Compliance and Complications in Catecholaminergic Polymorphic Ventricular Tachycardia

Based on this robust study, one can conclude that symptomatic pediatric CPVT patients are at high risk for arrhythmic syncope, SCA and SCD even when receiving medical treatment. Compliance and underdosing with medications play a major role in these risks. LCSD may be underutilized in CPVT. ICDs are protective against these risks but at the cost of a high rate of appropriate and inappropriate shocks and other complications.

Incidence and outcome of arrhythmias and electrical disease in patients with Trisomy 18

Patients with Trisomy 18 have a high incidence of cardiac anomalies and are associated with early death. Because of early mortality, electrical system disease and arrhythmia has been difficult to delineate and the incidence remain unknown. We sought to describe the association and clinical outcomes of electrical system disease and cardiac tachy-arrhythmias in patients with Trisomy 18. This was a retrospective, single institutional study. All patients with Trisomy 18 were included in the study. Patient characteristics, congenital heart disease (CHD), conduction system and clinical tachy-arrhythmia data were collected on all patients. Outcomes including cardiac surgical interventions, electrical system interventions and death were collected until the time of study. Patients with tachy-arrhythmias/electrical system involvement were compared to those without to identify potential associated variables. A total of 54 patients with Trisomy 18 were included in analysis. The majority of patients was female and had associated CHD. AV nodal conduction system abnormalities with either first or second degree AV block were common (15%) as was QTc prolongation (37%). Tachy-arrhythmias were common with 22% of patients having at least one form of tachy-arrhythmia and associated with concomitant conduction system disease (p = 0.002). Tachy-arrhythmias were typically treatable with monitoring or medication with eventual resolution without need for procedural intervention. Although early death was common, there were no causes of death associated with tachy-arrhythmia or conduction system disease. In conclusion, patients with Trisomy 18 have a high incidence of conduction system abnormalities and burden of clinical tachy-arrhythmias. Although frequent, electrical system disease did not affect patient outcome or difficultly of care delivery.

Atrial arrhythmias following lung transplant: a single pediatric center experience

Background

Outcomes after lung transplant (LTx) in children have slowly improved. Although atrial arrhythmia (AA) is a common and adverse complication following LTx among adults, there is limited data on pediatric recipients. We detail our pediatric single-center experience while providing further insights on occurrence and management of AA following LTx.

Methods

A retrospective analysis of LTx recipients at a pediatric LTx program from 2014 to 2022 was performed. We investigated timing of occurrence and management of AA following LTx, and its effect on post-LTx outcome.

Results

Three out of nineteen (15%) pediatric LTx recipients developed AA. The timing of occurrence was 9-10 days following LTx. Those patients in the older age group (age >12 years old) were the only ones who developed AA. Developing AA did not have a negative effect on hospital stay duration or short-term mortality. All LTx recipients with AA were discharged home on therapy that was discontinued at 6 months for those who was on mono-therapy without recurrence of AA.

Conclusions

AA is an early post-operative complication in older children and younger adults undergoing LTx at a pediatric center. Early recognition and aggressive management can mitigate any morbidity or mortality. Future investigations should explore factors that place this population at risk for AA in order to prevent this complication post-operatively.

IoT-enabled smart healthcare data and health monitoring based machine learning algorithms

A smart healthcare network can use sensors and the Internet of Things (IoT) to enhance patient care while decreasing healthcare expenditures. It has become more difficult for healthcare providers to keep track and analyze the massive amounts of data it generates. Health care data created by IoT devices and e-health systems must be handled more efficiently. A wide range of healthcare industries can benefit from machine learning (ML) algorithms in the digital world. However, each of these algorithms has to be taught to anticipate or solve a certain problem. IoT-enabled healthcare data and health monitoring-based machine learning algorithms (IoT-HDHM-MLA) have been proposed to solve the difficulties faced by healthcare providers. Sensors and IoT devices are vital for monitoring an individual’s health. The proposed IoT-HDHM-MLA aims to deliver healthcare services via remote monitoring with experts and machine learning algorithms. In this system, patients are monitored in real-time for various key characteristics using a collection of small wireless wearable nodes. The health care business benefits from systematic data collection and efficient data mining. Thus, the experimental findings demonstrate that IoT-HDHM-MLA enhances efficiency in patient health surveillance.

EKG Abnormalities in a Youth Athlete Following COVID-19: It's Not Always Myocarditis!

COVID-19 associated myocarditis following mild infections is rare while incidental findings may be more common. A young athlete fully recovered from a mild COVID-19 infection presented with inferolateral T-wave inversions and left ventricular hypertrophy on imaging. Exercise testing aided in correctly diagnosing the patient with masked systolic hypertension.

Fuzzy Machine Learning Model in Real-World Physical Domains; A State-of-the-Art Approach

Day after day, individuals all across the world come up with fresh ideas for improving the future. Several intriguing discoveries and ideas paved the way for a new age of electronics, telecommunications, business, and medicinal innovation. Using less resources, greater changes in these domains can be achieved. As improving efficiency and productivity allow exponential development in some areas of the global economy, artificial intelligence (AI) and machine learning (ML) is being adopted by a growing number of individuals, corporations, and governments. Since real-world scenarios influence imprecise and unpredictable situations, fuzzy systems have become an inescapable machine learning aspect. Thus, this research presents a qualitative analysis of the significance of fuzzy machine learning systems like fuzzy support vector machines (FSVM) in various physical domains. Based on this analysis, this research extends with the proposal of a fuzzy machine learning-based framework for two different physical domains: (1) intelligent transportation and (2) ecological risk handling. Thereby, this state-of-the-art approach presents fault detection using FSVM (FD-FSVM) model in the intelligent transportation domain. In ecological risk handling, this study proposes an improved FSVM for risk level classification (FSVM-RLC) approach, which uses the persistent organic pollutants data for training and validation. These two domains are chosen randomly to evaluate the classification performance of the fuzzy machine learning algorithms based on their mean absolute error, accuracy, precision, recall, and F1 score. Apart from this, the mean square error and mean absolute error are measured. Compared to existing machine learning models, the individual results of these two approaches show the highest performance. Furthermore, this fuzzy integrated machine learning technique kept consistency in both domains by giving 98.2% and 97.89% accuracy levels for FD-FSVM and FSVM-RLC, respectively.

Outcomes of Implantable Loop Monitoring in Patients <21 Years of Age

Rhythm-symptom correlation in pediatric patients with syncope/palpitations or at risk cohorts can be difficult, but important given potential associations with treatable or malignant arrhythmia. We sought to evaluate the use, efficacy and outcomes of implantable loop recorders (ILR) in pediatrics. We conducted a retrospective study of pediatric patients (<21 years) with implanted ILR. Patient/historical characteristics and ILR indication were obtained. Outcomes including symptom documentation, arrhythmia detection and ILR based changes in medical care were identified. Comparison of outcomes were performed based on implant indication. Additional sub-analyses were performed in syncope-indication patients comparing those with and without changes in clinical management. A total of 116 patients with ILR implant were identified (79 syncope/37 other). Symptoms were documented 58% of patients (syncope 68% vs nonsyncope 35%; p = 0.002). A total of 37% of patients had a documented clinically significant arrhythmia and 25% of patients had a resultant change in clinical management independent of implant indication. Arrhythmia type was dependent on implant indication with nonsyncope patients having more ventricular arrhythmias. Pacemaker/defibrillator implantation and mediation management were the majority of the clinical changes. In conclusion, IRL utilization in selected pediatric populations is associated with high efficacy and supports clinical management. ILR efficacy is similar regardless of indication although patients with nonsyncope indications had a higher frequency of ventricular arrhythmias as opposed to asystole and heart block in syncope indications. The majority of arrhythmic findings occurred in the first 12 months, and new technology that would allow for less invasive monitoring for 6 to 12 months may be of value.

Predictors and outcomes of heart block during surgical stage I palliation of patients with a single ventricle: A report from the NPC-QIC

BACKGROUND

Mortality in cohorts with a single ventricle remains high with multiple associated factors. The effect of heart block during stage I palliation remains unclear.

OBJECTIVE

The purpose of this study was to study patient and surgical risks of heart block and its effect on 12-month transplant-free survival in patients with a single ventricle.

METHODS

Patient, surgical, outcome data and heart block status (transient and permanent) were obtained from the National Pediatric Cardiology Quality Improvement Collaborative single ventricle database. Bivariate analysis was performed comparing patients with and without heart block, and multivariate modeling was used to identify variables associated with block. One-year outcomes were analyzed to identify variables associated with lower 12-month transplant-free survival.

RESULTS

In total, 1423 patients were identified, of whom 28 (2%) developed heart block (second degree or complete) during their surgical admission. Associated risk factors for block included heterotaxy syndrome (odds ratio [OR] 6.4) and atrial flutter/fibrillation (OR 3.8). Patients with heart block had lower 12-month survival, though only in patients with complete heart block as opposed to second degree block. At 12 months of age, 43% (12/28) of patients with heart block died and were more likely to experience mortality at 12 months than patients without block (OR 4.9; 95% confidence interval 1.4-17.5; P = .01).

CONCLUSION

Although rare, complete heart block after stage I palliation represents an additional risk of poor outcomes in this high-risk patient population. Heterotaxy syndrome was the most significant risk factor for the development of heart block after stage I palliation. The role of transient block in outcomes and potential rescue with long-term pacing remains unknown and requires additional study.

Evaluation and Management of Common Neonatal Arrhythmias

Neonates can have different types of arrhythmias that range from benign to life-threatening. The evaluation, approach to acute presentation, and long-term management depend on correct identification of the arrhythmia. A systematic approach to analyzing the electrocardiogram and the telemetry monitor, if available, is often sufficient to diagnose the type of arrhythmia.

Concurrent service access and management framework for user-centric future internet of things in smart cities

Future Internet of Things (FIoT) is a service concentric distributed architecture that is used by the smart city users for information sharing and access. The design of FIoT focuses in achieving reliable service and response to the growing user demands through different interoperability features. In this manuscript, concurrent service access and management framework is introduced to improve the swiftness in user concentric request processing. Based on the availability of the services and the density of the users, the concurrency in information access is provided to the users in a reliable manner. The framework incorporates convolution neural learning process in linear and differential manner for improving the access and service usage rates of the requesting users. The access sessions are differentiated for the accessible and offloaded requests to the available service providers based on the learning instances. The proposed framework is assessed using the metrics access rate, service usage rate, access delay, time lag, and failure ratio.

Automatic Human Emotion Classification in Web Document Using Fuzzy Inference System (FIS)

Textual information mining deals with various information extraction methods that can be evolved from the rapid growth of textual information through human machine interface for analyzing emotions which are taken by a facial expression. The problem of emotions in text is concerned with the fast development of web 2.0 documents that are assigned by users with emotion labels, namely: sadness, surprise, happiness, empathy, anger, warmness, boredom, and amusement. Such emotions can give a new characteristic for document categorization. Textual information mining deals with various information extraction methods that can evolved from the rapid growth of textual information through a human machine interface for analyzing emotions, which are taken by a facial expression. The problem of emotions from text is concerned with the fast development of web 2.0 documents that are assigned by users with emotion labels. Such emotions can give a new characteristic for document categorization.

Characteristics and Outcomes of Pediatric Patients Who Undergo Placement of Implantable Cardioverter Defibrillators: Insights From the National Cardiovascular Data Registry

Background Implantable cardioverter defibrillators (ICDs) are an important part of therapy for many patients, yet there is little data on population characteristics, complications, or system survival in pediatric patients. Methods A retrospective review of ICD recipients in the National Cardiovascular Data Registry ICD Registry was performed from 2010 to 2016. Patient characteristics and complications between pediatric (≤21 years) and adult populations (>21 years) were compared. Variables associated with complications and early device interventions within the pediatric cohort were evaluated using multivariate modeling. Results There were 562 209 total ICD implants, of which 3461 occurred in the pediatric cohort. Among the pediatric patients, 60% of implants were for primary prevention, and nonischemic cardiomyopathy was the most common underlying disease (60%). Over time, there was an increasing trend of both primary and secondary prevention ICD implantations ( P<0.05). Compared with adults, pediatric patients were more likely to have structural heart disease, hypertrophic cardiomyopathy, and channelopathy, and to receive a single-chamber device (all P<0.001). There was no difference in inhospital complications between the adult and pediatric cohorts (2.4% versus 2.6%, P=0.3). However, among the pediatric patients, lower weight, Ebstein anomaly, worse New York Heart Association class, dual chamber, and cardiac resynchronization therapy-defibrillator were associated with greater risk of complications. Although reintervention for generator replacement or upgrade was more common in adults, the time to reintervention was shorter in the pediatric cohort. Conclusions We observed an increasing trend in ICD device implantation among pediatric patients. The pediatric cohort had similar inhospital complication rates compared with adults but had a shorter time to reintervention.

DIC-DOC-K-means: Dissimilarity-based Initial Centroid selection for DOCument clustering using K-means for improving the effectiveness of text document clustering

In this article, a new initial centroid selection for a K-means document clustering algorithm, namely, Dissimilarity-based Initial Centroid selection for DOCument clustering using K-means (DIC-DOC- K-means), to improve the performance of text document clustering is proposed. The first centroid is the document having the minimum standard deviation of its term frequency. Each of the other subsequent centroids is selected based on the dissimilarities of the previously selected centroids. For comparing the performance of the proposed DIC-DOC- K-means algorithm, the results of the K-means, K-means++ and weighted average of terms-based initial centroid selection +  K-means (Weight_Avg_Initials +  K-means) clustering algorithms are considered. The results show that the proposed DIC-DOC- K-means algorithm performs significantly better than the K-means, K-means++ and Weight_Avg_Initials+  K-means clustering algorithms for Reuters-21578 and WebKB with respect to purity, entropy and F-measure for most of the cluster sizes. The cluster sizes used for Reuters-8 are 8, 16, 24 and 32 and those for WebKB are 4, 8, 12 and 16. The results of the proposed DIC-DOC- K-means give a better performance for the number of clusters that are equal to the number of classes in the data set.

Ventricular force-frequency relationships during biventricular or multisite pacing in congenital heart disease

BACKGROUND

Traditional indices to evaluate biventricular (BiV) pacing are load dependent, fail to assess dynamic changes, and may not be appropriate in patients with congenital heart disease (CHD). We therefore measured the force-frequency relationship (FFR) using tissue Doppler-derived isovolumic acceleration (IVA) to assess the dynamic adaption of the myocardium and its variability with different ventricular pacing strategies.

METHODS

This was a prospective pilot study of pediatric and young adult CHD patients with biventricular or multisite pacing systems. Color-coded myocardial velocities were recorded at the base of the systemic ventricular free wall. IVA was calculated at resting heart rate and with incremental pacing. FFR curves were obtained by plotting IVA against heart rate for different ventricular pacing strategies.

RESULTS

Ten patients were included (mean: 22 ± 7 years). The FFR identified a best and worst ventricular pacing strategy for each patient, based on the AUC at baseline, submaximal, and peak heart rates (P < .001). However, there was no single best ventricular pacing strategy that was optimal for all patients. Additionally, the best ventricular pacing strategy often differed within the same patient at different heart rates.

CONCLUSION

This novel assessment demonstrates a wide variability in optimal ventricular pacing strategy. These inherent differences may play a role in the unpredictable clinical response to BiV pacing in CHD, and emphasizes an individualized approach. Furthermore, the optimal ventricular pacing varies with heart rate within individuals, suggesting that rate-responsive ventricular pacing modulation may be required to optimize ventricular performance.

Characteristics of hospital admissions associated with implantable cardioverter defibrillator placement among adults with congenital heart disease

BACKGROUND

Characteristics of hospitalizations including healthcare utilization for adult patients with congenital heart disease (ACHD) at the time of implantable cardioverter defibrillator (ICD) placement has not been well studied.

METHODS

We analyzed data from the 2002-2014 United States National Inpatient Sample (NIS). ICD implantation, CHD, complications, and indications for admissions were determined based on diagnostic codes among adults. Propensity score matching was performed, based on age, sex and in-hospital mortality index with a 10:1 ratio between adults without CHD and those with CHD, to determine relative healthcare utilization attributable to CHD.

RESULTS

ACHD accounted for 136,509 ± 3488 admissions of which 1451 ± 121 admissions (1.1 ± 0.06%) were associated with an ICD placement. ICD placement occurred most frequently among patients with TOF, VSD, and transposition complexes usually in the context of a dysrhythmia. Compared to those without CHD, ACHD patients had higher adjusted total hospital charges ($147,002 ± 5516 vs $132,455 ± 2182; p < 0.001), length of stay (6.2 ± 0.5 vs 5.2 ± 0.1 days; p < 0.001), lower readmission score (5.5 ± 0.5 vs 9.7 ± 0.1; p = 0.04) and a higher complication rate (13.4% vs 8.3%; p < 0.001). Dysrhythmias were more frequently the primary diagnosis for admission in the ACHD cohort (63% vs 38%; p < 0.001).

CONCLUSION

Compared to a matched non-CHD population, ACHD patients had greater healthcare utilization and had more frequent complications. The reasons underlying this difference bear investigation to improve care quality.

Cloud based framework for diagnosis of diabetes mellitus using K-means clustering

Diabetes mellitus is a serious health problem affecting the entire population all over the world for many decades. It is a group of metabolic disorder characterized by chronic disease which occurs due to high blood sugar, unhealthy foods, lack of physical activity and also hereditary. The sorts of diabetes mellitus are type1, type2 and gestational diabetes. The type1 appears during childhood and type2 diabetes develop at any age, mostly affects older than 40. The gestational diabetes occurs for pregnant women. According to the statistical report of WHO 79% of deaths occurred in people under the age of 60, due to diabetes. With a specific end goal to deal with the vast volume, speed, assortment, veracity and estimation of information a scalable environment is needed. Cloud computing is an interesting computing model suitable for accommodating huge volume of dynamic data. To overcome the data handling problems this work focused on Hadoop framework along with clustering technique. This work also predicts the occurrence of diabetes under various circumstances which is more useful for the human. This paper also compares the efficiency of two different clustering techniques suitable for the environment. The predicted result is used to diagnose which age group and gender are mostly affected by diabetes. Further some of the attributes such as hyper tension and work nature are also taken into consideration for analysis.

Cardiac morphology for the millennial cardiology fellow: Nomenclature and advances in morphologic imaging

Cardiology fellows-in-training, both in adult and pediatric hospitals, need structured education in regards to congenital heart disease (CHD) nomenclature. With improved survival of patients with CHD, it is not uncommon for these patients to seek care in multiple adult and pediatric hospitals. A deep understanding of CHD nomenclature would aid in providing accurate medical and surgical care for these patients. In this forum, we share our experience with such structured education and also comment on recent advances in morphologic imaging that would aid in understanding the nomenclature.

Maintaining Security and Privacy in Health Care System Using Learning Based Deep-Q-Networks

In the recent past, Internet of Things (IoT) plays a significant role in different applications such as health care, industrial sector, defense and research etc.… It provides effective framework in maintaining the security, privacy and reliability of the information in internet environment. Among various applications as mentioned health care place a major role, because security, privacy and reliability of the medical information is maintained in an effective way. Even though, IoT provides the effective protocols for maintaining the information, several intermediate attacks and intruders trying to access the health information which in turn reduce the privacy, security and reliability of the entire health care system in internet environment. As a result and to solve the issues, in this research Learning based Deep-Q-Networks has been introduced for reducing the malware attacks while managing the health information. This method examines the medical information in different layers according to the Q-learning concept which helps to minimize the intermediate attacks with less complexity. The efficiency of the system has been evaluated with the help of experimental results and discussions.

Right ventricular contractile reserve in tetralogy of Fallot patients with pulmonary regurgitation

BACKGROUND

The right ventricular (RV) contractile reserve is a measure of the dynamic function of the RV and is a sensitive indicator of volume load. This can be measured noninvasively using the tricuspid annular plane systolic excursion (TAPSE) during exercise. We studied the RV contractile reserve of patients after tetralogy of Fallot (TOF) repair with varying degree of RV dilation and pulmonary regurgitation (PR), and compared them to a control group.

METHODS

Twenty-six patients who had undergone TOF repair (mean age 29 ± 10 years) were identified and stratified into three group based on the presence and severity of RV dilation and PR. We recruited 13 age- and sex-matched controls with normal cardiac anatomy for comparison. After obtaining a baseline echocardiogram in the resting state, patients underwent exercise testing on a treadmill utilizing Bruce protocol. At maximal voluntary ability during the exercise testing, the patient was immediately laid down on an echocardiography couch, and a peak exercise echocardiogram was obtained.

RESULTS

TOF patients, regardless of RV size and PR severity, had significantly shorter exercise duration (685 vs 802 s, P = .02), lower TAPSE at rest (1.7 vs 2.3 cm, P < 0.001) and at peak exercise (1.6 ± 0.4 vs 2.6 ± 0.5 cm P < .001) when compared to the control group. Patients with RV dilation were more likely to have worse RV contractile reserve but increased TAPSE and tricuspid annular acceleration at rest when compared to patients without RV dilation.

CONCLUSIONS

TOF patients with dilated RV and PR have worse RV function at rest and during exercise, compared to TOF subjects without RV dilation. Long-axis RV contractile reserve as assessed by TAPSE, was lower in TOF subjects versus controls, and was worse in those with significant RV dilation, suggesting a decline in contractile reserve with an increase in RV volume.

First-Line Antiarrhythmic Transplacental Treatment for Fetal Tachyarrhythmia: A Systematic Review and Meta-Analysis

Background

There is no consensus on the most effective and best tolerated first‐line antiarrhythmic treatment for fetal tachyarrhythmia. The purpose of this systematic review and meta‐analysis was to compare the efficacy, safety, and fetal–maternal tolerance of first‐line monotherapies for fetal supraventricular tachycardia and atrial flutter.

Methods and Results

A comprehensive search of several databases was conducted through January 2017. Only studies that made a direct comparison between first‐line treatments of fetal tachyarrhythmia were included. Outcomes of interest were termination of fetal tachyarrhythmia, fetal demise, and maternal complications. Ten studies met inclusion criteria, with 537 patients. Overall, 291 patients were treated with digoxin, 137 with flecainide, 102 with sotalol, and 7 with amiodarone. Digoxin achieved a lower rate of supraventricular tachycardia termination compared with flecainide (odds ratio [OR]: 0.773; 95% confidence interval [CI], 0.605–0.987; I²=34%). In fetuses with hydrops fetalis, digoxin had lower rates of tachycardia termination compared with flecainide (OR: 0.412; 95% CI, 0.268–0.632; I²=0%). There was no significant difference in the incidence of maternal side effects between digoxin and flecainide groups (OR: 1.134; 95% CI, 0.129–9.935; I²=80.79%). The incidence of maternal side effects was higher in patients treated with digoxin compared with sotalol (OR: 3.148; 95% CI, 1.468–6.751; I²=0%). There was no difference in fetal demise between flecainide and digoxin (OR: 0.767; 95% CI, 0.140–4.197; I²=44%).

Conclusions

Flecainide may be more effective treatment than digoxin as a first‐line treatment for fetal supraventricular tachycardia.

Patient understanding of disease and the use and outcome of implantable cardioverter defibrillators in hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is the most common cause of sudden cardiac death (SCD) in young individuals. Implantable cardioverter defibrillators (ICD) are the primary therapy for sudden death prevention; however, are associated with both physical and psychological complications. We sought to determine factors associated with ICD understanding and patient satisfaction. This was a cross-sectional study, using patient/parent answered questionnaires distributed to patients enrolled in the Hypertrophic Cardiomyopathy Association. Patient characteristics and satisfaction data were obtained via questionnaire. Patients were compared based on age at diagnosis and presence of ICD. ICD patients with high satisfaction were compared to those with low satisfaction to determine factors associated with poor satisfaction. A total of 538 responses were obtained (53 ± 16 years); 46% were females. Seventy patients (13%) were diagnosed with HCM < 18 years of age and 356 (66%) had an ICD. Compared to those without an ICD, patients with ICDs were younger at age of diagnosis (P = 0.001) and time of study (P = 0.008). Patients with ICDs were more likely to have presented with syncope and have family history of ICD, SCD, or HCM-related death. Nineteen patients (5%) felt that issues surrounding their ICD outweighed its benefit. Compared to patients with a favorable satisfaction, the only significant difference was the preimplant ICD discussion (P < 0.001) and history of lead replacement (P = 0.01). In conclusion, the majority of HCM patients with ICDs are satisfied with their ICD management and feel the benefits of ICDs outweigh issues associated with ICDs. Additionally, these data highlight the importance of the preimplant patient-physician discussion around the need for ICD prior to implantation.

Sedation methods for transthoracic echocardiography in children with Trisomy 21-a retrospective study

BACKGROUND

Many children with Trisomy 21 have neurologic or behavioral problems that make it difficult for them to remain still during noninvasive imaging studies, such as transthoracic echocardiograms (TTEcho). Recently, intranasal dexmedetomidine sedation has been introduced for this purpose. However, dexmedetomidine has been associated with bradycardia. Children with Trisomy 21 have been reported to have a higher risk of bradycardia and airway obstruction with sedation or anesthesia compared to children without Trisomy 21.

OBJECTIVE

Our aim was to quantify the incidence of age-defined bradycardia and other adverse effects in patients with Trisomy 21 under sedation for TTEcho using a variety of sedation and anesthesia techniques available and utilized at our institution in this challenging patient population, including intranasal dexmedetomidine, oral pentobarbital, general anesthesia with propofol, and general anesthesia with sevoflurane. Our primary hypothesis was that intranasal dexmedetomidine sedation would result in a significantly higher risk of bradycardia in patients with Trisomy 21, compared with other sedative or anesthetic regimens.

METHODS

This is a retrospective, observational study of 147 consecutive patients with Trisomy 21 who were sedated or anesthetized for transthoracic echocardiography. Efficacy of sedation was defined as no need for rescue sedation or conversion to an alternate technique. Lowest and highest heart rate, systolic blood pressure, oxygen saturation, and PR interval from formal electrocardiograms were extracted from the electronic medical record. These data were compared to age-defined normal values to determine adverse events.

RESULTS

Four methods of sedation or anesthesia were utilized to perform sedated transthoracic echocardiography: general anesthesia with sevoflurane by mask, general anesthesia with sevoflurane induction followed by intravenous propofol maintenance, oral pentobarbital, and intranasal dexmedetomidine. Intranasal dexmedetomidine 2.5 mcg·kg^-1 was an effective sedative as a single dose for TTEcho in 37 of 41 (90%) cases. Oral pentobarbital 5 mg·kg^-1 as a single dose for young children with Trisomy 21 was effective in 55 of 75 (73%) cases. Intranasal dexmedetomidine sedation was not associated with a significantly higher risk of bradycardia in patients with Trisomy 21, compared with other sedative or anesthetic regimens, when compared to oral pentobarbital for patients under 2 years of age and general anesthesia for children 3 years and older. The two general anesthesia groups showed lowest heart rates of 66.9 ± 15.9 min^-1 for sevoflurane and 69.0 ± 11.5 min^-1 for sevoflurane-propofol. Hypotension was present in all groups ranging between an incidence of 56% in the sevoflurane group to 11% in the oral pentobarbital group. Oxygen saturation and clinically significant desaturation occurred in 14% of the oral pentobarbital group.

CONCLUSION

Intranasal dexmedetomidine sedation was not associated with a significantly higher risk of bradycardia in patients with Trisomy 21, compared with other sedative or anesthetic regimens.

Synthesis of Evolvulus alsinoides derived gold nanoparticles for medical applications

Plant mediated synthesis of metallic nanoparticles is an increasing commercial demand due to the wide applicability in various areas such as electronics, catalysis, chemistry, energy, cosmetics and medicine. This is greatly due to their special features, which include unusual optical and electronic properties, high stability and biological compatibility, controllable morphology and size dispersion, and easy surface functionalization. In the present investigation, synthesis of gold nanoparticle is done by using leaf extracts of Evolvulus alsinoides. Gold nanoparticles (AuNPs) were characterized by using UV visible absorption spectra. Their morphology, elemental composition and crystalline phase were determined by scanning electron microscopy, energy dispersive X-ray spectroscopy and FT-IR analysis was used to confirm the presence of gold nanoparticles in the extracts. The plant derived gold nanoparticles were also showing more inhibition activity in both bacterial and fungus strains. In bacteria, gram negative strains are highly affected by the test samples than gram positive. In fungal strains, the highest effect was noticed in Trichophyton rubrum while less effect was observed in Candida albicans.