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.

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.

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.

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.

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.

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.

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.

Controlling rate and rhythm increases feasibility of CT angiography in atrial fibrillation.

A woman, aged 48 years, with severe rheumatic mitral stenosis and uncontrolled permanent atrial fibrillation (AF) underwent preoperative assessment of coronary arteries. Invasive coronary angiography was not possible because of occluded common iliac artery and bilateral radial spasm. Transesophageal echocardiogram showed a very large mobile left atrial appendage clot, precluding cardioversion. The severe motion artifacts during cardiac CT angiography (64 slices) due to atrial fibrillation were overcome by controlling rhythm and rate through insertion of a temporary pacemaker via right femoral vein, and slowing heart rate below 65 beats per minute by intravenous metoprolol (25 mg) and verapamil (5 mg). Clear pictures of all coronary arteries as well as the left atrial appendage clot were obtained. The temporary pacemaker was removed after eight hours. Uneventful mechanical mitral valve replacement and maze procedure were performed and the patient was discharged in a stable condition.

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.

Pneumococcal endophthalmitis associated with nasolacrimal obstruction.

Pneumococcal endophthalmitis can be a devastating postoperative infection after cataract extraction or penetrating keratoplasty. Streptococcus pneumoniae was isolated as the causative agent in three of the 124 patients (2%) who were treated for endophthalmitis at our institution between 1984 and 1990. Two of the three patients lost light perception in the affected eye. All three patients had previously unrecognized or untreated chronic nasolacrimal obstruction of varying causes. We studied the role of pneumococcal lacrimal conjunctivitis in the pathogenesis of the postoperative pneumococcal endophthalmitis in these patients.

Nosocomial infections and misuse of antibiotics in a provincial community hospital, Saudi Arabia.

The incidence of nosocomial infection and prevalence of antibiotic misuse were studied in a 174-bed community hospital in Saudi Arabia over a six-month period. Of 2445 patients admitted, 8.5% developed nosocomial infection, the rates were highest for nursery (35.8%), intensive care (19.8%), gynaecological (16.2%) and surgical (11.7%) patients. Urinary tract (31.3%), wound (27.1%) and blood (14.9%) infections accounted for more than 70% of the infections. Staphylococcus aureus (23%) and Pseudomonas aeruginosa (11%), caused more than 90% of the infections. The majority of the bacterial pathogens (79%) were multi-drug resistant. Over 80% of patients were administered prophylactic and/or therapeutic antibiotics, with 53% receiving multiple antibiotics; 72% of the antibiotics were judged to be misused. Both prophylaxis and treatment were mostly misguided and clinically unwarranted. Host- and hospital-associated infection risk factors were identified. The minimum government cost estimates for the nosocomial infections and misused antibiotics were US $273 180 and $565 603, respectively. The findings emphasize the need for effective measures to reduce both the high infection rates and widespread antibiotic misusage in the hospital. Such measures should include institution of an effective infection control committee and a hospital antibiotic policy.

Do systemic corticosteroids effectively treat obstructive sleep apnea secondary to adenotonsillar hypertrophy?

To determine if pediatric obstructive sleep apnea syndrome (OSAS) caused by adenotonsillar hypertrophy (ATH) could be treated by a short course of systemic corticosteroids, we conducted an open-label pilot study in which standardized assessments of symptomatology, OSAS severity, and adenotonsillar size were performed before and after a 5-day course of oral prednisone, 1.1+/-0.1 (+/-SE) mg/kg per day. Outcome measures included symptom severity, adenotonsillar size, and polysomnographic measures of OSAS. Selection criteria included age from 1 to 12 years, ATH, symptomatology suggesting OSAS, an apnea/hypopnea index (AHI) > or = 3/hour, and intent to perform adenotonsillectomy. Only one of nine children showed enough improvement to avoid adenotonsillectomy. Symptomatology did not improve after corticosteroid treatment but did after removal of tonsils and adenoids. Polysomnographic indices of OSAS severity did not improve after corticosteroid treatment. After corticosteroids, tonsillar size decreased in only two patients, adenoidal size was only marginally reduced, and the size of the nasopharyngeal airway was not significantly increased. These results suggest that a short course of prednisone is ineffective in treating pediatric OSAS caused by ATH.

Post intubation laryngeal sequelae in an intensive care unit.

The incidence, severity and pattern of post-intubation laryngotracheal sequelae in a 12 bed multidisciplinary intensive care unit (ICU) were assessed in this prospective study. One-hundred and fifty consecutive patients requiring intubation for more than 24 hours for various indications were studied. Evaluation of the larynx and trachea was done using a fibreoptic bronchoscope introduced through the endotracheal tube prior to elective extubation. Rigid bronchoscopy and direct laryngoscopy were performed in very small children and adults requiring tracheostomy. One-hundred and thirty-one (87.6 per cent) patients had visible laryngeal pathology in the immediate post-extubation period. Thirteen (8.6 per cent) had long term sequelae. A high incidence of long term sequelae was noted in patients with seizures (25 per cent) followed by patients with head injury (19 per cent). Steroid therapy failed to offer any significant protection but resulted in doubling of pulmonary sepsis. A grading system was adopted to classify acute laryngotracheal injury and a significant correlation was found between the presence of slough in the immediate post-extubation period and subsequent development of long term sequelae. There was also a significant correlation between a deeper insertion of the endotracheal tube and development subsequently of long term sequelae. The significance of these findings is discussed.

Hormonal profile of infertile Makkans.

Male factor infertility, being a complex and heterogeneous disorder, precludes any reliance on a single laboratory test and requires broad spectrum assessment. Sociobiological factors also influence the parameters. In this context we examined serum concentrations of nine hormones in infertile and fertile male Makkans. Infertility was implicated in 21% of the population with correlated abnormalities of gonadotrophins, thyroid, thyroid stimulating hormone (TSH), and testosterone. Hypothyroidism was established in 35% and hyperthyroidism in 14% of the infertile population, where 28% of thyroid abnormality constituted an independent infertile group. Hyperprolactinaemia associated with low levels of luteinizing hormone (LH) and testosterone signifies a cluster of 28%, while 14% of testosterone deficiency alone was causal for infertility. However, infertility in 9% of the patients examined might have been psychogenic in nature. We present a responder panel based on cluster analysis.

Tympanostomy tubes and prophylactic antibiotic ear drops.

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