Background – Children with exposure to COVID-19 in recent times (asymptomatic or symptomatic infection) approaching congenital heart surgery (CHS) program are in increasing numbers. Understanding outcomes of such children will help risk-stratify and guide optimization prior to CHS. Objective: The objective of the present study was to determine whether convalescent COVID-19 children undergoing congenital heart surgery have any worse mortality or postoperative outcomes. Design: Consecutive children undergoing CHS from Oct 2020 to May 2021 were enrolled after testing for RT-PCR (Reverse Transcriptase Polymerase chain test) or rapid antigen test (RAT) and IgG antibody prior to surgery. Convalescent COVID-19 was defined in any asymptomatic patient positive for IgG antibodies and negative for RT-PCR or RAT anytime 6 weeks prior to surgery. Control patients were negative for any of the three tests. Mortality and postoperative outcomes were compared among the groups. Results: 1129 consecutive CHS were stratified as convalescence and control. COVID-19 Convalescent (n=349) and COVID-19 control (n=780) groups were comparable for all demographic and clinical factors except younger and smaller kids in control. Convalescent children had no higher mortality, ventilation duration, ICU and hospital stay, no higher support with ECMO, HFNC, no higher need for re-intubations, re-admissions, and no higher infections as CLABSI, SSI, and VAP on comparison with COVID-19 control children. Conclusions: Convalescent COVID-19 do not have any unfavorable outcomes as compared to COVID-19 control children. Positive IgG antibody screening prior to surgery is suggestive of convalescence and supports comparable outcomes on par with control peers.

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Objectives Sub-chronic exposures to chlorpyrifos, an organophosphorus pesticide is associated with incidence of diabetes mellitus. Biochemical basis of chlorpyrifos-induced diabetes mellitus is not known. Hence, effect of its sub-toxic exposure on redox sensitive kinases, insulin signaling and insulin-induced glucose uptake were assessed in rat muscle cell line. Methods In an in vitro study, rat myoblasts (L6) cell line were differentiated to myotubes and then were exposed to subtoxic concentrations (6 mg/L and 12 mg/L) of chlorpyrifos for 18 h. Then total anti-oxidant level in myotubes was measured and insulin-stimulated glucose uptake was assayed. Assessment of activation of NFκB & p38MAPK and insulin signaling following insulin stimulation from tyrosine phosphorylation of insulin receptor substrate-1 (IRS-1) and serine phosphorylation of Akt were done in myotubes after chlorpyrifos exposure by western blot (WB) and compared with those in vehicle-treated controls. Results The glucose uptake and total antioxidant level in L6-derived myotubes after sub-toxic exposure to chlorpyrifos were decreased in a dose-dependent manner. As measured from band density of WB, phosphorylation levels increased for redosensitive kinases (p38MAPK and IκBα component of NFκB) and decreased for IRS-1 (at tyrosine 1222) and Akt (at serine 473) on insulin stimulation following chlorpyrifos exposure as compared to those in controls. Conclusion We conclude that sub-toxic chlorpyrifos exposure induces oxidative stress in muscle cells activating redox sensitive kinases that impairs insulin signaling and thereby insulin-stimulated glucose uptake in muscle cells. This probably explains the biochemical basis of chlorpyrifos-induced insulin resistance state and diabetes mellitus. Keywords Chlorpyrifos. Type 2 diabetes mellitus. Insulin signaling. Insulin resistance. NFκB. p38MAPK Key message 1. Sub-toxic chlorpyrifos exposure imparts oxidative stress and thus activates redox sensitive kinases. 2. The activated redox sensitive kinases impair insulin signaling, that in turn induce insulin resistance in muscle cells leading to decreased glucose uptake.

“Harlequin effect” may be observed in the watershed region of a patient with pulmonary dysfunction, receiving peripheral veno-arterial extracorporeal membrane oxygenation via the femoral vessels. In such cases, retrograde oxygenated blood from the peripheral inflow cannula converges with the antegrade deoxygenated blood ejected from the left ventricle. This occurs when the left ventricle is ejecting significantly but the recovery of pulmonary function lags behind. Herein, we describe the occurrence of “Harlequin effect” in the setting of central veno-arterial extracorporeal membrane oxygenation that ensues due to the persistence of right ventricular dysfunction in the presence of an interatrial communication. This results in right to left shunting at the atrial level while weaning the patient from extracorporeal life support.

Abnormal proximal aortic origin of the brachiocephalic artery is a very rare condition. It can occur in isolation or associated with complex congenital heart disease affecting the right ventricular outflow tract. Its recognition carries relevant surgical implications for the safe conduct of cardiopulmonary bypass and for any surgical procedures that directly involve the proximal ascending aorta and its branches.