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COVID-19 has profoundly reshaped our world. The disruption to lives and livelihoods has been staggering. The economic devastation has thrown many industries into survival mode. As we begin to revive jobs and economies, it will be important to understand the impact of the crisis on the skills landscape. Universities among the ones adapting to the crisis. Equal access to education and skills is one of them. COVID-19 has further exposed many inequalities with respect to education and employability .Online learning has proven effective in delivering on that promise, now more than ever. From March to July of this year, more than 15 million new learners registered on different courses. School closures have disrupted higher education for millions of students in countries already in need of more accessible learning. Eighty percent of students enrolled in tertiary education are located in countries that have both closed schools due to COVID-19 and are in the bottom half of the world rankings for proficiency in business, technology, and data science skills. To help overcome deepening skill inequities, institutions must work together to democratize access to quality online learning resources and ensure we are all prepared for the rapidly changing economy.

Background Adults with congenital heart disease (CHD) have been considered potentially high risk for novel coronavirus disease-19 (COVID-19) mortality or other complications. Objectives This study sought to define the impact of COVID-19 in adults with CHD and to identify risk factors associated with adverse outcomes. Methods Adults (age 18 years or older) with CHD and with confirmed or clinically suspected COVID-19 were included from CHD centers worldwide. Data collection included anatomic diagnosis and subsequent interventions, comorbidities, medications, echocardiographic findings, presenting symptoms, course of illness, and outcomes. Predictors of death or severe infection were determined. Results From 58 adult CHD centers, the study included 1,044 infected patients (age: 35.1 ± 13.0 years; range 18 to 86 years; 51% women), 87% of whom had laboratory-confirmed coronavirus infection. The cohort included 118 (11%) patients with single ventricle and/or Fontan physiology, 87 (8%) patients with cyanosis, and 73 (7%) patients with pulmonary hypertension. There were 24 COVID-related deaths (case/fatality: 2.3%; 95% confidence interval: 1.4% to 3.2%). Factors associated with death included male sex, diabetes, cyanosis, pulmonary hypertension, renal insufficiency, and previous hospital admission for heart failure. Worse physiological stage was associated with mortality (p = 0.001), whereas anatomic complexity or defect group were not. Conclusions COVID-19 mortality in adults with CHD is commensurate with the general population. The most vulnerable patients are those with worse physiological stage, such as cyanosis and pulmonary hypertension, whereas anatomic complexity does not appear to predict infection severity., Central Illustration

MATERIAL & METHOD: This retrospective study was conducted during the period of June-August 2020 for 3months in newborns born to COVID-19 positive mothers at YMCH after obtaining ethical clearance. All newborns born to mothers with COVID-19 positive status during any trimester of pregnancy, irrespective of neonatal COVID-19 RT-PCR test, and delivered at YMCH during the study period were included. Relevant history and complete systemic examination ndings of the neonate were noted down from the case records and laboratory results of RT-PCR test on nasopharyngeal and throat swab if done was noted down which was done at 24-48hours of birth.RESULT:Total of 25newborns born to COVID-19 positive mothers were included in the study. Among the neonates born, 64% were female and 36% were male. 76% of the pregnant mothers were asymptomatic at the time of detection of COVID-19 infection. The neonatal outcome found to have only 1 newborn with positive COVID-19 infection compared to 24 healthy newborns. CONCLUSION: Signicant measures for preventing neonatal SARS-CoV-2 infection are to prevent maternal illness and to decrease the potential of neonatal viral exposure.

Purpose: The aim is to evaluate the safety and efficacy of neodymium-doped: yttrium–aluminum–garnet laser peripheral iridotomy (LPI) in the superior versus inferior quadrant in the treatment of primary angle-closure (PAC) disease. Design: Randomized, prospective, single-masked, comparative clinical study. Materials and Methods: Patients with PAC or PAC suspects were recruited and randomized to receive LPI in the superior or inferior quadrant in both eyes. Patients were masked to the location of treatment in each eye. The main outcome measures assessed were patency of iridotomy, laser parameters, complications, and visual symptoms between the two groups at 1 week and 1 month after the laser intervention. Results: A total of 100 patients were recruited, 50 into each group. The mean age was 51.46 ± 7.91 years. Average intraocular pressure (IOP) measurements before LPI was 18.24 ± 5.37 mm Hg and 18.6 ± 5.63 mm Hg in superior LPI and inferior LPI eyes, respectively. After LPI, average IOP was 17.4 ± 3.31 mm Hg and 17.1 ± 3.13 mmHg in superior LPI and inferior LPI eyes, respectively. Inferior LPIs required less use of mean total laser energy (P = 0.001) and less number of laser shots (P = 0.016) to perforate the iris tissue. There was a lower incidence of iris bleeding and focal corneal damage at the time of treatment; a lower postlaser iritis and lower need for PI enlargement in the inferior LPI group. All the iridotomies were patent at 1 month follow-up. There was no statistically significant difference between the two groups in terms of the dysphotopsias and visual symptoms experienced after the LPI (P = 0.122). Conclusions: LPI in the inferior quadrant appears to be a safe and efficient alternative to superior LPI with fewer complications in the treatment of PAC disease. Dysphotopsias and visual symptoms following inferior LPI are similar to superior LPI.

Fine Needle Aspiration Cytology is the preliminary investigation employed for superficial and deep swelling in the body. It provides early information regarding the lesions before performing biopsy and aid in the treatment plan of the patient. However sample inadequacy from representative lesion may render patients to repeat aspirations and may also cause delay in reports. There is an ever increasing demand for rapid diagnosis in cytology. The present study was conducted to assess the utility of brilliant cresyl blue as a rapid stain in fine needle aspiration cytology. Objective: To assess the utility of rapid Brilliant cresyl blue (BCB) stained wet mount preparation in routine fine needle aspiration cytology. Materials and Methods : The study was carried out in the Cytology laboratory, Govt. Medical College Thiruvananthapuram and PG Pathology Lab, Department of MLT, Govt. Medical College Thiruvananthapuram for a period of six months. A total of 50 cases referred to cytology laboratory for FNAC were included in this study. A wet mount preparation with Brilliant cresyl was prepared immediately after aspiration and examined for cellular adequacy and cytomorphology, which was then compared with the routine Papanicolau stained smear . Results & Conclusion: In situations for rapid diagnosis, and to assess the cellular adequacy of a lesion Brilliant cresyl blue staining method is very helpful. Most of the cases diagnosed as malignant on Brilliant cresyl blue staining correlate with the Pap stain. All the cases diagnosed as benign on rapid brilliant cresyl blue stain were also diagnosed as benign with Pap stain. The result clearly indicate that the brilliant cresyl blue stained wet mount preparation can be used as a rapid supplementary diagnostic procedure in FNAC at least for urgent reporting and sample adequacy assessment. Keywords: FNAC, Papanicolaou stain, Brilliant cresyl blue supravital stain, Cytology

Since the original description, the Fontan operation has been widely used for the palliation of children with single ventricle physiology. Although the Fontan operation revolutionized the survival rates of patients with single ventricle physiology, it carries an inevitable risk for long-term morbidity and mortality that impacts clinical outcomes and quality of life. This review will focus on the evaluation and treatment of the patient with the failing Fontan phenotype, with an emphasis on creating an individualized treatment plan.

Background: The Fontan operation creates a total cavopulmonary connection, a circulation in which the importance of pulmonary vascular resistance is magnified. Over time, this circulation leads to deterioration of cardiovascular efficiency associated with a decline in exercise performance. Rigorous clinical trials aimed at improving physiology and guiding pharmacotherapy are lacking. Methods: The FUEL trial (Fontan Udenafil Exercise Longitudinal) was a phase III clinical trial conducted at 30 centers. Participants were randomly assigned udenafil, 87.5 mg twice daily, or placebo in a 1:1 ratio. The primary outcome was the between-group difference in change in oxygen consumption at peak exercise. Secondary outcomes included between-group differences in changes in submaximal exercise at the ventilatory anaerobic threshold, the myocardial performance index, the natural log of the reactive hyperemia index, and serum brain-type natriuretic peptide. Results: Between 2017 and 2019, 30 clinical sites in North America and the Republic of Korea randomly assigned 400 participants with Fontan physiology. The mean age at randomization was 15.5±2 years; 60% of participants were male, and 81% were white. All 400 participants were included in the primary analysis with imputation of the 26-week end point for 21 participants with missing data (11 randomly assigned to udenafil and 10 to placebo). Among randomly assigned participants, peak oxygen consumption increased by 44±245 mL/min (2.8%) in the udenafil group and declined by 3.7±228 mL/min (–0.2%) in the placebo group ( P =0.071). Analysis at ventilatory anaerobic threshold demonstrated improvements in the udenafil group versus the placebo group in oxygen consumption (+33±185 [3.2%] versus –9±193 [–0.9%] mL/min, P =0.012), ventilatory equivalents of carbon dioxide (–0.8 versus –0.06, P =0.014), and work rate (+3.8 versus +0.34 W, P =0.021). There was no an improvement in myocardial performance index (–0.02 vs 0.01, P =0.030), but no change in reactive hyperemia index, or serum brain-type natriuretic peptide level. Conclusions: In the FUEL trial, treatment with udenafil (87.5 mg twice daily) was not associated with an improvement in oxygen consumption at peak exercise but was associated with improvements in multiple measures of exercise performance at the ventilatory anaerobic threshold. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02741115.

Aim: This clinical study was undertaken to evaluate the profile, mechanisms, and course of traumatic glaucoma (TG) in patients who have sustained blunt ocular trauma. Methods: One hundred consecutive patients who sustained ocular blunt trauma (OBT) during the 1-year were enrolled in the study. All the patients underwent a comprehensive ophthalmic evaluation of the anterior and posterior segments along with relevant investigations. Patients who were found to have an intraocular pressure (IOP) ≥21 mm Hg with or without glaucomatous optic neuropathy were considered to have TG and started on appropriate treatment. Results: Eleven of the 100 consecutive patients who sustained OBT developed TG. The age of patients ranged between 8 and 65 years, 8 were male and 3 female; 6 patients were

Mucormycosis is a rare opportunistic infection, usually seen in diabetics, immunocompromised, or those with coronavirus disease 2019 (COVID-19). Gastrointestinal involvement is uncommon but often deadly. We report a case of gastrointestinal mucormycosis causing intestinal perforation in a non-diabetic, COVID-19 negative, immunocompetent woman, associated with puerperal sepsis. A 22-year-old woman presented to our center on post-natal day five, following delivery with insertion of an intrauterine contraceptive device (IUCD). She had complaints of breathlessness, fatigue, and giddiness. Examination revealed tachycardia, tachypnea, hypotension, and bilateral pedal edema. Following appropriate investigations, she was diagnosed with puerperal sepsis with pre-renal acute kidney injury. Imaging was suggestive of retained products of conception, and she subsequently underwent dilation and evacuation (D&E) on day eight of admission. Following brief symptomatic improvement, on day 10 of admission, she developed vomiting, abdominal distension, and pain, with obstipation. Erect X-ray showed air under the diaphragm, suggestive of perforation. She emergently underwent laparotomy with limited right hemicolectomy, ileostomy with mucous fistula. Intraoperative findings revealed a closed-loop obstruction involving terminal ileum, with two perforations. The biopsy report later revealed colonization of Mucor and hemorrhagic necrosis along the entire length of the resected specimen. She was started on amphotericin B, and after a slow recovery, was discharged. Gastrointestinal mucormycosis is rare and has a mortality rate of 94%. It is usually seen in those with predisposing factors for mucormycosis. This is the first report of mucormycosis associated with puerperal sepsis. It is typically acquired via ingestion and may cause perforation, where mortality is further increased. Diagnosis can only be confirmed by histopathology demonstrating the characteristic morphology of Mucor. Treatment requires resection of necrotic tissues, intensive treatment with amphotericin B, and correction of predisposing factors. Our case highlights the need for a high degree of suspicion for mucormycosis in patients with intestinal perforation, even if immunocompetent, and its potential association with puerperal sepsis.

Spontaneous coronary artery dissection (SCAD) is an uncommon form of acute coronary syndrome (ACS). With the increasing recognition of this condition…, Spontaneous coronary artery dissection (SCAD) is an uncommon form of acute coronary syndrome (ACS). With the increasing recognition of this condition presenting as ACS in females, clinicians should always remain vigilant for it. This case describes a patient with congenital heart disease presenting with SCAD. (Level of Difficulty: Advanced.), Graphical abstract

Premenopausal women taking anticoagulation therapy are at risk of developing hemorrhagic ovarian cysts. This paper presents 3 cases of acute…, Premenopausal women taking anticoagulation therapy are at risk of developing hemorrhagic ovarian cysts. This paper presents 3 cases of acute hemoperitoneum, with resultant surgical menopause, secondary to cystic hemorrhage in premenopausal women with repaired congenital heart disease (CHD). Adults with CHD taking long-term anticoagulation should be considered candidates for ovulation suppression with hormone-based contraception. (Level of Difficulty: Intermediate.), Graphical abstract

Advancement in technology has paved the way for the growth of big data. We are able to exploit this data to a great extent as the costs of collecting, storing, and analyzing a large volume of data have plummeted considerably. There is an exponential increase in the amount of health-related data being generated by smart devices. Requisite for proper mining of the data for knowledge discovery and therapeutic product development is very essential. The expanding field of big data analytics is playing a vital role in healthcare practices and research. A large number of people are being affected by Alzheimer's Disease (AD), and as a result, it becomes very challenging for the family members to handle these individuals. The objective of this chapter is to highlight how deep learning can be used for the early diagnosis of AD and present the outcomes of research studies of both neurologists and computer scientists. The chapter gives introduction to big data, deep learning, AD, biomarkers, and brain images and concludes by suggesting blood biomarker as an ideal solution for early detection of AD.

Background: Although several factors have been cited for risk stratification in patients with simple transposition of the great arteries (dTGA), no single predictor emerges consistently. We aimed to assess survival and determine factors associated with survival in a large cohort of dTGA adults with atrial switch. Methods and Results: We included 1,169 dTGA adults (median age 28.1 years, 38.7% female) under regular follow-up at 28 institutions between 2002 and 2019. The primary outcome was a composite of death, mechanical circulatory support (MCS) and heart transplant. During a median follow-up of 9.2 [IQR 5.5-14.2] years, 67 (5.7%) patients died, six (0.5%) patients underwent MCS and 21 (1.8%) had a heart transplant. Cumulative incidence of composite endpoint at 15 years was 12.8% [95% CI 9.8 - 15.7], see Figure). Median age at time of primary outcome was 39.5 [IQR 33.9 - 45.1] years. Leading causes of death were worsening of heart failure (34%), non-cardiac (21%) and sudden unexplained death (12%). In multivariable Cox analyses for baseline variables, age, VSD, ventricular arrhythmia and heart failure admission were each associated with increased risk of the outcome, whereas prior pacemaker (26% of patients) was not. New pacemaker implantation was performed in 107 (9.1%), ICD in 109 (9.3%), and cardiac surgery in 35 (3%) patients. Patients who died were more likely to develop arrhythmias, be admitted for heart failure or require surgery during follow-up. Conclusion: In this large contemporary cohort of dTGA adults after atrial switch, late survival was excellent and seemed to be determined by arrhythmia and heart failure-related complications. Few patients underwent advanced heart failure therapies. Figure. Cumulative incidence of the composite primary outcome (MCS, heart transplant or death) over a period of 15 years from first visit at an adult congenital heart disease clinic since 2002. Shading represents upper and lower 95% confidence limits.

Background: The Pediatric Heart Network’s Fontan Udenafil Exercise Longitudinal (FUEL) Trial (Mezzion Pharma Co. Ltd., NCT 02741115) demonstrated improvements in exercise capacity and ventricular performance following six months of treatment with udenafil (87.5 mg twice daily). In this analysis we evaluated whether subgroups within the population experienced a differential effect on exercise performance in response to treatment. Methods: The effect of udenafil on exercise was evaluated within subgroups defined by gender, race, ventricular morphology, and baseline peak oxygen consumption (VO 2 ). Linear regression modeling evaluated for differential response to udenafil (interaction of subgroup with treatment arm). Individual subgroups were excluded if the number of participants was Results: Subgroup analyses demonstrated qualitative improvements in peak VO 2 , work rate at the ventilatory anaerobic threshold (VAT), VO 2 at VAT, and ventilatory efficiency (VE/VCO 2 ) for those randomized to udenafil compared to placebo in all subgroups (Table). There was not a differential response to udenafil based on gender, race, ventricular morphology, or baseline peak VO 2 , although participants in the lowest tertile of baseline peak VO 2 and those with single left ventricles trended toward larger improvements. Conclusion: The relatively uniform improvement among subgroups in response to treatment with udenafil is consistent with the findings from the primary analysis of the FUEL trial. While the absence of a statistically significant differential effect between subgroups suggests that the effect of udenafil may not be gender, race, or morphology specific, and may not vary based on baseline exercise performance, the possibility of a larger improvements in those with poor baseline peak VO 2 and those with single left ventricle warrants further investigation.

Background: Occasionally patients with congenitally corrected transposition of the great arteries (ccTGA) exhibit little clinical evidence of cardiovascular limitation even to their 8th decade. We aimed to assess survival prospects in a large cohort of ccTGA adults. Methods & Results: We included 555 ccTGA adults (median age 33.0 years, 48.3% female) under regular follow-up at 28 institutions between 2002 and 2019. The primary outcome was a composite of death, mechanical circulatory support (MCS) and heart transplant. During a median follow-up of 8.1 [IQR 4.4 - 13.3] years, 56 (10.1%) patients died, 10 (1.8%) patients underwent MCS and 14 (2.5%) had a heart transplant. Median age at time of primary outcome was 51.1 [IQR 37.5 - 63.2] years and cumulative incidence at 15 years from baseline was 21.5% [95% CI 16.1 - 26.5]. Leading causes of death were worsening of heart failure (43%) and sudden death (10%). Patients who died were more likely to use heart failure (HF) medications. In multivariable Cox analyses for baseline variables, age, prior atrial arrhythmia and HF admission were each associated with an increased risk of the primary outcome. Figure shows cumulative incidence according to history of atrial arrhythmia. During follow-up, 91 (16.4%) were admitted for HF, pacemaker implantation was performed in 68 (12.3%) patients, ICD in 82 (14.7%), and major cardiac surgery (mostly for systemic AV-valve) in 89 (15.8%) patients. Conclusion: In this large cohort of ccTGA adults, survival seemed to be primarily determined by heart failure-related complications. Prior atrial arrhythmia also seems to be a harbinger for adverse outcome. Few patients underwent advanced HF therapies. Figure: Cumulative incidence of the composite primary outcome (MCS, heart transplant or death) over a period of 14 years from first visit at an adult congenital heart disease clinic since 2002 stratified according to history of atrial arrhythmia. Shading represents upper and lower 95% confidence limits.

Background Patient‐reported outcome metrics ( PRO s) quantify important outcomes in clinical trials and can be sensitive measures of patient experience in clinical practice. Currently, there is no validated disease‐specific PRO for adults with congenital heart disease ( ACHD ). Methods and Results We conducted a preliminary psychometric validation of a novel ACHD PRO . ACHD patients were recruited prospectively from 2 institutions and completed a series of questionnaires, a physician health assessment, and a 6‐minute walk test. Participants returned to complete the same questionnaires and assessment 3 months±2 weeks later. We tested the internal consistency and test–retest reliability by comparing responses among clinically stable patients at the 2 study visits. We assessed convergent and divergent validity by comparison of ACHD PRO responses to existing validated questionnaires. We assessed responsiveness by comparison with patient‐reported clinical change. One hundred three patients completed 1 study visit and 81 completed both. The ACHD PRO demonstrated good internal consistency in each of its 5 domains (Cronbach's α: 0.87; 0.74; 0.74; 0.90; and 0.89, respectively) and in the overall summary score (0.92). Test–retest reliability was good with an intraclass correlation ≥0.73 for all domains and 0.78 for the Summary Score. The ACHD PRO accurately assessed domain concepts based on comparison with validated standards. Preliminary estimates of responsiveness suggest sensitivity to clinical status. Conclusions These studies provide initial support for the validity and reliability of the ACHD PRO . Further studies are needed to assess its sensitivity to changes in clinical status.

ObjectivesWomen with Turner syndrome (TS) are frequently counselled against pregnancy due to lack of data and unclear aortic dissection risk. However, with advances in fertility therapy, more women with TS are contemplating pregnancy. This study compared rates of adverse cardiovascular (CV) outcomes among: (1) pregnant and non-pregnant women with TS and (2) pregnant women with TS with/without structural heart disease.MethodsRetrospective analysis of pregnant and age-matched non-pregnant controls with TS (2005–2017) across 10 CV centres was done. Data were collected at initial evaluation in pregnancy and outcomes were assessed to 6 months postpartum. Adverse CV events were defined as CV death, aortic dissection/rupture and/or aortic intervention. Non-pregnant age-matched controls were followed over the same time period.ResultsSixty-eight pregnancies were included (60 women, mean age 33 years, 48% primigravid, 49% fertility therapy, 80% structurally normal heart, 25% XO karyotype). Based on American Society of Reproductive Medicine criteria, 10 pregnancies occurred in women stratified to high-risk category. There were no CV events in the pregnant women or in the non-pregnant women with TS. Obstetric events complicated 12 (18%) pregnancies with 9 (13%) attributed to hypertensive disorder of pregnancy. Fetal events included small for gestational age neonates (18%), preterm delivery (15%) and fetal death (3%).ConclusionsThis study helps to refine the approach to pregnancy in women with TS. Among women with TS without structural heart disease, pregnancy does not impose an increased risk of CV outcomes. Among women with TS with structural heart disease, the risk of pregnancy is not as prohibitive as previously described but does require ongoing evaluation.

The initial "Frontiers in Fontan Failure" conference in 2015 in Atlanta, GA, provided an opportunity for experts in the field of pediatric cardiology and adult congenital heart disease to focus on the etiology, physiology, and potential interventions for patients with "Failing Fontan" physiology. Four types of "Fontan Failure" were described and then published by Dr Book et al. The acknowledgment that even Dr Fontan himself realized that the Fontan procedure "imposed a gradually declining functional capacity and premature late death after an initial period of often excellent palliation." The purpose of the second "Frontiers in Fontan Failure" was to further the discussion regarding new data and technologies as well as novel interventions. The 2017 "Frontiers in Fontan Failure: Innovation and Improving Outcomes" was sponsored by Children's Healthcare of Atlanta, Sibley Heart Center Cardiology, and Emory University School of Medicine. Future directions in the management of Fontan failure include further investigations into the risk of sudden cardiac death and how to properly prevent it, achievable interventions in modifying the Fontan physiology to treat or prevent late complications, and improved and refined algorithms in Fontan surveillance. Finally, further research into the interventional treatment of lymphatic-related complications hold the promise of marked improvement in the quality of life of advanced Fontan failure patients and as such should be encouraged and contributed to.

Congenital heart disease (CHD) remains the most common birth defect, with an estimated incidence of approximately 1% of all births. The population of adults with CHD is growing rapidly with advances in medical care. Overall survival to adulthood in the current era estimated to exceed 90%. Genetic causes of CHD can be classified into several broad categories: (a) chromosomal aneuploidy, (b) large chromosomal deletion or duplication, (c) single gene mutation, and (d) copy number variation. However, only 20-30% of CHD cases have an established etiology characterized by either genetic abnormalities or environmental factors. The role of genetics in the field of adult CHD is only increasing. More adult patients with CHD are seeking genetic counseling to understand the etiology of their underlying CHD and the risks to future offspring. A multidisciplinary approach is essential to provide appropriate counseling to patients regarding indications for genetic testing and interpretations of results. Novel advances with precision medicine may soon enable clinicians to individualize therapies for a comprehensive approach to the care of adult patients with CHD.

Over the past decade, as the majority of patients with single ventricle anatomy who have undergone the Fontan operation reach adulthood, a newly recognized disease process, Fontan-associate...

Objectives: To assess the clinical characteristics, laboratory parameters and outcomes in paediatric patients with COVID-19. Method: Case records of all paediatric patients admitted with COVID-19 were included in the study. Data regarding mode of presentation, presence of comorbid conditions, severity of COVID-19, laboratory investigations and management were noted. Results: A total of 32 children was admitted with COVID-19 infection in our institute. COVID-19 infection was mild in 16 (50%) patients, moderate in 6 (18.8%) and severe in 10 (31.3%). Ages of the children ranged from 6 months to 16 years with a mean age of 10.75 years. Of them 17 (53%) were boys and 15 (47%) were girls. Pre-existing comorbidities were present in 8 (25%) children. Respiratory symptoms were the commonest presenting complaints, being observed in 18 (59%) cases. Atypical presentation of COVID-19 (other than respiratory) was seen in 31% of cases. Presence of undernutrition and elevated C-reactive protein (CRP) were associated with severe Covid-19 illness (p

BACKGROUND The history of ocular injuries began when primitive men fought with another, hunted their prey for food or first chipped a stone to make his primitive tool. However, in modern times, the scenario has been widened to include occupational, industrial, domestic accidents, as also vehicular accident. The ever increasing number of vehicles on road has ensured that injuries due to the latter cause is on the rise. Eye injuries often resulting in some visual loss, create economic loss both to victim and society. Although, RTA is not the major cause of ocular injuries. Many such injuries that do occur are preventable by the use of safety measures. MATERIALS AND METHODS Prospective case series of 235 patients who sustained road traffic accidents and admitted in medical college, Trivandrum, were followed up for one year to assess the clinical pattern of ophthalmic injuries and the change in visual outcome. RESULTS The commonest group were young males in 31 to 40 years riding two wheelers. A significant number of them were not using helmets. Most RTA occurred at night when wakefulness is less and alcohol abuse is more. Periorbital oedema and subconjunctival haemorrhage was the commonest finding either as isolated or associated with severe ocular injuries. Lid lacerations in 17 eyes, corneal full thickness wound with iris prolapse in 6 eyes, lenticular involvement in 25 eyes and hyphaema in 16 eyes were the significant anterior segment presentations. 53 eyes had posterior segment involvement in the form of vitreous haemorrhage, traumatic optic neuropathy (6), Berlin oedema (14), retinal detachment (5), choroidal rupture (6), orbital and midfacial fracture were seen in 30 eyes with orbital floor fracture being the commonest. CONCLUSION The incidence of RTA is on the rise. The higher incidence of trauma in men is due to the fact that they are more exposed to two wheeler use, highway traffic, night traffic and use of alcohol. Strict adherence to traffic rules, better road conditions and use of public transport systems to reduce the traffic helps in preventing accidents. Use of first aids and tertiary centres to treat accidents primarily and message of early treatment leading to better outcome should be spread among public.

Background: Diagnosis of Tuberculosis in children is challenging. Hereby we report a case series of 4 patients where Cartridge Based Nucleic Acid Amplification Test (CB NAAT) helped us in early diagnosis. Case characteristics: Case 1 was a 14-year old girl who was on anti-tuberculous therapy (ATT) for 2 months without any improvement; sputum CBNAAT detected multi-drug resistant tuberculosis (MDR-TB). Case 2 was a 9-year old boy with history and examination findings suggestive of meningitis; CB-NAAT of the cerebrospinal fluid (CSF) was positive. Case 3 was a 1-year old child having fever, cough of 1 month duration with Mantoux positive. CB-NAAT of gastric lavage was positive. Case 4 was a 3- month old child who presented with severe respiratory distress of 11 days duration. Chest x-ray showed miliary mottling; CB-NAAT of gastric lavage was positive. Conclusion: CB-NAAT testing was very useful in making an early and definitive diagnosis of tuberculosis, including MDR-TB. Keywords: CB-NAAT, Pediatric, Tuberculosis, GeneXpert

Background As patients with congenital heart disease ( CHD ) are living longer, understanding the comorbidities they develop as they age is increasingly important. However, there are no published population‐based estimates of the comorbidity burden among the US adult patients with CHD. Methods and Results Using the IBM MarketScan commercial claims database from 2010 to 2016, we identified adults aged ≥18 years with CHD and 2 full years of continuous enrollment. These were frequency matched with adults without CHD within categories jointly defined by age, sex, and dates of enrollment in the database. A total of 40 127 patients with CHD met the inclusion criteria (mean [ SD ] age, 36.8 [14.6] years; and 48.2% were women). Adults with CHD were nearly twice as likely to have any comorbidity than those without CHD ( P CHD ” (risk ratio, 9.41; 95% CI , 7.99–11.1), “other cardiovascular” (risk ratio, 1.73; 95% CI , 1.66–1.80), and “noncardiovascular” (risk ratio, 1.47; 95% CI , 1.41–1.52) comorbidities. After adjusting for covariates and considering interaction with age, patients with severe CHD had higher risks of previously recognized to be common in CHD and lower risks of other cardiovascular comorbidities than age‐stratified patients with nonsevere CHD . For noncardiovascular comorbidities, the risk was higher among patients with severe than nonsevere CHD before, but not after, the age of 40 years. Conclusions Our data underscore the unique clinical needs of adults with CHD compared with their peers. Clinicians caring for CHD may want to use a multidisciplinary approach, including building close collaborations with internists and specialists, to help provide appropriate care for the highly prevalent noncardiovascular comorbidities.

Background Total cavopulmonary connection (TCPC) is associated with a lower risk of incident atrial arrhythmias as compared to atriopulmonary Fontan, but the risk of recurrent atrial arrhythmias is unknown in this population. The purpose of this study was to determine the incidence and risk factors for recurrent atrial arrhythmias and thromboembolic complications in patients with TCPC. Methods This is a retrospective multicenter study conducted by the Alliance for Adult Research in Congenital Cardiology (AARCC), 2000–2018. The inclusion criteria were TCPC patients (age > 15 years) with prior history of atrial arrhythmia. Results A total of 103 patients (age 26 ± 7 years; male 58 [56%]) met inclusion criteria. The mean age at initial arrhythmia diagnosis was 13 ± 5 years, and atrial arrhythmias were classified as atrial flutter/tachycardia in 85 (83%) and atrial fibrillation in 18 (17%). The median duration of follow-up from the first episode of atrial arrhythmia was 14.9 (12.1–17.3) years, and during this period 64 (62%) patients had recurrent atrial arrhythmias (atrial flutter/tachycardia 51 [80%] and atrial fibrillation 13 [20%]) with annual incidence of 4.4%. Older age was a risk factor for arrhythmia recurrence while the use of a class III anti-arrhythmic drug was associated with a lower risk of recurrent arrhythmias. The incidence of thromboembolic complication was 0.6% per year, and the cumulative incidence was 4% and 7% at 5 and 10 years respectively from the time of first atrial arrhythmia diagnosis. There were no identifiable risk factors for thromboembolic complications in this cohort. Conclusions Although TCPC provides superior flow dynamics and lower risk of incident atrial arrhythmias, there is a significant risk of recurrent arrhythmias among TCPC patients with a prior history of atrial arrhythmias. These patients may require more intensive arrhythmia surveillance as compared to other TCPC patients.

Background: The objective was to study adequacy of valid informed consent in caesarean section and to quantify the proportion of patients who receive a proper informed consent before undergoing caesarean section.Methods: A cross-sectional questionnaire-based study involving 200 registered antenatal women undergoing caesarean section for various reasons both as elective or emergency basis, and data was analyzed.Results: Among the study group, 98.5% patients were informed about the said procedure in their own local language and consent was taken, in 3 (1.5%) patients informed consent was not taken. Detailed procedure was explained to only 29 patients (14.5%) whereas 171 patients (85.5%) had no clue about the detailed nature of the procedure. 193 patients (96.5%) were satisfied with the given informed patients; 7 patients (3.5%) were not satisfied.Conclusions: Women need consistent and adequate information for consent. Sessions should be held regarding the procedure, its risks and benefits; in this way patient will undergo the procedure with proper knowledge, awareness and confidence.

BACKGROUND AND OBJECTIVE Pre-eclampsia is a systemic syndrome that occurs in 3-5% of the pregnant women and is the leading cause of maternal/neonatal morbidity and mortality. We designed a study to compare perinatal outcome in women with recurrent preeclampsia to women with women with pre-eclampsia who were normotensive during their previous pregnancies. MATERIALS AND METHODS This study was conducted in Dept. of Obstetrics and Gynaecology, Institute of Maternal and Child Health, Government Medical College, Kozhikode for a period of 1 year from March 2013 to February 2014. We conducted this study in multiparous women who developed pre-eclampsia in index pregnancy (n=110). Among these, women who had pre-eclampsia in previous pregnancies (n=55) were compared to those who remained normotensive during their prior pregnancies (n=55). Maternal and foetal variables were compared. Multivariate logistic analyses were performed to examine the impact of pre-eclampsia on foetal outcome, preterm delivery, IUGR, still births adjusted for confounding variables. RESULTS No statistical significant difference was observed between the 2 groups in terms of age, gravida, parity. Women who experienced recurrent pre-eclampsia were at elevated risk for early onset of pre-eclampsia, deranged laboratory investigations (Hepatic and Renal parameters, Coagulation Profile), higher chances of maternal complications, foetal mortality and morbidity (Statistically significant P

BackgroundFontan survivors have depressed cardiac index that worsens over time. Serum biomarker measurement is minimally invasive, rapid, widely available, and may be useful for serial monitoring. The purpose of this study was to identify biomarkers that correlate with lower cardiac index in Fontan patients.Methods and resultsThis study was a multi-centre case series assessing the correlations between biomarkers and cardiac magnetic resonance-derived cardiac index in Fontan patients ⩾6 years of age with biochemical and haematopoietic biomarkers obtained ±12 months from cardiac magnetic resonance. Medical history and biomarker values were obtained by chart review. Spearman’s Rank correlation assessed associations between biomarker z-scores and cardiac index. Biomarkers with significant correlations had receiver operating characteristic curves and area under the curve estimated. In total, 97 cardiac magnetic resonances in 87 patients met inclusion criteria: median age at cardiac magnetic resonance was 15 (6–33) years. Significant correlations were found between cardiac index and total alkaline phosphatase (−0.26, p=0.04), estimated creatinine clearance (0.26, p=0.02), and mean corpuscular volume (−0.32, p2versus lower-risk group=2.96 L/minute/m2, (pConclusionsHigher total alkaline phosphatase and mean corpuscular volume as well as lower estimated creatinine clearance identify Fontan patients with lower cardiac index. Using biomarkers to monitor haemodynamics and organ-specific effects warrants prospective investigation.

AB Background: Both intense endurance training and valvular regurgitation place a volume load on the right and left ventricles, potentially leading to dilation, but their effects in combination are not well-known. Purpose: The purpose of this case series is to describe the combined volume load of intense endurance athletic training and regurgitant valvular disease as well as the challenging assessment of each component's cardiovascular effect. Methods: In this article, the clinical course of three elite endurance athletes with congenital valvular disease were reviewed. Results: A swimmer with aortic regurgitation, a cyclist with aortic regurgitation, and a cyclist with pulmonary regurgitation were found to have severe dilation of the associated ventricles despite continuing to train at an elite level without symptoms. Conclusions: Because of the cumulative effects of endurance training and valvular regurgitation, each athlete manifested ventricular dilation out of proportion to their valvular disease and symptoms. Although the effects of congenital valvular disease and athletic remodeling on ventricular dilation have been thoroughly studied individually, their cumulative effect is not well understood. This complicates the assessment of athletes with valvular regurgitation and underscores the need for athlete-specific recommendations for valve replacement.

The Fontan operation is a unique approach to create a circulation in series without 2 distinct pumping chambers. Although the approach has enabled many patients to live well into adulthood, the unique physiology results in many complications, cardiac and extracardiac. This review focuses on the pathophysiology of the failing Fontan and suggests possible treatment strategies. By understanding the physiology and interpreting patient data based on this understanding, an individualized treatment plan can be designed for this unique patient population.

Background: Febrile convulsion is one of the commonest seizure disorders in children. Prevention of febrile convulsions is therefore desirable, and is of particular relevance in children with factors carrying a high risk of recurrence. Aim and objectives were to study the demographic profile and some risk factors of febrile seizures among children.Methods: Retrospective study was conducted at Pediatric department of Yenepoya Medical College, Mangalore. Considering inclusion & exclusion criteria all children in the 6 months to 5-year age who were diagnosed as having febrile convulsion admitted during January 2018 to October 2019 were included in the study.Results: Total out of the 96 children 53 (55.2%) were boys and 43 (44.7%) were girls. 61% children were in the 1-3-year age group. Mean age of occurrence was 2.2 years (±1.5 years). In this study, 81.25% (78) of the patients had simple and 18.75% (18) had the complex form of febrile seizure. In our study, 61.4% (59) of affected children had positive family history of febrile seizure. Acute gastroenteritis (AGE) (22.9%) followed by upper respiratory tract infection (URTI) and lower respiratory tract infection (LRTI) (20.8%) was the most common co-morbidity. 47.9% children were hospitalized for 1-3 days.Conclusions: Most of the children had a positive family history and the most common causative factor was Age, URTI, LRTI etc. are associated with febrile convulsion and these diseases can be managed effectively thereby reducing the occurrence of febrile convulsion.

This study examines the ambulatory health care use and costs of adults with congenital heart disease in the US.

Background: Cardiovascular diseases (CVDs) are the leading cause of mortality and morbidity with dyslipidemia as an important contributing risk factor. Objective of the study was to determine whether there is an association between maternal lipid profile and the cord blood lipid profile of their newborns.Methods: This was a hospital-based Cross-sectional study on 60 mothers and their respective newborns (30 term and 30 preterm) conducted in Yenepoya medical college hospital from August to November 2019. Umbilical cord blood samples from the newborns were collected after birth and the mother's venous blood was collected in the fasting state (8hrs of fasting) before delivery. The levels of total cholesterol, triglycerides, HDL, LDL and VLDL were determined in mothers and their newborns by an enzymatic colorimetric method. Data obtained was analyzed by the SSPS software 23.0 version and Pearson's correlation was done.Results: There was a significant correlation between the mean concentration of maternal Triglycerides and the Triglycerides and HDL levels of neonates (p-value

We sought to analyze the trends and resource utilization of adult congenital heart disease (ACHD)-related heart failure admissions at children's hospitals. Heart failure admissions in patients with ACHD continue to rise at both pediatric and adult care facilities. Data from the Pediatric Health Information Systems database (2005 to 2015) were used to identify patients (≥18 years) admitted with congenital heart disease (745.xx-747.xx) and principal diagnosis of heart failure (428.xx). High resource use (HRU) admissions were defined as those over the 90th percentile. There were 562 admissions (55.9% male) across 39 pediatric hospitals. ACHD-related heart failure admissions increased from 4.1% in 2006 to 6.3% in 2015 (p = 0.015). Median hospital charge for ACHD-related heart failure admissions was $59,055 [IQR $26,633 to $156,846]. Total charges increased with more complex anatomic category (p = 0.049). Though HRU admissions represented 10% of ACHD-related heart failure admissions, they accounted for66% of the total charges. The median total hospital charges for HRU admissions were $1,018,656 [IQR $722,574 to $1,784,743], compared with $58,890 [IQR $26,456 to $145,890] for non-HRU admissions (p0.001). Inpatient mortality rate (26.3% vs 4.0%) and the presence of ≥2 comorbidities (68% vs 31%) were higher for HRU admissions (p0.001). On multivariable analysis, technology dependence (aOR: 4.4, p0.001) and renal comorbidities (aOR: 3.0, p = 0.04) were associated with HRU. In conclusion, heart failure-related ACHD admissions in pediatric hospitals are increasing. Compared with non-HRU, HRU admissions had higher inhospital mortality and greater comorbidities. Additional care strategies to reduce resource use among these patients and improve overall quality of care merits further study.

Since its original description, the Fontan operation has been widely used for the palliation of children with single ventricle physiology and has resulted in an increasing number of these patients surviving to adulthood. The Fontan operation is a unique approach to create a circulation in series without two distinct pumping chambers. Although the Fontan operation increased the survival rates of patients with single ventricle physiology, it carries an inevitable risk of long-term morbidities that impacts the outcomes and quality of life in these patients. In this review, we discuss the challenges resulting from the unique pathophysiology of Fontan circulation and propose management strategies.

Background Nd YAG laser finds a number of applications in the treatment of anterior segment diseases like primary angle closure and postoperative complications of extracapsular cataract surgery Aim To assess the safety and efficacy of Nd YAG laser in the management of diseases of anterior segment Methods This prospective study included patients who underwent Nd YAG laser therapy for the treatment of anterior segment during a one year period The nature of procedure complications during and after laser treatment and outcomes were noted Patients were followed upto months post treatment Results eyes of patients were included The age of patients ranged from years males and females Nd YAG laser posterior capsulotomy n was the most common indication followed by laser peripheral iridotomy n anterior vitreolysis n Fibrin membrane lysis n and corticolysis n There was an improvement in visual acuity from baseline in patients with posterior capsular opacification and cystoid macular edema due to vitreous tug syndrome There was a reduction in the IOP from baseline and widening of the anterior chamber angles following peripheral iridotomy in of the patients with primary angle closure disease Hyphaema and transient IOP elevation were the most common complications encountered which resolved with therapy Conclusion Nd YAG laser is a safe and effective means of treating the spectrum of primary angle closure disease and complications of extracapsular cataract surgery It has a better acceptance by patients is cost effective may be performed as an outpatient procedure and avoids complications of surgery

Conventional Invasive technique for blood glucose monitoring requires a finger prick blood sample, a repetitive painful process that creates the peril of infection and costly too. Complications aroused due to the abnormal blood glucose level in diabetic patients have created the necessity of BGM. Laser light based sensors have demonstrated a superior potential for BGM. Near-infrared (NIR) based BGM technique is existing one but it has shortcomings, such as absorption of light in human tissue, higher signal to noise ratio (SNR) and lower accuracy. A simple compact and cost-effective non-invasive devise using visible red laser light of 650 nm for Blood Glucose Monitoring (RL-BGM) is implemented in this paper. The RL-BGM device has major technical advantages over NIR such as 30 times better transmittance through human tissue. The refractive index of Red laser light is more sensitive to the variations in glucose level concentration. RL-BGM has faster response time (approx 7-10 s). Linearity and accuracy are higher in case of RL-BGM and both in-vitro and in-vivo cases and several experimental results have been generated to ensure the accuracy and precision of the RL-BGM device.