Criss cross heart: A challenging diagnosis.

Crisscross heart (CCH) is a rare anomaly characterized by twisting of the inflow streams of right and left ventricles. The etiology of CCH is not known. Its frequency is less than 8/10, 00,000 live births. Cyanosis is common in neonatal age, while shortness of breath is the main presenting complaint in older children. We present a case series of CCH with array of associations, diagnosed by echocardiography. CCH is a rare heart defect that can be diagnosed by echocardiography by a vigilant operator. Early diagnosis is the key to successful management resulting in increased survival rate, better outcomes and improved quality of life.

Towards Parallel Selective Attention Using Psychophysiological States as the Basis for Functional Cognition.

Attention is a complex cognitive process with innate resource management and information selection capabilities for maintaining a certain level of functional awareness in socio-cognitive service agents. The human-machine society depends on creating illusionary believable behaviors. These behaviors include processing sensory information based on contextual adaptation and focusing on specific aspects. The cognitive processes based on selective attention help the agent to efficiently utilize its computational resources by scheduling its intellectual tasks, which are not limited to decision-making, goal planning, action selection, and execution of actions. This study reports ongoing work on developing a cognitive architectural framework, a Nature-inspired Humanoid Cognitive Computing Platform for Self-aware and Conscious Agents (NiHA). The NiHA comprises cognitive theories, frameworks, and applications within machine consciousness (MC) and artificial general intelligence (AGI). The paper is focused on top-down and bottom-up attention mechanisms for service agents as a step towards machine consciousness. This study evaluates the behavioral impact of psychophysical states on attention. The proposed agent attains almost 90% accuracy in attention generation. In social interaction, contextual-based working is important, and the agent attains 89% accuracy in its attention by adding and checking the effect of psychophysical states on parallel selective attention. The addition of the emotions to attention process produced more contextual-based responses.

Decarbonization pathways: the roles of foreign direct investments, governance, democracy, economic growth, and renewable energy transition.

The Paris Agreement has united the global nations to embark on pathways to the decarbonization of their respective economies. However, the objective of achieving low-carbon growth is not as straightforward as it seems since the rapidly emerging and fossil fuel-dependent world economies are focused on expediting economic growth at the expense of poorer environmental consequences. Against this background, this study aims to explore the effects of foreign direct investments, governance, democracy, renewable energy use, and economic growth on carbon dioxide emissions in the context of the BRICS countries over the period from 2006 to 2017. The estimation strategy involved in this study specifically accounts for addressing the issues of cross-sectional dependency and slope heterogeneity in the data set utilized for analysis. The associated findings reveal cointegrating associations between the study variables. Besides, the regression outcomes reveal that good governance (achieved by controlling corruption) and strong democracy (achieved by ensuring greater freedom for journalists) help to reduce carbon dioxide emissions in the long run. More importantly, the results also confirm that both good governance and stronger democracy further reduce carbon dioxide emissions by mediating between emission-inhibiting effects of foreign direct investment inflows in the BRICS countries. In addition, good governance and stronger democracy exert moderating effects to reduce the emission-stimulating impacts associated with higher economic growth. Lastly, it is also witnessed that forgoing non-renewable energy use and adopting renewable energy instead help to curb the carbon dioxide emission levels further. Accordingly, considering these key findings, it is recommended that the BRICS countries should enhance the quality of governance and democracy, attract clean foreign direct investments, promote renewable energy use, and adopt clean economic growth strategies to decarbonize their respective economy.

No safe place for war survivors: War memory, event exposure, and migrants' psychological trauma.

The present study explores the concept of reenactment of known and unknown war trauma that may be unfamiliar to the readers while also opening up new discourses of understanding and empathy through the lens of Cathy Caruth's trauma theory by focusing on the novel A Land of Permanent Goodbyes by Atia Abawi. War fiction, such as Abawi's novel, highlights the concept of psychological trauma as a double wound (known as "outsiders" and unknown as "insiders") through the textual analysis and characterization of characters by presenting their haunting pasts, present lives, and losses concerning traumatic events. The present study also recounts what the trauma of the unknown means to war-torn survivors by focusing on "trauma as double wounds" from three aspects: cause, effects, and recuperation. Finally, the study concludes with a new paradigm in which trauma is portrayed as a healer rather than a wound.

Formulation and Evaluation of Novel Thiolated Intra Pocket Periodontal Composite Membrane of Doxycycline.

Localized intra-pocket, retentive, biodegradable, prolonged release thiolated membrane can provide an improved therapeutic efficacy of doxycycline at the site of action with evading off target side effects. To this end, thiolated chitosan-hyaluronic acid composite polymeric complex next-generation of the periodontal membrane was manufactured by solvent casting method. FTIR spectroscopic analysis displayed successful immobilization of thiol groups on the manufactured thiolated periodontal membrane. Moreover, XRD, DSC, AFM and TGA of the membrane confirmed the compatibility of ingredients and modifications in surface chemistry. The thiolated periodontal film was also investigated in terms of thickness, weight uniformity, water-uptake capacity, drug content, pH, entrapment efficiency, lysozymal degradation and release patterns. Also, mucoadhesion profile was explored on gingival mucosa. The immobilized thiol groups on thiolated chitosan and thiolated hyaluronate were found to be 168 ± 11 µM/g (mean ± SD, n = 3) and 189 ± 8 µM/g (mean ± SD, n = 3) respectively. Swelling capacity of the thiolated periodontal membrane was significantly ∼2-fold higher (p < 0.05) as compared to unmodified membrane. The obtained thiolated membrane depicted 3 -old higher mucoadhesive features as compared to the un-modified membrane. In vitro release kinetics indicated approximately more than 80% prolonged release within 7 days. Mechanical strength of the Thiolated bandage was also significantly ∼2-fold higher (p < 0.05) as compared to unmodified membrane. Ex-vivo retention study revealed enhanced retention of thiolated membrane as compared to unmodified membrane. In-vitro antimicrobial studies demonstrated that thiolated membrane could efficiently kill Porphyromonas gingivalis cells as compared to the native membrane. Moreover, ex-vivo biodegradation results indicated that 90% of the thiolated membrane was biodegradable in 28 days. Based on these findings, thiolated next-generation of the periodontal membrane seems to be promising for periodontitis therapy.

Screening of phytochemicals against Keap1- NRF2 interaction to reactivate NRF2 Functioning: Pharmacoinformatics based approach.

The transcription factor NF- E2 p45-related factor 2 (NRF2; encoded by NFE2L2) and its principal negative regulator, the E3 ligase adaptor Kelch- like ECH- associated protein 1 (KEAP1), significantly contribute to regulation of redox, metabolic and protein homeostasis, as well as inflammation. Therefore, activation of NRF2 imparts cytoprotective effect in numerous pathophysiological conditions including chronic diseases of the lung and liver; autoimmune, neurodegenerative and metabolic disorders and cancer initiation. The objective of this study was to screen library of phytochemicals to identify phytochemicals for direct inhibition of the Keap1-Nrf2 interaction using molecular docking approach. As a result, natural compounds such as 3-(Dimethylamino)-3-imino-N-(4-methylphenyl) propanamide, Phlorizin, Diffutin, Liquiritin and Dihydrogenistin were identified as direct inhibitors of the Keap1-Nrf2 interaction, as evident from its high binding affinity and occupancy of specific binding sites of Klech domain. Thus these phytochemical could be proposed to improve cell resistance to oxidative stress, suggesting their potential as antioxidants. Moreover, the selected compounds fulfilled the Lipinksi rule and appropriate ADMET properties potentiating its efficacy. However, these need to be validated through experimental approaches to ensure its safety profile and efficacy.

Determining the factors causing delayed referral for fetal echocardiography at a tertiary care hospital.

OBJECTIVE: To determine the factors causing delayed referral for fetal echocardiography at a tertiary care hospital. BACKGROUND: Timely referral for fetal echocardiogram is considered essential for identification of congenital heart diseases, interventions, and counseling of parents. The present study highlights the factors associated with delayed referral for fetal echocardiography. MATERIAL AND METHODS: This prospective study includes a total of 200 pregnant females who were referred for fetal echocardiography. The data collected included referral indications, gestational age, maternal age, educational status, referral personale, and final diagnosis on echocardiography. RESULTS: The mean gestational age of presentation was found to be 33 weeks [standard deviation (SD), 4.8 weeks]. Among 200 females, 24% were referred at second trimester, 69% presented at third trimester, and 6% of the females presented at term. No female presented before 18 weeks of gestation. Our results showed that most of the females (94%) were referred by their gynecologist. Eighty-nine percent of the females were booked since the first trimester. The most common indication for referral was unexplained death of children (60%). Of 200 pregnant women, 40% were found to be illiterate and 60% were educated. However, the mean gestational age of presentation of illiterate females was 32.9 weeks (SD, 4.2 weeks), and for educated women it was 33 weeks (SD, 5 weeks). Congenital heart disease was diagnosed in 12% of the cases. CONCLUSION: On the basis of the results, it could be concluded that delayed presentation for fetal echocardiography was not associated with the educational status of females. By contrast, referral personnel were found to be responsible for the delayed referral of females. Therefore, we strongly recommend that both pregnant women and gynecologists be educated about the importance of timely diagnosis for identification of congenital heart diseases.