The negative effects of high normal glucose on cognitive function were previously reported in euglycemic individuals of middle age and the elderly population. This study aimed at examining the effect of baseline blood glucose levels on spatial ability, specifically verticality perception on the computerized rod and frame test (CRFT) in young healthy adults. 63 healthy male medical students (age range from 18–23 years), of whom 30 were non-fasting outside the month of Ramadan and 33 fasting during Ramadan of the year 2016, were recruited in order to create varying degrees of glycemia during which verticality perception was carried out. Baseline blood glucose reading was obtained prior to commencing the CRFT test. Blood glucose levels at the time of testing decreased as the duration between the last meal and testing increased. A blood glucose range of 62–117 mg/dl was achieved among participants for this study. Linear regression analysis showed that blood glucose level at testing correlated positively with all alignment spatial error parameters, indicating a probable reduction of spatial perception ability with higher blood glucose levels. These results are consistent with other cognitive studies in older healthy humans and emphasize the critical impact of early glucose dys-homeostasis on cognitive function. They also indicate that elevated blood glucose may affect cognitive functioning outside of the usual complications of diabetes.

Introduction: Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Surgical correction has improved survival but re-intervention is often required. Objectives: The objective is to assess outcomes after surgical repair of TOF, long-term follow-up, and factors that influence these results. Materials and Methods: This is a retrospective study conducted in a tertiary care center. Records of patients diagnosed with TOF from 1992 to 2019 (37 years) were retrieved from a detailed database. Patients who underwent complete correction were grouped according to diagnosis, the technique utilized in surgical repair, need for staged repair, and syndromic association. Univariate actuarial and event-free survival analysis was performed. The endpoint for an event was death or re-intervention. Results: A total of 230 patients were diagnosed with TOF and 174 patients underwent complete surgical repair. At 40 years postoperatively, survival was 96%. Actuarial survival was independent of syndromic associations, anatomical diagnosis, type of surgery, or previous shunt. Event-free survival (EFS) survival was 8.12%. EFS was significantly worse for patients with pulmonary atresia (PA) (Hazard ratio, 4.1125; 95% confidence interval [CI], 1.2654–13.3657; P < 0.0001) and for those that required homograft/conduit. The median duration for EFS was 22.73 years, 19.58 years, and 9.12 years for transannular patch (TAP), pulmonary valve-sparing (PVS), and homograft group, respectively. The survival curve for the PVS group merged with that of TAP 20 years postoperatively. Similarly, it merged at 22 years for staged versus primary repair and at 22.73 years for syndromic versus nonsyndromic patients. A weak correlation was found between age at surgery and event-free duration (cc, 0.309; P < 0.0001). The need for TAP was not influenced by the previous palliation, χ2(1, n = 154) = 3.36, P = 0.0667, or with interval to complete correction after the shunt procedure (P = 0.9672). Conclusions: Total correction of TOF has low perioperative mortality and good long-term survival, but the need for re-interventions is high. This study demonstrated that patients requiring homograft/conduit and those with a diagnosis of PA had worse outcomes. Comparison between different surgical groups showed merging of survival curves in follow-up that signifies gradual loss of survival advantage over time.

1 Abstract Purpose-Ramadan intermittent fasting (RIF) has produced heterogeneous and domain-specific effects on cognitive function. The present study investigates the effect of RIF on verticality perception or estimation of subjective visual vertical (SVV) in young adults. The significance of SVV is that it is essential for spatial orientation, upon which many daily activities depend.Methodology -Verticality perception was assessed with a computerized version of the Rod and Frame Test (CRFT) in two visual conditions: without a surrounding frame, and with a distracting tilted frame. The tilted frame condition measures level of visual dependence, or reliance of visual cues for posture and orientation. 39 young adult male males were recruited at different stages of Ramadan fasting: 21 were tested at the end of the first week (Week 1) and 18 others at the end of the third week (Week 3) of Ramadan. 39 participants were also recruited to serve as a non-fasting control group. Factorial ANOVA analyses were conducted to identify the main effects of fasting status, time-of-day and the interaction between them on blood glucose levels, nocturnal sleep duration and vertical alignment errors. Findings-The main effect of fasting status on glucose level was significant (P = 0.03). There was a significant time-of-day main effect on glucose levels (P = 0.007) and sleep duration (P = 0.004) only in fasting participants. Neither the main effects of fasting status nor time-of-day were significant for rod alignment errors in both visual conditions. The interaction of fasting status and time-of-day was not significant either. This may indicate that any negative effect of Ramadan fasting on activities that are critically dependent on verticality perception and spatial orientation, such as sports and driving, may not be due to verticality misperception.Originality-The present study was the first to investigate the effect of Ramadan fasting on spatial orientation. It demonstrated robustness of verticality perception to fasting status and the point of fasting during Ramadan. Verticality perception was also unaffected by time of day effects in nonfasting and fasting groups at two different points of Ramadan. This study corroborates others reporting heterogeneous effects of Ramadan fasting on cognitive function.

Background & Objectives: Arrhythmias are common in pediatric population and is suspected in patients presenting with palpitations and/or syncope. These patients are commonly referred to Pediatric Cardiology for further evaluation either after identifying rhythm abnormality or based on clinical suspicion only. The objective of this study was to assess the yield of pediatric cardiology referrals for arrhythmia evaluation. Methods: This is a single-center retrospective observational descriptive study. A total of 486 patients referred to the pediatric cardiology department from the year 1998 to 2020 were included. Patients were grouped based on referral, Group 1 consisted of patients referred with documented arrhythmia and Group 2 had patients referred on clinical suspicion. Patient’s age at presentation, gender, reason for referral, type of arrhythmias, any associated structural heart disease, interventions, and outcomes were analysed. Results: Group 1 had 156 (32.1%) patients and group 2 had 330 (67.9%) patients. The most common diagnosis in group 1 was atrioventricular re-entry tachycardia and in group 2 was premature ventricular contractions. There was no variability for the type of arrhythmia between the two groups. Among patients in group 2, 315 (95.4%) had no evidence of electrophysiological abnormalities. Positivity rates for arrhythmia were only 3.2% for palpitations and 9% for syncope. 28 (5.8 %) patients required interventions; all from group 1. Conclusion: Clinically significant arrhythmias were mostly diagnosed at the point of first contact. Patients referred on clinical suspicion were mostly normal electro-physiologically. Inappropriate referrals increase the workload on pediatric cardiology services. There is an urgent need to regularise referrals.