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The Clinical Outcome of Patients Undergoing Fontan Surgery; Over 10 Years of Experience in a Single Center

Background: The modified Fontan operation is one of the essential surgical techniques in children with congenital heart diseases. Therefore, we sought to identify the characteristics as well as the early and late outcomes of patients who have undergone Fontan operation during more than 10 years. Methods: This study was conducted with a cross-sectional design. The medical records of 52 patients who underwent modified Fontan operation from March 21th, 2006 to March 20th, 2018, at Tabriz Children's Hospital including the bassline, clinical and surgical data were extracted retrospectively reviewed. Patients were invited for follow up visits and clinical examination and echocardiographic evaluations were conducted. Findings: The most prevalent heart anomaly was tricuspid valve disorders (28 cases, 51.9%). The majority of patients (42 cases, 80.2 %) underwent intracardiac lateral tunnel Fontan. The most prevalent complications were prolonged pleural effusion and neurologic events (each one in 10 cases, 19.2%). The in-hospital mortality rate was 15.3%. The patients were followed for a median 7 years. The survival of those successfully followed was 74.5 percent in 5 years. The most common valvular disorder was mitral valve regurgitation (MR), which was present in 84% of cases. The group of patients with single ventricle had a significantly higher mortality rate than the other groups (P = 0.018). Conclusion: The clinical data of patients who have undergone Fontan surgery was reviewed. Despite acceptable survival, patients remain at risk for morbid events in particular prolonged pleural effusion and neurologic events. Moreover, patients with Fontan circulation should be strictly followed to investigate the development of MR and to timely repair in severe cases to prevent further deterioration. Of note, due to some limitations of our study, further multi-centric studies are warranted to confirm our findings.

Impact of family planning on maternal and infant mortality in Cameroon: Protocol for a clustered non-randomized controlled trial

The study aimed to assess the impact of family planning on maternal and infant mortality in Tiko CDC plantation camp. This is a clustered non-randomized controlled trial with a predetermined intervention site (Tiko CDC plantation camp) and a control site (Pena Mboko camp). Four clusters were randomly selected in each group using simple ballot and the intervention administered in all clusters in the intervention site. Households/participants were then systematically sampled (250 in each site) for data collection and analysis. The intervention comprises a triad of health education, facilities strengthening and distribution of contraceptives in the intervention cohort. After baseline study, re-evaluation visits are scheduled for 3rd, 6th and 9th month of intervention and a post-intervention data collection at 12th months of intervention. The pre-intervention phase was conducted from December 2019 to February 2020; data was partially analysed and intervention was designed. Primary outcomes to be measured are contraceptive knowledge, perception and practice while secondary outcomes are maternal and infant morbi-mortality. Ethical clearance was obtained from the institutional ethics committee for research on human health at University of Douala. While the study adds to existing literature, its strengths and limits could be useful in informing similar interventions in the study area and beyond. Key words: Non-randomized clustered, Family planning, Health education, Maternal, Infant, mortality, Cameroon.

Investigating reasons for clinic absence among HIV-infected patients in Guinea-Bissau - a cohort study

Clinic absence or lost to follow-up is still a big challenge in West Africa, especially in Guinea-Bissau, where retention in care is lower compared to all other low- or middle-income countries. The study aims to explore the reasons for clinic absence among HIV-infected patients in Guinea-Bissau, and to evaluate whether the telephone tracing is associated with patients returning to clinic follow-up. A prospective cohort analysis was conducted. Data were collected through telephone calls in which patients or their contact persons were asked for reasons for non-attendance. A total of 3,668 patients, who had been considered as clinic absent were enrolled in this study; 1,883 (51.3%) on antiretroviral treatment (ART) and 1,785 (48.7%) without ART. The median time between patients last clinic visit to time of calling was 203 days (interquartile range (IQR) 59 - 360 days). 748 (20.4%) patients and additional 364 (9.9%) contact persons were successfully reached. Reasons for clinic absence included traveling 346 (31.1%), death 211 (19.0%), and still having medicine 186 (16.7%). After tracing, 555 (49.9%) of the traced patients returned to the clinic. Nineteen percent of the absent HIV-infected patients had died by the time of calling, underscoring the need to improve patient follow-up in Guinea-Bissau. Telephone calls provide an important tool to address reasons for clinic absence and may lead to patients returning to clinical follow-up. Key words: Clinic Absence, Loss to follow-up, Return, HIV, ART, Telephone, Sub Saharan Africa.

Tourists’ Attitude Towards Cultural Heritage and their Willingness to Pay to Visit: a Case Study of Lahore, Pakistan

Tourists’ interest in traveling to Lahore (more specifically to the Badshahi Mosque and the Royal fort) has increased in recent years and is expected to continue. Despite this, very few facts are known about an individual's attitude towards cultural heritage. This study looks at the pre- and post- visit factors that encourage tourists to come to the cultural heritage sites and also identifies variables that help to estimate their willingness to pay (WTP) for admission to visit them. The data from 200 tourists was collected through a well-prepared questionnaire and then used in the final analysis. The contingent valuation method (CVM), considered to be the most useful, with a dichotomous choice question, was used to estimate the WTP. Two models were used in estimating the WTP, i.e. binary regression and ordinary least squares (OLS). The findings acknowledged that tourists were interested in retaining happy memories, experiences and knowledge through the visit. More than 75% of the tourists were willing to pay for cultural heritage, had a positive attitude toward it and would like to visit these destinations again. Tourists’ income was a positive and significant determiner of WTP; the total cost of the visit and environmental issues were negatively related to WTP. As tourism provides an important source of income, the findings of this study point to some practical recommendations that may be implemented in the future by local authorities.

Evaluation of multiple subgingival irrigations with 10% povidone-iodine after scaling and root planing: a randomized clinical trial.

This 6-month randomized controlled study aimed at evaluating the clinical outcomes of multiple irrigations of 10% povidone-iodine (PVP-I) as an adjunct to full-mouth scaling and root planing (SRP) in the treatment of chronic periodontitis. Seventeen patients were included. A split-mouth design randomly assigned one side as the test side (SRP + PVP-I) and the other side as the control side (SRP + NaCl). After full-mouth SRP, the control side received subgingival irrigation with 10 mL 0.9% NaCl solution. The test side received 10 mL of PVP-I 10%. Plaque Index (PI), bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) parameters were assessed at baseline and after 3 and 6 months. During recall visits (3 and 6 months), residual deep periodontal pockets of ≥ 6 mm were cleaned with the same protocol and randomization. PI, BOP, PPD, and CAL were improved in both sides after 6 months. No significant differences were seen between control and test sides for the all clinical parameters after 6 months. Multiple subgingival irrigations of 10% PVP-I or 0/9% NaCl combined to one-stage full mouth SRP in patients with chronic periodontitis showed a reduction of all clinical parameters until 6 months. There was a trend in favor of the povidone group for PPD. ( 2021;52:496-504; doi: 10.3290/j.qi.b1044059).

Is there any Need to Visit a Dentist Every Six Months?

Is there any Need to Visit a Dentist Every Six Months?

Randomized controlled trial of functional outcome of periarthritis of shoulder (Adhesive Capsulitis) in a group of 60 patients using intraarticular triamcinolone vs. intraarticular platelet rich plasma

Background: Periarthritis shoulder is the most common cause of shoulder pain and stiffness encountered in day to day practice. Though the condition is self-limiting it may not be practical to wait for spontaneous resolution as it is associated with significant morbidity hampering routine activities. The various treatment options available include simple physiotherapy, intra articular injections, manipulation under general anaesthesia and surgical intervention. This study was undertaken to compare the efficacy and safety of two intraarticular injections that is triamcinolone acetonide and platelet rich plasma (PRP). Materials and Methods: Patients with periarthritis shoulder were randomly allocated into two groups. Group A receiving intraarticular triamcinolone acetonide injection and Group B receiving intra articular platelet rich plasma. Patients were followed up every four weeks for 24 weeks. And outcome was assessed using SPADI score before treatment and at every visit. Results were assessed using Epi Data version 2.2.2.186. Results: PRP treatment resulted in statistically significant improvement over triamcinolone acetate therapy in both SPADI and VAS scale. Conclusion: Intraarticular PRP is more effective and safe in treatment of periarthritis shoulder. Keywords: Periarthritis shoulder, Triamcinolone acetonide, Platelet rich plasma.

Impacts of Ambient Air Pollution on Health Risk in Korea: A Spatial Panel Model Assessment

This paper investigates the impact of air quality pollution on respiratory health risk in Korea. In particular, we consider transboundary effects of particulate matter (PM10) on the health risk of pneumonia by using the spatial panel model. PM10, generated by natural phenomena and anthropogenic activities, migrates to neighboring areas contributing to not only local but also ambient regional health risks. We employ the spatial panel model to explain the spillover effects of air pollution on the respiratory health risk. The panel data covers environmental, demographic and economic variables that are associated with pneumonia of 120 local districts in Korea during the period from 2010 to 2015. Empirical evidence based on non-spatial and spatial models commonly indicates that the impact of air pollution on pneumonia-related risk is significant. The spatial panel model assessment reveals improvement in explanation and evidences more significant effect of ambient air pollution on pneumonia related hospital visits. As such, evidences of spatial dependence and borderless impacts of air pollution on the health risk of pneumonia are found to be strong. We also investigate the spatial dynamics of the potential association between air pollution and respiratory diseases with respect to variations in wind direction by extending the conventional weight matrix specification. Empirical results imply that transboundary effects of PM10 on health risk are stronger for districts located downwind from Northwest districts than from other directions.

Impact of the Coronavirus Disease 2019 Pandemic on an Ongoing Pragmatic Pediatric Clinical Trial

Background: The coronavirus disease 2019 (COVID-19) pandemic has a significant negative impact on clinical trials. Therefore, maintaining an optimal trial conduct should be considered to minimize risks to trial integrity while ensuring the safety of trial staff and participants. In this study, we aimed to describe the impact of the COVID-19 pandemic on conducting an ongoing clinical trial, along with challenges and solutions encountered and required to continue the trial. Methods: This Phase IV pragmatic randomized superiority controlled open-label trial included children with epilepsy receiving Vitamin D supplementation at King Saud University Medical City, Riyadh, Saudi Arabia (clinicaltrials.gov registration number: NCT03536845). Children with epilepsy receiving chronic antiepileptic medications and with normal baseline 25-hydroxyvitamin D level were randomized to receive cholecalciferol 400 IU/day versus 1000 IU/day for 6 months. The primary outcome was the percentage of children with Vitamin D insufficiency at 6 months. The secondary outcomes included seizure control, bone mineral density, and safety. Results: Under COVID-19 public health emergency measures, exceptional methods were used, such as telemedicine, home visit for blood extractions, shipping of the study medication to the patient's home, using reminder text messages to follow patients' compliance, and using privacy-compliant platforms to connect the research team members. Conclusion: During the widespread pandemic, ethical dilemmas are of major concern, especially when conducting trials on vulnerable age groups. Therefore, actions should be proportionate and based on benefit-risk considerations, affecting the risk of bias from protocol deviation and overall results.

Foodstragramming of Solo Dining Experiencescape: The Fear of Missing Out

This study explored the foodstragramming or consumption photo-sharing and the solo dining experiencescape. Solo dining experiencescape is framed by culinary tourists and food neophobia of Instagram users. The narrative approach was employed to explore an Instagram post on Brooklyn ramen shop by BuzzFeed’s Tasty in relation to food-related personality traits and perceived territoriality. The collaborative branding of culinary tourism experiencescape denotes the use of Instagram. Introverted Instagram users were found to be co-creators, but food-related personality traits did not exclusively construct their visit plan. As the perceived territoriality and social distancing were found to augment foodstragramming of solo dining in this study, the visit plan of solo dining in culinary tourism was not solely perceived by introverted people. The use of the narrative approach in this study provided unique and valuable insights to these theoretical perspectives that may be overlooked by other analyses or approaches.

Outpatient Clinic Practice of Hospice and Palliative Care in Peking Union Medical College Hospital

Objective To share the outpatient clinic practice of hospice and palliative care at the Department of Geriatrics,Peking Union Medical College Hospital.Methods We conducted a retrospective analysis on the consecutive clinic data of doctor N in Geriatric Outpatient Clinic,Peking Union Medical College Hospital from January 1,2016 to December 31,2019.The patients aged 85 years and older,as well as those with end stage malignant tumor,non-tumor dysfunction due to chronic diseases or primary diseases without effective treatment were defined as patients with palliative care need.The basic information,symptoms,consultation purposes and treatments of these patients were collected.Results Among the 2502 visits during the study period,1388 patients with palliative care needs were admitted and recorded,with an average age of(69.7±13.5)years(8-105 years),among which 73.3% were patients over 60 years old and 712(51.3%)were males.Among these patients,63.4% visited specifically to seek for palliative care service and 87.2% of the visits were due to distress caused by advanced malignant tumors.Of the 221 patients with non-tumor diseases,frailty and neurodegenerative diseases were the leading life-threating cause.Of the 5483 symptoms recorded,pain(21.2%),anorexia(13.1%),fatigue(11.6%),constipation(6.9%),insomnia(4.6%),and abdominal distension(4.6%)were the six common symptoms.In the 2502 visits,26.2% of the patients had mutiple visits,and 50.3% of the patients with multiple visits had more than three visits;38.6% of patients visited the clinic themselves,and 65.7% of visits were attended by two or more family members(including the patients).The average duration of visit was(19.6±8.5)min(2-85 min),and 13.5%,53.0%,25.6% and 7.9% of the patients completed the consultation within 10,11-20,21-30 and over 30 min,respectively.Conclusion There is strong demand of palliative care in the outpatient clinic of Department of Geriatrics in Peking Union Medical College Hospital and it is feasible to provide palliative care service for patients with serious diseases in geriatric outpatient clinics.

Awareness, Use, Care of Insecticide-treated Bed Nets among Pregnant Women in Buea (Buea) and Bonassama (Douala)

Background: Malaria in pregnancy (MiP) remains a major health problem in Cameroon, with an unacceptably high annual maternal mortality rate pegged at 782 maternal deaths per 100,000 live births. Despite the gains made through the free distribution of Long Lasting Insecticide Treated Nets (LLITNs) during the antenatal visit and the mass campaign, there is a paucity of data about how pregnant women effectively care for LLITNs. Methods: This was a hospital-based descriptive cross-sectional study conducted from June 2016 to September 2017 among consecutive consenting pregnant women attending antenatal clinics in Bonassama Health District (BHDa) and Buea Health Districts (BHD) located in Douala and Buea respectively using structured questionnaires. Results: Seventy-eight point two (78.2%) of participants never used LLITNs in BHD compared to 7.0 % in BHDa. A greater proportion of participants in both health districts declared having acquired LLITNs during antenatal visits 502 (65.2%) and LLITNs acquisition were facilitated mostly by health workers (77.92 %) in BHD and (53.5%) BHDa. In BHD, 125 (32.5%) never washed their ITNs and the reasons cited were the difficulties to mount when removes 72 (18.7%) in BHD and 47 (12.2%) in BHDa. The majority of pregnant women do self-repaired 383(99.5%) their LLITNs when their damaged than taking them to the tailor 138(17.9%). Conclusion: The high level of knowledge of LLITNs in protecting pregnant women against mosquito bites does not parallel the use of LLITNs in the study population. Forgetfulness and heat were the main reasons for not using the LLITNs in both Health Districts. Continuous health education and sensitization on the use of LLITNs as an effective preventive method for malaria during pregnancy should be accelerated especially during an antenatal visit.

Navigating Ph.D. recruitment virtual ‘visits’

Navigating Ph.D. recruitment virtual ‘visits’

Trend of Emergency Department Visits for Elderly Patients with Chronic Diseases : 2014-2019

Trend of Emergency Department Visits for Elderly Patients with Chronic Diseases : 2014-2019

Borrell Visits Moscow for Fraught Talks

Borrell Visits Moscow for Fraught Talks

Kreuzfahrtterminal Warnemünde: Abfertigung, kommunale Nutzung, Landmark

AbstractDie steigenden Schiffsanläufe und Passagierzahlen in Rostock‐Warnemünde, einem der bedeutendsten Standorte für den Kreuzfahrttourismus im Ostseeraum, erforderten eine Erweiterung und Modernisierung der Infrastruktur. Das neue Cruise‐Terminal wurde 2020 eröffnet. Trotz der in diesem Jahr geringeren Auslastung durch die weltweite Corona‐Pandemie bleibt die Nachfrage und Prognose für den Ostseeraum hoch. Die Gestaltung des Gebäudes folgt den Anforderungen der unterschiedlichen Nutzungen im Jahresverlauf als EU‐Außengrenze und kommunaler Veranstaltungsraum. Die Windlasten waren aufgrund der exponierten Lage in unmittelbarer Küstennähe sowie durch die Position der Schiffe im Bezug zum Gebäude versuchsgestützt zu ermitteln. Der gewünschte repräsentative Charakter des Gebäudes, kombiniert mit einer komplizierten Gründungssituation, erzeugt ein außergewöhnliches Tragwerk in Stahlbauweise. In diesem Beitrag wird detailliert auf die anspruchsvolle Tragwerksplanung eingegangen.

Augmentation in Healthcare Utilization of Patients with Opioid Use Disorder After Methadone Maintenance Treatment: A Retrospective Nationwide Study.

The health benefits of entering methadone maintenance treatment (MMT) for opioid-dependent persons may not be merely limited to therapy of opioid use disorder. We aimed to compare the healthcare utilization of MMT patients before and after MMT. A retrospective analysis was performed using the Taiwan Illicit Drug Issue Database and the National Health Insurance Research Database (NHIRD) between 2014 and 2016. We included 1255 newly enrolled MMT patients in 2015 and randomly selected 5020 patients from NHIRD matched by age and gender as the comparison group. Changes in healthcare utilization 1year before and 1year after the date of the index date (MMT initiation) were compared within and between MMT and comparison groups. During the 1-year period following MMT, the hospitalization length was considerably decreased, while the number of outpatient visits, emergency department (ED) visits, and ED expenditure significantly increased in MMT patients. Multivariable linear regression with the difference-in-difference approach revealed that all the categories of healthcare utilization increased, except for a minor increase of outpatient expenditure and a slight decrease of hospitalization length for the MMT group relative to the comparison group. Increases in utilization of the departments of psychiatry and infectious diseases of the MMT patients were considerable. MMT is associated with increased healthcare utilization, and departments of psychiatry and infectious diseases play substantial roles. Policy-makers should warrant access for all who need healthcare by ensuring the availability of the treatment for drug dependence.

Pulmonary Adenosquamous Cell Carcinoma With Systemic Lymphadenopathy due to Immunoglobulin G4-Related Disease: A Case Report

A 75-year-old man with diabetes mellitus showed elevated C-reactive protein (CRP) level at his regular visit. Computed tomography scan showed a lung tumor in his left lower lobe and systemic lymphadenopathy including abdominal lymph nodes. The patient was diagnosed as primary pulmonary squamous cell carcinoma with systemic lymph node metastasis. Thereafter, unexpected steroid pulse therapy for accidental acute exacerbation of interstitial pneumonia rapidly shrank lymphadenopathy. At this time, we also found elevated serum immunoglobulin G4 (IgG4) level (385 mg/dL). Considering these findings, we doubted the lymph nodes metastases at the initial staging, and then corrected cancer-staging (C-staging) from inferior vena cava (IVC) to inferior abdomen (IA). In addition, during the steroid tapering, sudden onset and uncontrollable left pneumothorax required surgical approach. Curative-intent left lower lobectomy with lymphadenectomy was performed for the lung cancer. Pathological findings revealed coexistence of adenosquamous carcinoma and infiltration of IgG4-positive plasma cells in the resected mediastinal lymph node. We detected 384 IgG4-positive cells per high power field. IgG4/IgG-positive cell ratio was 54%. Based on these findings, the diagnosis of IgG4-related disease with primary adenosquamous carcinoma (p-stage IIIA) was confirmed. The patient died 24 days after surgery because of another acute exacerbation of interstitial pneumonia. Our case alerts oncologists to IgG4-related disease as a possible underlying comorbidity which may confuse pretreatment clinical stage. J Med Cases. 2021;12(4):164-171 doi: https://doi.org/10.14740/jmc3649

Use of Professional Interpreters During Pediatric Emergency Department Visits

Professional medical interpretation is critical for delivering high-quality care to patients and families with limited English proficiency (LEP).