The fatality rate for pediatric population with complex congenital cardiac disease has decreased as a result of improvements in surgical techniques and conservative management [1]. Therefore, more patients are presenting for non-cardiac surgeries as adults with congenital cardiac history [2]. For individuals with complex congenital cardiac disease and single ventricle physiology, the fontan procedure is a palliative operation that reroutes the systemic venous return to the pulmonary artery [3]. Despite improvements in outcomes, this aberrant circulation has a number of co-morbidities, including cardiac dysfunction, arrhythmias, shunt abnormalities, limited exercise ability, and other systemic manifestations [4]. These patients raise various anaesthetic concerns, such as understanding underlying cardiac morphology and mechanics and being conversant with the complexities of fontan physiology for efficient intra-operative management. In this report, we present a case of a 17-year-old male, with complex congenital heart disease with fontan physiology, posted electively for left tibia nailing under sequential combined spinal epidural anaesthesia.
Purpose:
The purpose of this study was to identify pathogens associated with the 2022 conjunctivitis outbreak in Tamil Nadu, India.
Methods:
This prospective study was conducted in November 2022. Patients with presumed acute infectious conjunctivitis presenting to the Aravind Eye Clinic in Madurai, India, were eligible. Anterior nares and conjunctival samples from participants were obtained and processed for metagenomic RNA deep sequencing (RNA-seq).
Results:
Samples from 29 patients were sequenced. A pathogen was identified in 28/29 (97%) patients. Coxsackie virus A24v, a highly infectious RNA virus, was the predominant pathogen and detected in 23/29 patients. Human adenovirus D (HAdV-D), a DNA virus commonly associated with conjunctivitis outbreaks, was detected in the remaining patients (5/29). Hemorrhagic conjunctiva was documented in both HAdV-D and Coxsackie virus A24v affected patients but was not the predominant clinical presentation. Phylogenetic analysis of Coxsackie virus A24v revealed a recent divergence from the 2015 outbreak.
Conclusions:
Coxsackie virus A24v and HAdV-D were cocirculating during the 2022 conjunctivitis outbreak in Tamil Nadu, India. Clinical findings were similar between patients with HAdV-D and Coxsackie virus A24v–associated conjunctivitis. As high-throughput sequencing technologies become more readily available and cost-effective, unbiased pathogen surveillance may prove useful for outbreak surveillance and control.
Impression creep is a versatile technique that is used nowadays for studying the creep deformation of different materials and there is no tertiary stage in this method; it's a non-destructive process. The present work deals with finite element analysis of plastic deformation corresponding to the impression creep deformation of P91 steel. In the FE model, a 3D deformable body is used as a specimen along with a rigid hollow cylindrical indenter with a 0.07 fillet. The effect of sizes of the specimen and indenter was studied, the diameter of the specimen was changed from 10mm,15mm, and 20mm whereas the indenter diameter was changed from 1mm,1.5mm, and 2mm respectively. Moreover, it was found that when punch diameter is increased the induced stress is reduced. It is observed that there is no effect on the diameter of the specimen, however, when the diameter of the indenter is increased from 1mm to 1.5mm and 1.5mm to 2mm, induced stress is reduced by approximately 10% and 20%, respectively. The simulation was run for 100 hours. Furthermore, the optimum distance between two impressions in P91 steel was studied and the distance between two indenters was altered from 10mm,8mm,6mm and 4mm respectively with the same loading and boundary conditions, and the same mesh size. It was observed that for P91 there is no contact between two deformations at 4mm.For P91 steel we can perform two impression creep tests from 4mm apart.
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