EFFECT OF ENLARGED ADENOIDS AND TONSILS ON BLOOD OXYGEN SATURATION IN AL BAHA, SAUDI ARABIA.

INTRODUCTION: The adenoids and palatine tonsils, part of the lymphoid tissue, act as a first line of defense protecting the lower airways and gastrointestinal tract. Adenotonsillar hypertrophy in children may lead to airway obstruction. This study aims to demonstrate the association between adenotonsillar hypertrophy and decreased blood oxygen saturation. METHODS: A retrospective cohort study was conducted among children aged 7-12 years with adenotonsillar hypertrophy and obstructive symptoms, admitted to King Fahad Hospital and Prince Mishari Hospital, Saudi Arabia, for tonsillectomy between July 2023 and January 2024. Exclusion criteria included respiratory diseases, cardiac disease, nasal polyps, nasal septum deviation, chest wall abnormality, and lower airway diseases. The control group included 56 healthy children. An otolaryngologist determined the severity of airway obstruction using the tonsil size. Oxygen saturation was measured using pulse oximetry. The determinants of oxygen saturation were assessed using multiple linear regression, with significance set at p<0.05. RESULTS: The study included 357 participants, with an even age distribution between 7-9 years (49.6%) and 10-12 years (50.4%), and 52% males. Diagnoses included adenoid hypertrophy (30%), tonsil hypertrophy (35%), both conditions (19%), and the control group (16%). Tonsil sizes ranged from Grade 1 (48%) to Grade 4 (8.4%), with 17% normal. The median oxygen saturation was 96.0% for the adenotonsillar hypertrophy group and 99.0% for the control. Oxygen saturation levels differed significantly across groups (p<0.0001), with lower median saturation in hypertrophy groups than controls. Males had a lower oxygen than females (estimate: -0.338, 95% CI [--0.640, -0.036], p=0.028). Adenoid hypertrophy (estimate: -3.863, 95% CI [-5.241, -2.484], p<0.001), tonsil hypertrophy (estimate: -3.631, 95% CI [-5.053, -2.208], p<0.001) and having both conditions (estimate: -3.777, 95% CI [-5.3.7, -2.247], p<0.001) was associated with lower oxygen saturation. Grade 1 tonsil size was associated with an increase in oxygen saturation (estimate = 2.905, 95% CI [1.616, 4.194], p<0.001). In contrast, Grade 4 tonsil size was linked to lower oxygen saturation (estimate=-4.848, 95% CI [-6.367, -3.329], p<0.001). Grades 2 and 3 were not significantly associated with changes in oxygen saturation. CONCLUSION: Adenotonsillar hypertrophy is significantly associated with decreased blood oxygen saturation and related cardiopulmonary complications in children. Early adenotonsillectomy may be of benefit in preventing these complications and improving oxygen saturation levels.

Facile Biogenic synthesis of Europium doped lanthanum silicate nanoparticles as novel supercapacitor electrodes for efficient energy storage applications.

In this work, we demonstrated for the first time, use of Europium doped lanthanum silicate nanoparticles (LS NPs) as electrodes for supercapacitor applications. Europium (Eu3+) doped (5 mol%) LS NPs were synthesized by green solution combustion method using Mexican mint leaf extracts. Various analytical techniques such as High-Resolution Transmission Electron Microscopy (HRTEM), Selected Area Diffraction (SAED), Powder X-ray Diffraction (PXRD), Fourier Transform Infra-Red Spectroscopy (FTIR) and Diffuse Reflectance Spectroscopy (DRS) techniques were used to confirm the morphological and structural characteristics of the synthesized nanoparticles. The HRTEM and SAED patterns confirms the formation of NPs having agglomerated structure with a particle size less than 50 nm. The PXRD patterns reveals crystalline cubic structure for the NPs. Further, the FT-IR spectra reveal the successful doping of Europium in Lanthanum Silicate NPs. The DRS (Diffuse Reflectance Spectroscopy) studies confirm the reduced band gap for Europium (Eu3+) doped (5 mol%) LS NPs. Cyclic voltametric and electrochemical impedance spectroscopy experiments were performed in an alkaline medium to compare the electrochemical activity of Eu3+ doped LS NPs with that of their undoped counterpart. The Eu3+ doped (5 %) LS NPs electrodes attained a specific capacitance of 373.3 Fg-1 at a current density of 0.5 Ag-1 in comparison to pure LS NPs which is about 267 Fg-1. The long-term stability of the Eu3+ doped (5 %) LS NPs electrodes show excellent stability up to 4000 cycles of operation in comparison pure LS NPs electrodes. Doping of Eu3+ had a favourable effect on the conductivity and electrochemical activity of LS NPs. Due to favourable green combustion synthesis, superior electrochemical performance, these Eu3+ doped LS NPs could be potential materials for new generation supercapacitors in energy storage applications.

Optical and electronic properties of MgPc-Ch-diisoQ blend organic thin film as an active layer for photovoltaic cells.

Organic photovoltaic cells are a promising technology for generating renewable energy from sunlight. These cells are made from organic materials, such as polymers or small molecules, and can be lightweight, flexible, and low-cost. Here, we have created a novel mixture of magnesium phthalocyanine (MgPc) and chlorophenyl ethyl diisoquinoline (Ch-diisoQ). A coating unit has been utilized in preparing MgPc, Ch-diisoQ, and MgPc-Ch-diisoQ films onto to FTO substrate. The MgPc-Ch-diisoQ film has a spherical and homogeneous surface morphology with a grain size of 15.9 nm. The optical absorption of the MgPc-Ch-diisoQ film was measured, and three distinct bands were observed at 800-600 nm, 600-400 nm, and 400-250 nm, with a band gap energy of 1.58 eV. The current density-voltage and capacitance-voltage measurements were performed to analyze the photoelectric properties of the three tested cells. The forward current density obtained from our investigated blend cell is more significant than that for each material by about 22%. The photovoltaic parameters (Voc, Isc, and FF) of the MgPc-Ch-diisoQ cell were found to be 0.45 V, 2.12 µA, and 0.4, respectively. We believe that our investigated MgPc-Ch-diisoQ film will be a promising active layer in organic solar cells.

Synthesis of novel Cu/Fe based benzene Dicarboxylate (BDC) metal organic frameworks and investigations into their optical and electrochemical properties.

In the recent past Metal-organic frameworks (MOFs) based thin films have demonstrated superior performance in various technological applications such as optical and optoelectronic devices, electrochemical energy storage, catalysis, and sensing. Herein we report tuning the optical performance of stable complexes using Cu and Fe metal ions with carboxylate benzene dicarboxylic (BDC), leading toward the formation of novel MOF structures. The formation of Cu-BDC and Fe-BDC were confirmed by XRD and SEM studies. The thermal stability of two MOFs was investigated, indicating that, the Cu-BDC is more stable than Fe-BDC. Further, the optical properties were investigated in the wavelength range 325-1100 nm, and the Fe-BDC exhibited greater optical transmission properties than Cu-BDC by 33 %, as investigated by Wemple-DiDomenico and Tauc models. The dispersion parameters related to optical studies for Cu-BDC were better in comparison to Fe-BDC, which could be attributed to the increase in Cu valence electrons due to an increase in the number of cations. The electrochemical behavior in terms of CV measurements shows the presence of pseudo capacitance in both Fe-BDC and Cu-BDC MOFs. The improved CV performance of Cu-BDC MOF suggests that it could be used as a storage material. This work successfully demonstrates the tailoring of optical properties related to MOF thin films through the formation of stable complexes using BDC as a potential material for the fabrication of OLED's and Solar cells. The improved CV performance suggests that these MOF based materials could be used as anodes in fabrication of batteries or supercapacitors.

Expression of concern: Design and development of highly sensitive PEDOT-PSS/AuNP hybrid nanocomposite-based sensor towards room temperature detection of greenhouse methane gas at ppb level.

Expression of concern for 'Design and development of highly sensitive PEDOT-PSS/AuNP hybrid nanocomposite-based sensor towards room temperature detection of greenhouse methane gas at ppb level' by Syed Khasim et al., RSC Adv., 2021, 11, 15017-15029. DOI https://doi.org/10.1039/D1RA00994J.

Synchrotron-based operando X-ray diffraction and X-ray absorption spectroscopy study of LiCo0.5Fe0.5PO4 mixed d-metal olivine cathode.

Lithium-ion batteries based on high-voltage cathode materials, such as LiCoPO4, despite being promising in terms of specific power, still suffer from poor cycle life due to the lower stability of common non-aqueous electrolytes at higher voltages. One way to overcome this issue might be decreasing the working potential of the battery by doping LiCoPO4 by Fe, thus reducing electrolyte degradation upon cycling. However, such modification requires a deep understanding of the structural behavior of cathode material upon lithiation/delithiation. Here we used a combination of operando synchrotron-based XRD and XAS to investigate the dynamics of d-metal local atomic structure and charge state upon cycling of LiCo0.5Fe0.5PO4 mixed d-metal olivine cathode material. Principal components analysis (PCA) of XAS data allowed the extraction of spectra of individual phases in the material and their concentrations. For both Co and Fe two components were extracted, they correspond to fully lithiated and delithiated phases of LixMPO4 (where M = Fe, Co). Thus, we were able to track the phase transitions in the material upon charge and discharge and quantitatively analyze the M2+/M3+ electrochemical conversion rate for both Fe and Co. Rietveld's refinement of XRD data allowed us to analyze the changes in the lattice of cathode material and their reversibility upon (de)lithiation during cycling. The calculation of DFT and Bader charge analysis expects the oxygen redox procedure combined with d-metals redox, which supplements iron charge variations and dominates at high voltages when x < 0.75 in LixCoFePO4.

The association between salivary zinc levels and dysgeusia in COVID-19 patients.

OBJECTIVE: Zinc insufficiency has been proposed to play a role in taste and smell impairment in Coronavirus disease 2019 (COVID-19) patients. Therefore, this study aimed at comparing salivary zinc levels in COVID-19 patients with and without dysgeusia. PATIENTS AND METHODS: A total of 127 participants were recruited for this study. The patients were divided into three groups based on their COVID-19 test results and taste impairment. Groups I and II were COVID-19 positive with and without taste loss, respectively. Group III included the negative control participants. Salivary zinc levels were measured at baseline in all groups and three months after baseline in groups I and II. Wilcoxon signed-rank test was used to compare the zinc levels between baseline and three months after baseline within each group. Mann-Whitney U test was used to compare zinc levels between groups with different degrees of taste loss. RESULTS: Salivary zinc levels were significantly lower in the COVID-19 positive group with taste loss compared to levels in the group without taste loss or the negative controls (p<0.005). Three months after baseline, salivary zinc levels were significantly elevated in both COVID-19 positive groups (p<0.001). CONCLUSIONS: COVID-19 patients with dysgeusia had significantly lower levels of salivary zinc than positive and negative controls. Zinc levels were elevated after recovery, which may indicate that salivary zinc is directly associated with taste abnormalities and COVID-19 outcomes. This study showed that taste impairment is associated with lower salivary zinc levels in COVID-19 patients.

Enhancement of Gamma-ray Shielding Properties in Cobalt-Doped Heavy Metal Borate Glasses: The Role of Lanthanum Oxide Reinforcement.

The direct influence of La3+ ions on the gamma-ray shielding properties of cobalt-doped heavy metal borate glasses with the chemical formula 0.3CoO-(80-x)B2O3-19.7PbO-xLa2O3: x = 0, 0.5, 1, 1.5, and 2 mol% was examined herein. Several significant radiation shielding parameters were evaluated. The glass density was increased from 3.11 to 3.36 g/cm3 with increasing La3+ ion content from 0 to 2 mol%. The S5 glass sample, which contained the highest concentration of La3+ ions (2 mol%), had the maximum linear (µ) and mass (µm) attenuation coefficients for all photon energies entering, while the S1 glass sample free of La3+ ions possessed the minimum values of µ and µm. Both the half value layer (T1/2) and tenth value layer (TVL) of all investigated glasses showed a similar trend of (T1/2, TVL)S1 > (T1/2, TVL)S2 > (T1/2, TVL)S3 > (T1/2, TVL)S4 > (T1/2, TVL)S5. Our results revealed that the S5 sample had the highest effective atomic number (Zeff) values over the whole range of gamma-ray energy. S5 had the lowest exposure (EBF) and energy absorption (EABF) build-up factor values across the whole photon energy and penetration depth range. Our findings give a strong indication of the S5 sample's superior gamma-ray shielding characteristics due to the highest contribution of lanthanum oxide.

Design and development of highly sensitive PEDOT-PSS/AuNP hybrid nanocomposite-based sensor towards room temperature detection of greenhouse methane gas at ppb level.

Herein, we present fabrication of a novel methane sensor based on poly (3,4-ethylenedioxythiophene:poly (styrene sulfonic acid)) (p-PEDOT-PSS) and gold nanoparticles (AuNPs) treated with dimethyl sulfoxide (DMSO) and Zonyl using a spin coating technique. The nanocomposite films were further post treated with H2SO4 to improve the charge transport mechanism. The structural and morphological features of the composites were analyzed through scanning electronic microscopy, transmission electron microscopy, Fourier transform infra-red spectroscopy, UV-Vis spectroscopy and thermogravimetric analysis. Treatment with organic solvents and post treatment of H2SO4 significantly enhances the conductivity of the composite to 1800 S cm-1. The fabricated sensor shows an excellent sensing response, fast response and recovery time along with acceptable selectivity towards methane gas at ppb concentrations. Due to a simple fabrication technique, excellent conductivity, superior sensing performance and improved mechanical properties, the sensor fabricated in this study could potentially be used to detect greenhouse methane gas at low concentrations.

Aberrant right subclavian artery in a cadaver: a case report of an aortic arch anomaly.

In early embryogenesis, aortic anomalies occur as a consequence of disorders in the development of the primitive aortic arches system. Aberrant right subclavian artery, also known as arteria lusoria, is one of the important congenital anomalies of the aortic arch, in which the right subclavian artery arises from the arch of aorta instead of the brachiocephalic trunk. During routine dissection of a female cadaver, we observed retro-oesophageal aberrant right subclavian artery arising as the fourth branch from the aortic arch. In this case, the brachiocephalic trunk was absent. Early detection of aortic arch anomalies through diagnostic interventions is helpful to avoid complications during surgical procedures.

Cardiac magnetic resonance indices reflecting pulmonary regurgitation burden after tetralogy of Fallot repair.

AIM: To investigate cardiac magnetic resonance (CMR)-derived parameters to determine a convenient index reflecting the degree of pulmonary regurgitation (PR) after Tetralogy of Fallot (TOF) repair. MATERIALS AND METHODS: Sixty-three patients (age at CMR study, 23.6 [10.2-34.7] years, 55.6% male) underwent CMR after TOF repair. PR was quantified using ventricular stroke volume difference and phase-contrast mapping of the main pulmonary artery flow. In both approaches, the PRV index (PRVI) and the PR fraction (PRF) were calculated and correlated to the right ventricle end-diastolic volume index (RVEDVI) and the right ventricle end-systolic volume index (RVESVI). RESULTS: No statistically significant difference was observed between the PR volumes and the PRF measured by the stroke volume difference or the phase-contrast method. The PRVI was better correlated to RVEDVI and RVESVI than the PRF. CONCLUSION: The PRVI exhibits more correlation to the RVEDVI than PRF. Thus, it could be a preferable parameter to reflect the PR burden.

An Initiative Technique to Facilitate Axillary Vein Puncture During CRT Implantation.

OBJECTIVES: The aim of the study was to describe a new technique to minimize requirement of contrast and the time to puncture the axillary vein during implantation of cardiac resynchronization therapy (CRT) devices. BACKGROUND: One of the challenges to the wide applications of CRT has been the technical difficulty encountered while obtaining venous access utilizing axillary venous puncture. This is mainly due to vague anatomical land marks. The axillary vein is the preferred access point because of fewer associated risks and better lead protection in the future. METHODS: We introduced a 0.035 mm guidewire retrogradely from the femoral vein up to the left axillary vein. A single anteroposterior scene at 7.5 frames/second was captured while the guidewire was in the vein. The scene was kept as a roadmap for the axillary vein puncture during the implantation procedure. RESULTS: The axillary vein was accessed in all patients (100%) and the time to axillary vein puncture was <1 minute in 36 patients (41%) and between 1-5 minutes in the remaining patients. There were no related vascular complications and no contrast venography was required. CONCLUSION: The use of retrograde axillary vein wiring simplifies axillary venous puncture and minimizes the need for contrast media during CRT device implantation without compromising visualized anatomy.

Genotype-phenotype analysis of Jervell and Lange-Nielsen syndrome in six families from Saudi Arabia.

We sought to explore the genotype-phenotype of Jervell and Lange-Nielsen syndrome (JLNS) patients in Saudi Arabia. We have also assessed the plausible effect of consanguinity into the pathology of JLNS. Six families with at least one JLNS-affected member attended our clinic between 2011 and 2013. Retrospective and prospective clinical data were collected and genetic investigation was performed. Pathogenic mutations in the KCNQ1 gene were detected in all JLNS patients. The homozygous mutations detected were Leu273Phe, Asp202Asn, Ile567Thr, and c.1486_1487delCT and compound heterozygous mutations were c.820_ 830del and c.1251+1G>T. All living JLNS patients except one had a QTc of >500 ms and a history of recurrent syncope. ß-Blockers abolished the cardiac-related events in all patients except two siblings with homozygous Ile567Thr mutation. Four of the six mutations were originally reported in autosomal dominant long QT syndrome (LQTS) patients. Eighty percent of the heterozygote mutation carriers showed prolongation of QTc, but majority of these reported no symptoms attributable to arrhythmias. Mutations detected in this study will be advantageous in tribe and region-specific cascade screening of LQTS in Saudi Arabia.

De novo mutation in the KCNQ1 gene causal to Jervell and Lange-Nielsen syndrome.

Jervell and Lange-Nielsen syndrome (JLNS) is an autosomal recessive disorder, clinically characterized by severe cardiac arrhythmias [due to prolonged QTc interval in electrocardiogram (ECG)] and bilateral sensory neural deafness. Molecular defects causal to JLNS are either homozygous or compound heterozygous mutations, predominantly in the KCNQ1 gene and occasionally in the KCNE1 gene. As the molecular defect is bi-allelic, JLNS patients inherit one pathogenic mutation causal to the disorder from each parent. In this report, we show for the first time that such a disorder could also occur due to a spontaneous de novo mutation in the affected individual, not inherited from the parent, which makes this case unique unlike the previously reported JLNS cases.

Simultaneous antegrade dual AV node conduction initiates AV nodal re-entrant tachycardia (a rare initiation mechanism).

Typical atrioventricular nodal reentrant tachycardia (AVNRT) is the most common paroxysmal supraventricular tachycardia among adults. The concept of dual pathway physiology remains widely accepted, although this physiology likely results from the functional properties of anisotropic tissue within the triangle of Koch, rather than anatomically distinct tracts of conduction. AVNRT is typically induced with anterograde block over the fast pathway and conduction over the slow pathway, with subsequent retrograde conduction over the fast pathway. On rare occasions, anterograde AV node conduction occurs simultaneously through fast and slow pathways resulting in two ventricular beats in response to one atrial beat. We report a case of AVNRT where the tachycardia is always induced by the same mechanism described above. Successful ablation was achieved by slow pathway modification.

The practical approach to discerning between atrial lead displacement and reversal in dual chamber pacemakers.

We describe a 12-lead electrocardiogram image of a pacemaker malfunction due to atrial lead displacement. Facilitating the understanding of pacemaker timing cycles could explain the underlying mechanisms in this instance. This review utilizes the feature of the ventricular safety pacing interval to discern between atrial lead displacement and reversal.

The impacts of dental filling materials on RapidArc treatment planning and dose delivery: challenges and solution.

PURPOSE: The presence of high-density material in the oral cavity creates dose perturbation in both downstream and upstream directions at the surfaces of dental filling materials (DFM). In this study, the authors have investigated the effect of DFM on head and neck RapidArc treatment plans and delivery. Solutions are proposed to address (1) the issue of downstream dose perturbation, which might cause target under dosage, and (2) to reduce the upstream dose from DFM which may be the primary source of mucositis. In addition, an investigation of the clinical role of a custom-made plastic dental mold∕gutter (PDM) in sparing the oral mucosa and tongue reaction is outlined. METHODS: The influence of the dental filling artifacts on dose distribution was investigated using a geometrically well-defined head and neck intensity modulated radiation therapy (IMRT) verification phantom (PTW, Freiberg, Germany) with DFM inserts called amalgam, which contained 50% mercury, 25% silver, 14% tin, 8% copper, and 3% other trace metals. Three RapidArc plans were generated in the Varian Eclipse System to treat the oral cavity using the same computer tomography (CT) dataset, including (1) a raw CT image, (2) a streaking artifacts region, which was replaced with a mask of 10 HU, and (3) a 2 cm-thick 6000 HU virtual filter [a volume created in treatment planning system to compensate for beam attenuation, where the thickness of this virtual filter is based on the measured percent depth dose (PDD) data and Eclipse calculation]. The dose delivery for the three plans was verified using Gafchromic-EBT2 film measurements. The custom-made PDM technique to reduce backscatter dose was clinically tested on four head and neck cancer patients (T3, N1, M0) with DFM, two patients with PDM and the other two patients without PDM. The thickness calculation of the PDM toward the mucosa and tongue was purely based on the measured upstream dose. Patients' with oral mucosal reaction was clinically examined initially and weekly during the course of radiotherapy. RESULTS: For a RapidArc treatment technique, the backscatter dose from the DFM insert was measured to be 9.25±2.17 in the IMRT-verification-phantom. The measured backscatter upstream dose from DFM for a single-field was 22% higher than without the DFM, whereas the downstream dose was lower by 14%. The values of homogeneity index for the plans with and without the application of mask were 0.09 and 0.14, respectively. The calculated mean treatment planning volume (PTV) dose differed from the delivered dose by 13% and was reduced to 2% when using the mask and virtual filter together. A grade 3 mucosa reaction was observed in the control group after 22-24 fractions (44-48 Gy). In contrast, no grade 3 mucositis was observed in the patients wearing the PDM after 25-26 fractions (50-52 Gy). CONCLUSIONS: The backscatter from the DFM for a single, parallel-opposed fields, and RapidArc treatment technique was found significant. The application of mask in replacing streaking artifacts can be useful in improving dose homogeneity in the PTV. The use of a virtual filter around the teeth during the planning phase reduces the target underdosage issue in the phantom. Furthermore, a reduction in mucositis is observed in the head and neck patients with the use of PDM.

Traumatic diaphragmatic hernia: delayed presentation with tension viscerothorax--lessons to learn.

Diaphragmatic rupture is a serious complication of thoracoabdominal trauma. The condition may be missed initially. We describe the clinical course of a patient who sustained blunt abdominal trauma in a car accident. His diaphragmatic injury passed unnoticed, to present two years later with left tension viscerothorax, a rarely reported and hardly recognised entity. Nasogastric tube insertion aborted the emergency situation and the hernia was repaired successfully in a semielective setting.

The ECG role in identifying the etiology of tachycardia-induced cardiomyopathy (TIC).

Tachycardia-induced cardiomyopathy (TIC) is a well recognized entity of heart failure (HF) and various mechanisms due to tachyarrhythmias have been postulated to be responsible for impaired cardiac contractility. Previously reported cases showed reversibility of such disorders whenever stable cardiac rhythm is maintained adequately and we report on a 16-year-old boy who has been diagnosed to have TIC, which was misinterpreted initially as sinus tachycardia secondary to dilated cardiomyopathy and heart failure. A complete recovery of his left ventricular function was achieved by radiofrequency catheter ablation and highlights the importance of a 12-lead electrocardiogram (ECG) assessment in such patients.