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The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery (WCPCCS) will be held in Washington DC, USA, from Saturday, 26 August, 2023 to Friday, 1 September, 2023, inclusive. The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery will be the largest and most comprehensive scientific meeting dedicated to paediatric and congenital cardiac care ever held. At the time of the writing of this manuscript, The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery has 5,037 registered attendees (and rising) from 117 countries, a truly diverse and international faculty of over 925 individuals from 89 countries, over 2,000 individual abstracts and poster presenters from 101 countries, and a Best Abstract Competition featuring 153 oral abstracts from 34 countries. For information about the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery, please visit the following website: [www.WCPCCS2023.org]. The purpose of this manuscript is to review the activities related to global health and advocacy that will occur at the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery.
Acknowledging the need for urgent change, we wanted to take the opportunity to bring a common voice to the global community and issue the Washington DC WCPCCS Call to Action on Addressing the Global Burden of Pediatric and Congenital Heart Diseases. A copy of this Washington DC WCPCCS Call to Action is provided in the Appendix of this manuscript. This Washington DC WCPCCS Call to Action is an initiative aimed at increasing awareness of the global burden, promoting the development of sustainable care systems, and improving access to high quality and equitable healthcare for children with heart disease as well as adults with congenital heart disease worldwide.
Dietary patterns describe the combination of foods and beverages in a diet and the frequency of habitual consumption. Better understanding of childhood dietary patterns and antenatal influences could inform intervention strategies to prevent childhood obesity. We derived empirical dietary patterns in 1142 children (average age 6·0 (sd 0·2) years) in New Zealand, whose mothers had participated in the Screening for Pregnancy Endpoints (SCOPE) cohort study and explored associations with measures of body composition. Participants (Children of SCOPE) had their diet assessed by FFQ, and dietary patterns were extracted using factor analysis. Three distinct dietary patterns were identified: ‘Healthy’, ‘Traditional’ and ‘Junk’. Associations between dietary patterns and measures of childhood body composition (waist, hip, arm circumferences, BMI, bioelectrical impedance analysis-derived body fat % and sum of skinfold thicknesses (SST)) were assessed by linear regression, with adjustment for maternal influences. Children who had higher ‘Junk’ dietary pattern scores had 0·24 (sd 0·08; 95 % CI 0·04, 0·13) cm greater arm and 0·44 (sd 0·05; 95 % CI 0·01, 0·10) cm greater hip circumferences and 1·13 (sd 0·07; 95 % CI 0·03, 0·12) cm greater SST and were more likely to be obese (OR 1·74; 95 % CI 1·07, 2·82); those with higher ‘Healthy’ pattern scores were less likely to be obese (OR 0·62; 95 % CI 0·39, 1·00). In a large mother–child cohort, a dietary pattern characterised by high-sugar and -fat foods was associated with greater adiposity and obesity risk in children aged 6 years, while a ‘Healthy’ dietary pattern offered some protection against obesity. Targeting unhealthy dietary patterns could inform public health strategies to reduce the prevalence of childhood obesity.
The study aims to assess whether supplementation with the probiotic Lactobacillus rhamnosus HN001 (HN001) can reduce the prevalence of gestational diabetes mellitus (GDM). A double-blind, randomised, placebo-controlled parallel trial was conducted in New Zealand (NZ) (Wellington and Auckland). Pregnant women with a personal or partner history of atopic disease were randomised at 14–16 weeks’ gestation to receive HN001 (6×109 colony-forming units) (n 212) or placebo (n 211) daily. GDM at 24–30 weeks was assessed using the definition of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) (fasting plasma glucose ≥5·1 mmol/l, or 1 h post 75 g glucose level at ≥10 mmol/l or at 2 h ≥8·5 mmol/l) and NZ definition (fasting plasma glucose ≥5·5 mmol/l or 2 h post 75 g glucose at ≥9 mmol/l). All analyses were intention-to-treat. A total of 184 (87 %) women took HN001 and 189 (90 %) women took placebo. There was a trend towards lower relative rates (RR) of GDM (IADPSG definition) in the HN001 group, 0·59 (95 % CI 0·32, 1·08) (P=0·08). HN001 was associated with lower rates of GDM in women aged ≥35 years (RR 0·31; 95 % CI 0·12, 0·81, P=0·009) and women with a history of GDM (RR 0·00; 95 % CI 0·00, 0·66, P=0·004). These rates did not differ significantly from those of women without these characteristics. Using the NZ definition, GDM prevalence was significantly lower in the HN001 group, 2·1 % (95 % CI 0·6, 5·2), v. 6·5 % (95 % CI 3·5, 10·9) in the placebo group (P=0·03). HN001 supplementation from 14 to 16 weeks’ gestation may reduce GDM prevalence, particularly among older women and those with previous GDM.
Although all three types share some common characteristics, there are also important differences which will be individually discussed below. Cardiac muscle will be more fully described in Chapter 14. A summary table is provided in Figure 13.1 highlighting the differences between the muscle types and should be referred to in concert with the fuller descriptions.
The failure of cardiovascular system to maintain adequate organ perfusion pressure causes inadequate oxygen delivery resulting in tissue hypoxia, lactic acidosis and end organ damage. Inotropes affect the force of myocardial contraction. A positive inotrope will increase myocardial contractility. Vasopressors cause vasoconstriction of blood vessels (most act by α1 receptor activation) and therefore increase mean arterial blood pressure (MAP) and systemic vascular resistance (SVR). Vasoactive drugs are used to support tissue perfusion and hence oxygenation. Vasoactive drugs act on various receptors in the body to produce their effects. Treatment with vasoactive drugs should be considered, if optimization of oxygenation, ventilation and adequate fluid resuscitation fail to restore cardiac output. Therapy may need to be started with minute-by-minute assessment of the patient's response. The response to vasoactive drugs is often unpredictable and dependent on the cause of shock and baseline circulation.
Patients who present in emergency situations are assumed to have a full stomach and in the UK, it is recommended that a rapid sequence induction (RSI) is used in intubation. The majority of anaesthetic induction agents is vasodilators and has cardiodepressant effects. This chapter discusses extubation/weaning protocols. Tracheostomy is utilized in critical care units to facilitate weaning after prolonged ventilation. A cricothyroidotomy is usually performed as an emergency procedure when a secure airway is needed and attempts at orotracheal or nasotracheal intubation have failed. The anatomical landmark and insertion of a mini tracheostomy are similar to performing cricothyroidotomy. Generally they are not recommended for ventilation as the airway resistance is high but recent small studies have been carried out where the combination of a mini tracheostomy plus non-invasive ventilation (NIV) has been used in patients with respiratory failure due to neuromuscular disorder.
The initial assessment of the critically ill patient should begin with a brief, targeted history and an appraisal of the patient's vital signs to identify life threatening abnormalities that merit immediate attention. The goals of resuscitation are usually achieved by the use of supplemental oxygen, fluid or red blood cell transfusion, inotropic support or antibiotics as needed. Physiological Scoring Systems (PSS) developed from the recognition that critically ill patients, and in particular patients who suffered cardiac arrests, often had long periods of deterioration before the crisis or medical emergency occurred. Medical emergency teams (METs) and critical care outreach (CCO) teams aim to provide critical care skills rapidly to critically ill patients. Referrals to the critical care services may happen from any level, but the final decision to admit a patient to a critical care bed should be made by an experienced critical care physician.
Maternal nutritional status before and during pregnancy is important for the growth and development of the fetus. The effects of pre-pregnancy nutrition (estimated by maternal size) are well documented. There is little information in today's Western society on the effect of maternal nutrition during pregnancy on the fetus. The aim of the study was to describe dietary patterns of a cohort of mothers during pregnancy (using principal components analysis with a varimax rotation) and assess the effect of these dietary patterns on the risk of delivering a small-for-gestational-age (SGA) baby. The study was a case–control study investigating factors related to SGA. The population was 1714 subjects in Auckland, New Zealand, born between October 1995 and November 1997, about half of whom were born SGA ( ≤ 10th percentile for sex and gestation). Maternal dietary information was collected using FFQ after delivery for the first and last months of pregnancy. Three dietary patterns (traditional, junk and fusion) were defined. Factors associated with these dietary patterns when examined in multivariable analyses included marital status, maternal weight, maternal age and ethnicity. In multivariable analysis, mothers who had higher ‘traditional’ diet scores in early pregnancy were less likely to deliver a SGA infant (OR = 0·86; 95 % CI 0·75, 0·99). Maternal diet, particularly in early pregnancy, is important for the development of the fetus. Socio-demographic factors tend to be significantly related to dietary patterns, suggesting that extra resources may be necessary for disadvantaged mothers to ensure good nutrition in pregnancy.
During 1989 the Pisidian survey project continued for its fifth season at Sagalassos. The survey was directed in the first half of the season by Dr. S. Mitchell (University College of Swansea) and in the second half by Prof. M. Waelkens (Catholic University of Leuven and National Fund for Scientific Research, Belgium). The team consisted of Prof. W. Viaene (geologist), Dr. M. Lodewijckx, R. Degeest, E. Scheltens, L. Vandeput, H. Bracke, A. De Daele, P. De Jonghe (Catholic University of Leuven, Belgium), Dr. E. Owens (University College of Swansea), Dr. Chr. Lightfoot (The British Institute of Archaeology at Ankara), Mr. R. Fursdon, R. Harrison and A. Young (topographers, University of Newcastle), and F. Richards (Sydney University). For 3 weeks we were joined by Selçuk Baser, director of the Museum of Burdur, who with M. Waelkens, directed a rescue excavation in the potters' quarter. Muhsin Endoǧru (Boǧazköy Museum) represented the Turkish Antiquities Department. The main financial support came from the National Fund for Scientific Research (Belgium), the Prime Ministry of the Flemish Community (Belgium), the Flemish Ministry of Education (Belgium), the British Academy and the British Institute of Archaeology at Ankara.
During 1988 the Pisidian survey project continued at a new site, Ariassos, and for a fourth season at Sagalassos. The team, directed at Ariassos by Dr. S. Mitchell and at Sagalassos by Professor M. Waelkens (Dept. of Archaeology, Catholic University of Leuven, Research Associate of the National Fund for Scientific Research (Belgium)) consisted of Bay Sabri Aydal of Antalya Museum (topographer), Dr. E. Owens, Y. Day, and A. Millard (University College of Swansea), S. Cormack (Yale University), Dr. M. Lodewijckx, R. Degeest, L. Vandeput, and C. Nuitjen (University of Leuven), D. Roberts, R. Johnson, and S. Corker (University of Newcastle), A. Schulz and D. Pohl (University of Münster), and Osman Ermişler (Konya Museum), who represented the Turkish Antiquities Department. The main financial support for Ariassos came from the British Academy and the British Institute of Archaeology at Ankara, and for Sagalassos from the National Fund for Scientific Research (Belgium) and from the Flemish Ministry of Education (Belgium). Thanks are due to the Eski Eserler ve Müzeler Genel Müdürlüǧü, who gave permission for the survey and provided surveying equipment, to the staff of the Emniyet Müdürlüǧü in Antalya and in Burdur, and to the Belediye officials and the inhabitants of Bademaǧacı and of Aǧlasun.
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