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Yasui procedure is surgical repair intended to preserve biventricular function for patients with left ventricle outflow tract obstruction associated with aortic arch lesions and ventricular septal defect.
Retrospective chart review analysis of all patients who had Yasui procedure (2008–2020) comparing midterm outcome of one versus two stage repair.
Twenty patients (70% female) underwent Yasui procedure in our center. Eight patients (40%) had left ventricle outflow tract obstruction /interrupted aortic arch, 7 patients (35%) had left ventricle outflow tract obstruction /coarctation of aorta, 3 patients (15%) had double outlet ventricle and ventricular septal defect that were unattainable for tunneling to one of the semilunar valves without creating obstruction, and 2 patients (10%) had aortic atresia with hypoplastic aortic arch. All patients had associated ventricular septal defect. Fifteen patients (75%) had one-stage repair and 5 patients (25%) had two-stage repair. Means age and weight for one and two-stage repair were 1.3 ± 2 months, 13.4 ± 11.5 months and 3.3 ± 0.6 kg, 7.8 ± 3.4 kg, respectively. During follow up, 8 patients (40%) required re- intervention, mainly for right ventricle–pulmonary artery conduit either dilation or replacement. The average duration of follow up was 5 years with nil mortality.
Yasui procedure is effective approach for children who have left ventricle outflow tract obstruction associated with aortic arch anomalies and ventricular septal defect. Survival rate with single or staged repair is comparably good. During the first 5 year of follow up, nearly 40% of operated patients required re-intervention.
Chronic aflatoxin exposure has been associated with childhood stunting (length-for-age/height-for-age < –2 sd), while data lacks for Bangladesh, a country with substantial burden of childhood stunting. This paper examined the association between aflatoxin exposure and childhood stunting in a slum setting of Dhaka city.
In this MAL-ED aflatoxin birth cohort study, plasma samples were assayed for aflatoxin B1-lysine adduct (AFB1-lys) by MS at 7, 15, 24 and 36 months of age for 208, 196, 173 and 167 children to assess chronic aflatoxin exposure. Relationship between aflatoxin exposure and anthropometric measures was examined by mixed-effects logistic regression models.
Setting and participants:
The study was conducted in Mirpur, Dhaka, where children were followed from birth to 36 months.
Prevalence of stunting increased from 21 % at 7 months to 49 % at 36 months of age. Mean AFB1-lys concentrations at 7, 15, 24 and 36 months were 1·30 (range 0·09–5·79), 1·52 (range 0·06–6·35), 3·43 (range 0·15–65·60) and 3·70 (range 0·09–126·54) pg/mg albumin, respectively, and the percentage of children with detectable AFB1-lys was 10, 21, 18 and 62 %, respectively. No association was observed between aflatoxin exposure and stunting in multivariable analyses. Factors associated with childhood stunting were age, low birth weight, maternal height, stool myeloperoxidase and number of people sleeping in one room.
A relatively lower exposure to aflatoxin may not influence the linear growth of children. This finding indicates a threshold level of exposure for linear growth deficit and further investigation in other areas where higher concentrations of aflatoxin exposure exist.
Conflicting reports have been published on the association between Clostridium difficile ribotypes and severe disease outcomes in patients with C. difficile infection (CDI); several so-called hypervirulent ribotypes have been described. We performed a multicenter study to assess severe disease presentation and severe outcomes among CDI patients infected with different ribotypes.
Stool samples that tested positive for C. difficile toxin were collected and cultured from patients who presented to any of 7 different hospitals in Houston, Texas (2011–2013). C. difficile was characterized using a fluorescent PCR ribotyping method. Medical records were reviewed to determine clinical characteristics and ribotype association with severe CDI presentation (ie, leukocytosis and/or hypoalbuminemia) and severe CDI outcomes (ie, ICU admission, ileus, toxic megacolon, colectomy, and/or in-hospital death).
Our study included 715 patients aged 61±18 years (female: 63%; median Charlson comorbidity index: 2.5±2.4; hospital-onset CDI: 45%; severe CDI: 36.7%; severe CDI outcomes: 12.3%). The most common ribotypes were 027, 014-020, FP311, 002, 078-126, and 001. Ribotype 027 was a significant independent predictor of severe disease (adjusted odds ratio [aOR], 2.24; 95% confidence interval [CI], 1.53–3.29; P<.001) and severe CDI outcomes (aOR, 1.71; 95% CI, 1.02–2.85; P=.041) compared with all other ribotypes in aggregate. However, in an analysis using all common ribotypes as individual variables, ribotype 027 was not associated with severe CDI outcomes more often than other ribotypes.
Ribotype 027 showed virulence equal to that of other ribotypes identified in this endemic setting. Clinical severity markers of CDI may be more predictive of severe CDI outcomes than a particular ribotype.
Infect. Control Hosp. Epidemiol. 2015;36(11):1318–1323
The aim of this study was to explore the awareness and views of members of the ethnic minority community towards primary health care interpreting provision in two localities in Hertfordshire.
Ethnic minority groups often have to undertake many aspects of their day-to-day lives with limited English. The provision of high quality language interpretation services is vital for enabling access to public services, including healthcare. The use of accredited or professional interpreters has been minimal within primary care and undermines the principle of equity in the National Health Service. The local Primary Care Trust and ethnic minority forums initiated this study.
The overall research design was qualitative and data collection was undertaken using focus groups. Twenty-four participants from the Pakistani (Punjabi and Urdu speakers), Bangladeshi (Bengali speakers) and Chinese (Cantonese and Mandarin speakers) communities took part in one of five focus groups. Ethnic minority members recruited participants, conducted the focus groups and translated the interviews after receiving in-depth training.
Participants were unaware that healthcare professionals could access interpreting provision for their primary health care consultations, which were usually managed with the assistance of family members (including children) and friends. Both the appropriateness of using children and the potential compromising of confidentiality and privacy when using friends to interpret were concerns. Women discussed inventing illnesses rather than talking openly about embarrassing health issues in front of their children or husbands, which they suggested, may lead to depression or other mental health problems. Trust, accuracy, independence and confidentiality were important attributes participants expected in a professional interpreter whom they would prefer was from their own gender and culture.
The impacts of hydropower developments on local environment, ecology, and socio-economics, has influenced, and will continue to influence, the efficacy in decisionmaking and planning/design processes. Big dams have several disadvantages: (a) high costs, (b) possible collapse, (c) evaporation loss, (d) flooding of prime agricultural land, (e) siltation of reservoir, (f) salt-water intrusion in coastal areas, (g) deforestation and ‘greenhouse’ effect, and (h) destruction of habitat for rare species. We must refine our environmental understanding of how hydropower development affects species, both individually and in their interactions with each other. The utter dependence of organisms on appropriate environments is what frustrates most attempts to proceed with development and still protect ecosystems and wider ecocomplexes. Conservation objectives must be integrated with other objectives in formulating national and other policies, before they crystallize into projects and programmes. When ecological factors are considered only at the end of the process, they are liable to be viewed as obstructing development, which can be disastrously wrong. But if integrated at the basic level of decision-making, they can positively guide development most propitiously and beneficially. Translated to the global context, this is best served by holistic thinking.
Three galactopoietic stimuli, frequent milking (4X), bovine somatotrophin (bST) and thyroxine (T4) were used in an additive stair-step design to achieve maximum output (metabolic capacity) in six peak-lactation cows of high genetic merit (HT) and six of low genetic merit (LT). A further six of each merit were untreated controls (HC, LC). Milk yield was increased significantly by 4X, increased further by the combination of 4X and bST and increased further still and significantly by the full combination of 4X, bST and T4. The magnitude of the yield response to the sequence of treatments did not differ significantly between HT and LT. The yield response to 4X and bST was sustainable without significant loss of body weight or body condition score for the 6 weeks during which these stimuli were administered. The response to the full combination, which included T4, was accompanied by significantly elevated heart rate and significant loss of body weight and condition compared with the combination of 4X and bST. As a result, treatments were discontinued, on an individual cow basis, before completion of this 6-week phase. Time on experiment did not differ between HT and LT. The results do not support the commonly held belief that selective breeding of dairy cows for high milk production has rendered them markedly more susceptible to metabolic disturbances.
Artisanal fishing communities include some of the ‘poorest of the poor’. Using data from gill net fishers in Malaysia, the paper presents the first technical efficiency study of an artisanal fishery and finds that artisanal fishers are poor, but enjoy a high level of technical efficiency. If the relatively high levels of technical efficiency found in the Malaysian gill net fishery existed in other artisanal fisheries, it suggests that targeted development assistance that has traditionally been focussed on the harvesting sector may be better directed to other priorities in artisanal fishing communities.
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