Eisenmenger’s syndrome and agenesis of the right pulmonary artery: A case of double diagnosis

We present a case of patent ductus arteriosus with severe pulmonary hypertension with the rare association of absent right pulmonary artery

Editorial: Challenges in implementing digital health in public health settings in low and middle income countries.

Healthcare challenges in low- and middle-income (LMICs) have been the focus of many digital initiatives that have aimed to ensure consistent implementation of these services. During the COVID-19 pandemic, several lockdowns were imposed globally by government authorities to contain the spread of the virus. This triggered a rapid effort to integrate digital technologies into the existing health systems of LMICs (1). Digital services have the potential to improve access and care coordination across health facilities by overcoming the conventional obstacles and weaknesses of traditional systems. To promote better adoption of digital health tools the challenges need to be understood and strategies to overcome barriers must be evaluated. Hence the aim of this Research Topic was to identify specific organizational and related barriers in implementing digital health in public health settings in LMICs and further explore facilitators for successful implementation of digital technologies

Optimized Feasibility Analysis for the Design to Set up Solar Power Plant During Operating Hours in the Academic E–Block Area – Case Study

This paper is regarding the optimized design feasibility analysis of a solar power plant in our academic area i.e. E-block in Thapar University. For this design analysis, the technical feasibility and financial feasibility has been considered completely. Further, the technical feasibility of the project puts emphasis on irradiation analysis, connected load analysis, rooftop analysis, shadow analysis, load analysis, design of the on-grid system as well as design of the off-grid system. Financial feasibility analysis includes Cost analysis, Payback period, Funding options. This paper also discusses the type of solar power system to be installed based on the conclusions drawn out of the technical analysis for optimal solution for the utilization of block based analysis specifically. The financial feasibility also supports the selection

Optimized Feasibility Analysis for the Design to Set up Solar Power Plant During Operating Hours in the Academic E–Block Area – Case Study

This paper is regarding the optimized design feasibility analysis of a solar power plant in our academic area i.e. E-block in Thapar University. For this design analysis, the technical feasibility and financial feasibility has been considered completely. Further, the technical feasibility of the project puts emphasis on irradiation analysis, connected load analysis, rooftop analysis, shadow analysis, load analysis, design of the on-grid system as well as design of the off-grid system. Financial feasibility analysis includes Cost analysis, Payback period, Funding options. This paper also discusses the type of solar power system to be installed based on the conclusions drawn out of the technical analysis for optimal solution for the utilization of block based analysis specifically. The financial feasibility also supports the selection

Study of nickel levels in patients with atrial septal defect undergoing amplatzer device closure

Transcatheter closure of atrial septal defects (ASDs) using nickel titanium Naval Ordnance Laboratory (Nitinol)-containing devices (Amplatzer, AGA Medical, Golden Valley, Minnetosa) is being widely practiced. Controversies still exist regarding the release of nickel from these devices and the allergy and other ill effects of nickel and also the duration of antiplatelet therapy to aid endothelization of the device. Objective: To study the nickel levels in patients who underwent ASD closure with platinum-coated Nitinol-containing Amplatzer septal occluder. Methodology: A prospective study was conducted on 25 patients, between 6 years and 40 years of age who underwent ASD closure with Amplatzer septal occlude sizes ranging from 12 to 36 mm from January 2009 to January 2010. Blood nickel levels were estimated using atomic absorption photometry before and 24 h after the procedure and later at 1 month, 3 months, and 6 months postprocedure. A value of <2 mcg/dl was considered to be normal. Statistical analysis was performed by the use of the Wilcoxon test. Results: The blood nickel levels at mean baseline, 24 h, 1 month, 3 months, and 6 months postprocedure were 1.05, 1.39, 0.98, 0.79, and 0.74 (mcg/dl), respectively. Conclusions: Percutaneous ASD closure using Nitinol devices can be carried out safely without any significant ill effects related to nickel release

Assessment of regional and global myocardial systolic function by 2D longitudinal speckle tracking in children with beta thalassemia major

Background: Thalassemias constitute a group of chronic, inherited anemias that are transfusion dependent. Cardiac disease as a result of transfusional iron overload remains as the principal cause of death in these patients even though there have been lots of improvements in iron chelation therapy during the past 25 years. For this reason, it is recommended that regular cardiac evaluation should be done for all patients with thalassemia major. Objective: The present study was conducted with the primary objective to investigate the left ventricular (LV) myocardial function using conventional echocardiographic measures as well as two-dimensional (2D) speckle tracking in patients with beta-thalassemia major who received regular transfusions and chelation therapy. Methodology: This prospective observational study was conducted in the Department of Paediatrics, Sir Jamshedji Jeejeebhoy Group of Hospitals, Mumbai, over a period of 6 months from February 2012 to July 2012. The study comprised 25 consecutive cases of beta-thalassemia major who were diagnosed on the basis of hemoglobin electrophoresis and 25 controls with normal hemoglobin electrophoresis pattern. Patients with any congenital or acquired heart disease and also patients with heart disease of infectious, metabolic, autoimmune etiology were excluded from the study. 2D, M-mode, Doppler, and longitudinal speckle tracking echocardiographic assessment was performed in all the study cases and controls. Results: The mean age of beta-thalassemia group was 7.02 ± 3.00 years whereas the control group was 5.06 ± 3.62 years. The mean hemoglobin was 5.54 ± 1.30 g/dl in beta-thalassemia patients and 10.96 ± 1.36 g/dl in controls (P < 0.001). The thalassemia patients had lower LV ejection fraction (EF) (62.20 ± 7.93% vs. 66.40 ± 1.19%, P < 0.001) and lower global longitudinal strain (GLS) (−21.73 ± 3.68% vs. −26.80 ± 1.29%, P < 0.001) as compared to the controls. The age of the child, hemoglobin level, and serum ferritin level correlated with the LVEF and GLS. Conclusions: LV systolic dysfunction is common in patients with beta-thalassemia major. This is likely to be a consequence of chronic anemia as well as transfusional iron load, compounded by poor compliance to chelation therapy and sometimes nonavailability of proper cardiac monitoring. These findings suggest that even in young children with beta-thalassemia major, who are asymptomatic, serial echocardiography is warranted to permit early recognition of LV systolic dysfunction and timely initiation of appropriate cardioprotective therapy

Does left atrial appendage morphology and dimension differ amongst etiological stroke subtypes in patients without known atrial fibrillation? Results from the left atrial appendage morphology and dimension assessment by TEE in patients with stroke without known atrial fibrillation (LAMDA-STROKE) study

Context: Complex left atrial appendage (LAA) morphology is increasingly associated with cryptogenic ischemic stroke as compared to cardioembolic stroke due to atrial fibrillation (AF). However, data on such an association in patients with other etiological stroke subtypes in the absence of AF is limited. Aim: The study aimed to assess the LAA morphology, dimension and other echocardiographic parameters by transesophageal echocardiography (TEE) in patients with embolic stroke of undetermined source (ESUS) and compare it with other etiological stroke subtypes without known AF. Methods: This was a single-Centre, observational study involving comparison of echocardiographic parameters including LAA morphology and dimension in ESUS patients (group A; n = 30) with other etiological stroke subtypes i.e., TOAST (Trial of Org 10172 in Acute Stroke Treatment) class I-IV without AF (group B; n = 30). Results: Complex LAA morphology was predominant in group A (18 patients in group A versus 5 patients in group B, p-Value = 0.001). Mean LAA orifice diameter (15.3 + 3.5 mm in group A versus 17 + 2.0 mm in group B, p-Value = 0.027) and LAA depth were significantly lower in group A (28.4 + 6.6 mm in group A versus 31.7 + 4.3 mm in group B, p-Value = 0.026). Out of these three parameters only complex LAA morphology was found to be independently associated with ESUS [OR = 6.003, 95% CI {1.225–29.417}, p = 0.027]. Conclusion: Complex LAA morphology is a predominant feature in ischemic stroke patients with ESUS and may contribute to an increased risk of stroke in these patients

Survival outcomes post percutaneous coronary intervention: Why the hype about stent type? Lessons from a healthcare system in India - Fig 6

<p>A. A linear trend was seen between the probability of death and stented length (i.e., total length of implanted stents) The risk of death increased significantly with total stented length (Fig 6A). After the age of 50 years, the risk of adverse outcomes increased significantly with age (Fig 6B). There was no difference in outcomes between BMSs and DESs wider than 4 mm (Fig 6C).</p

Procedural details.

<p>Procedural details.</p