An Entire Coronary System Arising from Right Coronary Cusp: A Rare Anomaly

The prevalence of coronary artery anomalies is approximately 0.6% in individuals undergoing angiography. Most of the anomalies are benign, but some can lead to myocardial infarction, cardiomyopathy, and sudden cardiac death. It is very rare to have an entire coronary circulation that arises from the right coronary cusp. We present a case of a 57-year-old male who presented with complaints of chest pain and dyspnea on exertion. An invasive angiogram revealed all the three coronary arteries originating from the right coronary cusp. It is crucial to define coronary anatomy as anomalies dictate which cardiac intervention should be attempted in cases of ischemia

Multicultural Teacher Preparation in Practice: A Hermeneutical Disposition

It is a fact that learning to teach is basically a social and practical activity that is supported and informed by theoretical reflections. Field experience and realities should be the core component of any teacher preparation program. That is why, most of the teacher education programs based on theory into practice model. The main aim of this research is not to reject this model, but to sketch out an alternative way of teacher preparation that is based upon teacher’s own context and socio cultural settings or in other words teacher preparation must be organized Hermeneutically. The hermeneutical approach of Hans-Georg Gadamer, is not only of philosophical importance but contains practical implications also. The concepts of understanding, interpretation and application are the core concepts of teacher preparation. In contrast to adopting an entire theory as the guiding principle to the whole content and practice of teacher preparation courses, this research argue for the focus to be on inculcating a hermeneutic disposition in all teachers preparation programs and courses. Hermeneutics is basic to human interaction, especially in dealing with student-teachers belongs to diverse socio-cultural settings or multicultural environment. The main argument or focus of this research is that it is necessary that the teacher preparation programs must be consider the problem of multiculturalism (inter and intra cultural). Multicultural Teacher Preparation (MTP) or hermeneutical mode of teacher preparation plays an important role in the preparation of teachers. It will be helpful for teachers to develop a deep level understanding of students needs belongs to various backgrounds and perspectives, not through applying a predetermined model of classroom activities, but through helping future teachers to recognize their own prejudices and how these help to determine their understandings of diversity in their future classrooms. Developing a hermeneutic disposition in teachers training facilitates and enrich experience of future teachers. A mixed method design was used to conduct the study

A Rare Case of Adult Congenital Heart Disease: Single Ventricular Chamber with Anomalous Right Coronary Artery in an Octogenarian

ABSTRACT Patients with single-ventricle physiology encompass a wide array of anatomic subtypes, including but not limited to: tricuspid atresia, hypoplastic left heart syndrome, doubleoutlet or double-inlet ventricles. The outcomes for patients with single ventricle born before 1990 are relatively poor. An 81-year-old female presented to the hospital as non-ST elevation myocardial infarction. She was started on antiplatelet and anticoagulation. Echocardiogram revealed a single ventricle which was thought to be left ventricle with possible transposition of great vessels. Angiography was performed that identified the single ventricle and anomalous origin of the right coronary artery (RCA). She was also found to have double vessel coronary artery disease with diffuse stenosis of mid-RCA at 80% and proximal circumflex at 95%. She was managed conservatively as was high risk for CABG given her rare congenital condition. Patients with single ventricle are at risk of long-term morbidity, including heart failure, neurological injury, and early death. The mortality risk of these patients is high as most of the patients without corrective surgery do not proceed to adulthood. Our case had multivessel coronary artery stenosis along with a rare presentation of congenital heart disease in adulthood. The patient was offered percutaneous coronary intervention, but she declined and chose to be treated conservatively with only medical management. We present a rare case of an elderly female surviving with a single ventricular chamber. The patient is an exception to the usual process of the pathology as most patients without corrective surgery seldom survive into adulthood

Anomalous Origin of a Right Coronary Artery from Pulmonary Artery

Congenital defects of the coronary arteries are noted in 0.2–1.4% of the general population. The first case of an anomalous origin of right coronary artery from pulmonary artery (ARCAPA) was described by Brooks in 1885. ARCAPA has an overall incidence of 0.002% in the general population. Most of the cases are asymptomatic; however, it can lead to serious complications such as heart failure, ischemia, and sudden death. A 57-year-old man presented to the cardiologist’s office with complaints of shortness of breath and fatigue. The patient also had a previous history of coronary stents and heart failure. Initially, he was evaluated with a stress test which was reported as abnormal. The patient then underwent an invasive coronary angiography that revealed anomalous origin of the right coronary artery (RCA) and multivessel disease. Cardiothoracic surgery evaluated the patient and coronary artery bypass graft was performed. During the surgery, the anomalous origin of RCA from the pulmonary artery was identified and was successfully corrected by reimplanting the RCA into the ascending aorta. The anomalous origin of RCA is a rare yet life-threatening condition. The RCA due to its location of origin from the pulmonary artery tends to be a low-pressure vessel with a very thin and fragile wall. It also serves as a retrograde venous conduit from the left coronary circulation into the pulmonary artery. This connection results in a left-to-right shunt that explains the increase in oxygen saturation in the pulmonary artery and the high cardiac output which is normally seen in these cases. The clinical presentation can vary from coronary ischemia to heart failure or sudden death. Therefore, surgical correction is recommended even in asymptomatic patients. We present a case of an anomalous origin of RCA from the pulmonary artery which, unlike the origin of left coronary from pulmonary artery, is very rare. Patients with this condition should have early correction even if they are asymptomatic in order to prevent long-term complications

Chemical Characterisation, Antidiabetic, Antibacterial, and In Silico Studies for Different Extracts of Haloxylon stocksii (Boiss.) Benth: A Promising Halophyte

The objective of the study is to evaluate the chemical characterisation, and biological and in silico potential of Haloxylon stocksii (Boiss.) Benth, an important halophyte commonly used in traditional medicine. The research focuses on the roots and aerial parts of the plant and extracts them using two solvents: methanol and dichloromethane. Chemical characterisation of the extracts was carried out using total phenolic contents quantification, GC-MS analysis, and LC-MS screening. The results exhibited that the aerial parts of the plant have significantly higher total phenolic content than the roots. The GC-MS and LC-MS analysis of the plant extracts revealed the identification of 18 bioactive compounds in each. The biological evaluation was performed using antioxidant, antibacterial, and in vitro antidiabetic assays. The results exhibited that the aerial parts of the plant have higher antioxidant and in vitro antidiabetic activity than the roots. Additionally, the aerial parts of the plant were most effective against Gram-positive bacteria. Molecular docking was done to evaluate the binding affinity (BA) of the bioactive compounds characterised by GC-MS with diabetic enzymes used in the in vitro assay. The results showed that the BA of γ-sitosterol was better than that of acarbose, which is used as a standard in the in vitro assay. Overall, this study suggests that the extract from aerial parts of H. stocksii using methanol as a solvent have better potential as a new medicinal plant and can provide a new aspect to develop more potent medications. The research findings contribute to the scientific data of the medicinal properties of Haloxylon stocksii and provide a basis for further evaluation of its potential as a natural remedy

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

From Information Society to Knowledge Society: The Asian Perspective

In an era, where ‘traditional society’ is replaced by a ‘knowledge society’, there is a global inclination towards creating knowledge and nurturing its affiliated factors. Accordingly, this paper intends to scrutinize the hypothesized causal relationship b etween ICT and knowledge creation. Variables for ICT and knowledge creation are taken from World Development Indicators (WDI).To the best of our knowledge, this is the first study of its kind that explicitly constructs an empirical framework for ICT and kn owledge creation. Depending on the availability of data, 24 countries have been selected from Asia. Time dimension for the data set is from 1990 - 2013, yielding a panel data set. To conduct statistical analysis of the relevant variables, we use Pooled Mean Group Estimator (PMGE), Mean Group Estimator (MGE) and Dynamic Fixed Effects Estimator (DFEE).Recommendations are made on the basis of findings from empirical analysis. To nurture knowledge creation in the knowledge society, the role of ICT is found to be positive. For a mature knowledge society, ICT, expenditure in R&D and researchers in R&D have a constructive role

From Information Society to Knowledge Society: The Asian Perspective

In an era, where ‘traditional society’ is replaced by a ‘knowledge society’, there is a global inclination towards creating knowledge and nurturing its affiliated factors. Accordingly, this paper intends to scrutinize the hypothesized causal relationship between ICT and knowledge creation. Variables for ICT and knowledge creation are taken from World Development Indicators (WDI).To the best of our knowledge, this is the first study of its kind that explicitly constructs an empirical framework for ICT and knowledge creation. Depending on the availability of data, 24 countries have been selected from Asia. Time dimension for the data set is from 1990-2013, yielding a panel data set. To conduct statistical analysis of the relevant variables, we use Pooled Mean Group Estimator (PMGE), Mean Group Estimator (MGE) and Dynamic Fixed Effects Estimator (DFEE).Recommendations are made on the basis of findings from empirical analysis. To nurture knowledge creation in the knowledge society, the role of ICT is found to be positive. For a mature knowledge society, ICT, expenditure in R&D and researchers in R&D have a constructive role.&nbsp

From Information Society to Knowledge Society: The Asian Perspective

In an era, where ‘traditional society’ is replaced by a ‘knowledge society’, there is a global inclination towards creating knowledge and nurturing its affiliated factors. Accordingly, this paper intends to scrutinize the hypothesized causal relationship between ICT and knowledge creation. Variables for ICT and knowledge creation are taken from World Development Indicators (WDI).To the best of our knowledge, this is the first study of its kind that explicitly constructs an empirical framework for ICT and knowledge creation. Depending on the availability of data, 24 countries have been selected from Asia. Time dimension for the data set is from 1990-2013, yielding a panel data set. To conduct statistical analysis of the relevant variables, we use Pooled Mean Group Estimator (PMGE), Mean Group Estimator (MGE) and Dynamic Fixed Effects Estimator (DFEE).Recommendations are made on the basis of findings from empirical analysis. To nurture knowledge creation in the knowledge society, the role of ICT is found to be positive. For a mature knowledge society, ICT, expenditure in R&D and researchers in R&D have a constructive role.&nbsp

Anomalous Origin of a Right Coronary Artery from Pulmonary Artery

Congenital defects of the coronary arteries are noted in 0.2–1.4% of the general population. The first case of an anomalous origin of right coronary artery from pulmonary artery (ARCAPA) was described by Brooks in 1885. ARCAPA has an overall incidence of 0.002% in the general population. Most of the cases are asymptomatic; however, it can lead to serious complications such as heart failure, ischemia, and sudden death. A 57-year-old man presented to the cardiologist’s office with complaints of shortness of breath and fatigue. The patient also had a previous history of coronary stents and heart failure. Initially, he was evaluated with a stress test which was reported as abnormal. The patient then underwent an invasive coronary angiography that revealed anomalous origin of the right coronary artery (RCA) and multivessel disease. Cardiothoracic surgery evaluated the patient and coronary artery bypass graft was performed. During the surgery, the anomalous origin of RCA from the pulmonary artery was identified and was successfully corrected by reimplanting the RCA into the ascending aorta. The anomalous origin of RCA is a rare yet life-threatening condition. The RCA due to its location of origin from the pulmonary artery tends to be a low-pressure vessel with a very thin and fragile wall. It also serves as a retrograde venous conduit from the left coronary circulation into the pulmonary artery. This connection results in a left-to-right shunt that explains the increase in oxygen saturation in the pulmonary artery and the high cardiac output which is normally seen in these cases. The clinical presentation can vary from coronary ischemia to heart failure or sudden death. Therefore, surgical correction is recommended even in asymptomatic patients. We present a case of an anomalous origin of RCA from the pulmonary artery which, unlike the origin of left coronary from pulmonary artery, is very rare. Patients with this condition should have early correction even if they are asymptomatic in order to prevent long-term complications