bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fontan procedure on deep hypothermic circulatory arrest
Authors: Malankar Dhananjay P , Mali Shivaji , Dhake Shyam , Mhatre Amit , Bind Dilip , Soni Bharat , Kandavel Dinesh , Raj Jinil , Patel Parvez , Garekar Swati 
Published: November 2022

ABSTRACT

Background :
Various operative strategies are described for the Fontan procedure. In this study, we describe our short-term results and technique of Fontan procedure on cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA).

Methods :
This was a retrospective study of 32 patients, median age of 6 years (4–19 years) and median weight of 20 kg (13–51 kg), who underwent Fontan procedure on CPB and DHCA from July 2016 to July 2021.

Results :
The median CPB time was 125 min (77–186 min), the median DHCA time was 42 min (27–50 min), and the median Fontan pressure was 14 mmHg (10–18 mmHg). The median time to extubation was 4 h (1–20 h), the duration of chest tube drainage was 8 days (5–24 days), and the median intensive care unit stay was 4 days (3–8 days). The presence of heterotaxy was associated with longer duration of pleural drainage (P = 0.01). There was no operative mortality and no major adverse events such as seizures, gross neurological deficits, or arrhythmias in the postoperative period.

Conclusions :
Fontan procedure can be safely performed on CPB and DHCA with good operative results. This operative strategy may be used in special circumstances like in patients with situs and systemic venous anomalies and those requiring repair of a complex intracardiac defect. Long-term follow-up will be required to evaluate if this strategy has any impact on the neurodevelopmental outcome and the long-term sequelae of Fontan.
Strategies to mitigate inflammation in management of complex congenital heart disease complicated by “multisystem inflammatory syndrome in children”
Authors: Kumar Anil , Joshi Reena K. , Aggarwal Neeraj , Ray Mily , Joshi Raja 
Published: November 2022

ABSTRACT
A 6-month-old boy, a case of Shone's complex, presented in decompensated state was found to have severe mitral stenosis along with multisystem inflammatory syndrome in children (MISC) warranting urgent surgical intervention. Various modalities including cytokine-adsorbing hemofilter were used to target inflammation. Postoperatively, the child recovered from low cardiac output accompanied by decrease in the levels of inflammatory markers, inopressors, and ventilatory requirements. Open heart surgery in itself is a proinflammatory process and is best avoided during the active inflammatory phase of MISC. In the rare and unavoidable circumstance exemplified by this index case, multipronged strategy targeting inflammation as described can be successfully implemented.
Outcomes of primary repair of sternal cleft defects
Authors: Jaytesh Parashar , Joshi Reena K. , Aggarwal Neeraj , Joshi Raja 
Published: November 2022

ABSTRACT

Background :
Sternal clefts are rare congenital anterior chest wall defects created by a lack of midline thoracic fusion. Various surgical repairs have been proposed to provide protection to underlying viscera in these defects.

Aim :
This study aims to perform primary sternal cleft repair using techniques, leading to the provision of a complete bony cover and to assess their outcomes on follow-ups.

Materials and Methods :
During 2009–2020, seven patients were referred to our unit with sternal defects. Out of them, four infants with sternal clefts underwent primary repair using bilateral perichondrial flap creation of the sternal bars and sliding costal chondrotomy at our institute. In one of them with a wider defect, bilateral “intraperiosteal” sliding clavicular osteotomy was additionally performed to achieve tension-free closure.

Results :
Satisfactory surgical outcomes were achieved with an uneventful postoperative period. On follow-up, all four patients are thriving well and have a stable anterior chest wall. Those with follow-ups longer than 5 years showed evidence of bone formation.

Conclusion :
Bony cover to the heart can be provided in all varieties of sternal cleft defects using primary surgical repair early in infancy. The delay in surgical correction increases the complexity of the procedure and may require the use of prosthetic material which has its own disadvantages.
Is there an association of near-infrared spectroscopy with low cardiac output and adverse outcomes in single-ventricle patients after stage 1 palliation?
Authors: Doctor Pezad , Aggarwal Sanjeev , Garcia Richard 
Published: November 2022

ABSTRACT

Objective :
Our primary objective study was to evaluate the association between near-infrared spectroscopy (NIRS) and low cardiac output (LCO) in patients with single-ventricle physiology after stage 1 palliation.

Methods :
In this retrospective study, infants ≤6 months of age with single-ventricle physiology who underwent stage 1 palliation were included. Cerebral and renal NIRS values at various time intervals after surgery were compared between patients with low and normal cardiac output. LCO within the first 48 after surgery was defined as per the pediatric cardiac critical care consortium database. NIRS values were also compared with other adverse outcomes such as cardiac arrest, need for extracorporeal membrane oxygenation and mortality. The receiver operative characteristic curve was generated to determine an optimal cut-off NIRS value for detecting LCO.

Results :
Ninety-one patients with median (Interquartile range) age of 10 days (6–26) and weight of 3.3 kg (3–3.5) were included in the study. Cerebral NIRS at 1 h (41.2 vs. 49.5; P = 0.002), 6 h (44 vs. 52.2; P = 0.001), and 12 h (51.8 vs. 56; P = 0.025) was significantly lower in the grouP with LCO compared to no LCO. Cerebral NIRS at 6 h was independently associated with LCO (P = 0.018), and cerebral NIRS at 6 h ≤57% had 91% sensitivity and 72% specificity to detect LCO.

Conclusions :
Cerebral NIRS ≤57% at 6 h after surgery detected LCO after stage 1 palliation in single-ventricle patients. Cerebral or renal NIRS was not associated with adverse outcomes and therefore, may not be useful in predicting adverse outcomes in this population.
A two-dimensional speckle-tracking echocardiography for the diagnosis of early myocardial disease in beta-thalassemia major patients
Authors: Tantawy Azza Abdel Gawad , Elsherif Nayera H. K. , Habeeb Neveen M. , Hasan Esraa M. , Abdelhameed Abdelhameed E. 
Published: November 2022

ABSTRACT

Background :
Although magnetic resonance imaging T2* is considered the gold standard to assess myocardial iron overload in β-thalassemia patients, its routine use is limited by the high cost and limited availability. Recent data demonstrated that strain imaging by speckle tracking is a sensitive tool for early assessment of the left ventricular myocardial dysfunction. This study aims to evaluate the clinical utility of two-dimensional (2D) speckle-tracking echocardiography (STE) for the detection of early myocardial disease in beta-thalassemia major (β-TM) patients

Materials and Methods :
2D STE, magnetic resonance imaging (MRI) heart T2* and MRI liver iron content were done for 30 β-TM patients with no clinical heart disease, compared to 2D STE in 30 healthy age- and sex-matched controls.

Results :
There was a significant reduction in the longitudinal systolic strain values by STE among β-TM patients compared to controls (P = 0.05). A longitudinal peak systolic strain cutoff values of ≤-19 was able to detect β-TM patients having subclinical cardiac iron overload by MRI T2* (sensitivity = 90%–93.3%, specificity = 83%–100%). Mean serum ferritin in the past 2 years correlated negatively to longitudinal systolic strain values global longitudinal peak systolic strain average (P = 0.05).
Renal oncocytoma in a 13-year-old girl: A case report and literature review
Authors: Wei Xia , Wang Yizhen , Fang Yuan , Chen Lian 
Published: November 2022

ABSTRACT
Renal oncocytoma is a benign renal neoplasm which has mostly been reported in adults. Occurrence in children is infrequent. To date, there are only six pediatric cases of renal oncocytoma reported previously. Herein, we report a 13-year-old girl presented with hematuria for a week. Abdominal computed tomography showed a well-defined heterogeneous solid mass with a stellate central scar in the left kidney. The patient underwent a nephron sparing surgery. Histopathological and immunohistochemical findings confirmed the diagnosis of renal oncocytoma. Though uncommon, renal oncocytoma should be considered as the differential diagnosis of renal tumor in children. In addition, intranuclear inclusions were firstly described in this pediatric patient with unclear significance, which need a large cohort to summarize and analyze.
Syphilis in the era of re-emergence
Authors: Jeevanandham Palanisamy , Ambooken Betsy , Asokan Neelakandhan , Salam Sarin Abdul , Venugopal Renu 
Published: November 2022

Background:
During the last several years, we have observed a rise in the number of patients with syphilis in our center.

Aims:
To find out the trends in the presentation of syphilis to our clinic over a 6-year period and to analyze the clinicoepidemiological features of those patients.

Settings and Design:
A retrospective chart review.

Subjects and Methods:
We analyzed the case records of all cases of syphilis registered in our sexually transmitted infection (STI) clinic from October 1, 2012, to September 30, 2018. Syphilis was diagnosed based on clinical or serological evidence. We also evaluated these patients for any concomitant STI, including hepatitis B, hepatitis C, and HIV.

Statistical Analysis Used:
The data were analyzed using SPSS software (version 20). Chi-square test was done for comparing categorical data, and P < 0.05 was considered statistically significant.

Results:
During the study period, 215 patients with STI attended our clinic. Of these, 66 (31%) patients had acquired syphilis. Among them, 3 (4.5%) had primary syphilis, 23 (34.8%) had secondary syphilis, and 40 (60.6%) had latent syphilis. Fifteen (22.7%) patients had concomitant HIV infection. A statistically significant rise in the number of cases of syphilis compared with other STIs was noted in the latter half of the study period (P = 0.001). Among the 50 males with acquired syphilis, 29 (58%) were men having sex with men (MSM), including 19 bisexual persons. Among the five antenatal cases, two were detected very late in pregnancy.

Conclusions:
We observed a marked increase in the number of cases of syphilis during the latter half of the study period. Primary and secondary syphilis were more frequent among MSM, suggesting a need to strengthen targeted intervention programs among them. More rigorous antenatal screening is necessary to prevent congenital syphilis.
Prevalence of nonviral reproductive tract infections/sexually transmitted infections in female patients with cervicovaginal discharge
Authors: Sethi Sunil , Sharma Nandita , Sharma Megha , Dadwal Rajneesh , Singh Charu , Chaudhary Hemant , Malhotra Sakshi , Yadav Rakesh , Gupta Vanita 
Published: November 2022

Background:
To study the prevalence of common nonviral reproductive tract infections/sexually transmitted infections (RTI/STI) prevailing among females who presented to our regional STI reference center and to ascertain the association of various symptoms with different RTI/STIs.

Materials and Methods:
A retrospective analysis of female patients presenting to our STI Regional center located in the Department of Medical Microbiology in PGIMER, Chandigarh, was done between April 2018 and December 2019 for patients presenting with cervico-vaginal discharge. Two to three swabs were collected from each patient. The first swab was subjected to wet mount, gram stain, Potassium hydroxide (KOH) test, and culture on blood agar, the colonies obtained were identified by matrix-assisted laser desorption time of flight mass spectrometer (MALDI TOF-MS). Second swab was used for DNA extraction and detection of Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV), and Chlamydia trachomatis (CT) by polymerase chain reaction. The third swab, when available, was inoculated onto pleuropneumonia-like organisms (PPLO) broth.

Results:
One thousand and thirteenth of 1472 (69%) female patients were symptomatic and the most common presenting symptoms were vaginal discharge (707/1013 [69.8%]), infertility (266/1013 [26.2%]), genital itching (60/1013 [5.9%]), lower abdomen pain (47/1013 [4.6%]) and burning micturition (16/1013 [1.6%]). The most prevalent RTI/STI was bacterial vaginosis (BV) 18.2% (269/1472), followed by vulvovaginal candidiasis (VVC) 6.8% (100/1472) and trichomoniasis (TV) 1.9% (28/1472). Five cases each of Mycoplasma genitalium and Ureaplasma urealyticum, three of NG and one of CT were also identified. Coinfections were seen in 40 (2.7%) cases. The most common causative agent responsible for VVC in our study was Candida albicans (65%).

Conclusion:
RTI/STIs were common among women and 69% were symptomatic. BV was the most common STI present in 18.2%, followed by VVC (6.8%) and trichomoniasis (1.9%).
Female sexual dysfunction
Authors: Shenoi Shrutakirthi Damodar , Prabhu Smitha S. 
Published: November 2022

Introduction:
Female sexual dysfunction (FSD) is a much-neglected area of medicine possibly due to the stigma attached to sexual functioning in most religions and cultures.

Materials and Methods:
Here, we report a case series of 12 females with FSD from the data collated from the sexual dysfunction clinic of a tertiary care hospital in South India.

Results:
Of the 370 patients who were seen in the sexual dysfunction clinic, only 12 (3.24%) were women aged from 22 to 58 years with a duration of marriage 3 months to 25 years. The commonly encountered problems were dyspareunia and hypoactive sexual disorder. Three had nonconsummated marriages. After evaluation, two patients were treated with antipsychotics and all were offered psychosexual counseling.

Conclusion:
Female sexual dysfunction remains unrecognized and under reported, especially in patriarchal cultural societies of the Indian subcontinent.
Development and Assessment of SCI Model Systems Complicated UTI Consensus Guidelines: A Psychometrically Designed Mixed-Methods Protocol
Authors: Tractenberg Rochelle E. , Groah Suzanne L. 
Published: November 2022

Background
Complicated UTI (cUTI) is highly prevalent among people with spinal cord injury and disease (SCI/D), but neither consistent nor evidence-based guidelines exist.

Objectives
We propose a two-phase, mixed-methods study to develop consensus around diagnostic and decision-making criteria for cUTI among people with SCI/D and the clinicians who treat them.

Methods
In phase 1 (qualitative), we will engage Spinal Cord Injury Model Systems (SCIMS) clinicians in focus groups to refine existing cUTI-related decision making using three reliable and validated Urinary Symptom Questionnaires for Neurogenic Bladder (USQNBs; intermittent catheterization, indwelling catheterization, and voiding) as points of departure, and then we will conduct a Delphi survey to explore and achieve consensus on cUTI diagnostic criteria among a nationally representative sample of clinicians from physical medicine and rehabilitation, infectious disease, urology, primary care, and emergency medicine. We will develop training materials based on these new guidelines and will deploy the training to both clinicians and consumers nationally. In phase 2 (quantitative), we will assess clinicians’ uptake and use of the guidelines, and the impact of the guidelines training on consumers’ self-management habits, engagement with the health care system, and antibiotic use over the 12 months after training.

Results
The output of this study will be diagnostic guidelines for cUTI among people with neurogenic lower urinary tract dysfunction (NLUTD) due to SCI/D, with data on uptake (clinicians) and impact (patients).

Conclusion
This mixed-methods protocol integrates formal psychometric methods with large-scale evidence gathering to derive consensus around diagnostic guidelines for cUTI among people with NLUTD due to SCI/D and provides information on uptake (clinicians) and impact (patients).
LIVABILITY, GROWTH AND DEVELOPMENT OF REPLACEMENT HEIFERS OF RED DAIRY BREEDS
Authors: TIMOSHENKO V. N. , SHEIKO I. P. , PESOTSKY N. I. , BEREZOVIK R. V. , KORONETS I. N. , VOROBYEVA T. A. , ROGACH V. N. 
Published: November 2022

The article contains the materials of research, the purpose of which was to study the livability, growth and development of replacement heifers of red dairy breeds. The object of research were purebred cows and young replacements of Holstein and red
dairy breeds. Studies have shown that under the same industrial housing conditions, replacement heifers of red dairy breeds aged from 6 months to the first insemination are considerably superior to their counterparts of Holstein breed in live weight and average daily weight gain. Their first insemination came 0.7 months earlier than that of their Holstein counterparts. The rate of withdrawal from the herd due to breeding culling in heifers of red dairy breeds was lower compared to their Holstein counterparts.
CALIBRATION FREE LIBS FOR THE DETERMINATION OF Mn/Fe RATIO IN FERROMANGANESE NODULES WITH PORTABLE DIODE PUMPED SOLID STATE LASER
Authors: Akhmetzhanov T. F. , Drozdova A. N. , Popov A. M. 
Published: November 2022

The Mn/Fe ratio, which serves as a marker of the content of rare earth elements and the platinum group elements in ferromanganese nodules, was determined in samples taken during expeditions to the Kara Sea and the Laptev Sea, as well as in a set of certified reference materials (ОOPE 601—604). The analysis was carried out by calibration-free laser-induced breakdown spectroscopy, based on the use of plasma parameters and intensities of analytical lines of manganese and iron (Mn I 542.04 nm and Fe I 539.71 nm). Boltzmann plot was used to determine the plasma temperature and Stark broadening of Fe I line 538.34 nm was used to determine electron density. We have shown the possibility of determining the Mn/Fe ratio in range
from 0.2 to 4.2 in ferromanganese nodules of various geographic origin. A high coefficient of linear determination (R2 = 0.938) and proportionality between the results of calibration-free laser-induced breakdown spectroscopy and inductively coupled plasma atomic emission spectrometry (1:0.99) were achieved.
THERMALLY INDUCED BIREFRINGENCE AND MODE SELECTION IN CAVITY OF PASSIVELY Q-SWITCHED DIODE PUMPED Nd:YAG LASER
Authors: Bogdanovich M. V. , Grigor’ev A. V. , Dudikov V. N. , Ryabtsev A. G. , Ryabtsev G. I. , Tatura P. O. , Shpak P. V. , Shchemelev M. A. 
Published: November 2022

Operating regimes of an optical system consisted of compact pulsed master diode-pumped Q-switched Nd:YAG laser and triple-crystal (KTP) ring cell of the optical parametric oscillator have been investigated. It has been experimentally shown that frequency-selective properties of a passive Q-switched unit in the “natural mode selection” are enhanced by creating a polarization interference filter Lyot with the phase plate in the form of a laser active element with the thermally induced birefringence and a polarizer. Such filter Lyot appears in the Nd:YAG laser cavity during operation at relatively high energy and repetition rate of radiation pulses (60–100 mJ, 20 Hz). The combined action of the “natural mode selection” process and the Lyot filter ensures the stable operation of a passive Q-switched Nd:YAG laser in the single frequency lasing mode (the lasing bandwidth is less than 57 MHz). The master single frequency pulsed Nd:YAG laser (λ = 1.06 μm) allows reducing the energy of pulses applied to the input of the optical parametric oscillator by more than 1.5 times while maintaining the specified energy level of the output pulses (30 mJ, λ = 1.57 μm). An additional increase in the efficiency of the optical parametric oscillator conversion is achieved by introducing
a two-lens 1.3x telescope into the master laser cavity.
Pneumonia Detection Using Novel Deep Learning Techniques
Authors: Chandrashekhara K T, Thungamani M  
Published: November 2022

Pneumonia is one of the leading infectious disease that can kill children and elderly people around the world. The development of an automated system to detect pneumonia would be advantageous, especially to enable treatment of this disease in remote areas without much delay. pneumonia is an lung infectious disease which mainly affects the small air sacs known as alveoli. The main symptoms of pneumonia includes cough, fever and breathing problems . Aged people, children and persons who have medical problems are the main victims of this disease. Around 450 million people are affected by this disease on an average of each and every year. The most commonly used technique for diagnosing this disease is chest X-ray imaging. Chest X-ray examination is complex procedure to detect the disease because it involves lots of vulnerabilities. With latest advances in technologies we can use deep learning algorithms to detect the disease using chest x ray images. To deal with the scarcity of data, we used Deep Transfer Learning and designed the Hybrid Algorithms. The images of the chest X-rays were fed into the individual algorithms for training purposes. Parallel Deep Feature Extractors are used in conjunction with various algorithms. For classifying chest X-ray images into normal and pneumonia, Here we are proposing an hybrid model based on VGG16, VGG19, CNN, and Mobile Net networks. Individual image classification algorithms were combined to form a hybrid model .In comparison to individual algorithms, the new Hybrid Model with Deep Learning achieved higher accuracy than existing methods.
Personalized A-Theory of Time and Perspective
Authors: Conitzer Vincent 
Published: November 2022

A-theorists and B-theorists debate whether the "Now" is metaphysically distinguished from other time slices. Analogously, one may ask whether the "I" is metaphysically distinguished from other perspectives. Few philosophers would answer the second question in the affirmative. An exception is Caspar Hare, who has devoted two papers and a book to arguing for such a positive answer. In this paper, I argue that those who answer the first question in the affirmative---A-theorists---should also answer the second question in the affirmative. This is because key arguments in favor of the A-theory are more effective asarguments in favor of the resulting combined position, and key arguments against the A-theory are ineffective against the combined position.
Disputas, justificaciones y posturas éticas de niños bilingües quechua-español en Bolivia
Authors: Terceros Carmen 
Published: November 2022

Este estudio examina la construcción y la función de las justificaciones en el marco de las disputas que se llevan a cabo entre niños y niñas bilingües del quechua y del español bolivianos en dos comunidades rurales de Bolivia, T’ojlu Rancho y San Isidro, en el departamento de Cochabamba. Enmarcado en el enfoque de la socialización en y para el lenguaje, el estudio adopta el método etnográfico mediante la recolección de datos interactivos espontáneos, el registro video, el análisis conversacional y la multimodalidad. Los datos interactivos analizados se enfocan en secuencias opositivas de niñas y niños de entre 3 y 9 años de edad, en espacios del hogar, la comunidad y la escuela. Los resultados muestran la conexión de las justificaciones con la emergencia de la persona mediante, en parte, las posturas y disponibilidades éticas de la niñez de la región, que van desde la adopción de posturas polarizadas hasta intermedias, según la interpretación y la elección de normas sociales realizadas. Así también, estos resultados exponen las maneras como la niñez de la región puede construir las justificaciones mediante un uso estratégico de autorías atribuidas a las normas sociales, además de defender e intentar legitimar posturas mediante recursos discursivos creativamente utilizados: por ejemplo, el cambio de código.