Search

Background Pulmonary arterial hypertension (PAH) is a progressive disease with high morbidity and mortality. Risk stratification and initiation of dual or triple combination therapy has a better clinical response, especially in high-risk patients. Unfortunately, prostacyclin analogues are not marketed in India; hence, the use of these medications is limited. We report the benefits and difficulties of using iloprost inhalation in patients with advanced PAH in India. Methods In this prospective observational study, we included patients with group 1 PAH. Inhaled iloprost was initiated as an add-on therapy for patients who had clinical, echocardiographic or laboratory deterioration on dual oral medications. Patients with clinical instability were excluded. All patients underwent thorough clinical evaluation, detailed echocardiogram and laboratory investigations. Patients were started on inhaled iloprost 2.5 μg six times daily and closely followed up. The dose was escalated if necessary. On follow-up, clinical echocardiographic and laboratory evaluation was done on all patients. Results Fourteen patients (11 women) with a median age of 32 years (2–66 years) with group 1 PAH were started on inhaled iloprost as an add-on therapy. Improvement in clinical parameters, WHO functional class, echocardiographic-derived right ventricular function, and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels were observed in 10 of 14 patients. A median increase of 31% (4.2, 106%) in the distance travelled during 6-minute walk test, a median increase of 45% (–20, 120%) in right ventricular fractional area change, a median increase of 27% (–16.7, 60%) in tricuspid annular peak systolic excursion and a median decrease of 36.7% (–69.6, 17.2%) in NT-pro-BNP levels were observed after initiation of medication. Three patients had progression of symptoms and were then referred for lung/heart–lung transplant. One patient developed progression of symptoms after an excellent initial response and transitioned to subcutaneous treprostinil. Improvement in clinical, echocardiographic and laboratory features allowed us to successfully perform surgical Potts shunt in 2 patients. The medications were well tolerated with minimal and transient side-effects. There were no deaths. Conclusion Inhaled iloprost can be used with acceptable benefits and minimal side-effects in patients with PAH.

Background:Surgical care for CHD is increasingly available in low- and middle-income countries, and efforts to optimise outcomes are growing. This study characterises cardiac imaging and prenatal diagnosis infrastructure in this setting.Methods:An infrastructure survey was administered to sites participating in the International Quality Improvement Collaborative for CHD. Questions regarding transthoracic, transesophageal and epicardial echocardiography, cardiac CT, cardiac magnetic resonance, prenatal screening and fetal echocardiography were included. Associations with in-hospital and 30-day mortality were assessed.Results:Thirty-seven sites in 17 countries responded. Programme size and geography varied considerably: < 250 cases (n = 13), 250–500 cases (n = 9), > 500 cases (n = 15); Americas (n = 13), Asia (n = 18), and Eastern Europe (n = 6). All had access to transthoracic echo. Most reported transesophageal and epicardial echocardiography availability (86 and 89%, respectively). Most (81%) had cardiac CT, but only 54% had cardiac magnetic resonance. A third reported impediments to imaging, including lack of portable machines, age/size-appropriate equipment and advanced cardiac imaging access and training. Only 19% of centres reported universal prenatal CHD screening in their catchment area, and only 46% always performed fetal echocardiography if screening raised concern for CHD. No statistically significant associations were identified between imaging modality availability and surgical outcomes.Conclusions:Although access to echocardiography is available in most middle-income countries; advanced imaging modalities (cardiac CT and magnetic resonance) are not always accessible. Prenatal screening for CHD is low, and availability of fetal echocardiography is limited. Imaging infrastructure in low- and middle-income countries and associations with outcomes merits additional study.

Neem (Azadirachta indica), a Meliaceae family member, is a rapidly growing tropical evergreen tree with a thick, branching trunk. It has been used for hundreds of years in traditional Indian medicine as a home cure against numerous human illnesses in the Indian and African continents. Different components of the plant, including the flowers, leaves, seeds, and bark, have been used to treat both acute and chronic human illnesses, as well as an insecticide, antibiotic, larvicidal, antimalarial, antibacterial, antiviral, and spermicidal. The plant's anticancer qualities have been extensively researched in terms of its preventative, protective, tumor-suppressive, immunomodulatory, and apoptotic actions against different cancers and their molecular processes. Triple-negative breast cancer (TNBC), which lacks the expression of progesterone and estrogen receptors, has a dismal prognosis and no viable therapeutic options. Gedunin compound isolated from Azadirachta indica's seed oil shows potential anticancer effect against triple-negative breast cancer (TNBC) cancer cells, which acts as heat shock protein 90 (Hsp90) inhibitor.

Sickle cell disease (SCD) is a genetic blood disorder that affects the shape and transportation of red blood cells (RBCs) in blood vessels, leading to various clinical problems. Several drugs are available for treating SCD, these medicines are insufficiently effective, toxic, or too expensive to be used. So there is a need to arise a safe, effective, and inexpensive therapeutic agent from indigenous plants used in ethnomedicines. SCD is affecting millions of people worldwide. Due to lack of progress in drug discovery and appropriate treatment methods, victims often turn to traditional Ayurvedic medicines that take advantage of the plant extracts. The use of complementary and alternative medicine (CAM) has been thought worldwide, most especially in patients with chronic diseases. SCD is one of such chronic diseases. Sickle cell anemia (SCA) has been treated for ages with natural products, especially herbs and Ayurvedic medicines worldwide. The proven medicines for sickle cell anemia includes, the use of hydroxyurea, folic acid and amino acids supplementation that manage the condition of blood transfusions and stabilize the patient’s hemoglobin level. But these clinical treatments are quite expensive and have attendant risk factors. As a research for medicinal plants into anti-sickling properties has been satisfy, so the alternative therapy of using phytomedicines has proven to reduce the crisis and reverse for sickling of RBC’s. As the use of medicinal plants and nutrition in managing SCD is gaining attention so the enormous benefits of phyto-medicine and nutraceuticals are discussed in this paper. Here in we have summarized the use of tradition Ayurvedic medicines in treating SCA.

Familial hypercholesterolemia (FH) is an autosomal dominant genetic disorder with a very high prevalence of almost 1 in 200-500 people. Genetic testings have commonly revealed mutations in genes namely LDLR, APOB, and PCSK9. In order to provide better management and minimize the risk of premature Coronary heart disease (CHD) in the affected people, early identification of FH in patients and screening of their first-degree relatives is recommended. In this paper, we present a rare case of a complicatedly related Indian family with a homozygous LDLR mutation detected in three members. The case study re-emphasizes the importance of screening for genetic mutations in patients with Hypercholesterolemia and also their immediate family members for better management, improving the quality of life, and increasing the life span. &nbsp

Objectives We describe the presentation, treatment and outcome of children with multisystem inflammatory syndrome with COVID-19 (MIS-C) in Mumbai metropolitan area in India. Methods This is an observational study conducted at four tertiary hospitals in Mumbai. Parameters including demographics, symptomatology, laboratory markers, medications and outcome were obtained from patient hospital records and analyzed in patients treated for MIS-C (as per WHO criteria) from 1 May, 2020 to 15 July, 2020. Results 23 patients (11 males) with median (range) age of 7.2 (0.8–14) years were included. COVID-19 RT-PCR or antibody was positive in 39.1% and 30.4%, respectively; 34.8% had a positive contact. 65% patients presented in shock; these children had a higher age (P=0.05), and significantly higher incidence of myocarditis with elevated troponin, NT pro BNP and left ventricular dysfunction, along with significant neutrophilia and lymphopenia, as compared to those without shock. Coronary artery dilation was seen in 26% patients overall. Steroids were used most commonly for treatment (96%), usually along with intravenous immunoglobulin (IVIg) (65%). Outcome was good with only one death. Conclusion Initial data on MIS-C from India is presented. Further studies and longer surveillance of patients with MIS-C are required to improve our diagnostic, treatment and surveillance criteria.

A number of guidelines are available for management of congenital heart diseases from infancy to adult life. However, these guidelines are for patients living in high income countries. Separate guidelines, applicable to Indian children, are required when recommending an intervention for congenital heart diseases, as often these patients present late in the course of the disease and may have co-existing morbidities and malnutrition. Guidelines emerged following expert deliberations at the National Consensus Meeting on Management of Congenital Heart Diseases in India, held on 10th and 11th of August 2018 at the All India Institute of Medical Sciences, New Delhi. The meeting was supported by Children’s HeartLink, a non-governmental organization based in Minnesota, USA. To frame evidence based guidelines for (i) indications and optimal timing of intervention in common congenital heart diseases; (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for congenital heart diseases. Evidence based recommendations are provided for indications and timing of intervention in common congenital heart diseases, including left-to-right shunts (atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus and others), obstructive lesions (pulmonary stenosis, aortic stenosis and coarctation of aorta) and cyanotic congenital heart diseases (tetralogy of Fallot, transposition of great arteries, univentricular hearts, total anomalous pulmonary venous connection, Ebstein anomaly and others). In addition, protocols for follow-up of post surgical patients are also described, disease wise.

Congenital portosystemic shunts (CPSS) are rare and present variably with hepatic encephalopathy, pulmonary arteriovenous malformations (PAVMs), and pulmonary hypertension (PH).The objective of the study was to see the feasibility of transcatheter closure of CPSS and their outcome.We analyzed the data of 24 patients of CPSS who underwent transcatheter closure from five institutions (March 2013 to April 2019). Baseline evaluation included echocardiography with bubble contrast study, ultrasound examination of the abdomen, computed tomography angiogram, and cardiac catheterization with test balloon occlusion of the CPSS. The evaluation showed cyanosis due to PAVM in 12, PH in 8, and respiratory distress in 2. Two had both cyanosis and PH. Criteria for eligibility for complete catheter closure of CPSS included demonstration of intrahepatic portal vein (PV) radicals together with a PV pressure of ≤18 mmHg on occlusion.The median age and weight were 8 years (0.5-21) and 19.5 kg (4.2-73), respectively. Transcatheter closure was performed in 21 patients (22 procedures) using a variety of occlusive devices and stent-graft exclusion was done in one patient. Closure was not done in 3 in view of high portal venous pressures and hypoplastic PVs. During the follow-up (median: 42 months and range: 61 days-4.8 years), saturation normalized in 14 patients with PAVM. PH declined in all eight patients who underwent the procedure. Respiratory distress improved in two patients.Early and short-term follow-up results of catheter closure of CPSS appear promising. However, further, follow-up is needed to demonstrate long-term effectiveness.

Falls in older adults can be prevented with early identification. Recent research investigates the use of wearable sensors to provide quantitative data on mobility parameters to assess risk of fall. However, the efficiency of these new methods in comparison to conventional fall risk assessment tools is unknown. Therefore, the current study compares the sensor-based fall risk assessment with conventional fall risk measures. The study included 659 community-dwelling older adults (>60 years) who were followed for 12 months after baseline. The American Geriatric Society Fall Risk Assessment tool was used to assess risk of fall conventionally and Kinesis QTUG was used to assess the fall risk using sensors. Receiver operating characteristics curve (ROC) was used to compare the sensor-based method and the conventional method of assessing fall risk. Out of the 659 community-dwelling older adults, 24% (163) of older adults reported a fall in 12 months. According to the sensor-based assessment, 23% of older adults had low risk, 50% had medium risk and 27% had high risk of fall and according to the conventional method 66.1% were in low risk, 27.1% were in medium risk and 6.8% were in high risk. The ROC analysis showed that the sensor-based methods (AUC-78%; sensitivity- 93.8% specificity – 56.3%) outperformed the conventional method (AUC – 61.2%; sensitivity – 82.8% and specificity - 67.2%) of identifying older adults at risk of fall. Therefore, use of simple wearable sensors can determine the risk of future falls.

An aortopulmonary window is known to be associated in 5% of interrupted aortic arch cases. The combination of these lesions with a bovine-type aortic arch is much more uncommon. We report its embryological explanation and successful single-stage surgical repair in a three-month-old infant.

Introduction: A number of guidelines are available for management of congenital heart diseases from infancy to adult life. However, these guidelines are for patients living in high-income countries. Separate guidelines, applicable to Indian children, are required when recommending an intervention for congenital heart diseases, as often these patients present late in the course of the disease and may have co-existing morbidities and malnutrition. Process: Guidelines emerged following expert deliberations at the National Consensus Meeting on Management of Congenital Heart Diseases in India, held on the 10th and 11th of August, 2018 at the All India Institute of Medical Sciences. Objectives: The aim of the study was to frame evidence-based guidelines for (i) indications and optimal timing of intervention in common congenital heart diseases and (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for congenital heart diseases. Recommendations: Evidence-based recommendations are provided for indications and timing of intervention in common congenital heart diseases, including left-to-right shunts, obstructive lesions, and cyanotic congenital heart diseases. In addition, protocols for follow-up of postsurgical patients are also described. Keywords: Congenital heart disease, Intervention, Surgery

The present paper aims to understand the fear of falling (FOF) and risk factors associated with FOF in community-dwelling individuals aged over 60 years in Pune, India. The study examined a random sample of 351 community-dwelling older adults. Data on demographic characteristics, health conditions, history of falls, and psychological factors were collected using a pre-tested, structured questionnaire. The Falls Efficacy Scale International (FES-I) was used to measure FOF. Univariate and bivariate logistic regression analyses were carried out to examine associations between various factors and FOF. A high FES-I score was significantly associated with older age, females, unmarried status, education less than 6 years, living alone, unstable balance and gait, hypertension, arthritis, previous falls, self-reported loss of confidence, and depression. Adults older than 70 years of age (odds ratio, OR = 2.411), those with a history of falls (OR = 2.285), those reporting loss of confidence in the past 6 months (OR = 6.766), who had answered yes to the direct question of FOF (OR = 4.632), and had unstable balance (OR = 2.522) were also more likely to have higher FES-I values. A large number of older adults expressed concerns about falling and we also found several factors to be associated with developing FOF, supporting the need for screening. Thus, further research is needed in order to understand the relationship between severity of FOF and actual fall events for developing preventive measures which can be implemented before FOF becomes a problem.

Cor triatriatum sinister is a rare congenital cardiac anomaly. It consists of a fibro-muscular membrane that separates the left atrium into two chambers resulting in a tri-atrial heart. It is often found in association with other structural cardiac anomalies. The "acquired" form is extremely rare and only anecdotal reports are found in literature. We describe a case of acquired cor triatriatum following surgical repair of coronary sinus type of total anomalous pulmonary venous connection (TAPVC), which presented 11 years after initial repair of TAPVC.

Background Potts shunt has been suggested as an effective palliative therapy for patients with pulmonary artery hypertension (PAH) not associated with congenital heart disease. Materials and methods This is a prospective single-center study performed to assess outcomes of Potts shunt in patients with PAH who are in functional class III or IV. Results 52 patients in functional class III/IV with pulmonary arterial hypertension without significant intra or extracardiac shunt on maximal medical therapy were evaluated and counseled for undergoing Potts shunt/patent ductus arteriosus (PDA) stenting. 16/52 patients (13 females) consented for the procedure; 14 patients underwent surgical creation of Potts, and 2 underwent transcatheter stenting of PDA, which physiologically acted like a Potts shunt. Standard medical therapy was continued in patients who did not consent for the procedure. 12/16 patients survived the procedure. Patients who did not survive the procedure were older, with severe right ventricular systolic dysfunction, and functional class IV. Patients who survived the procedure were followed up in the pulmonary hypertension clinic. The Median follow-up was 17 months (1–40 months). 11/13 patients discharged after the operation showed sustained clinical, echocardiographic, and biochemical improvement, which reduced need for pulmonary vasodilator therapy in 10/13 patients. There was one death in the follow-up period 16 months post-surgery due to lower respiratory tract infection. Conclusion Potts shunt is feasible in patients with PAH without significant intra or extracardiac shunts. It can be done safely with an acceptable success rate. Patient selection, preoperative stabilization, and meticulous postoperative management are essential. It should be performed at the earliest sign of clinical, echocardiographic, or laboratory deterioation for optimal outcomes. Long-term follow-up is required to see a sustained improvement in functional class and the need for a lung transplant in the future.

Objective Abernethy malformation (congenital extrahepatic portosystemic shunt) is a rare anomaly of the splanchnic venous system. Though rare, it is an important cause of pulmonary artery hypertension (PAH) which is often missed. All patients with PAH should be carefully evaluated for presence of Abernethy malformation before labelling them as Idiopathic PAH. Methods This is a retrospective analysis of prospectively collected data. We reviewed the data of all patients referred to our center for evaluation of PAH. 10 patients were diagnosed to have an extrahepatic portocaval malformation. We reviewed their presentation, diagnosis, catheterization data, intervention and their outcome along with review of literature. Results 10/104 patients with pulmonary hypertension and no intra or extracardiac shunt were found to have extrahepatic portocaval shunt (EHPCS). 3 patients had EHPCS type 1 and 7 had type 2 EHPCS. 6/7 patient with EHPCS type 2 underwent closure of the shunt. There was no procedure related complication. There was one death 3 months post procedure and one patient who was advised surgical closure was lost to follow up. Closure of the shunt resulted in normalization of the pulmonary artery pressures in 4/5 patients. Conclusion Congenital portosystemic malformations form an important and potentially treatable cause of pulmonary hypertension.

Background An unstable gait pattern is an indicator of an increased risk of falls among older adults. Data on basic gait parameters is useful in the early identification of gait impairment. However, reference gait measurements are not available in low- and middle-income countries. Research question What are the normative reference values of gait parameters and do fall risk factors such as impaired balance, functional difficulty, and multimorbidity affect the gait patterns of older adults in India? Methods A cross-sectional data of 659 older adults were collected using a semi-structured schedule. Gait parameters were measured using wearable sensors. Descriptive statistics, independent t-test, and one-way ANCOVA were used to determine the significant difference (p Results A mean stride length of 123.00 ± 15.19 cm, stride velocity of 110.57 ± 17.57 cm/s, and a cadence of 106.14 ± 11.44 steps/minute were reported in the study. Functional difficulties and balance impairment were the two major risk factors that affected stride velocity, stride length, and cadence after adjusting for age and height. No difference in gait parameters was observed among participants with and without multimorbidity. Significance This study provides a baseline or reference values of various gait parameters measured on a large sample of population aged 60 and above from India. Assessment of gait patterns and associated risk factors in a clinical setup will help identify the older adults at risk of falls and reduce the enormous burden of fall injuries. Since gait parameters show a large variation across geographical regions, it is important to have region-specific reference values.

Many historical documents and letters are written in MODI script. Study of “Shivakalin” and “Peshvekalin” era documents is almost impossible without the knowledge of MODI script. This work aims to bridge the gap between Devanagari and MODI Script by developing a system to map the recognized MODI characters to its Devanagari equivalent. Our dataset would comprise 57 different classes of MODI Script characters. The various approaches for feature extraction usually used include moment invariant, affine moment invariant, chain code histogram, intersection junction and for character classification include SVM and KNN classifiers. Deep Neural Networks on the other hand do not require any feature to be explicitly defined, instead they work on the raw pixel data to generate the best features and use them to classify the inputs into different classes. Hence, we propose a deep learning architecture for character recognition. CNN uses little pre-processing compared to other image classification algorithms. This means that the network learns the filters which in traditional algorithms were hand-engineered. The system aims to provide a good recognition rate by implementing CNN.

System records the behavior and patterns of surfing of customers on websites. These records then mine and this will be used to identify their behavioral pattern through web mining. Ecommerce websites evaluate this data with the purpose of giving better services and also recommend improved options of products and services to customers. This system is customized to note down e-shopping and patterns of buying and track various data analytics features. The system noted down different factors like, stickiness, age of the user, product category, the day for purchasing and other site usage factors. Ecommerce sites have to review and mine for recorded data to monitor their website performance and frequently enhance it as per customer necessities or demands.

Purpose Inadequate research on midlife health-related quality of life particularly in low-and-middle-income countries has often led to poor recognition of the issues in health programmes and policy. To address these concerns, this study was aimed at examining health-related quality of life and its determinants in middle-aged (45–59 years) men and women in low-resource settings in India. Methods Data on health-related quality of life and other relevant parameters were collected from 1112 individuals between 45 and 59 years of age from an urban agglomeration of Pune, India. Independent t-test was used to determine the association between means of Short Form-12 and other variables. Multilinear regression analyses were conducted to study the direction of these associations. Results The mean physical and mental component scores were 45.33 (±8.88) and 51.48 (±9.87), respectively. After adjusting for other variables, functional impairment emerged as a common factor that was negatively associated with physical and mental component scores of men (PCS: −5.557, 95%CI = −6.793 to −4.322; MCS:−1.816, 95% CI = −3.443 to −0.189) and women (PCS: −7.985, 95%CI = −9.782 to −6.188; MCS; = −2.289, 95% CI = −4.160–0.419). Good life satisfaction was positively associated with physical scores in men (2.300, 95%CI = 1.180 to 3.421) and mental scores in women (3.066, 95%CI = 1.333 to 4.798). Unemployment, sitting hours (>3) and no physical activity affected men, while lower education, marital status, body mass index and chronic illness affected health-related quality of life of women at midlife. Conclusions Functional decline, level of life satisfaction and stress affected health-related quality of life of middle-aged individuals in India.

Present study focuses on comparison between the efficacies of jigsaw and snowball methods active learning.An interventional study was conducted among first year medical undergraduates. Overall, 167 studentsstudied by jigsaw method and 173 students studied by Snowball method. To study the preferences of studentsbetween Jigsaw and Snowball metSelf-directed learning, Jigsaw method, Snowball method, Physiology.hod a structured questionnaire using five point likert scale was used. Boththe method significantly improved the knowledge of students. Overall response based on the questionnaireabout jigsaw method was positive. Students found it to be simple, enjoyable and effective means of learning.

BackgroundHypertension in children is often under recognized, especially in developing countries. Data from rural areas of developing countries is particularly lacking.ObjectivesTo study prevalence of hypertension and its determinants in apparently health school children from predominantly rural populations of India.MethodsApparently healthy schoolchildren ( n = 14,957) aged 5–15 years (mean (standard deviation) age 10.8 (2.8) years; 55.5% boys) at four predominantly rural sites in separate states of India were studied. Systolic and diastolic blood pressures were recorded by trained staff in addition to age, gender, height, weight, type of school and season. Waist circumference was also recorded in 12,068 children. Geographic location and type of school (government, government-aided or private) were used to determine socio-economic status.ResultsSystolic and/or diastolic hypertension was present in 3443 (23%) children. Systolic hypertension was present in 13.6%, diastolic hypertension in 15.3% and both in 5.9%. Isolated systolic hypertension was present in 7.7% while isolated diastolic hypertension was present in 9.4%. On univariate analysis, age, gender, geographical location, socio-economic status, season and anthropometric parameters (z-scores of height, weight and waist circumference, waist/height ratio and body mass index) were all significantly related to risk of hypertension ( p ConclusionThere is a high prevalence of hypertension in apparently healthy schoolchildren even in predominantly rural areas of India. Screening and management programs targeted to high risk groups identified may prove cost-effective.

Background: Native aortic coarctation in young infants can be treated surgically or with balloon angioplasty, although the latter approach remains controversial. We sought to compare midterm outcomes of balloon and surgical coarctoplasty at our center and to review the current practices in literature. Methods: The study design was a retrospective record review. Patients with coarctation aged 6-month post-procedure follow-up were studied. Patients with significant arch hypoplasia or interruption, long-segment coarctation, and associated intracardiac lesions were excluded from the study. Clinical, echocardiographic, and procedural details were recorded at initial presentation and follow-up. Need for reintervention was noted. Results: Out of a total of 75 patients, 28 underwent balloon (Group A) and 47 underwent surgical coarctoplasty (Group B). There were two deaths in Group B (mortality 4.2%) and none in Group A. In neonates, 63.6% of Group A and 17.4% of Group B patients required reintervention (P = 0.007). Beyond the neonatal age, 29.4% of Group A and 41.6% of Group B patients required reintervention (not statistically significant). On univariate analysis, residual coarctation on predischarge echocardiogram was the only significant predictor of reintervention (P = 0.04). On Kaplan–Meier analysis, with neonatal presentation, freedom from reintervention in Group B was significantly higher than Group A (P = 0.028). Conclusion: In neonates with native aortic coarctation, surgery unequivocally yields better immediate and midterm results and is the preferred treatment modality. In older infants, balloon coarctoplasty has good early and midterm outcomes with acceptable reintervention rates and should be considered a viable alternative to surgery, especially in critical patients with high surgical risk.

Cardiac catheterization is important in the diagnosis and risk stratification of pulmonary hypertensive vascular disease (PHVD) in children. Acute vasoreactivity testing provides key information about management, prognosis, therapeutic strategies, and efficacy. Data obtained at cardiac catheterization continue to play an important role in determining the surgical options for children with congenital heart disease and clinical evidence of increased pulmonary vascular resistance. The Pediatric and Congenital Heart Disease Task Forces of the Pulmonary Vascular Research Institute met to develop a consensus statement regarding indications for, conduct of, acute vasoreactivity testing with, and pitfalls and risks of cardiac catheterization in children with PHVD. This document contains the essentials of those discussions to provide a rationale for the hemodynamic assessment by cardiac catheterization of children with PHVD.

Extremophiles, especially alkaliphiles, are the group of microorganisms growing optimally at or above pH 9. These organisms have been isolated from various alkaline niches such as soda lakes, soda deserts, etc. Out of those, Rift Valley, Wadi Natrun, and Lonar Lake are extensively studied. The microorganisms found are adapted to these alkaline habitats through pH homeostasis in which various cell membrane proteins are involved. Many researchers throughout the globe have explored these extreme habitats for isolation of novel alkaliphiles, alkalithermophiles belonging to various phyla such as Firmicutes, Gammaproteobacteria, Actinobacteria, Archaea, etc. Advancement in molecular biology technique leads to study diversity by culture independent methods such as metagenomics and genome sequencing. Many novel phyla described through this process are Cytophaga/Flavobacterium/Bacteroides, Planctomycetes, Cyanobacteria, Spirochaeta, etc. This vast diversity of alkaliphiles harbors a great biotechnological potential in production of industrially important enzymes, antibiotics, exopolysaccharides, and polyhydroxyalkanoates. Thus, one has to conserve these pristine habitats to preserve the wealth of microbes in future.

INTRODUCTION: Delayed sternal closure is used in paediatric cardiac surgery as a management strategy for patients with unstable hemodynamics or postoperative bleeding routinely. We hypothesise that planned postponement of sternal closure leads to better outcomes than emergent reopening in the intensive care unit (ICU) in patients exhibiting some hemodynamic indication for the same. METHODS: We retrospectively analysed the outcomes of delayed sternal closure 220/2111 (10.42%) out of which 14 sternums were opened in the ICU after shifting the patients. RESULTS: A total of 220/2111 (10.42%) sternums were left open postoperatively, out of which 14 were opened after shifting to the ICU. Total mortality of the delayed sternal closure was 33/220, i.e. 15%. The patients whose sternums were left open from the theatre had a mortality of 23/206, i.e. 11.16%, whereas those patients whose sternums were opened in the ICU had a mortality of 10/14, i.e. 71.42%. CONCLUSION: In doubtful postoperatively hemodynamic, the choice of leaving the sternum open electively has better outcomes, rather than opening the sternum as a terminal bail out procedure.

Introduction There are few published studies on reference ranges of ECG parameters in children; some ethnic differences have been described. Methods We studied digital 12‑lead ECGs (1000 samples/s) from 906 healthy rural Indian children (467 boys: 439 girls) aged 5–15 years. PR, QRS, and QT were measured using superimposed median beat. Age-wise normal limits (median, 2nd and 98th percentile) were defined. Results Heart rate decreased while PR interval and QRS duration increased with age. QTcB interval remained unchanged from 5 to 12 years and decreased thereafter due to QTcB shortening in boys but not in girls. “Juvenile T wave pattern” was seen in 95% of children aged 5–8 years in lead V1 and 55–60% in V2, V3; it decreased with age. RV dominance (R/S > 1) in lead V1 was seen in 13% at 5 years, 1% at 10 years and none at 14 years. Conclusion Reference ranges in Indian children are similar to those in other ethnic groups.

A 14-day-old neonate presented with severe left ventricular outflow tract obstruction (LVOTO) and type B interrupted aortic arch. The child underwent a neonatal Ross Konno with interposition graft for arch reconstruction.