Abstract Introduction: Acyanotic congenital heart disease (ACHD) patients with pulmonary hypertension (PH) are prone to postoperative complications, and characterization of the risk profile continues to fail in identifying inflammatory predilection. Our objective is to investigate the role of platelet-leukocyte indices (neutrophil-lymphocyte ratio [NLR], platelet-lymphocyte ratio [PLR], and systemic immune-inflammation index [SII] [neutrophil × platelet/lymphocyte]) in predicting poor outcomes following cardiac surgery in ACHD cohort with preoperative PH. Methods: This single-center, retrospective risk-predictive study included ACHD patients undergoing surgical correction at our tertiary cardiac center between January 2015 and December 2019. Standard institutional perioperative management protocol was followed, and poor postoperative outcome was defined as ≥ 1 of: low cardiac output syndrome, new-onset renal failure, prolonged mechanical ventilation (MV > 24 hours), stroke, sepsis, and/or death. Results: One hundred eighty patients out of 1,040 (17.3%) presented poor outcome. On univariate analysis, preoperative factors including right ventricular systolic pressure (RVSP) (PH-severity marker), congestive heart failure, albumin, NLR, PLR, SII, and aortic cross-clamping (ACC) and cardiopulmonary bypass (CPB) times predicted poor outcome. However, on multivariate analysis, RVSP, NLR, SII, and ACC and CPB times emerged as independent predictors. An NLR, SII prognostic cutoff of 3.33 and 860.6×103/mm3 was derived (sensitivity: 77.8%, 78.9%; specificity: 91.7%, 82.2%; area under the curve: 0.871, 0.833). NLR and SII values significantly correlated with postoperative MV duration, mean vasoactive-inotropic scores, and length of intensive care unit and hospital stay (P<0.001). Conclusion: Novel parsimonious, reproducible plateletleukocyte indices present the potential of stratifying the risk in congenital cardiac surgical patients with pre-existing PH.

Abstract Introduction: The presence of aortic regurgitation (AR) in the setting of ventricular septal defect (VSD) has always been a management challenge. Methods: This is a retrospective study looking at patients who underwent VSD closure with or without aortic valve intervention between January 1st, 1992 and December 31st, 2014 at the Institute Jantung Negara. This study looked at all cases of VSD and AR, where AR was classified as mild, moderate, and severe, the intervention done in each of this grade, and the durability of that intervention. The interventions were classified as no intervention (NI), aortic valve repair (AVr), and aortic valve replacement (AVR). Results: A total of 261 patients were recruited into this study. Based on the various grades of AR, 105 patients had intervention to their aortic valve during VSD closure. The rest 156 had NI. All patients were followed up for a mean time of 13.9±3.5 years. Overall freedom from reoperation at 15 years was 82.6% for AVr. Various factors were investigated to decide on intervening on the aortic valve during VSD closure. Among those that were statistically significant were the grade of AR, size of VSD, age at intervention, and number of cusp prolapse. Conclusion: We can conclude from our study that all moderate and severe AR with small VSD in older patients with more than one cusp prolapse will need intervention to their aortic valve during the closure of VSD.

Abstract Introduction: Rapid prototyping is a process by which three-dimensional (3D) computerized surface models are converted into physical models. In this study, a 3D heart bio model was created using the rapid prototyping method and the accuracy of this heart model was assessed by clinicians. Methods: The two-dimensional images of normal heart from gated computed tomography scan datasets were used to create a 3D model of the heart. The slices were then processed using the software BioModroid and printed with the 3D printer. The evaluation of the model was performed by a questionnaire answered by four cardiothoracic surgeons, 12 cardiologists, five radiologists, and nine surgical registrars. Results: Eighty-six percent of the anatomy structures showed in this model scored 100% accuracy. Structures such as circumflex branch of left coronary artery, great cardiac vein, papillary muscle, and coronary sinus were each rated 77%, 70%, 70%, and 57% accurate. Among 30 clinicians, a total of 93% rated the model accuracy as good and above; 64% of the clinicians evaluated this model as an excellent teaching tool for anatomy class. As a visual aid for surgery or interventional procedures, the model was rated excellent (40%), good (50%), average (23%), and poor (3%); 70% of the clinicians scored the model as above average for training purpose. Overall, this 3D rapid prototyping cardiac model was rated as excellent (33%), good (50%), and average (17%). Conclusion: This 3D rapid prototyping heart model will be a valuable source of anatomical education and cardiac interventional management. Introduction threedimensional three dimensional D (3D study Methods twodimensional two printer surgeons 1 cardiologists radiologists registrars Results Eightysix Eighty six 100 artery vein muscle 77 77% 70 57 accurate 3 93 64 class procedures 40%, 40 40% , (40%) 50%, 50 50% (50%) 23%, 23 23% (23%) 3% (3%) purpose Overall 33%, 33 33% (33%) 17%. 17 17% . (17%) Conclusion management 10 7 5 9 6 4 (40% (50% 2 (23% (3% (33% (17% (40 (50 (23 (3 (33 (17 (4 (5 (2 ( (1

Abstract Introduction Vitiligo is an acquired pigmentary disorder of unknown etiology, clinically characterized by whitish macules caused by selective loss of melanocytes. There are many melanocytes in the human cochlea. Recent studies have suggested a direct relation between cochlear dysfunction and decreased amounts of melanin. Objective To determine the effect of vitiligo on auditory function. Methods The present prospective, case control study was performed over a period of 1 year in patients between 15 and 40 years old with nonsegmental disease and the same number of controls. Pure tone audiometry (PTA) and Otoacoustic emission (OAE) were performed to analyze the correlation between vitiligo and auditory function. Results The mean pure tone audiometric threshold in the right ear at 0.5, 8 kHz, and in the left ear at the frequency of 8 kHz in the case group were significantly higher as compared with controls. The average band reproducibility (%) in the right and left ear of controls was significantly higher at the frequency of 4 kHz as compared with cases. It has been observed that signal to noise ratio was statistically higher at the frequency of 5kHz in the right ear and at 2, 3, and 5kHz in the left ear in controls as compared with cases. On the basis of disease type and duration of disease; mean pure tone audiometric threshold, average band reproducibility and signal to noise ratio, no significant effect was observed in the present study. Conclusion Vitiligo has an effect on cochlear function irrespective of the duration or distribution of the disease.

The present study was carried out to find the effect of fruit harvesting stage (October, November and December) on the physicochemical and antioxidant properties in five kiwi cultivars (Abbot, Bruno, Allison, Hayward, Monty). Results showed that soluble solid content (SSC) and pH increased while ascorbic acid (Vit C), titrated acidity (TAD) and SSC/TAD decreased in all the cultivars with delay in harvesting. Total polyphenols (TP) were decreased while total flavonoids (TF) increased in all tested cultivars with delay in harvesting. The highest concentration of TP (2.02 mg gallic acid equivalent/g fresh weight) and TF (51.12 mg catechin equivalent/100g FW) were found in cultivar 'Allison' in the month of October and December, respectively. Antioxidant activities (AA) were genotype depended and no trend was observed with month of harvesting. Principal component analysis (PCA) showed strong correlation between Vit C, TP and antioxidant activities. Two major clusters were computed using agglomerative hierarchical clustering (AHC). All the studied important traits may be used in the breeding programmes to increase the variability for different physiochemical and antioxidative characteristics and to make suitable selections that could be acceptable to consumers.

The present study was undertaken to investigate the sedative, analgesic and clinical effects of xylazine, medetomidine and dexmedetomidine with fentanyl as pre-anaesthetics in water buffaloes and to compare the dose-sparing effect of xylazine, medetomidine and dexmedetomidine on thiopental for induction and isoflurane for maintenance of anaesthesia in water buffaloes. Six male water buffaloes randomly received intravenous fentanyl (5.0 pg/kg body weight) and xylazine (0.05 mg/kg body weight), fentanyl (5.0 pg/kg body weight) and medetomidine (2.5 pg/kg body weight), fentanyl (5.0 pg/kg body weight) and dexmedetomidine (5.0 pg/kg body weight) at weekly intervals in groups I1, I2 and I3, respectively. After 15 min, the animals were restrained in right lateral recumbency and anaesthesia was induced by 5% thiopental sodium administered intravenously. The intubated animal was connected to the large animal anaesthesia machine and isoflurane in 100% oxygen (5 L/min) was insufflated for 60 min. The treatments were compared by clinicophysiological, haematobiochemical and haemodynamic parameters. Fentanyl-medetomidine and fentanyl-dexmedetomidine produced more cardiovascular depression during the pre-anaesthetic period but less depression of cardio-respiratory dynamics in the post induction and maintenance period. Quicker recovery was recorded in I2 and I3 groups. A lower dose of thiopental was required in group I3 (4.33 mg/kg ± 0.66 mg/kg) than in groups I2 (4.41 mg/kg ± 0.98 mg/kg) and I1 (4.83 mg/kg ± 0.79 mg/kg). The dose of isoflurane was less in group I3 (45.50 mL ± 5.45 mL) than in group I1 and I2 (48.66 mL ± 5.10 mL and 48.00 mL ± 6.38 mL). Better anaesthesia was recorded with fentanyl-dexmedetomidine-thiopental-isoflurane (group I3) than with fentanyl-medetomidine-thiopental-isoflurane (group I2) and fentanyl-xylazine-thiopental-isoflurane (group Fentanyl-medetomidine and fentanyl-dexmedetomidine were better pre-anaesthetic agents in comparison to fentanyl-xylazine for thiopental and isoflurane anaesthesia. Fentanyl-dexmedetomidine-thiopental-isoflurane and fentanyl-medetomidine-thiopental-isoflurane produced effective surgical anaesthesia and were found to be safe, as cardio-pulmonary functions were well preserved during maintenance anaesthesia with no deleterious effect on vital organ functions in water buffaloes.

PROBLEM: India has the world's largest number of maternal deaths estimated at 117 000 per year. Past efforts to provide skilled birth attendants and emergency obstetric care in rural areas have not succeeded because obstetricians are not willing to be posted in government hospitals at subdistrict level. APPROACH: We have documented an innovative public-private partnership scheme between the Government of Gujarat, in India, and private obstetricians practising in rural areas to provide delivery care to poor women. LOCAL SETTING: In April 2007, the majority of poor women delivered their babies at home without skilled care. RELEVANT CHANGES: More than 800 obstetricians joined the scheme and more than 176 000 poor women delivered in private facilities. We estimate that the coverage of deliveries among poor women under the scheme increased from 27% to 53% between April and October 2007. The programme is considered very successful and shows that these types of social health insurance programmes can be managed by the state health department without help from any insurance company or international donor. LESSONS LEARNED: At least in some areas of India, it is possible to develop large-scale partnerships with the private sector to provide skilled birth attendants and emergency obstetric care to poor women at a relatively small cost. Poor women will take up the benefit of skilled delivery care rapidly, if they do not have to pay for it.

PROBLEMA: La India es el país con mayor número de defunciones maternas, estimadas en 117 000 al año. Los esfuerzos desplegados hasta ahora para dotar de parteras cualificadas y atención obstétrica de urgencia a las zonas rurales no han tenido éxito porque los obstetras no están dispuestos a trabajar en hospitales públicos a nivel subdistrital. ENFOQUE: Hemos documentado una innovadora fórmula de colaboración publicoprivada acordada entre el gobierno de Gujarat, India, y obstetras privados que ejercen en zonas rurales para proporcionar atención obstétrica a las mujeres pobres. CONTEXTO LOCAL: En abril de 2007, la mayoría de las mujeres pobres dieron a luz en el hogar sin atención cualificada. CAMBIOS DESTACABLES: Más de 800 obstetras participaron en ese sistema, y más de 176 000 mujeres pobres dieron a luz en centros privados. Estimamos que la cobertura de partos asistidos entre las mujeres pobres en el marco de ese sistema aumentó del 27% al 53% entre abril y octubre de 2007. El programa, que se considera que ha tenido gran éxito, muestra que este tipo de iniciativas de seguro social de enfermedad pueden ser administradas por el ministerio de salud sin ayuda de ningún donante internacional o aseguradora. ENSEÑANZAS EXTRAÍDAS: Al menos en algunas zonas de la India, es posible forjar alianzas en gran escala con el sector privado al objeto de proporcionar parteras cualificadas y atención obstétrica de urgencia para las mujeres pobres a un costo relativamente bajo. Si saben que pueden obtenerla gratuitamente, las mujeres pobres no tardan en recurrir a la atención obstétrica de urgencia.

PROBLÉMATIQUE: L'Inde est le pays du monde subissant la plus forte mortalité maternelle, estimée à 117 000 décès par an. Les efforts consentis dans le passé pour fournir une assistance à la naissance par du personnel qualifié et des soins obstétricaux d'urgence dans les zones rurales n'ont pas abouti car les obstétriciens étaient peu disposés à être affectés dans des hôpitaux publics de niveau inférieur au district. DÉMARCHE: Nous avons réuni des informations sur un partenariat public/privé innovant entre le Gouvernement du Gujarat en Inde et des obstétriciens privés exerçant dans des zones rurales, ayant pour objectif de proposer des soins à l'accouchement aux femmes pauvres. CONTEXTE LOCAL: En avril 2007, la majorité des femmes pauvres accouchaient à domicile, sans recevoir de soins qualifiés. MODIFICATIONS PERTINENTES: Plus de 800 obstétriciens ont accepté de participer au schéma et plus de 176 000 femmes pauvres ont accouché dans des établissements privés. Nous estimons que la couverture par l'assistance à l'accouchement dans le cadre du schéma chez les femmes pauvres est passée de 27 % à 53 % entre avril et octobre 2007. Ce programme est considéré comme très fructueux et montre que les programmes sociaux d'assurance santé de ce type peuvent être gérés par le Ministère de la santé, sans l'aide d'une compagnie d'assurance ou d'un donateur international. ENSEIGNEMENTS TIRÉS: Dans certaines zones de l'Inde au moins, il est possible de développer des partenariats à grande échelle avec le secteur privé pour offrir une assistance à la naissance par du personnel qualifié et des soins obstétricaux d'urgence aux femmes pauvres, à un coût relativement faible. Les femmes pauvres seront rapidement demandeuses de soins à l'accouchement qualifiés si elles n'ont pas à les payer.