Echocardiographic Parameters of Severity in Isolated Neonatal Patent Ductus Arteriosus

Background: A hemodynamically-significant patent ductus arteriosus (hsPDA) compromises the early neonatal transition. There is no general agreement on echocardiographic indicators of hsPDA that can predict clinical decompensation. Aim of the Work: We aimed to assess echocardiographic parameters that are associated with the isolated PDA effects on hemodynamics, which could help in subsequent management decision making. Materials and Methods: We conducted a prospective observational analytical study on 50 neonates with isolated PDA and 20 controls. They underwent clinical and echocardiographic assessment at 48 hours of age, after another 48-72 hours and prior to discharge. Results: No correlation was found between PDA diameter and weight (p=0.72), length (p=0.11), Body surface area (BSA) (p=0.33), gestational age (p=0.13). A strong association of PDA-related hemodynamic instability was found with pulmonary hypertension (p=<0.01 & 0.05 for initial and latter studies). Left atrium diameter (LA) Z-score was higher among cases, correlated with PDA size in the 3 echocardiographic studies (p=0.001, 0.001 and 0.007 respectively), and correlated with hemodynamic instability in the initial study (p=0.03). Diameter of descending aorta at level of diaphragm and pulmonary flow/systemic flow ratio (Qp:Qs) correlated with PDA diameter in the latter 2 studies (p=0.001). Main pulmonary artery and left pulmonary artery (LPA) Z-scores were correlated with PDA size at the initial and follow-up studies as expected (p=0.001, 0.047 & 0.047; and p=0.004, 0.018 & 0.032, respectively). LPA Z-score correlated with hemodynamic instability at the follow-up study (p=0.005), which was not sustained at the subsequent study. Conclusion: Pulmonary hypertension, larger LA Z-score and LPA Z-scores are important early (at 48 hours) associations of a hsPDA and hemodynamic instability

The Ontological (In)security of Similarity: Wahhabism versus Islamism in Saudi Foreign Policy

It has long been argued that identity matters in international relations. Yet, how identity impacts enmity and conflict among states remains the subject of debate. The existing literature asserts that differences in identity can be a source of conflict, whereas convergence and similarity lead to cooperation. Nevertheless, empirical evidence from the Middle East has long defied this hypothesis. The Kingdom of Saudi Arabia, which prides itself on being an Islamic model and claims Islamic leadership, has opposed the rise to power of Islamist movements in the Middle East. To address this paradox, this article builds on the growing literature on ontological security to propose a theoretical framework explaining how similarity can generate anxiety and identity risks. This framework, I argue, moves beyond traditional regime‐security approaches to reveal that security is not only physical but also ontological. I then illustrate the argument through a comparison of Saudi identity risks in the wake of the Iranian revolution (1979) and the ascendance of the Muslim Brotherhood to power in Egypt (2012). Ultimately, these cases provide intriguing insights into foreign policy behaviour during critical situations