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Of 319 children with invasive candidiasis, 67 (21%) transitioned from intravenous to enteral antifungal therapy. Eight (12%) transitioned back to intravenous antifungal therapy, one due to perceived treatment failure defined by clinical progression or worsening. Global treatment response at study completion was success in 66 participants transitioned to enteral therapy., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Better access to direct-acting antiviral (DAA) therapy has broadened the utilization of hepatitis C virus (HCV) nucleic acid testing (NAT) positive organs with excellent outcomes. However, DAA therapy has been associated with hepatitis B virus (HBV) reactivation., Aim: To determine the risk of HBV transmission or reactivation with utilization of HBV core antibody positive (HBcAb+) and HCV NAT positive (HCV+) organs, which presumably required DAA therapy., Methods: The number of HBcAb+ donors with delineated HCV NAT status was obtained from the Organ Procurement and Transplantation Network (OPTN) database. The number of unexpected HBV infections from transplanted organs adjudicated as "proven" or "probable" transmission was obtained from the OPTN Ad Hoc Disease Transmission Advisory Committee database. A chart review of the donors of "proven" or "probable" cases was conducted., Results: From January 1, 2016, to December 31, 2021, 7735 organs were procured from 3767 HBcAb+ donors and transplanted into 7469 recipients; 545 (14.5%) donors were also HCV+. HBV transmission or reactivation occurred in seven recipients. The rate is not significantly different between recipients of HCV+ (0.18%, 2/1115) and the HCV NAT negative (HCV-) organs (0.08%, 5/6354) (p = 0.28) or between recipients of HCV+ and HCV- livers as well as non-liver organs. HBV transmission or reactivation occurred within a median of 319 (range, 41-1117) days post-transplant in the setting of missing, inadequate, or truncated prophylaxis., Conclusion: HBV reactivation associated with DAA therapy for HBcAb+ HCV+ organs is less frequent than reported in the non-transplant population, possibly due to the common use of HBV prophylaxis in the at-risk transplant population., (© 2024 The Author(s). Transplant Infectious Disease published by Wiley Periodicals LLC.)

Some studies have reported increased infectious morbidity and all-cause mortality risk among infants HIV-exposed uninfected compared with infants HIV-unexposed uninfected. In a retrospective analysis of infants enrolled in the Botswana-based Tshilo Dikotla study, we found no difference in the prevalence of infectious hospitalizations or deaths from any cause in the first year of life by perinatal HIV exposure., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Valganciclovir is the only approved antiviral for cytomegalovirus (CMV) prevention in pediatric solid organ transplantation (SOT). Additional approaches may be needed to improve outcomes., Methods: A multicenter retrospective study from 2016 to 2019 was conducted of pediatric SOT recipients in whom at least 3 months of valganciclovir prophylaxis was planned. Episodes of CMV DNA in blood (DNAemia), CMV disease, drug-related toxicities, as well as other infections in the first year posttransplant and demographic and clinical data were collected. CMV DNAemia in the first year after prophylaxis or during prophylaxis (breakthrough) was analyzed by multivariate hazard models., Results: Among the 749 patients enrolled, 131 (17.5%) had CMV DNAemia at any time in the first year; 85 (11.4%) had breakthrough DNAemia, and 46 (6.1%) had DNAemia after prophylaxis. CMV disease occurred in 30 (4%). In a multivariate model, liver transplantation compared to kidney or heart, intermediate or high risk based on donor/recipient serologies, neutropenia, and valganciclovir dose modifications attributed to toxicity were associated with increased risk of total and/or breakthrough DNAemia. Bacteremia was also associated with increased hazard ratio for CMV DNAemia. In a separate multivariate analysis, rejection occurred more often in those with breakthrough CMV DNAemia ( P = .002); liver transplants, specifically, had increased rejection if CMV DNAemia occurred in the first year ( P = .004). These associations may be bidirectional as rejection may contribute to infection risk., Conclusions: CMV DNAemia in the first year posttransplantation occurs despite valganciclovir prophylaxis and is associated with medication toxicity, bacteremia, and rejection. Pediatric studies of newer antivirals, especially in higher-risk subpopulations, appear to be warranted., Competing Interests: Potential conflicts of interest. All authors: No reported conflicts., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Background and aim Anterior cruciate ligament (ACL) injuries often occur along with menisci tears. ACL reconstruction with meniscectomy has long been the preferred technique for such injuries; however, it has been postulated to increase the chances of osteoarthritis (OA). Therefore, recent techniques have involved preserving menisci while reconstructing ACL to prevent OA and improve overall functional outcomes. This study aimed to evaluate the functional outcomes of arthroscopic meniscal repair performed concurrently with ACL reconstruction at six months post-surgery. Methodology We conducted a cross-sectional study at a tertiary care center after getting appropriate ethics committee approval. A total of 67 participants who met the inclusion and exclusion criteria were enrolled in the study after obtaining informed consent. Their demographics were recorded retrospectively from hospital records, while their Lysholm Knee Score (LKS) responses were collected prospectively during their sixth-month follow-up visit to our department. Analysis was done using Microsoft Excel. Appropriate statistical tests including chi-square, analysis of variance (ANOVA), and independent t-tests were applied to keep an alpha of 0.05. Results We found that the mean age of participants was 35 years. The mean LKS of patients who underwent isolated ACL reconstruction (ACLR) was 86.02 ± 9.38. For those who underwent ACLR plus meniscus repair (MR), the mean LKS was marginally higher at 87.4 ± 7.41 during their sixth-month follow-up, with a P -value of 0.27. Furthermore, the mean LKS of patients who underwent ACLR plus meniscectomy was 86 ± 10.48. Comparing the means of all three groups revealed no statistical difference among any surgical approach with a P -value of 0.69. A total of 33 (49.25%) participants achieved an LKS falling within the Good  category (84-94). Comparing between three surgical groups and their LKS categories also revealed no statistical difference with a P -value of 0.7. Conclusions Short-term functional outcomes in patients undergoing ACLR or ACLR plus MR using patient-reported knee scores like LKS demonstrate favorable outcomes but fail to demonstrate statistical significance. On a longer follow-up period, a reduction in the prevalence of OA is a possibility with the preservation of menisci; however, conflicting evidence in the literature about the approach to ACL injuries with menisci involvement warrants large-scale randomized controlled trials to decide upon the standard of care., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Soni et al.)

To address the weight, cost, and sustainability associated with fibreglass application in structural composites, plant fibres serve as an alternative to reduce and replace the usage of glass fibres. However, there remains a gap in the comprehensive research on plant fibre composites, particularly in their durability for viable structural applications. This research investigates the fatigue and impact properties of pultruded kenaf/glass-reinforced hybrid polyester composites tailored for structural applications. Utilising kenaf fibres in mat form, unidirectional E-glass fibre direct roving yarns, and unsaturated polyester resin as key constituents, pultruded kenaf/glass hybrid profiles were fabricated. The study reveals that pultruded WK/UG alternate specimens exhibit commendable fatigue properties (18,630 cycles at 60% ultimate tensile strength, UTS) and fracture energy (261.3 kJ/m 2 ), showcasing promise for moderate load structural applications. Notably, the pultruded 3 WK/UG/3WK variant emerges as a viable contender for low-load structural tasks recorded satisfactory fatigue properties (10,730 cycles at 60% UTS) and fracture energy (167.09 kJ/m 2 ). Fatigue failure modes indicate that the stress applied is evenly distributed. Ductile failures and delaminations during impact test can be attributed to damping and energy absorbing properties of kenaf fibres. Moreover, incorporating kenaf as a hybrid alternative demonstrates substantial reductions in cost (35.7-50%) and weight (9.6-19.1%). This research establishes a foundation for advancing sustainable and efficient structural materials and highlights the significant role of materials design in shaping the future of engineering applications.

Introduction: There is increasing recognition of infections due to multidrug-resistant Gram negative (MDRGN) bacterial infections among children undergoing solid organ and hematopoietic cell transplantation, which may be associated with morbidity and mortality., Methods: We present two vignettes that highlight the clinical challenges of evaluation, management, and prevention of MDRGN bacterial infections in children prior to and after transplantation. The goal of this discussion is to provide a framework to help develop an approach to evaluation and management of these infections., Results: Source control remains the utmost priority in management of MDR infections and is paired with antibiotic selection guided by in vitro susceptibilities, adverse effect profiles, and clinical response. Identification and confirmation of resistance can be challenging and often requires additional testing for recognition of complex mechanisms. Current antimicrobial approaches to MDRGN infections include use of novel agents, prolonged infusion, and/or combination therapy. We also discuss preventative efforts including infection control, antimicrobial stewardship, targeted pre-emptive or prophylactic treatment, and decolonization., Discussion: The impact of MDRGN infections on patient and graft survival highlights the need to optimize treatment and prevention strategies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Dong, Sharma and Sue.)

Optimal dosing of valganciclovir (VGCV) for cytomegalovirus (CMV) prevention in pediatric solid organ transplantation recipients (SOTR) is controversial. Dosing calculated based on body surface area (BSA) and creatinine clearance is recommended but simplified body weight (BW) dosing is often prescribed. We conducted a retrospective 6-center study to compare safety and efficacy of these strategies in the first-year posttransplant There were 100 (24.2%) pediatric SOTR treated with BSA and 312 (75.7%) with BW dosing. CMV DNAemia was documented in 31.0% vs 23.4% (P = .1) at any time during the first year and breakthrough DNAemia in 16% vs 12.2% (P = .3) of pediatric SOTR receiving BSA vs BW dosing, respectively. However, neutropenia (50% vs 29.3%, P <.001), lymphopenia (51% vs 15.0%, P <.001), and acute kidney injury causing treatment modification (8.0% vs 1.8%, P <.001) were documented more frequently during prophylaxis in pediatric SOTR receiving BSA vs BW dosing. The adjusted odds ratio of VGCV-attributed toxicities comparing BSA and BW dosing was 2.3 (95% confidence interval [CI], 1.4-3.7] for neutropenia, 7.0 (95% CI, 3.9-12.4) for lymphopenia, and 4.6 (95% CI, 2.2-9.3) for premature discontinuation or dose reduction of VGCV, respectively. Results demonstrate that BW dosing is associated with significantly less toxicity without any increase in CMV DNAemia., Competing Interests: Disclosure The authors of this manuscript have no conflicts of interest to disclose, as described by the American Journal of Transplantation., (Copyright © 2023 American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc. All rights reserved.)

Diaphragmatic paralysis (DP), whether unilateral or bilateral, often leads to extended recovery and more severe complications, particularly in neonates and infants undergoing congenital heart surgery. This condition's impact is most pronounced after single-ventricle palliative procedures. Tracheostomy prevalence is rising in pediatric patients with congenital heart disease (CHD) despite its association with high resource utilization and in-hospital mortality. This study examines the reported incidence of diaphragmatic paralysis and timing of tracheostomy in pediatric patients undergoing surgery for congenital heart disease in the literature and a retrospective analysis of cases in our institution between 2018 and 2023, offering insights for prospective management. An electronic search of PubMed databases retrieved 10 studies on pediatric tracheostomy and 11 studies on DP. Our retrospective analysis included 15 patients, of whom 10 underwent tracheostomy, four underwent diaphragmatic plication, and one underwent both. Postoperative tracheostomy had an 11.8% mortality rate in our systematic review, rising to 40% in our observational study. Diaphragm repair and early diagnosis can reduce morbidity, prevent complications, and improve patients' quality of life., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Bhende et al.)

Objectives: This study had two aims: (i) to investigate outcomes of medication tapering in stable RA patients on biologic or targeted synthetic disease-modifying anti-rheumatic drugs (bDMARDs/tsDMARDs) and conventional synthetic DMARDs (csDMARDs) in a real-world prospective cohort; and (ii) to evaluate possible predictors of flare with medication taper., Methods: A prospective cohort of patients with RA in sustained remission or low disease activity while on stable bDMARD/tsDMARDs +/- csDMARDs for at least 6 months underwent medication tapering/stopping and was tracked for 2 years. Patients were evaluated for flares in four groups: no taper, only bDMARD/tsDMARD taper, only csDMARD taper and both csDMARD and bDMARD/tsDMARD taper., Results: The RHEUMTAP cohort included 131 patients that met eligibility criteria, of which 52 patients underwent a medication taper. Flare was experienced by 15 patients in the taper and two in the no-taper groups. Patients undergoing any taper/stop overall were 10 times more likely to experience a flare compared with those not tapered (HR 10.43, 95% CI 2.98-36.53, P = 0.0002). The group tapering bDMARD/tsDMARD had 31 times higher risk of flare (HR 31.43, 95% CI 6.35-155.55, P <0.0001) than the no-taper group. Patients tapering both csDMARDs and bDMARD/tsDMARDs had 18 times higher risk of flare than the no-taper group (HR 18.45, 95% CI 2.55-133.37, P = 0.0039). The only csDMARD taper group had a 91% lower risk of flare than the bDMARD/tsDMARD taper group (HR 0.09, 95% CI 0.01-0.69, P = 0.0213)., Conclusion: In our real-world prospective RHEUMTAP cohort study on the outcomes of different medication tapering groups in well-controlled RA, patients who tapered or stopped bDMARDs/tsDMARDs with or without background therapy were more likely to experience a flare than patients that did not taper any medications and those that tapered only csDMARDs., (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background and objective Complex congenital heart diseases (CHDs), such as the tetralogy of Fallot (TOF), often warrant reconstruction and augmentation of the right ventricular outflow tract (RVOT). This procedure requires the use of both synthetic and natural materials. However, finding the ideal material for tissue implants can be challenging. Biological materials often face issues such as tissue degeneration, calcium deposition, antigenicity, rejection, shrinkage, and fibrosis. These issues can lead to complications such as stenosis and insufficiency, potentially requiring early reoperations. In light of this, this study aimed to investigate the effectiveness of the Invengenx® bovine patch for RVOT reconstruction and augmentation. Methods This was a retrospective observational study conducted among eight children who underwent TOF correction cardiac surgery. Their demographic and clinical characteristics, intraoperative findings, and postoperative follow-up results at six months were collected from the hospital patient database. Results There were no deaths or complications in this study. We observed a significant reduction in the gradient across the pulmonary valve and the outflow tract at six months post-procedure. The analysis demonstrated that the Invengenx® bovine patch was successful and did not lead to any complications. Conclusions This study demonstrates the safety and efficacy of this engineered bovine pericardial patch (Invengenx®) as a cardiovascular substitute for surgical repair of both simple and more complex congenital cardiac defects., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Bhende et al.)

Background: Adjunctive diagnostic studies (aDS) are recommended to identify occult dissemination in patients with candidemia. Patterns of evaluation with aDS across pediatric settings are unknown., Methods: Candidemia episodes were included in a secondary analysis of a multicenter comparative effectiveness study that prospectively enrolled participants age 120 days to 17 years with invasive candidiasis (predominantly candidemia) from 2014 to 2017. Ophthalmologic examination (OE), abdominal imaging (AbdImg), echocardiogram, neuroimaging, and lumbar puncture (LP) were performed per clinician discretion. Adjunctive diagnostic studies performance and positive results were determined per episode, within 30 days from candidemia onset. Associations of aDS performance with episode characteristics were evaluated via mixed-effects logistic regression., Results: In 662 pediatric candidemia episodes, 490 (74%) underwent AbdImg, 450 (68%) OE, 426 (64%) echocardiogram, 160 (24%) neuroimaging, and 76 (11%) LP; performance of each aDS per episode varied across sites up to 16-fold. Longer durations of candidemia were associated with undergoing OE, AbdImg, and echocardiogram. Immunocompromised status (58% of episodes) was associated with undergoing AbdImg (adjusted odds ratio [aOR] 2.38; 95% confidence intervals [95% CI] 1.51-3.74). Intensive care at candidemia onset (30% of episodes) was associated with undergoing echocardiogram (aOR 2.42; 95% CI 1.51-3.88). Among evaluated episodes, positive OE was reported in 15 (3%), AbdImg in 30 (6%), echocardiogram in 14 (3%), neuroimaging in 9 (6%), and LP in 3 (4%)., Conclusions: Our findings show heterogeneity in practice, with some clinicians performing aDS selectively, potentially influenced by clinical factors. The low frequency of positive results suggests that targeted application of aDS is warranted., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction Antimicrobial prophylaxis, involving short antibiotic courses preceding surgical procedures, is recommended to minimize postoperative infections. Paediatric cardiac surgeries are classified as clean procedures, though infection challenges persist due to illness severity and extended ICU stays. Antimicrobial prophylaxis varies, ranging from single doses to extended administration until catheters are removed. Typically lasting 24 to 48 hours, it has proven infection-reduction benefits. Despite these practices, uncertainties surround the optimal nature, timing, and duration of administration. This concern is amplified by escalating antimicrobial resistance driven by antibiotic overuse. Vulnerable paediatric populations bear heightened consequences of irrational antimicrobial use, contributing to global resistance trends. Yet, a defined optimal prophylaxis schedule for paediatric cardiac surgery is lacking. Importing adult guidelines may be inadequate due to paediatric research complexities and population diversity. Developing effective prophylaxis protocols is crucial for children undergoing cardiac surgery, given global antibiotic overuse and evolving drug resistance. Establishing an optimal prophylactic strategy remains a challenge, necessitating further research for evidence-based protocols to mitigate infections in this vulnerable patient cohort. Methods This study investigates antibiotic use in paediatric cardiac surgery. A retrospective analysis of 100 patients from a rural Indian hospital (2017-2018) assesses antibiotic patterns, including type, dose, duration, and adherence to prophylaxis protocols. Results In the studied cohort of paediatric cardiac surgery patients, complete compliance (100%) with antibiotic prophylaxis was observed. However, deviations were identified: 30% received antibiotics prematurely, and 30% did not align with institutional protocol criteria. Concerning antibiotic selection, 87% followed hospital policy with the recommended cefoperazone and sulbactam combination plus amikacin, while 9% received piperacillin/tazobactam + amikacin due to sepsis. Irregular use (22%) based on clinical records occurred. Furthermore, 4% received piperacillin/tazobactam + teicoplanin, with one instance of inappropriate higher antibiotic use. Regarding prophylaxis duration, only 27% adhered to the appropriate timeline, with 40% exceeding 48 hours, indicating extended use. Upon discharge, a notable proportion (45 patients) received antibiotic prescriptions. Among them, 73% were prescribed rationally, while 27% exhibited irrational antibiotic use. Conclusion The findings of this study shed a significant light on the issue of antibiotic misuse within the context of paediatric cardiac surgery. It underscores the pressing need for more stringent measures to regulate and address this concerning trend. The study underscores the pivotal importance of adhering rigorously to established protocols and guidelines for antibiotic prophylaxis. This adherence not only holds the potential to elevate the overall quality of patient care but also plays a critical role in combating the escalating challenge of antibiotic resistance. Through a concerted effort to optimize antibiotic usage, we can simultaneously enhance patient outcomes and contribute to the ongoing fight against the emergence of antibiotic-resistant strains, thus preserving the efficacy of these vital medications for future generations., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Pathan et al.)

Monoclonal antibodies for COVID-19 are authorized in high-risk patients aged ≥12 years, but evidence in pediatric patients is limited. In our cohort of 142 patients treated at seven pediatric hospitals between 12/1/20 and 7/31/21, 9% developed adverse events, 6% were admitted for COVID-19 within 30 days, and none received ventilatory support or died., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background and Aims: Cardiac surgery and cardiopulmonary bypass result in an immunoparalyzed state in children making them susceptible to sepsis and other hospital-acquired infections. Therefore, identification of the risk factors of sepsis would lead to appropriate management. The current study seeks to evaluate the prevalence of sepsis and risk factors linked to sepsis in pediatric cardiac surgical patients and the subsequent prevalence of multidrug-resistant organisms., Methods: A retrospective, single-center observational study was conducted including 100 pediatric patients admitted to the pediatric intensive care unit (ICU) after cardiac surgery between January 2017 and February 2018. All patient data were obtained from the medical record department of the hospital. Patient case report form comprised demography, surgery details, preoperative and postoperative hematological reports, and clinical details. After collecting the data, chi-square test and logistic regression analysis were used to determine the risk factors linked to sepsis., Results: The prevalence of sepsis in our population was 27% and the mortality rate due to sepsis was 1%. The only statistically significant risk factor for sepsis we discovered in this analysis was prolonged ICU stay for more than 5 days. A total of eight patients had blood cultures positive for bacterial infection. The alarming finding was that all eight were infected with multidrug-resistant organisms, demanding the last line of antibacterials., Conclusion: Our study indicates that special clinical care is required when ICU stay is prolonged to lower the risk of sepsis. These new and upcoming infections not only promote high mortality and morbidity rates but also contribute to increased cost of care due to the use of newer broad-spectrum antibiotics and longer hospital stay. The high prevalence of multidrug-resistant organisms is unacceptable in the current scenario and hospital infection and prevention control play a crucial role in minimizing such infections., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

The exploration of graphitic carbon nitride (g-C 3 N 4 ), a two-dimensional (2D) metal-free polymer semiconducting material, is largely discussed due to its large specific surface area, high electrical conductivity, thermal stability, and adaptable electronic structure. The adaption of sulfur (S) and phosphorous (P) atoms into the layers of g-C 3 N 4 increases the electrochemical performance of detecting nilutamide (NT). The aggregation severity can be decreased by integrating S/P into g-C 3 N 4 , thereby improving surface area and electrical conductance. The g-C 3 N 4 , S/gC 3 N 4 , P/g-C 3 N 4 , and S/P/g-C 3 N 4 were studied with X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), Field emission scanning electron microscopy (FESEM), Transmission electron microscopy (TEM), Fourier transform infrared (FTIR), Ultraviolet visible spectroscopy (UV), Thermogravimetric analysis (TGA), and Brunauer-Emmett-Teller (BET). The well-assigned S/P/g-C 3 N 4 exhibited a good crystalline structure with more active sites for improved electron transfer toward NT detection. Both differential pulse voltammetry (DPV) and amperometry (IT) was studied for NT detection. The electrochemical studies were done with a linear range of 0.019-1.17 μM to 5.36-1891.98 μM in DPV and 0.01 μM-158.3 μM in IT technique. The attained limit of detection in DPV analysis was 3.2 nM and with IT analysis 2.4 nM. The nanocomposite S/P/g-C 3 N 4 shows good selectivity towards NT. The fabricated electrode showed excellent repeatability, reproducibility, and stability, with a significant recovery range in real sample analysis., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background & aims  Intracardiac shunts are abnormal channels of blood circulation within the heart that develop either as an additional blood flow pathway or as a replacement for the normal channels of blood circulation. They are the commonest types of congenital heart defects. Various methods are available in the present times to identify, localize or quantify left-to-right intracardiac shunts. Methods may vary in sensitivity, indicators, or types of equipment available. One such method used in almost all cardiac centers for a long time has been oximetry run to detect step-up differences in oxygen saturation values. In the oximetry run the main approach to detect and estimate the left-to-right (L-->R) shunts requires the oxygen concentration expressed as a proportion of saturation to be evaluated in blood samples which are obtained from the right atrium (RA) and pulmonary artery (PA), respectively. A left-to-right shunt can be considered if there is a significant increase (step-up) in blood saturation. A significant step-up is defined as a substantial rise in blood oxygen content or saturation that is higher than normal values. Methods  Using a prospective observational design, this article investigates the application of the step-up method in detecting intracardiac shunts. The study was conducted between 2021 and 2022 on 35 pediatric cardiac patients (males/females, 24/11) diagnosed with post-tricuspid shunts. The pulmonary artery and right atrium were sampled before and after cardiopulmonary bypass surgery and analyzed using a blood gas test. As a result, nearly 91% of the patients had a saturation below 8%. However, the difference between PA oxygen saturation (SO 2) & RASO 2 before and after surgery was significant. As a result, the difference in O 2 saturation helped detect the residual ventricular septal defect (VSD) after the surgery. Results  There were no deaths or complications in this study. There were no re-interventions for post-tricuspid shunt surgery, though one patient had a step-up of >15% and residual VSD status was moderate to large on two-dimensional (2D) echocardiography. Conclusion A combination of physical findings, chest radiography, electrocardiogram (ECG), and echocardiography is routinely done for all these patients undergoing pediatric cardiac surgery. Echocardiography can detect the occurrence of shunt but does not calculate the shunt ratio. Transesophageal or epicardial echocardiography is the standard of care but has its limitations like perception difference between the operating surgeon and the person performing echocardiography. In this study, we have added an oximetry analysis of blood-gas samples before and after surgery and compared it to 2D echocardiography to test the validation of oximetry in isolation and comparison to 2D echocardiography., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Bhende et al.)

Background and Aims: Sinus venosus atrial septal defects (SVASDs) constitute a substantial part of atrial septal defects and are usually characterized by anomalous pulmonary venous connection (APVC), causing complications like sinus node dysfunction and arrhythmias. Several surgical approaches are used for treating SVASDs in pediatric patients, including single- and two-patch techniques. The study aimed to prospectively evaluate and compare the safety and efficacy of these two methods with different follow-up periods., Methods: Ten patients aged 1-8 years with SVASDs and partial APVC were enrolled in the study at Bhanubhai and Madhuben Patel Cardiac Centre, Karamsad, India, between December 2018 and October 2021. The single-patch (sandwich-patch) technique was used in two patients, whereas the two-patch (dual-patch) technique with autologous pericardium was used in seven. Safety was assessed as the absence of complications in the follow-up periods of 6 months, 1, and 2 years, whereas efficacy was estimated by the preserved sinus rhythm and the development of arrhythmias. Electrocardiographic and echocardiographic methods were used to evaluate both parameters., Results: No deaths, reoperations, pulmonary vein, and superior vena cava (SVC) stenosis or phrenic nerve palsy were observed among the 10 patients in the three follow-up periods. Sinus rhythm was arrested in two of the seven patients who underwent two-patch repair, whereas no rhythm disturbances occurred in those who underwent single-patch repair., Conclusion: Both techniques used in SVASD repair with autologous pericardium proved to cause the smaller rate of complications in midterm postsurgical phase. However, there is a potentially great risk of the development of sinus node malfunction after the application of the two-patch technique. Therefore, methods avoiding sinus node interference are preferred in patients with partial APVC involving SVC., Competing Interests: The authors declare no conflict of interest., (© 2022 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Understanding the molecular cross-talk between the embryo and uterine endometrium is crucial for the improvement of IVF outcomes. The present work was undertaken to investigate the effect of pre-implantation embryo on the expression profile of immune-related genes in uterine epithelial cells (UECs) and PBMCs in buffalo. UECs were isolated from slaughterhouse-derived non-gravid uteri, cultured ex vivo and characterized, and buffalo embryos were produced in vitro from slaughterhouse-derived ovaries. Embryos co-cultured with steroid-treated UECs significantly stimulated (p < 0.05) the relative mRNA abundance of PTGS2, ISG15, OAS1, MX2, IFNAR1 and IFNAR2 in UECs while they significantly suppressed the mRNA expression of NFkβIA, NFkβ2, TNFα and IL1B, with no significant change in TGFβ1 and IL10 in the co-culture of embryos with UECs. In vitro treatment of PBMCs with conditioned media (CM) derived from embryos as well as UEC−embryo co-culture upregulated the mRNA abundance of ISG15, TGFβ1, PTGS2OAS1, MX2 and STAT1 while it downregulated IL17 and TNFα expression. The expression of IFNAR1 and IFNAR2 was elevated in PBMCs cultured in embryo-derived CM, but there was no significant change in PBMCs cultured in UEC−embryo co-culture CM. Thus, it can be concluded that the developing embryo and its secretions modulate the expression of immune responses by inducing an anti-inflammatory action in uterine epithelial cells for acceptance of the semi-allogenic embryo in the uterus to sustain pregnancy in buffalo.

The ill effects of prolonged use of rifamycin antibiotics such as rifampicin accentuates its need for detection in the environment as well as in biological fluids. Antibiotics in water and soil are long-lasting, bio-accumulative, and hazardous to aquatic species as well as human health. To address this issue, a sensing platform has been developed using Molybdenum diselenide (MoSe 2 ) embedded on reduced graphene oxide (rGO) functionalized with β-cyclodextrin (β-cd) polymer. The formation of hybrid composite was validated with X-ray diffraction analysis (XRD), Raman spectroscopy, fourier transform infrared spectroscopy (FT-IR), X-ray photoelectron spectroscopy (XPS), and field emission scanning electron microscopy (FE-SEM) with EDX analysis. The formation of microspheres were observed with hexagonal crystal system and P63/mmc space group. Furthermore, the composite was employed to fabricate an efficient electrochemical sensor for detecting the widely used antibiotic, rifampicin (RIF). The results reveal excellent activity of the sensor with a limit of detection (LOD) of 28 nM in a linear working range from 0.019 to 374.5 μM. The sensor also exhibited a high sensitivity of 11.64 μA μM -1 cm -2 . Additionally, the sensor showed appreciable recovery range when monitored in real-samples such as human serum and urine, and industrial water, and fish samples., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background and Aims: Postoperative cardiac outcomes after intracardiac repair (ICR) are determined by numerous factors whereas right ventricle (RV) dysfunction is considered essential for them, as only few studies attempted to evaluate it postsurgically. RV's function is supposed to be the strong prognostic factor for patients diagnosed with congenital heart defects; therefore, assessing it is the main objective of the study., Methods: This is a prospective single-centered cohort study performed on 50 pediatric patients with congenital heart disease (CHD) who underwent ICR between January 2019 and January 2022. All patients underwent echocardiographic assessment of RV function via tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC) at 1, 24, and 48 h. After surgery, where pre- and postoperative RV pressure, cardiopulmonary bypass (CPB), and aortic cross-clamp (ACC) time were assessed. Similarly ventilation intensive care unit (ICU) and hospital stay times and mediastinal drainage were also monitored., Results: The mean ± standard deviation for pre- and postoperative RV pressure was 49.1 ± 16.12 and 42.7 ± 2.9 mmHg, respectively, whereas that for pre- and postoperative pulmonary artery pressure was 30.4 ± 2.6 and 24.2 ± 12.9 mmHg, with p value of <0.002 and <0.001, respectively. The mean ± standard deviation of CPB and ACC times was 120.92 ± 74.17 and 78.44 ± 50.5 min accordingly, while those for mean ± standard deviation of ventilation time, mediastinum chest drainage, ICU and hospital stays were 30.36 ± 54.04, 43.78 ± 46.7 min, 5.9 ± 4.01 h, were 30.36 ± 54.0, 43.78 ± 46.7 min, 5.9 ± 4.01 and 10.3 ± 4.83 h, respectively., Conclusions: RV dysfunction plays the important role in longer recovery and intraoperative time, while its effect is mostly transient. The use of TAPSE and FAC methods is valuable in the evaluation of postoperative outcomes, and the former proved to be more effective., Competing Interests: The authors declare no conflict of interest., (© 2022 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Application of synthetic fibres in composites has been raising environmental issues due to carbon emissions from the production site and reliability on non-renewable resources upon production. Hence, this research sets as a preliminary study to select suitable natural fibres to be hybridized with glass fibres for the development of sustainable and high-performance hybrid composites as potential alternative to conventional pultruded fibreglass composites in structural profile applications. In this study, analytical hierarchy process (AHP) was conducted to select the ideal natural fibre as reinforcement in the hybrid pultruded FRP composites suitable for structural applications. Hence, 13 natural fibre candidates were selected as alternatives and six criteria were chosen and analysed to select the best candidate for pultruded hybrid FRP. Criteria such as tensile strength, tensile modulus, density, cellulose content, elongation, and availability of fibres were assigned as the standard of selecting natural fibres for the application intended in this study. Among the 13 alternatives, kenaf was found to be the most suitable reinforcement for the application as it yielded the highest priority vector at 0.1. The results were then validated by carrying out sensitivity analysis to ensure kenaf is the most suitable material for the research.

Spinel structured aluminates TAl 2 O 4 (T = Mg, Zn, and Cu) were synthesized by a facile hydrothermal method. The resultant enhancement in the electrochemical behavior was achieved due to the covalent synergism among the elements coexisting together. Structural and morphological characterizations were performed by X-ray diffraction, Fourier transform infrared spectroscopy, Raman spectroscopy, and field emission scanning electron microscopy. MgAl 2 O 4 , ZnAl 2 O 4 and CuAl 2 O 4 has displayed same space group Fd3m of Laue class lattice type of the cubic structure as they were synthesized at same temperature (600 °C). CuAl 2 O 4 spinel structure displayed a nanoneedle like structure along with the small sized cylindrical particles alongside to which CuAl 2 O 4 spinel is combined with activated carbon (CuAl/C) and was applied to develop a facile sensor for the electrochemical detection of Acetaminophen (ACAP) using cyclic voltammetry (CV) and differential pulse voltammetry (DPV), which exhibited maximum conductivity, and a substantial electroactive surface area. Finally, the defect-rich composite, CuAl/C, showed excellent sensor performance towards DPV with 21.5 nM limit of detection (LOD) in a wide linear working range of 0.199 μM-165.88 μM ACAP concentration, with a high sensitivity of 19.1221 μA μM -1 cm 2 . Additionally, the sensor showed excellent recovery results in real-time analysis for environmental aquatic samples like industrial wastewater and Tuna Fish., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Cell lineage determination during mesenchymal stem cell (MSCs) differentiation is a highly orchestrated process involving diverse signaling pathways and distinct classes of regulatory molecules. Bone morphogenetic protein (BMP) signaling positively influence the osteoblast lineage determination, whereas the Notch signaling may have a dimorphic action. Effective regenerative therapy for repairing bone defects requires ample knowledge of the signaling pathways responsible for the differentiation of MSCs. To elucidate the signaling pathways that drives canine bone-marrow derived MSCs towards osteogenic lineage, the current work was focused on BMP and Notch signaling. Target genes of Runx2, Smad4 and γ-secretase were silenced by short hairpin RNA (shRNA) in canine MSCs. Evaluation of the effect of gene silencing on in-vitro osteogenic differentiation potential was done by quantitative polymerase chain reaction (qPCR) for osteoblastic markers (Osteocalcin and Osteopontin) and Alizarin red S staining for the extracellular deposition of calcium. Silencing of Runx2 significantly reduced the osteocalcin and osteopontin gene expression while a similar trend was observed in the case of smad 4 silencing and their combination groups, but there was no difference found in Hey 1 expression. Runx2 and Smad4 silencing groups showed very less positive staining with Alizarin red S staining, whereas knockdown of γ-secretase and its combination groups showed reverse results as that of Runx2 and Smad4. Runx2 plays an indispensable part in directing the canine mesenchymal stem cells towards osteogenic lineage. Also, Smad-mediated BMP signaling induced the osteoblast-specific gene expression, whereas the notch pathway negatively regulated the osteogenic differentiation of canine MSCs., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objective: To identify subgroups likely to benefit from monoclonal antibody and antiviral therapy by evaluating the relationship between comorbidities and hospitalization among US adolescents with symptomatic coronavirus disease 2019 (COVID-19)., Study Design: We analyzed the relationship between presence of comorbidities and need for hospitalization within 28 days of COVID-19 diagnosis for adolescents aged 12-17 years listed in the Pediatric COVID-19 US registry, a multicenter retrospective cohort of US pediatric patients with COVID-19. Comorbidities assessed included obesity, chronic kidney disease (CKD), diabetes, immunosuppressive disease or treatment, sickle cell disease (SCD), heart disease, neurologic disease/neurodevelopmental disorders, and pulmonary disease (excluding patients with mild asthma). We used multivariable logistic regression to determine race/ethnicity-adjusted associations between comorbidities and hospitalization., Results: A total of 1877 patients met our inclusion criteria, of whom 284 (15%) were hospitalized within 28 days of their COVID-19 diagnosis. In a race/ethnicity-adjusted model, the following comorbidities were independently associated with increased odds of hospitalization: SCD (aOR, 6.9; 95% CI, 3.0-15.9), immunocompromising condition (aOR, 6.4; 95% CI, 3.8-10.8), obesity (aOR, 3.2; 95% CI, 2.1-4.9), diabetes (aOR, 3.0; 95% CI, 1.4-6.2), neurologic disease (aOR, 2.8; 95% CI, 1.8-4.3), and pulmonary disease (excluding mild asthma) (aOR, 1.9; 95% CI, 1.2-3.1). Heart disease and CKD were not independently associated with hospitalization., Conclusions: SCD, immunocompromising conditions, obesity, diabetes, neurologic disease, and pulmonary disease (excluding mild asthma) were associated with hospitalization for symptomatic COVID-19. Adolescents with acute COVID-19 and these comorbidities should be prioritized for consideration of therapy to avert hospitalization., (Copyright © 2022 Elsevier Inc. All rights reserved.)

One of the challenges usually needs to be addressed in animal embryo production is to create the appropriate in vitro culture to improve blastocyst rate and produce high quality embryos. The present work was undertaken to investigate the impact of uterine epithelial cells and its conditioned medium (CM) on in vitro embryo production in buffalo. Buffalo uterine epithelial cells (UECs) were successfully isolated, cultured and characterized from slaughterhouse derived non gravid uteri. The well-characterized first passage UECs monolayer was exposed to steroid hormones (progesterone 3.14 ng/ml and estradiol-17β 5 pg/ml) supplemented fresh culture media and after 72 h conditioned media (CM) was harvested. Morula stage embryos were cultured in steroid supplemented modified synthetic oviductal fluid (mSOF-control), co-cultured with steroid treated UECs (T1) and CM of steroid treated UECs (T2). The attachment of single or clumps of variable sizes of UECs was observed after 24-48 h culture. The UE culture attained confluence with the formation of a tight, compact monolayer having the typical cuboidal shape in 7-8 days The UECs showed positive for cytokeratin and negative for vimentin expression on immunocytochemistry (ICC) and PCR assay. Blastocyst and hatching rate were evaluated on day 09 post IVF. Blastocyst rate in the T1 group was significantly higher (p < 0.05) followed by T2 than the control group. The hatching rate in both T1 and T2 groups were significantly higher (p < 0.05) as compared to control and no significant difference was observed between T1 and T2. Thus, it can be concluded that in vitro co-culture of embryos with steroid treated UECs and their CM improved the blastocyst rate as well as hatching rate. UECs and its secretions are essential to establish uterine receptivity and to mimic the internal in vivo environment., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Invasive aspergillosis (IA) remains a common cause of mortality in pediatric immunocompromised populations. Much of our knowledge of IA stems from adult literature. We conducted a retrospective evaluation of cases of proven or probable IA, defined according to the 2019 EORTC/MSG criteria, in patients with underlying immunocompromising conditions at Boston Children's Hospital from January 1, 2007 to January 1, 2019. We estimated survival curves over 12 weeks using the Kaplan-Meier method for all-cause mortality, and we used univariate Cox proportional hazards modeling to evaluate for mortality risk factors. We identified 59 cases, 29% with proven and 71% with probable IA. Pulmonary IA was the most common presentation (78%). The median age at diagnosis was 11 years (range, 0.5-28). Hematopoietic cell transplantation (HCT) was the most frequent predisposing underlying condition (41%). Among affected patients, 44.8% were neutropenic and 59.3% were lymphopenic at diagnosis. The 12-week all-cause mortality rate was 25.4%; HCT recipients comprised the majority of deaths (9/15) with a hazard ratio of 2.47 [95% CI, 0.87-6.95]. No patients with congenital immunodeficiencies (n = 8) died within 12 weeks of IA diagnosis. Other risk factors that were significantly associated with mortality included mechanical ventilation at diagnosis, intensive care unit stay, and lymphopenia; treatment with an Aspergillus-active azole was associated with decreased mortality.In conclusion, our study found that in pediatric immunocompromised hosts, IA is associated with a high 12-week all-cause mortality rate, with a particular impact on the HCT population., Lay Abstract: This study explores the epidemiology, outcomes and predictors of mortality of invasive aspergillosis (IA) at a high-volume pediatric center for immunocompromised hosts. Much of our understanding of pediatric IA is extrapolated from the adult literature. Our study found that IA is associated with a high 12-week all-cause mortality rate, with a particular impact on the hematopoietic cell transplantation study cohort., (© The Author(s) 2022. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology.)

Background: The prevalence of Gestational Diabetes Mellitus has been on the rise. With the dramatic increase in the prevalence of overweight, obesity, and inactivity amongst the population, it's becoming a common problem affecting antenatal women and their offspring., Subjects and Methods: A prospective cross-sectional study was carried out involving antenatal women between 24-28 weeks of gestation at a tertiary care centre in a rural part of Gujarat. Patients were screened using the Diabetes in Pregnancy Study Group India (DIPSI) guidelines. Analysis was carried out using Chi-square and ANOVA test., Results: Patients having PG2BS ≥140 mg/dl were diagnosed as having Gestational Diabetes Mellitus (GDM), while those having PG2BS values between 120-139 mg/dl were diagnosed as having Gestational Glucose Intolerance (GGI). Out of the 300 patients screened, we found an overall prevalence of 52 (17.33%) having GDM and 65 (21.67%) having GGI. Most patients belonged to the age bracket of 21-30 years across all groups. The prevalence of GDM in rural antenatal women was 23 (44.2%) and in semi-urban antenatal women was 25 (48.1%) while GGI in the rural antenatal women was 45 (69.2%) followed by semi-urban antenatal women 19 (29.2). We found that Occupation, Residence, Lifestyle, Socio-Economic Class, Family history of Diabetes Mellitus, Body Mass Index (BMI) were all statistically significant whereas Antenatal Complications and Perinatal outcomes weren't., Conclusion: With such a high prevalence of GGI, almost equivalent to GDM, it is important to identify patients having GGI and monitor them to prevent progression to GDM by starting an appropriate treatment modality., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Family Medicine and Primary Care.)

The COVID-19 pandemic continues to generate challenges for pediatric solid organ transplant (SOT) recipients and their families. As rates of COVID-19 fluctuate, new SARS-CoV-2 variants emerge, and adherence to and implementation of mitigation strategies vary from community to community, questions remain about the best and safest practices to prevent COVID-19 in vulnerable patients. Notably, decisions about returning to school remain difficult. We assembled a team of specialists in pediatric infectious diseases, transplant infectious diseases, public health, transplant psychology, and infection prevention and control to re-address concerns about school re-entry, as well as COVID-19 vaccines, for pediatric SOT recipients in the United States in 2021. Based on available literature and guidance from national organizations, we generated expert statements specific to pediatric SOT recipients focused on school attendance in 2021., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)