Background The timing of surgical repair of tetralogy of Fallot (TOF) is a key to alleviate complications and for long-term survival. Total correction was usually performed at the age of 6 months or older under the notion of decreasing the surgical risk. However, avoiding palliation with an aortopulmonary shunt and early correction of systemic hypoxia appear to be of more benefit than the inborn surgical risk in low body weight patients. Our objective was to assess early/midterm survival and operative complications and to analyze patients, surgical techniques, and morphological risk factors to determine their effects on outcomes. Patients and Methods We retrospectively reviewed 152 patients with TOF who were ≤60 days of age when they underwent total correction of TOF. All patients had either duct-dependent pulmonary blood flow or arterial blood oxygen saturation less than 65% on room air requiring urgent surgical correction. Exclusion criteria included TOF with pulmonary atresia, TOF with nonconfluent pulmonary arteries, TOF with multiple aortopulmonary collateral arteries, and associated complete atrioventricular septal defects. Results The mean age at repair was 34 ± 19 days, and the mean weight was 3.8 ± 0.9 kg. Before surgery, 96 patients received an infusion of prostaglandin, 45 were mechanically ventilated, and 32 required inotropic support. Right ventricular outflow tract obstruction was managed with a transannular patch in 112 patients, and all the others had a main pulmonary artery patch. Cardiopulmonary bypass (CPB) with moderate hypothermia was the standard, and the CPB time averaged 48 ± 21 minutes. The postoperative intensive care unit stay was 5.7 ± 6 days, with 2.8 ± 4 days of mechanical ventilation. Early mortality was 4.6% (7 of 152), and actuarial survival rates were 95% at 1 year and 92% at 5 years. Univariable and multivariable analyses of the patients' demographics, anatomical characteristics, and operative techniques revealed the presence of small pulmonary arteries and low body weight to be the only independent risk factors for death. Conclusion Early total correction of TOF during the first 60 days of life can be performed with low mortality and good intermediate-term survival and, from our point of view, “should be the gold standard for TOFs.”
Biomedical applications of body area networks (BANs) are evolving, where taking periodic medical readings of patients via means wireless technologies at home or in the office will aid physicians to periodically supervise the patient's medical status without having to see the patient. Thus, one important objective of BANs is to provide the doctor with the medical readings that can be collected electronically without being in close proximity to the patient. This is done through the measurement of the patient's physiological signals via means of wearable sensors. This paper investigates wireless BAN cooperation via actual measurements of human movement kinematics and electrocardiogram (ECG), which are believed to provide patients with easy healthcare for continuous health-monitoring. The collected information will be processed using specially designed software, which in turn will enable the patient to send a full medical chart to the physician's electronic device. In this way, physicians will have the ability to monitor their patients more efficiently.
The objective of this study is to provide a simplified worksheet based on the Total Equivalent Temperature Difference (TETD) Approach to estimate a building’s cooling load under Iraqi climate conditions. The heating, ventilation and air conditioning (HVAC) system was applied to scientific laboratories at the College of Engineering, University of Warith Al-Anbiyaa, Karbala, Iraq. The study estimates the cooling load of the building, which consists of 10 zones. Cooling load elements such as ventilation, lighting, walls, floors, roofs, windows, infiltration, and human factors were considered. The worksheet provides an appropriate alternative for easy and fast prediction within Iraq's climate conditions.
Two thermal cylinders with varied shapes (circular (R = 0.15), square (L = 0.15), ellipse (Rx = 0.2, Ry = 0.15), and circular (R = 0.15) near the cold wall of the square enclosure where the (AR = 0.7) is explored numerically in the present study. The nanofluid is contained within the cavity (Al2O3). Left-side vertical wall and inner bodies are maintained at a fixed temperature (Th), while the right-side vertical wall is maintained at a cool temperature (Tc). Thermal insulation is used to insulate the upper and lower horizontal walls. This code is used the (technique of finite elements), which is utilized to resolve dimensionless equations in the COMSOL program. The basic parameters that were utilized in this paper where: the Rayleigh number (Ra), which ranged from 103 to 106; the percentage of solid volume (ϕ=0.06); and the aspect ratio (AR =0.7). The outcome demonstrates that: When the heated internal bodies are used in different forms, the effect of fluid movement will be different, and when the two inner bodies are combined, the highest stream function of up to 33 can be obtained. The isotherm line shows the clear and important effect of internal bodies in enhancing and improving heat transfer. For the two-square case, the average Nu was at its lowest point. While the highest Nu was for two – the ellipse case followed by the cylinder – the ellipse and the two circular cylinders.
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