Clinical profile and outcome of cyanotic congenital heart disease in neonates

OBJECTIVE: To determine the clinical profile and assess the outcome of all neonates diagnosed with cyanotic congenital heart disease. STUDY DESIGN: A case series. PLACE AND DURATION OF STUDY: The Aga Khan University Hospital from January 1998 to December 2000. PATIENTS AND METHODS: Neonates admitted with diagnosis of cyanotic congenital heart disease were evaluated for clinical diagnosis, survival and mortality. RESULTS: Forty four neonates met the inclusion criteria. Eleven babies (25%) had Tetralogy of Fallot or its variants. Other malformations were d-transposition of great arteries, tricuspid valve anomalies (tricuspid atresia and Ebstein\u27s anomaly), hypoplastic left heart syndrome, truncus arteriosus, total anomalous pulmonary venous return and complex congenital heart disease like single ventricle. Twenty eight (63.6%) neonates survived and 16 (36.4%) expired during hospital stay. Cause of death was surgical in 2 cases and medical problems in 14 babies. CONCLUSION: Tetralogy of Fallot or variants was the commonest cyanotic heart disease in neonates with frequency of 27.27%. Majority of neonates with congenital cyanotic heart disease showed survival with appropriate management

Origin of the ungrouped achondrite NWA 4518: mineralogy and geochemistry of FeNi-metal

Ungrouped achondrite NWA 4518 is an ultramafic breccia with abundant siderophile rich IIA-like metal. Its silicate chemistry is similar to that of WINs, HEDs, and silicate inclusions of IIE irons. Oxygen isotopic composition is nearby IAB-IIICD-WIN

Potassium isotope cosmochemistry, volatile depletion and the origin of the Earth

We report the first results obtained by our techniques for the precise and accurate determination of the isotopic composition of potassium to constrain the mechanism of volatile element depletion in the formation of the Earth, Moon, and meteorites. Our measurements of delta(K-41) for six chondrites and ten terrestrial rocks attained an average precision of the individual measurement of plus or minus 0.4 percent (2 sigma; plus or minus 0.2 percent/a.m.u. and yield a net chondrite-Earth difference unresolved at the 99 percent confidence limit, delta(K-41) = 0.32 plus or minus 0.35 percent (3 delta). This sets a firm upper limit of 1.3 plus or minus 1.4 percent Rayleigh evaporation of terrestrial potassium (using alpha = square root of 41/39), compared with an observed approximately equals 85 percent chemical depletion of K relative to C1 chondrites. Similar conclusions are reached for the SNC meteorites, Shergotty and Zagami, for 15495 (lunar mare gabbro), and for the eucrite Juvinas. Our conclusion is that direct evaporation of volatile elements from planets (e.g. from silicate vapor atmospheres following giant impact) can be ruled out, and the cause of volatile loss must be sought elsewhere, e.g. nebular processes. Our present findings do not support the conclusions of Hinton et al., the discrepancy to be resolved at a later date. We also find lunar soil 64801, delta(K-41) = +4.99 plus or minus 0.53 percent, to be distinctly heavy in accord with Garner et al

Clinical screening for congenital heart disease in newborns at a tertiary care hospital of a developing country

Objective: To screen all newborns admitted to a tertiary care hospital to rule out congenital heart disease before discharge and to find out the utility of pulse oximetry to detect congenital heart disease. Methodology: This prospective study was done at Aga Khan University Hospital from January 2014 to December 2014 in 1,650 newborns over a period of 12 months. Pulse oximetry and clinical examination were done. Persistent oxygen saturation less than 95% was considered as positive pulse oximetry. Newborns who had positive pulse oximetry or abnormal clinical examinations findings were subjected to echocardiography. Result: Pulse oximetry was performed on 1,650 newborns, out of which 25 (1.5%) had congenital heart disease. Positive pulse oximetry cases were 16 (0.97%), out of which 10 had only positive pulse oximetry (negative clinical examination). Positive clinical examination cases were 45 (2.7%), out of which 39 cases had only positive clinical examinations (negative pulse oximetry). Six newborns had both positive pulse oximetry and positive clinical examination. Out of the 25 diagnosed cases of congenital heart disease, ventricular septal defect (VSD) was the most common congenital heart disease, followed by patent ductus arteriosus (PDA). The sensitivity, specificity, positive predictive value, and negative predictive value of pulse oximetry were 32%, 99.5%, 50%, and 98.9% respectively. Conclusion: The community setting of a developing country, a combination of pulse oximetry screening and clinical examination are better at detecting congenital heart defects than either test alon

Neonatal outcomes and congenital anomalies in pregnancies affected by hypothyroidism

Background: Maternal hypothyroidism has been reported to have concerns over neonatal outcomes, not only in the context of neurocognitive development but also in the short term as birth weight and neonatal jaundice.Patients and methods: We conducted a cross-sectional retrospective study on 638 cases who delivered live births in the Aga Khan University Hospital after ethical approval. Data were collected on hypothyroid pregnant females who were diagnosed before conception or during their antenatal visits during the year 2008-2016. Neonatal outcomes were noted for birth weight, maturity, and neonatal jaundice, neonatal hypothyroidism, neonatal respiratory distress syndrome, sepsis, hypocalcaemia, congenital anomalies, need for intensive care admission, and neonatal death. Subgroup analysis was performed on the timing of diagnosis of maternal hypothyroidism. Data analysis was performed on Statistical Package for the Social Sciences version 20.0.Results: Neonatal jaundice was the most common neonatal outcome (37.6%) in our cohort of 662 live births. Nearly 15% required intensive care unit admission, however, neonatal death was very rare. The most common clinically significant congenital anomalies were cardiovascular defects, whereas Mongolian spots were the commonest congenital condition to report. There is a statistically significant association between low birth weight (OR 1.86, 95% CI 1.0-3.2, p ≤ 0.05) and congenital anomalies (OR 2.39, 95% CI 1.4-4.0, p ≤ 0.05) with women diagnosed with hypothyroidism before pregnancy.Conclusion: We report the neonatal outcomes and spectrum of congenital anomalies of hypothyroid pregnancies diagnosed before and during conception for the first time from the region of Pakistan.Key Message: Overall, none of the neonates of hypothyroid pregnancies developed congenital hypothyroidism.Cardiovascular defects in these neonates imply extensive screening and monitoring during pregnancy.Low birth weight and congenital anomalies are associated with the timings of diagnosis of hypothyroidism in pregnancy

Majorite-Garnet Partitioning of the Highly Siderophile Elements: New Results and Application to Mars

HSE and Os isotopes are used to constrain processes such as accretion, mantle evolution, crustal recycling, and core-mantle mixing, and to constrain the timing and depth of differentiation of Mars. Although showed that the HSE contents of the martian mantle could have been established by metal-silicate equilibrium in early Mars, the role of a cooling magma ocean and associated crystallization in further fractionating the HSEs is unclear. Garnet is thought to have played an important role in controlling trace element concentrations in the martian mantle reservoirs. However, testing these models, including Os isotopes, has been hindered by a dearth of partitioning data for the HSE in deep mantle phases - majorite, wadsleyite, ringwoodite, akimotoite - that may be present in the martian mantle. We examine the partitioning behavior of HSEs between majorite garnet (gt), olivine (oliv), and silicate liquid (melt)

Needs assessment for curricular reform of a post graduate paediatric training programme at a private university hospital in Karachi, Pakistan

In order to make and sustain changes in the curriculum, needs assessment is the key. We conducted a need assessment survey using a questionnaire based on a 7 point Likert Scale by residents and alumni. Over all response rate in the study was 77.5%. Fifty eight percent participants were females. Highest level of agreement (mean score 5.7) was found between the alumni and residents regarding the need to revise the content, teaching and assessment strategies in the programme. Twenty seven alumni (n= 38, 71%) had cleared their FCPS exams. The alumni thought that the existing teaching and assessment strategies do not facilitate in passing professional certificate exams (mean score 3.6). The mean attempts required by the alumni for clearing this exam was 3.3, and 84.2% considered their weak clinical skills as the reason for their recurrent failure

Frequency and outcome of meconium aspiration syndrome in babies born with meconium-stained liquor at secondary care hospital in Pakistan: A case series study

Background: Meconium aspiration syndrome (MAS) in the newborn is characterized by hypoxia, hypercapnia, and acidosis. MAS is a leading cause of morbidity and mortality in neonates. The primary objective of this study was to estimate the frequency of meconium aspiration syndrome (MAP) in babies born with meconium-stained liquor. The secondary outcome was to estimate the meconium aspiration syndrome; in terms of hospital stay, complications, and mortality.Methods: The study was done at Aga Khan Maternal and Child Care Centre, Hyderabad, Pakistan. Study design was case series and the duration of the study was of 6 months. All patients who fulfilled the inclusion criteria were included in the study after taking informed written consent. A brief history was taken, clinical examination was done and laboratory investigations were sent to the institutional laboratory. Study outcomes were measured from this data i.e. MAS, its complications, mortality, and a number of days in the hospital.Results: A total of 87 babies born with meconiumstained liquor at secondary care hospital were included. A total of 45 patients (52%) were males and 42 patients (48%) were females with a mean gestational age of babies 38.896 ± 1.210 weeks. The mean Apgar score at 5 minutes was 8.896 ± 0.404. MAS was present in 13 patients (14.9%). Complications were seen only one patient (1.1%) and there was no neonatal death reported.Discussion: MAS was present in 14.9% of babies; the complication of subacute bacterial infection was low seen in just 1.1% cases with no neonatal mortality

Bifurcation analysis of phytoplankton-fish model through parametric control by fish mortality rate and food transfer efficiency

An Algae-zooplankton fish model is studied in this article. First the proposed model is evaluated for positive invariance and boundedness. Then,the Routh-Hurwitz parameters and the Lyapunov function are used to determine the presence of a positive interior steady state and the criteria for plankton model stability (both local and global). Taylor’s sequence is also used to discuss Hopf bifurcation and the stability of bifurcated periodic solutions. The model’s bifurcation analysis reveals that Hopf-bifurcation can occur when mortality rate and food transfer efficiency are used as bifurcation parameters. Finally, we use numerical simulation to validate the analytical results

Newborn screening for congenital hypothyroidism: Improvement in short-term follow-up by audit and monitoring

Objective: Newborn screening for congenital hypothyroidism (CH) at our hospital during this study was by measurement of thyroid stimulating hormone (TSH) in serum samples. This audit was conducted over a 2 year period, to determine the compliance of reporting of results greater than the screening cutoffs for serum TSH. Gaps of non-compliance were identified, and re-audit was undertaken after the corrective actions were taken.Results: The critical limit was defined as serum TSH (≥ 20 µIU/ml) following consultation with a pediatric endocrinologist. All results above this limit were reported urgently to physicians. During the audit period, 27,407 tests were performed, 0.7% had a value of ≥ 20 µIU/ml, of those only 62% were reported to the general paediatrician or neonatologist. Reasons for not reporting results included non-availability of contact information, lack of policy awareness by technologists, critical results not highlighted on the computer display, and absence of regular monitoring. Corrective measures were taken, and re-audit was done. During the re-audit period, a total of 22,985 tests was performed, 0.6% had a value of ≥ 20 µIU/ml. Of these, 77% were reported to the general paediatrician or neonatologist. Critical result reporting was improved after the audit, and further enhanced the laboratory service of CH screening