Retrievable leadless pacemakers (Aveir VR) may be beneficial in adult patients with congenital heart disease.

INTRODUCTION: Congenital heart disease may present in up to 1.6 % of newborns. Given high burden of pacing need in adult patients with repaired congenital heart disease and availability of different pacing options, more information on outcomes of newer pacemaker types are needed. Retrievable leadless pacemaker implants in adult congenital patients have not been described. METHODS: Retrospective review of three Aveir (Abbott) retrievable leadless pacemaker implants were reviewed at the UC Davis Medical Center. All patients underwent implant via femoral access. RESULTS: All patients had one deployment only, after mapping prior. No complications occurred. Implant thresholds were 0.5 V (V) @0.2msilliseconds (ms) for patients 1 and 2 and 1 V @0.4 ms for patient 3. With impedances between 500 and 1290 Ω. Sensing was 5.5-8 mV (mV). Follow-up occurred up to one year (for two patients) with similar values overall. The predicted longevities of each device were between 22.6 and >25 years. CONCLUSION: Safety and short-mid-term parameters of retrievable leadless pacemaker implantation is reported in three patients with adult congenital heart disease.

Balancing nitrate acquisition strategies in symbiotic legumes.

MAIN CONCLUSION: Legumes manage both symbiotic (indirect) and non-symbiotic (direct) nitrogen acquisition pathways. Understanding and optimising the direct pathway for nitrate uptake will support greater legume growth and seed yields. Legumes have multiple pathways to acquire reduced nitrogen to grow and set seed. Apart from the symbiotic N2-fixation pathway involving soil-borne rhizobia bacteria, the acquisition of nitrate and ammonia from the soil can also be an important secondary nitrogen source to meet plant N demand. The balance in N delivery between symbiotic N (indirect) and inorganic N uptake (direct) remains less clear over the growing cycle and with the type of legume under cultivation. In fertile, pH balanced agricultural soils, NO3- is often the predominant form of reduced N available to crop plants and will be a major contributor to whole plant N supply if provided at sufficient levels. The transport processes for NO3- uptake into legume root cells and its transport between root and shoot tissues involves both high and low-affinity transport systems called HATS and LATS, respectively. These proteins are regulated by external NO3- availability and by the N status of the cell. Other proteins also play a role in NO3- transport, including the voltage dependent chloride/nitrate channel family (CLC) and the S-type anion channels of the SLAC/SLAH family. CLC's are linked to NO3- transport across the tonoplast of vacuoles and the SLAC/SLAH's with NO3- efflux across the plasma membrane and out of the cell. An important step in managing the N requirements of a plant are the mechanisms involved in root N uptake and the subsequent cellular distribution within the plant. In this review, we will present the current knowledge of these proteins and what is understood on how they function in key model legumes (Lotus japonicus, Medicago truncatula and Glycine sp.). The review will examine their regulation and role in N signalling, discuss how post-translational modification affects NO3- transport in roots and aerial tissues and its translocation to vegetative tissues and storage/remobilization in reproductive tissues. Lastly, we will present how NO3-influences the autoregulation of nodulation and nitrogen fixation and its role in mitigating salt and other abiotic stresses.

Trivial injury with devastating complication-A case of pediatric pancreatic pseudocyst.

Key Clinical Message: Pancreatic pseudocysts are rare in the pediatric population, commonly a result of trauma. Timely diagnosis and adequate management with a multidisciplinary approach are the key to avoid morbidity and mortality. Larger cysts often require surgical intervention. Abstract: We report a case of a 4-year-old female child who presented with a massive pancreatic pseudocyst. Pseudocysts >10 cm are at an increased risk of rupture, hence require surgical intervention. Percutaneous external drainage via pigtail catheter was followed by cysto-gastrostomy due to continuous high output. The postoperative period was uneventful.

Effects of floods on the mental health of Pakistanis: a commentary.

Over the years, worsening climate change has led to multiple spells of heavy rain and floods in Pakistan, with the 2022 floods ranked as the deadliest in world history. To top it off, decades of political instability, mental health stigma, and lack of psychological support have tipped the after-effects over the edge. These floods have taken a toll on more than 13 000 people, with inaccessibility to vital necessities leading to further deaths every week. Local and international support is imminent for better handling of the crisis and reducing the incidence of post-traumatic stress disorders and other mental health-related issues.

Detecting Cotton Leaf Curl Virus Resistance Quantitative Trait Loci in Gossypium hirsutum and iCottonQTL a New R/Shiny App to Streamline Genetic Mapping.

Cotton leaf curl virus (CLCuV) causes devastating losses to fiber production in Central Asia. Viral spread across Asia in the last decade is causing concern that the virus will spread further before resistant varieties can be bred. Current development depends on screening each generation under disease pressure in a country where the disease is endemic. We utilized quantitative trait loci (QTL) mapping in four crosses with different sources of resistance to identify single nucleotide polymorphism (SNP) markers associated with the resistance trait to allow development of varieties without the need for field screening every generation. To assist in the analysis of multiple populations, a new publicly available R/Shiny App was developed to streamline genetic mapping using SNP arrays and to also provide an easy method to convert and deposit genetic data into the CottonGen database. Results identified several QTL from each cross, indicating possible multiple modes of resistance. Multiple sources of resistance would provide several genetic routes to combat the virus as it evolves over time. Kompetitive allele specific PCR (KASP) markers were developed and validated for a subset of QTL, which can be used in further development of CLCuV-resistant cotton lines.

Intergenerational trauma: A silent contributor to mental health deterioration in Afghanistan.

Multiple theories, including family systems, epigenetics, attachments, and many others, have proposed mechanisms for trauma transmission from generation to generation. Intergenerational trauma is today one of the most important psychosocial issues affecting Afghans' mental health and psychology, with the potential to affect subsequent generations. A variety of factors have impacted the mental health of the Afghan population over the years, including years of conflict, socioeconomic instability, natural disasters, chronic drought conditions, economic turmoil, and food insecurity, all of which have been exacerbated by recent political turbulence and the The Coronavirus pandemic COVID-19 pandemic that has further increased the susceptibility to intergenerational trauma among the Afghan population. International bodies must play a role in addressing intergenerational trauma among Afghans. Breaking the chain in future generations will be possible by resolving political issues, providing adequate health facilities, financial support, and eliminating stigmas associated with mental health issues.

The rise of diarrheal illnesses in the children of Pakistan amidst COVID-19: A narrative review.

Background: In Pakistan, 74 children out of 1000 lose their lives annually due to diarrheal illness. This commentary addresses the contributing factors aggravating this growing dilemma and the effect of a simultaneous rise in COVID-19 cases in a healthcare system ready to collapse, along with providing recommendations to alleviate the problems causing this spike in diarrheal cases. Methods: This narrative review has emphasized the causes of the spike in pediatric diarrheal illnesses in Pakistan as well as recommendations offered to lessen the burden by incorporating recent literature (n = 68). Tactics to tackle COVID-19 alongside diarrheal illnesses were also included. Pakistan was chosen to be assessed due to its high burden of child and infant mortality due to preventable causes. Results: The provision of safe drinking water, the proper use of Integrated Management of Newborn and Childhood Illnesses (IMNCI), adequate awareness of the benefits of breastfeeding, the use of correct rehydration techniques such as Oral Rehydration Therapy, and the crucial implementation of the EPI vaccination schedule can curb this increase in diarrheal cases. Conclusion: The increased prevalence of diarrheal diseases amongst the pediatric population of Pakistan can be attributed largely due to unsanitary drinking water. Emphasis must be put in the provision of safe drinking water. During the first years of life, children can be kept safe from deadly pathogens just by adequate breastfeeding. IMNCI and EPI must also be properly implemented.

Efficacy and Safety of Vericiguat for Treatment of Heart Failure: A Systematic Review.

Heart failure is a growing global health concern with high mortality and morbidity. Beta-blockers, mineralocorticoid receptor antagonists, and angiotensin-converting-enzyme inhibitors are the treatments of choice for worsening clinical symptoms. In early 2021, the FDA approved a new oral soluble guanylate cyclase stimulator, Vericiguat, for the treatment of chronic heart failure. To evaluate the efficacy and safety of this approved drug, we conducted a systematic review of the available randomized controlled trials (RCTs). A literature search was conducted using PubMed, The Cochrane Library, and Clinicaltrials.gov from inception to June 6, 2022, without any language restriction. The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The quality of the included studies was checked using the Cochrane Risk-of-Bias tool. After a thorough literature search, 7 studies met our pre-defined criteria and were therefore included in this review. Our review suggests that vericiguat was better in preventing all causes of death, cardiovascular death, and hospitalizations due to heart failure irrespective of the atrial fibrillation status of the patients and was even beneficial for patients with NT-proBNP levels up to 8000 pg/ml. The safety of the vericiguat, according to our review, is not up to the standards, especially with a higher dosage of vericiguat. Despite all of this, vericiguat can be a breakthrough in the treatment of heart failure as it has great potential to improve the disease severity.

The impact of COVID-19 followed by extreme flooding on vector borne diseases in Pakistan: A mini narrative review.

While the Coronavirus pandemic continues to spread havoc across the world, countries like Pakistan are faced with another challenge: the steady rise of vector borne diseases alongside a spike in COVID-19 cases. Moreover, signs and clinical manifestations of multiple arbovirus infections mimic those experienced in COVID-19, causing further complications in management and diagnosis. Without urgent adequate management and testing equipment, the recent surge of COVID-19 along with the steady rise in Vector Borne Diseases (VBDs) could collapse the exhausted Pakistani healthcare system. This article explores the impact of COVID-19 on the management, diagnosis, and treatment of the common arbovirus infections of Pakistan, including dengue (DENV), malaria, chikungunya (CHIKV), and other foreign infections that are on a hazardous rise.

Child malnutrition in Afghanistan amid a deepening humanitarian crisis.

Decades of political turmoil and stifling war, among other issues, has turned Afghanistan into the world's largest humanitarian crisis. Just 4 months after the Taliban seized control, the majority of the Afghan population face starvation, with >3.3 million children unable to afford basic food resources, leading to dozens of deaths every week. Restrictions on humanitarian assistance, withholding of vital food supplies and inadequate medical care play a major role in exacerbating the rates of malnutrition in the vulnerable paediatric population. Global interference is warranted to avoid unfathomable consequences in mitigating this public health catastrophe.

COVID-19 vaccine hesitancy in conflict zones: A review of current literature.

Background: Vaccine hesitancy (VH) is prevalent in conflict zones due to a lack of essential resources and knowledge, thereby escalating the coronavirus disease of 2019 (COVID-19) cases in these territories. This has resulted in a higher incidence of cases from exposure to a single COVID-19 positive case and further burdens the health care system of conflict zones which are already on the brink of collapsing. Aim: This narrative review aims to determine VH to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine in five conflict zones that include Somalia, Yemen, Palestine, Syria, and Afghanistan. Methodology: A Boolean search was carried out in MEDLINE-PubMed from inception till 6 June 2022. The search was performed by using the following keywords: "(SARS-CoV-2 OR covid OR covid 19) AND (vaccine hesitancy OR covid vaccine acceptance OR intention to vaccinate) AND (Syria OR Yemen OR Palestine OR Afghanistan OR Somalia"). The full text of all relevant articles in English along with their supplementary material was extracted. Results: All the included studies reported at least 30% or more increase in vaccine hesitancy among conflict settings. VH was mostly due to a lack of available resources, lack of appropriate knowledge, and believing misleading rumors about the vaccine. Discussion: Considering the massive amount of reluctance among people residing in conflict zones, the need to take effective measures against VH is undoubtedly apparent. This can be accomplished by carrying out mass vaccinations by the governments and proper health education through raising the public awareness regarding vaccines, thereby eliminating rumors that exacerbate the fear of adverse effects. Conclusion: The approach described in this article to combat VH can be implemented to increase vaccination rates and significantly alleviate R0 across the globe.

The impact of violence on healthcare workers' mental health in conflict based settings amidst COVID-19 pandemic, and potential interventions: A narrative review.

Healthcare workers (HCWs) have faced an increased amount of mental health struggles amidst the COVID-19 pandemic. However, those in conflict-based settings with fragile healthcare systems meet additional challenges. This study reviews violence, conflict and mental health among HCWs in five countries: Syria, Palestine, Yemen, Afghanistan and Lebanon. Our study reports that HCWs are targeted by violence, bombings, mistreatment and different forms of abuse, including verbal and physical. With the additional burdens of the pandemic including prolonged working hours, limited resources and insufficient humanitarian aid, the healthcare workers fall victim to increased levels of burnout and mental illnesses. The situation leads to dire consequences on their personal lives and professional development, compelling them to quit their job or country all together. Although healthcare workers remain resilient in these conflict-based settings, immediate interventions are required to prevent violence against them and cater to their rapidly declining mental health.

Mental health impacts of earthquake on Afghans amidst humanitarian crisis.

The deadly earthquake in southeast Afghanistan on June 22, 2022 was a tragedy amidst the country's humanitarian crisis. It cost more than a thousand people's lives, caused three times more injuries, and destroyed many houses, mainly in Spera, Giyan, and Barmal districts. WHO and other NGOs responded to incidence, focusing on physical injuries, food shortage, and shelter, while mental health was not adequately emphasized. Almost half of the Afghanistan population suffers from mental disorders due to decades of civil war, economic instability, and natural disasters. The recent earthquake further exacerbates the mental conditions among earthquake victims and their families, making them vulnerable to severe mental disorders. The absence of local mental facilities and proper roads delayed the early response and made the follow-up difficult leading to serious mental issues and costly management. Although WHO and HealthNet TPO sent their mental health professionals to consult the earthquake victims and train health care workers, the sociocultural beliefs made the approach difficult and its result suspicious. Moreover, the stigma around mental health and the lack of female HCWs stop people from seeking mental healthcare.

Food Insecurity during COVID-19 in Yemen.

The United Nations has declared Yemen as the world's worst humanitarian crisis with 21 million people in need of humanitarian assistance. Due to the convergence of severe economic instability exacerbated by the COVID-19 pandemic, stifling war, and spiking food prices, the Yemeni people are at the brink of famine with women and children especially malnourished. Desperate to feed their families, civilians are forced to resort to begging, participate in child marriages, or plunge into debt. An inflated currency has significantly diminished the purchasing power of the Yemeni population, and COVID-19 restrictions have made acquisition of food and essential commodity imports arduous. Immediate action by global and local governments is essential to prevent the deaths of thousands of people in the wake of severe food scarcity.

MDR-TB in Pakistan: Challenges, efforts, and recommendations.

Tuberculosis (TB), a global health concern is also a leading cause of mortality and morbidity across Pakistan affecting a major proportion of the population. The absence of an integrated system to control the spread of TB has led to a rise in multidrug resistant strains of TB (MDR-Tb) which do not exhibit any sensitivity towards the first line therapy for TB. Such adverse circumstances call for effective planning strategies to mitigate the health hazards of MDR-TB. This article briefly highlights the challenges encountered by the already burdened healthcare system and suggests relatively inexpensive approaches to tackle the ongoing crisis associated with MDR-TB on a national scale.

Improving access to maternal care in Africa through telemedicine and digital health.

Access to maternal health care is limited for women in Africa, while it remains a crucial determinant of maternal mortality and morbidity. The utilization of telemedicine and digital health can help remove barriers to access through economical and geographical convenience. In addition, feasible frameworks operating on themes such as technology, user acceptance, short-term and long-term funding, organizational factors, and political and legislative aspects can help overcome implementation challenges that persist in Africa and permit maximal utilization of telehealth to enhance maternal outcomes.

Dengue Virus Cases Surge Amidst COVID-19 in Pakistan: Challenges, Efforts and Recommendations.

Pakistan is currently facing two outbreaks, dengue and COVID-19; both have strained its healthcare system resulting in multiple concerns including the co-diagnosis of two. Due to poor healthcare capacity, low vaccination rate, increasing COVID-19 variants, socioeconomic disparities, and misinformation, it is inevitable that implications will prove to be damaging to both healthcare workers and civilians. Among these challenges, it is important to note the need for stronger epidemiological surveillance for both COVID-19 and dengue and the implementation of public health measures without endangering sources of livelihood. To sustain this, cooperation between WHO and Pakistan's government must continue through smart lockdowns, dengue awareness campaigns, and double laboratory procedures.