New Compounds Derived from Nitrophenol Synthesis, Structural investigation and anticorrision Properties.

A new azo compound [2-((4-hydroxy-3-(E)-(2-hydroxy-5-nitrophenyl)diazenyl)benzaldeyde and the azo schiff derivative [2-((4-hydroxy-3-((E)-(2-hydroxy-5-nitrophenyl)diazenyl)benzylidene)amino)-4-nitrophenol (Azo-S) has been synthesized. 13C-NMR, 1H-NMR, FT-IR, Mass apectroscopy and Uv-Visibl analysis was used to characterized new compounds. The new synthesized compound Azo-S was utilized to inhibit mild steel (MS) corrosion at little concentrations (0.001-0.006) M. Weight loss measurements studies in 1 M HCl and at 298 K  showed that Azo-S has a good corrosion inhibition efficiency, 75%  at 0.002 M of inhibitors.It was found that adsorption methods follow Lanngmuir isotherm with ΔG values around -23.8 kJ/mol, this confirms that a stable protective film is formed for the mild steel spontaneously during physical adsorption.

De novo generation of dual-target ligands for the treatment of SARS-CoV-2 using deep learning, virtual screening, and molecular dynamic simulations.

De novo generation of molecules with the necessary features offers a promising opportunity for artificial intelligence, such as deep generative approaches. However, creating novel compounds having biological activities toward two distinct targets continues to be a very challenging task. In this study, we develop a unique computational framework for the de novo synthesis of bioactive compounds directed at two predetermined therapeutic targets. This framework is referred to as the dual-target ligand generative network. Our approach uses a stochastic policy to explore chemical spaces called a sequence-based simple molecular input line entry system (SMILES) generator. The steps in the high-level workflow would be to gather and prepare the training data for both targets' molecules, build a neural network model and train it to make molecules, create new molecules using generative AI, and then virtually screen the newly validated molecules against the SARS-CoV-2 PLpro and 3CLpro drug targets. Results shows that novel molecules generated have higher binding affinity with both targets than the conventional drug i.e. Remdesivir being used for the treatment of SARS-CoV-2.Communicated by Ramaswamy H. Sarma.

Rapidly Progressing Autoimmune Hemolytic Anemia in a Pediatric Patient With COVID-19.

SARS-CoV-2 is a novel virus that is known to have a predilection for complications associated with the respiratory system. Although COVID-19 has a wide spectrum of manifestations, the pathophysiology of severe illness remains poorly understood but is thought to be associated with fulminant cytokine release. While severe complications secondary to COVID-19 in the pediatric population are considered rare, they do happen. Children with and without comorbidities have required intensive care unit admissions for respiratory distress and, more notably, multisystem inflammatory syndrome in children (MIS-C). While MIS-C is associated with hematologic complications, such as thrombocytopenia and coagulopathies, it is not associated with blood hemolysis. In this report, we describe a case of a 23-month-old previously healthy female, who presented with lethargy and positive COVID-19 PCR status. This case illustrates the rapid and fatal sequela caused by autoimmune hemolytic anemia (AIHA) from COVID-19. It stresses the importance of thorough workup and management of AIHA secondary to COVID-19 illness. Currently, there is limited understanding of AIHA from COVID-19 illness in children. Our aim is to describe this rare complication of COVID-19 illness in pediatric patients and discuss the best practices to manage it.

Deep Learning-Based Automatic Duckweed Counting Using StarDist and Its Application on Measuring Growth Inhibition Potential of Rare Earth Elements as Contaminants of Emerging Concerns.

In recent years, there have been efforts to utilize surface water as a power source, material, and food. However, these efforts are impeded due to the vast amounts of contaminants and emerging contaminants introduced by anthropogenic activities. Herbicides such as Glyphosate and Glufosinate are commonly known to contaminate surface water through agricultural industries. In contrast, some emerging contaminants, such as rare earth elements, have started to enter the surface water from the production and waste of electronic products. Duckweeds are angiosperms from the Lemnaceae family and have been used for toxicity tests in aquatic environments, mainly those from the genus Lemna, and have been approved by OECD. In this study, we used duckweed from the genus Wolffia, which is smaller and considered a good indicator of metal pollutants in the aquatic environment. The growth rate of duckweed is the most common endpoint in observing pollutant toxicity. In order to observe and mark the fronds automatically, we used StarDist, a machine learning-based tool. StarDist is available as a plugin in ImageJ, simplifying and assisting the counting process. Python also helps arrange, manage, and calculate the inhibition percentage after duckweeds are exposed to contaminants. The toxicity test results showed Dysprosium to be the most toxic, with an IC50 value of 14.6 ppm, and Samarium as the least toxic, with an IC50 value of 279.4 ppm. In summary, we can provide a workflow for automatic frond counting using StarDist integrated with ImageJ and Python to simplify the detection, counting, data management, and calculation process.

Fabrication and in vitro evaluation of chitosan-gelatin based aceclofenac loaded scaffold.

Scaffold development is a nascent field in drug development. The scaffolds mimic the innate microenvironment of the body. The goal of this study was to formulate a biocompatible and biodegradable scaffold, loaded with an analgesic drug, aceclofenac (Ace). The bioscaffold is aimed to have optimum mechanical strength and rheology, with drug released in a sustained manner. It was prepared via chemical cross-linking method: a chitosan (CS) solution was prepared and loaded with Ace; gelatin (GEL) was added and the mixture was cross-linked to get a hydrogel. 20 formulations were prepared to optimize different parameters including the stirring speed, drug injection rate and crosslinker volume. The optimal formulation was selected based on the viscosity, drug solubility, homogeneity, porosity and swelling index. A very high porosity and swelling index were attained. In vitro release data showed sustained drug delivery, with effective release at physiological and slightly acidic pH. SEM analysis revealed a homogeneous microstructure with highly interconnected pores within an extended polymer matrix. FT-IR spectra confirmed the absence of polymer-drug interactions, XRD provided evidences for efficient drug entrapment within the scaffold. Rheological analysis corroborated the scaffold injectability. Mathematical models were applied to in-vitro data, and the best fit was attained with Korsmeyer-Peppas.

Nonlinear Optical Properties of Zinc Oxide Nanoparticle Colloids Prepared by Pulsed Laser Ablation in Distilled Water.

The nonlinear optical properties of zinc oxide nanoparticles (ZnONPs) in distilled water were measured using a femtosecond laser and the Z-scan technique. The ZnONPs colloids were created by the ablation of zinc bulk in distilled water with a 532 nm Nd: YAG laser. Transmission electron microscopy, an ultraviolet-visible spectrophotometer, and atomic absorption spectrophotometry were used to determine the size, shape, absorption spectra, and concentration of the ZnONPs colloids. The nonlinear absorption coefficient and nonlinear refractive index were measured at different excitation wavelengths and intensities. The nonlinear absorption coefficient of the ZnONPs colloids was found to be positive, caused by reverse saturable absorption, whereas the nonlinear refractive index was found to be negative due to self-defocusing in the ZnONPs. Both laser parameters, such as excitation wavelength and input intensity, and nanoparticle features, such as concentration and size, were found to influence the nonlinear optical properties of the ZnONPs.

Fluorescent and Phosphorescent Nitrogen-Containing Heterocycles and Crown Ethers: Biological and Pharmaceutical Applications.

Fluorescent molecules absorb photons of specific wavelengths and emit a longer wavelength photon within nanoseconds. Recently, fluorescent materials have been widely used in the life and material sciences. Fluorescently labelled heterocyclic compounds are useful in bioanalytical applications, including in vivo imaging, high throughput screening, diagnostics, and light-emitting diodes. These compounds have various therapeutic properties, including antifungal, antitumor, antimalarial, anti-inflammatory, and analgesic activities. Different neutral fluorescent markers containing nitrogen heterocycles (quinolones, azafluoranthenes, pyrazoloquinolines, etc.) have several electrochemical, biological, and nonlinear optic applications. Photodynamic therapy (PDT), which destroys tumors and keeps normal tissues safe, works in the presence of molecular oxygen with light and a photosensitizing drugs (dye) to obtain a therapeutic effect. These compounds can potentially be effective templates for producing devices used in biological research. Blending crown compounds with fluorescent residues to create sensors has been frequently investigated. Florescent heterocyclic compounds (crown ether) increase metal solubility in non-aqueous fluids, broadening the application window. Fluorescent supramolecular polymers have widespread use in fluorescent materials, fluorescence probing, data storage, bio-imaging, drug administration, reproduction, biocatalysis, and cancer treatment. The employment of fluorophores, including organic chromophores and crown ethers, which have high selectivity, sensitivity, and stability constants, opens up new avenues for research. Fluorescent organic compounds are gaining importance in the biological world daily because of their diverse functionality with remarkable structural features and positive properties in the fields of medicine, photochemistry, and spectroscopy.

OpenBloodFlow: A User-Friendly OpenCV-Based Software Package for Blood Flow Velocity and Blood Cell Count Measurement for Fish Embryos.

The transparent appearance of fish embryos provides an excellent assessment feature for observing cardiovascular function in vivo. Previously, methods to conduct vascular function assessment were based on measuring blood-flow velocity using third-party software. In this study, we reported a simple software, free of costs and skills, called OpenBloodFlow, which can measure blood flow velocity and count blood cells in fish embryos for the first time. First, videos captured by high-speed CCD were processed for better image stabilization and contrast. Next, the optical flow of moving objects was extracted from the non-moving background in a frame-by-frame manner. Finally, blood flow velocity was calculated by the Gunner Farneback algorithm in Python. Data validation with zebrafish and medaka embryos in OpenBloodFlow was consistent with our previously published ImageJ-based method. We demonstrated consistent blood flow alterations by either OpenBloodFlow or ImageJ in the dorsal aorta of zebrafish embryos when exposed to either phenylhydrazine or ractopamine. In addition, we validated that OpenBloodFlow was able to conduct precise blood cell counting. In this study, we provide an easy and fully automatic programming for blood flow velocity calculation and blood cell counting that is useful for toxicology and pharmacology studies in fish.

In Vitro Antimicrobial Activity of Medicinal Plant Rumex Nervosus Against Selected Oral Pathogens.

Background: Rumex nervosus is a plant found and used in Saudi Arabia as traditional herbal medicine. Various types of plant extracts with inherent synergistic properties are being used against oral diseases. Thus, in the present study, the anti-microbial activity of Rumex nervosus extracts was studied against six common oral pathogenic bacterial strains and a pathogenic fungus. Materials and Method: Plants of R. nervosus were collected and air-dried, and extracts from various plant parts were obtained. Six clinical isolates of bacteria, namely Staphylococcus aureus, Streptococcus mutans, S. salivarius, S. sanguis, E. faecalis, and Lactobacillus acidophilus), and one pathogenic Candida (C. albicans) were obtained. Antibacterial and antifungal activity of R. nervosus was determined using the Kirby-Bauer agar disc diffusion method. Zones of inhibition were recorded after 48 h of incubation. Data collected were analyzed. A two-way analysis of variance (ANOVA) was applied. P < 0.05 was considered statistically significant. Results: Methanol extract from leaves were highly effective against S. aureus, with a mean inhibition zone of 33 mm, followed by a 28-mm zone of inhibition using an extract from roots and a minimum inhibition zone using an extract from stems. Zones of inhibition using methanol extract from roots were effective against S. mutans, S. sanguinis, E. faecalis, and L. acidophilus, with mean inhibition zones being 19, 17, 33, and 31 mm, respectively. Conclusion: The study has provided insight into a new potential herbal anti-microbial agent that may benefit dental care.

Optimize PLA/EVA Polymers Blend Compositional Coating for Next Generation Biodegradable Drug-Eluting Stents.

In this research work, polymer blends of poly-lactic acid (PLA)/ethylene vinyl acetate (EVA) were prepared as the drug carrier materials for a bi-layer drug-loaded coating film for coronary stents. Different optimum compositions of blends were prepared by using an intense mixer. Then, the blends were hot-pressed and later cold-pressed to prepare for films of different thickness. The changes in weight, surface analysis and biodegradability with increasing time were studied using Scanning electron microscopy (SEM), weight loss and biodegradability tests. The mechanical and thermal properties of drug-loaded films were studied through universal testing machine (UTM) and thermo-gravimetric analysis (TGA). The effects of PLA, EVA and drug contents on in-vitro drug contents were investigated through the Ultraviolet-Visible Spectroscopy (UV-VIS) chemical analysis technique. The results obtained clearly showed that the addition of PLA promoted the unleashing of the drug whereas the addition of EVA nearly did not have the same affect. The mechanical properties of these various films can be tuned by adjusting the contents of blend parts. The factors affecting the unleashing of the drug became a serious matter of concern in evaluating the performance of bio-resorbable drug eluting stents. As a result, today's chemical blends may be useful drug carrier materials for drug-loaded tube coatings capable delivering purgative drug in an incredibly tunable and regulated manner.

Automated Cardiac Chamber Size and Cardiac Physiology Measurement in Water Fleas by U-Net and Mask RCNN Convolutional Networks.

Water fleas are an important lower invertebrate model that are usually used for ecotoxicity studies. Contrary to mammals, the heart of a water flea has a single chamber, which is relatively big in size and with fast-beating properties. Previous cardiac chamber volume measurement methods are primarily based on ImageJ manual counting at systolic and diastolic phases which suffer from low efficiency, high variation, and tedious operation. This study provides an automated and robust pipeline for cardiac chamber size estimation by a deep learning approach. Image segmentation analysis was performed using U-Net and Mask RCNN convolutional networks on several different species of water fleas such as Moina sp., Daphnia magna, and Daphnia pulex. The results show that Mask RCNN performs better than U-Net at the segmentation of water fleas' heart chamber in every parameter tested. The predictive model generated by Mask RCNN was further analyzed with the Cv2.fitEllipse function in OpenCV to perform a cardiac physiology assessment of Daphnia magna after challenging with the herbicide of Roundup. Significant increase in normalized stroke volume, cardiac output, and the shortening fraction was observed after Roundup exposure which suggests the possibility of heart chamber alteration after roundup exposure. Overall, the predictive Mask RCNN model established in this study provides a convenient and robust approach for cardiac chamber size and cardiac physiology measurement in water fleas for the first time. This innovative tool can offer many benefits to other research using water fleas for ecotoxicity studies.

Design and Evaluation of pH Sensitive PEG-Protamine Nanocomplex of Doxorubicin for Treatment of Breast Cancer.

Cancer is the most common cause of mortality worldwide. There is dire need of modern strategies-such as surface modification of nanocarriers-to combat this global illness. Incorporation of active targeting ligands has arisen as a novel platform for specific tumor targeting. The aim of the current study was to formulate PEG-protamine complex (PPC) of doxorubicin (DOX) for treatment of breast cancer (BC). DOX coupling with PEG can enhance cell-penetrating ability: combating resistance in MDA-MB 231 breast cancer cells. Ionic gelation method was adopted to fabricate a pH sensitive nanocomplex. The optimized nanoformulation was characterized for its particle diameter, zeta potential, surface morphology, entrapment efficiency, crystallinity, and molecular interaction. In vitro assay was executed to gauge the release potential of nanoformulation. The mean particle size, zeta potential, and polydispersity index (PDI) of the optimized nanoparticles were observed to be 212 nm, 15.2 mV, and 0.264, respectively. Crystallinity studies and Fourier transform infrared (FTIR) analysis revealed no molecular interaction and confirmed the amorphous nature of drug within nanoparticles. The in vitro release data indicate sustained drug release at pH 4.8, which is intracellular pH of breast cancer cells, as compared to the drug solution. PPC loaded with doxorubicin can be utilized as an alternative and effective approach for specific targeting of breast cancer.

Design and Evaluation of pH-Sensitive Nanoformulation of Bergenin Isolated from Bergenia ciliata.

The aim of the current study is extraction and isolation of bergenin from Bergenia ciliata and fabrication of pH-sensitive Eudragit® L100 (EL100) polymeric nanoparticles (NP) to tackle limitations of solubility. Bergenin-loaded EL100 nanoparticles (BN-NP) were fabricated via nanoprecipitation and an experimental design was conducted for optimization. A reverse phase-high performance liquid chromatography (RP-HPLC) method was developed for the quantitation of bergenin. The optimized nanoformulation was characterized by its particle size, morphology, loading capacity, entrapment efficiency, drug-excipient interaction and crystallinity. An in vitro assay was executed to gauge the release potential of pH-sensitive nanoformulation. The mean particle size, zeta potential and polydispersity index (PDI) of the optimized nanoparticles were observed to be 86.17 ± 2.1 nm, -32.33 ± 5.53 mV and 0.30 ± 0.03, respectively. The morphological analysis confirmed the spherical nature of the nanoparticles. Drug loading capacity and entrapment efficiency were calculated to be 16 ± 0.34% and 84 ± 1.3%, respectively. Fourier transform infrared spectroscopy (FTIR) studies unfolded that no interaction was present between the drug and the excipients in the nanoformulation. Crystallography studies revealed that the crystalline nature of bergenin was changed to amorphous and the nanoformulation was stable for up to 3 months at 40 °C. The present study confirms that bergenin isolation can be scaled up from abundantly growing B. ciliata. Moreover, it could also be delivered by entrapment in stimuli-responsive polymer, preventing the loss of drug in healthy tissues.

Hydrogel Containing Solid Lipid Nanoparticles Loaded with Argan Oil and Simvastatin: Preparation, In Vitro and Ex Vivo Assessment.

Transdermal hydrogels have the potential to improve therapeutic outcomes via enhancing bioavailability and reducing toxicity associated with oral delivery. The goal of the present study was to formulate and optimise argan oil loaded transdermal hydrogel containing lipid nanoparticles. The high pressure homogenization (HPH) method was utilised to fabricate Simvastatin loaded solid lipid nanoparticles (SIM-SLNs) with precirol ATO 5 as a lipid core and Poloxamer 407 (P407) to stabilise the core. The optimised nanoformulation was characterised for its particle diameter, zeta potential, surface morphology, entrapment efficiency, crystallinity and molecular interaction. Furthermore, transdermal hydrogel was characterised for physical appearance, rheology, pH, bio adhesion, extrudability, spreadability and safety profile. In vitro and ex vivo assays were executed to gauge the potential of SLNs and argan oil for transdermal delivery. The mean particle size, zeta potential and polydispersity index (PDI) of the optimised nanoparticles were 205 nm, -16.6 mV and 0.127, respectively. Crystallinity studies and Fourier transform infrared (FTIR) analysis revealed no molecular interaction. The in vitro release model explains anomalous non-Fickian release of drug from matrix system. Ex vivo skin penetration studies conducted through a fluorescence microscope confirmed penetration of the formulation across the stratum corneum. Hydrogel plays a crucial role in controlling the burst release and imparting the effect of argan oil as hypolipidemic agent and permeation enhancer.

Prospective randomized study comparing outcome of myocardial protection with Del-Nido Cardioplegia versus Saint Thomas Cardioplegia in adult cardiac surgical patients.

Objectives: To compare the effectiveness of Del-Nido cardioplegia as myocardial protective agent with Saint Thomas cardioplegia in adult cardiac surgical patients. Methods: This prospective randomized study was conducted in cardiac surgery department of Bahawal Victoria hospital Bahawalpur, from October 2020 to March 2021. Eighty adult patients who underwent primary Isolated coronary artery bypass grafting (CABG) or isolated Valve surgery requiring cardiopulmonary bypass were randomly divided into Del Nido (DN, n=40) and Saint Thomas (ST, n=40) groups. Data regarding operative and post-operative variables such as cardiopulmonary bypass (CPB) and aortic cross clamp (AXC) times, inotropic requirements, resumption of sinus rhythm, need for electrical defibrillation, post-operative CKMB, blood requirement and ICU stay were noted. Results: CPB and AXC times were statistically insignificantly different. Resumption of Sinus rhythm was seen significantly in more patients of DN group (95%) than in ST group (72.5%) [p-value 0.05]. Less patients of DN group (5%) were candidates of electrical defibrillation than ST group (17.5%) [p-value <0.001). Post- operative CKMB values were significantly lower in DN group as compared to ST group (30.5±22.6 IU vs 50.5±50.28 IU, p value.008). Blood transfusion was significantly lower in DN group; 50% versus 80% in ST group (p-value 0.005). Ventilation time was significantly less in DN group than ST group (165.95±48.09 minutes versus 165.95±48.09 minutes respectively, p-value 0.03). While ICU stay was also less in DN group; 5.2±0.8 days versus 6.05±1.6 days in ST group (p-value 0.003). Conclusion: Del-Nido cardioplegia is a reliable and better myocardial protective agent than Saint Thomas cardioplegia in adult cardiac surgical procedures.

Association of Hypertension and Breast Cancer: Antihypertensive Drugs as an Effective Adjunctive in Breast Cancer Therapy.

Breast cancer (BC) is the most common malignancy affecting women, and its incidence in younger women is rising worldwide. Early-onset of BC is a multi-step process involving various biological aggressive tumors such as triple negative and human epidermal growth factor 2 (HER2)-positive cancers. BC prevention is still arduous across the globe. A series of observational studies have established a conclusive non-genetic clinical link between hypertension (HTN) and the development of invasive BC. Those clinical associations have driven a pharmacological seek to use the anti-hypertension (AHTN) drugs as an effective adjunctive in BC therapy. The use of AHTN, especially beta-blockers and thiazides, has been recognized as a potent anti-tumor drug to mitigate BC progression, reduce the side effects of cancer treatment, and stop the reoccurrence of cancer in the survivors. Considering the dire need to disseminate the research on how AHTN drugs can be opted as the effective adjunctive therapy to cure the BC, the current review aimed to provide an update on novel understandings on association and mechanisms of AHTN-drugs against BC as an additional cancer therapy.

Interactive Visualization Applications in Population Health and Health Services Research: Systematic Scoping Review.

BACKGROUND: Simple visualizations in health research data, such as scatter plots, heat maps, and bar charts, typically present relationships between 2 variables. Interactive visualization methods allow for multiple related facets such as numerous risk factors to be studied simultaneously, leading to data insights through exploring trends and patterns from complex big health care data. The technique presents a powerful tool that can be used in combination with statistical analysis for knowledge discovery, hypothesis generation and testing, and decision support. OBJECTIVE: The primary objective of this scoping review is to describe and summarize the evidence of interactive visualization applications, methods, and tools being used in population health and health services research (HSR) and their subdomains in the last 15 years, from January 1, 2005, to March 30, 2019. Our secondary objective is to describe the use cases, metrics, frameworks used, settings, target audience, goals, and co-design of applications. METHODS: We adapted standard scoping review guidelines with a peer-reviewed search strategy: 2 independent researchers at each stage of screening and abstraction, with a third independent researcher to arbitrate conflicts and validate findings. A comprehensive abstraction platform was built to capture the data from diverse bodies of literature, primarily from the computer science and health care sectors. After screening 11,310 articles, we present findings from 56 applications from interrelated areas of population health and HSR, as well as their subdomains such as epidemiologic surveillance, health resource planning, access, and use and costs among diverse clinical and demographic populations. RESULTS: In this companion review to our earlier systematic synthesis of the literature on visual analytics applications, we present findings in 6 major themes of interactive visualization applications developed for 8 major problem categories. We found a wide application of interactive visualization methods, the major ones being epidemiologic surveillance for infectious disease, resource planning, health service monitoring and quality, and studying medication use patterns. The data sources included mostly secondary administrative and electronic medical record data. In addition, at least two-thirds of the applications involved participatory co-design approaches while introducing a distinct category, embedded research, within co-design initiatives. These applications were in response to an identified need for data-driven insights into knowledge generation and decision support. We further discuss the opportunities stemming from the use of interactive visualization methods in studying global health; inequities, including social determinants of health; and other related areas. We also allude to the challenges in the uptake of these methods. CONCLUSIONS: Visualization in health has strong historical roots, with an upward trend in the use of these methods in population health and HSR. Such applications are being fast used by academic and health care agencies for knowledge discovery, hypotheses generation, and decision support. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/14019.

An OpenCV-Based Approach for Automated Cardiac Rhythm Measurement in Zebrafish from Video Datasets.

Cardiac arrhythmia has been defined as one of the abnormal heart rhythm symptoms, which is a common problem dealt with by cardiologists. Zebrafish were established as a powerful animal model with a transparent body that enables optical observation to analyze cardiac morphology and cardiac rhythm regularity. Currently, research has observed heart-related parameters in zebrafish, which used different approaches, such as starting from the use of fluorescent transgenic zebrafish, different software, and different observation methods. In this study, we developed an innovative approach by using the OpenCV library to measure zebrafish larvae heart rate and rhythm. The program is designed in Python, with the feature of multiprocessing for simultaneous region-of-interest (ROI) detection, covering both the atrium and ventricle regions in the video, and was designed to be simple and user-friendly, having utility even for users who are unfamiliar with Python. Results were validated with our previously published method using ImageJ, which observes pixel changes. In summary, the results showed good consistency in heart rate-related parameters. In addition, the established method in this study also can be widely applied to other invertebrates (like Daphnia) for cardiac rhythm measurement.

Scoping Review on the Impact of Outbreaks on Sexual and Reproductive Health Services: Proposed Frameworks for Pre-, Intra-, and Postoutbreak Situations.

INTRODUCTION: Recent experiences from global outbreaks have highlighted the severe disruptions in sexual and reproductive health services that expose women and girls to preventable health risks. Yet, to date, there is no review studying the possible impact of outbreaks on sexual and reproductive health (SRH). Methodology. Studies reporting outbreaks impacting sexual and reproductive health and pregnancy outcomes were identified using MEDLINE, Embase, and ISI-WoS. Reported impacts were reviewed at systems, community, and legislative levels. RESULTS: The initial run listed 4423 studies; the 37 studies that met all inclusion criteria were mainly from Latin America and Africa. Studies on outbreaks of diseases like Zika and Ebola have documented declines in facility-based deliveries, contraceptive use, and antenatal and institutional care due to burdened healthcare system. Service usage was also impacted by a lack of trust in the healthcare system and system shocks, including workforce capacity and availability. At the community level, poverty and lack of awareness were critical contributors to poor access to SRH services. Assessing the target population's knowledge, attitude, beliefs, and behavior and using health literacy principles for communication were fundamental for designing service delivery. Online resources for SRH services were an acceptable medium of information among young adults. In outbreak situations, SRH and pregnancy outcomes were improved by implementing laboratory surveillance, free-of-cost contraceptive services, improved screening through professional training, and quality of care. In addition, mobile health clinics were reported to be effective in remote areas. Knowledge Contribution. In outbreaks, the interventions are categorized into preoutbreak, during, and postoutbreak periods. The proposed steps can help to improve and do course correction in emergencies. Though conducted before the COVID-19 crisis, the authors believe that lessons can be drawn from the paper to understand and mitigate the impact of the pandemic on sexual and reproductive health services.

Surgical outcome of repair of aortic valve prolapse and regurgitation associated with ventricular septal defect.

OBJECTIVE: To analyze the outcome of repair of aortic valve disease associated with various types of ventricular septal defect. METHODS: In a retrospective observational study design, data of seventy-two patients of ventricular septal defect (VSD) associated with aortic valve prolapse (AVP) and aortic regurgitation (AR) who was operated in Punjab Institute of cardiology from May 2016 to April 2020 was collected. Depending on presence of AR, all patients were divided in four groups. Group-I (VSD and AVP but no AR) had fifteen patients. Only VSD was closed in this group. Group-II (VSD and Mild AR) had forty patients, only VSD was closed in this group as well. Group-III (VSD and Moderate AR) had ten patients, VSD closure and aortic valve repair was done. Group-IV (VSD and severe AR) had seven patients. Aortic valve was repaired in five patients and replaced (AVR) in two patients along with VSD closure. Associated anomalies were addressed as well. RESULTS: Group-I: Twelve out of fifteen patients (80%) showed no post-operative AR. While two patients (13.3%) showed Trace AR. Single patient (6.6%) showed mild AR. There results were unchanged after mean follow up of 36 months. Group-II: Eight out of forty patients (20%) had no AR, while eight (20%) had trace AR. Twenty-three (57.5%) patients had mild AR. Single (2.5%) patient had moderate AR. After follow up of 24 months the patient with moderate AR progressed to severe AR. We are planning to do Aortic Valve Replacement (AVR) in this case. Rest of cases showed no progression of disease. Group-III: Two out of ten patients (20%) had no AR, four (40%) had trace AR, while four (40%) had mild AR. Mean follow up was 42 months (2.5 years). Neither trace nor mild AR progressed to severe or moderate AR. Group-IV: Among seven patients, five underwent repair while two had AVR. Out of five patients who underwent aortic valve repair, four patients (57.1%) were declared mild AR, while severe AR was converted to moderate AR in single patient (14.28%). Mean follow up was 18 months. The moderate AR patient has progressed to severe AR for last six months and we are planning to do AVR in this patient. Postoperative echo of patients with AVR showed adequately functioning aortic valve with AVPG mean 10 mmHg and 15 mm Hg respectively, with no residual AR. CONCLUSIONS: Aortic regurgitation associated with VSD is a congenital lesion with continuously active aortic valve disease resulting in significant morbidity and mortality. Early diagnosis, effective treatment and meticulous follow up decelerate and in most cases arrest the disease process.