robust bedside method to predict prolonged LOS and mortality postpediatric cardiac surgery. VVR score at 48 h was the best to predict outcome. [ABSTRACT FROM AUTHOR]

Purpose: The present paper reports a systematic study on the effect of bifunctional chelators (BFC) namely, NOTA, DOTA, and DTPA, on the radiochemical formulation, in vitro stability, and in vivo biological properties of 68Ga-labeled RGD peptide derivatives.Methods: The three RGD conjugates namely, NOTA-Bn-E-[c(RGDfk)]2, DOTA-Bn-E-[c(RGDfk)]2, and DTPA-Bn-E-[c(RGDfk)]2 were radiolabeled with 68Ga and the radiolabeling was optimized with respect to the ligand amount, radiolabeling time, and temperature. Further, the 68Ga complexes were assessed for their in vitro and in vivo stabilities. The biodistribution studies of the three radiolabeled conjugates were carried out in C57BL/6 mice bearing melanoma tumor at 30 min and 1 h post-adimistration.Results: NOTA-Bn-E-[c(RGDfk)]2 could be radiolabeled with 68Ga at room temperature while DOTA-Bn-E-[c(RGDfk)]2 and DTPA-Bn-E-[c(RGDfk)]2 were radiolabeled at high temperature. 68Ga-NOTA-Bn-E-[c(RGDfk)]2 was found to be the most kinetically rigid in in vitro stability assay. The uptake of the three radiolabeled peptide conjugates in melanoma tumor was comparable at 1 h post-administration (NOTA; DOTA; DTPA (% I.D./g):: 2.78 ± 0.38; 3.08 ± 1.1; 3.36 ± 0.49). However, the tumor/background ratio of 68Ga-NOTA-Bn-E-[c(RGDfk)]2 was the best amongst the three radiotracers. 68Ga-complexes of NOTA-Bn-E-[c(RGDfk)]2 and DOTA-Bn-E-[c(RGDfk)]2 showed excellent in vivo stability while 68Ga-DTPA-Bn-E-[c(RGDfk)]2 showed significant metabolic degradation.Conclusion: These studies show that 68Ga-NOTA-Bn-E-[c(RGDfk)]2 would be the most appropriate 68Ga-labeled radiotracer and the most amenable for kit formulation. [ABSTRACT FROM AUTHOR]

A 26-year-old smoker male presented with a history of sudden onset dyspnea and right-sided chest pain. Chest radiograph revealed large right-sided pneumothorax which was managed with tube thoracostomy. High-resolution computed tomography thorax revealed multiple lung cysts, and for a definite diagnosis, a video-assisted thoracoscopic surgery-guided lung biopsy was performed followed by pleurodesis. This clinicopathologic conference discusses the clinical and radiological differential diagnoses, utility of lung biopsy, and management options for patients with such a clinical presentation. [ABSTRACT FROM AUTHOR]

PET based blood pool imaging tracers have tremendous potential for detection of vascular abnormalities. We synthesized Ga-1,4,7-triazacyclononane-1,4,7-triacetic acid-human serum albumin (Ga-NOTA-HSA) ( 1a) towards use in blood pool imaging and compared it with Ga-1,4,7,10-tetraazacyclo-dodecane-1,4,7,10-tetraacetic acid-HSA (Ga-DOTA-HSA) ( 2a). Both 1a and 2a had similar biodistribution profiles with ≥70% ID/g activity in blood at 2 min p.i. About 50% of initial radioactivity was retained in blood at 2 h p.i. However, the plasma stability of 1a was superior to that of 2a. Results of our study indicate that Ga-NOTA-HSA can be further investigated for clinical blood pool imaging applications. [ABSTRACT FROM AUTHOR]

Present work evaluates the potential of a newly synthesized 68 Ga-NOTA-folic acid conjugate for PET imaging of tumors over-expressing folate receptors (FRs). NOTA-folic acid conjugate was synthesized and characterized. It was radiolabeled with 68 Ga in ≥ 95% radiolabeling yields. In vitro cell binding studies showed a maximum cell uptake of 1.7±0.4% per million KB cells which was completely blocked on addition of cold folic acid showing specificity towards the FRs. However, further studies in tumor xenografts are warranted in order to assess the potential of 68 Ga-folic acid complex for imaging tumors over-expressing FRs. [ABSTRACT FROM AUTHOR]

Tc labeled macroaggregated albumin (MAA) is used worldwide for SPECT imaging of lungs, using commercially available MAA kits. An attempt was made to indigenously prepare MAA for radiolabeling with Ga, for PET imaging. MAA particles (59.9 ± 18.1 µm) were successfully prepared in-house and radiolabeled with Ga. Retention of in-house synthesized Ga-MAA in lungs of Swiss mice (71.6 ± 2.1 %ID) was similar to that of Ga-MAA prepared using commercial kits (83.5 ± 2.3 %ID). In vivo Cherenkov luminescent imaging of in-house prepared Ga-MAA in Swiss mice at 15 min and 60 min p.i. showed maximum retention of activity in lungs and negligible leaching into liver. [ABSTRACT FROM AUTHOR]

Design Randomised prospective double-blind study. Case selection Thirty-seven chronic periodontitis patients were randomly prescribed either saltwater (n = 17) or chlorhexidine (n = 20) mouth rinse following open flap debridement. Gingival Index (GI), post-operative pain, mouth rinse satisfaction, matrix metalloproteinase activity and tasting were assessed at baseline, one week and 12 weeks. Data analysis Inter-group and intra-group comparisons were done for all the parameters recorded at different time intervals using Friedman, Wilcoxon signed-rank and Mann-Whitney U tests. P value less than 0.05 was considered statistically significant. Results There was a statistically significant decrease in GI from baseline to week 1/week 12 following surgery in both the groups. However, there was no significant difference between the groups at any time point. Conclusions Saltwater rinses are as efficient as 0.12% chlorhexidine in reducing inflammation following minimal invasive periodontal surgery. Being an inexpensive and easily accessible option, it might be considered the mouth rinse of choice during the early stages of wound healing. [ABSTRACT FROM AUTHOR]

Background: On 11th March 2020, WHO declared Covid-19 as the global pandemic; affecting over 200 countries world-wide. the clinical features ranges from mild flu like symptoms to seveare illness like ARDS and septic shock. Clinicians are looking for are the reliable prognostic marker that may identify the patients who are at risk & need prior treatment. Neutrophil lymphocyte ratio(NLR) & platelet lymphocyte ratio (PLR) are emerging out to be the important prognostic markers in the developing countries like India where limited resources are available. These markers are the important biomarkers which help in triaging the patients. Objective: 1. To determine the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in COVID 19 patients on day one of ICU admission and before discharge. 2. To correlate neutrophil-lymphocyte ratio and platelet-lymphocyte ratio with the severity of illness in COVID 19 patients. 3. To correlate neutrophil-lymphocyte ratio and platelet-lymphocyte ratio with the respiratory support given to patients during the hospital stay. Method: It is a retrospective study and included two months data of covid positive patients admitted in ICU. A total of 200 cases that were RTPCR positive or RAT positive recorded with their clinical history. For all cases NLR & PLR were evaluated at the time of admission and before discharge and results were recorded. Clinical complains, age, gender and comorbid conditions were analyzed by cross tabulation to assess their relationship with NLR & PLR. Result: Out of 200 cases 119cases were males and 81 were females. Maxium deaths were noted in the age group of 40 to 60 years. There was no significant difference between the outcome of the disease in males and females. The most common complaint at the time of admission was breathlessness followed by fever. Hypertension was the most common co-mordidity amongst thepatients. NLR & PLR of the Covid positive patients were raised in the patients who died as compaired to the patients who were discharged from the hospital. Conclusion: In this study, it has been found that the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in COVID-19 patients are increasing in diseased individuals and ratios are decreasing in discharged people. NLR and PLR prognostic biomarkers emerged out be cost-effective, readily available biomarker to access the severity of illness in COVID-19 patients, especially in the countries with low medical resources, for the better outcome of the patients. [ABSTRACT FROM AUTHOR]

[Display omitted] Erlotinib is a first generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) which was granted Food and Drug administration (FDA) approval for treatment of patients with locally advanced or metastatic NSCLC. The present study aimed at development of radiolabeled erlotinib variants as tyrosine kinase inhibitors. Three DOTA-erlotinib conjugates were prepared for radiolabeling with 177Lu. The terminal alkyne group of erlotinib was modified by performing Cu-catalyzed click chemistry and three different linkers were introduced which were then conjugated to the chelator, DOTA. The DOTA-erlotinib conjugates were characterized by 1H NMR and ESI-MS. 177Lu-DOTA-erlotinib complexes were characterized using natLu-DOTA-erlotinib conjugates. The 177Lu-complexes exhibited high in vitro stability in human serum up to 48 h. They were highly hydrophilic in nature as observed from their log P o/w values (177Lu-DOTA-propyl-Er: −2.5 ± 0.1; 177Lu-DOTA-PEG 3 -Er: −3.0 ± 0.1; 177Lu-DOTA-PEG 6 -Er: −3.3 ± 0.1). The MTT assay in A431 human epidermoid carcinoma cell lines indicates that the chemical modification at the terminal alkyne group of the erlotinib molecule does not have significant effect on its TKI property. Biodistribution studies in normal Swiss mice demonstrated fast clearance and excretion of 177Lu-labeled erlotinib complexes. These studies indicate that erlotinib variants with hydrophobic pharmacokinetic modifiers/chelators may enhance the retention of 177Lu-labeled complexes in blood thereby increasing the probability to reach EGFR-expressing tumor. [ABSTRACT FROM AUTHOR]

Objective: To study intra-gastric pressures in neonates receiving bubble continuous positive airway pressure (BCPAP) by nasopharyngeal prong. Methods: Twenty seven neonates were recruited for the study. BCPAP pressure of 6 cm water was used in all the neonates. A pressure sensor attached to orogastric tube, measured the intra-gastric pressure prior to starting BCPAP and again between 30 and 90 min of BCPAP. The clinical variables like Downe's score, oxygen saturation, venous blood gas pH, pCO and abdominal girth were recorded alongside with pressure readings. Results: BCPAP resulted in improvement ( p < 0.05) in parameters of respiratory distress such as Downe's score (DS), oxygen saturation (SpO) and venous blood gas parameters (pH, pCO). There was no statistical significant increase in intra-gastric pressures ( p = 0.834). There were no gastrointestinal complications; abdominal distention, necrotising enterocolitis or gastric perforation during the study. Conclusions: Nasopharyngeal BCPAP at 6 cm of water pressure is an effective modality of treating babies with respiratory distress and the present study shows that it is not associated with a significant rise in intra-gastric pressures. [ABSTRACT FROM AUTHOR]