Midterm results of the Ross procedure

Objective: The lack of durable bioprosthetic valves and the inherent risks associated with anticoagulation for mechanical valves have led to the continued use of the Ross procedure, particularly in the pediatric population. Methods: We have reviewed our mid-term results retrospectively, following the Ross operation in both pediatric and adult groups. Results: Over a 11-year period from August 1991 to August 2002, 60 patients underwent the Ross procedure. The median age was 15 years (6–804 months), of which 63% were males and 55% were under the age of 20 years. The main indications were: aortic stenosis in 47 patients; aortic insufficiency in 6 patients; and mixed aortic valve disease in 28 patients. Fifteen patients had previously undergone balloon dilatation of the aortic valve, 4 had open valvotomy and 3 had both valvuloplasty procedures. The pulmonary autograft was implanted as a sub-coronary implant until 1995 (30%) after which time it was implanted using a partial inclusion cylinder technique (70%). There have been no deaths reported in this series. Over a median follow-up period of 59 months (2–122 months), there have been four re-operations for repair of autograft leak, and 2 adult patients have had autograft replacements. Conclusions: Despite the increased technical complexity, the Ross procedure can be performed safely in both paediatric and adult populations with satisfactory medium term results.     

An ecosystem service perspective on urban nature,physical activity,and health

Nature underpins human well-being in critical ways, especially in health. Nature provides pollination of nutritious crops, purification of drinking water, protection from floods, and climate security, among other well-studied health benefits. A crucial, yet challenging, research frontier is clarifying how nature promotes physical activity for its many mental and physical health benefits, particularly in densely populated cities with scarce and dwindling access to nature. Here we frame this frontier by conceptually developing a spatial decision-support tool that shows where, how, and for whom urban nature promotes physical activity, to inform urban greening efforts and broader health assessments. We synthesize what is known, present a model framework, and detail the model steps and data needs that can yield generalizable spatial models and an effective tool for assessing the urban nature–physical activity relationship. Current knowledge supports an initial model that can distinguish broad trends and enrich urban planning, spatial policy, and public health decisions. New, iterative research and application will reveal the importance of different types of urban nature, the different subpopulations who will benefit from it, and nature’s potential contribution to creating more equitable, green, livable cities with active inhabitants.     

Trends in hospitalizations for vertebral compression fracture in ankylosing spondylitis: data from the National Inpatient Sample 2000–2014

Clinical Rheumatology - Ankylosing spondylitis (AS) patients are at increased risk of vertebral compression fractures (VCF). Our objective was to examine the yearly trend of VCF hospitalizations in...     

Intravenous Bevacizumab for Refractory Hereditary Hemorrhagic Telangiectasia–Related Epistaxis and Gastrointestinal Bleeding

Objective

To present a multiyear clinical experience with intravenous bevacizumab for the management of severe gastrointestinal bleeding and/or epistaxis in patients with hereditary hemorrhagic telangiectasia (HHT).

Evaluation of Five International HBV Treatment Guidelines: Recommendation for Resource-Limited Developing Countries Based on the National Study in Nepal

Hepatitis B virus (HBV) infects the liver, causing cirrhosis and cancer. In developed countries, five international guidelines have been used to make a decision for the management of patients with chronic HBV infection. In this review, since the guidelines were established by clinical and epidemiological data of developed countries, we aimed to evaluate whether (1) HBV patient profiles of developing countries are similar to developed countries, and (2) which guideline can be applicable to resource-limited developing countries. First, as an example of the most recent data of HBV infections among developing countries, we evaluated the national HBV viral load study in Nepal, which were compared with the data from other developing countries. In Nepal, the highest number of patients had viral loads of 20–2000 IU/mL (36.7%) and belonged to the age group of 21–30 years; HBV epidemiology in Nepal, based on the viral loads, gender, and age groups was similar to those of not only other developing countries but also developed countries. Next, we reviewed five international HBV treatment guidelines of the World Health Organization (WHO), American Association for the Study of Liver Diseases (AASLD), National Institute for Health and Care Excellence (NICE), European Association for the Study of the Liver (EASL), and Asian Pacific Association for the Study of the Liver (APASL). All guidelines require the viral load and alanine aminotransferase (ALT) levels for decision making. Although four guidelines recommend elastography to assess liver cirrhosis, the WHO guideline alternatively recommends using the aspartate aminotransferase (AST)-to-platelet ratio index (APRI), which is inexpensive and conducted routinely in most hospitals. Therefore, in resource-limited developing countries like Nepal, we recommend the WHO guideline for HBV treatment based on the viral load, ALT, and APRI information.     

Adherence to the multiprofessional guidelines for the management of primary cutaneous squamous cell carcinoma: a re-audit of UK plastic surgeons

In January 2002 multiprofessional guidelines for the treatment of squamous cell carcinoma were published by the British Association of Dermatology in conjunction with the British Association of Plastic Surgery and members of the Faculty of Clinical Oncology of the Royal College of Radiologists. In July 2002 a survey was undertaken which demonstrated that despite the availability of these guidelines, there was no consensus of opinion regarding the treatment of squamous cell carcinoma amongst UK plastic surgeons [Staiano JJ, Juma A, Dhital SK, McGeorge DD Eur J Plast Surg 27:1352004]. It is now 3 years since the guidelines were published, and we have re-audited UK plastic surgeons to determine whether the published guidelines have affected the treatment of this common cutaneous malignancy. Our findings once again demonstrate that the guidelines have had little effect on clinical practice and that the treatment of cutaneous squamous cell carcinoma varies widely amongst UK plastic surgeons.     

Importance of advanced analytical techniques and methods for food quality control and pollution analysis for more sustainable future in the least developed countries

Chemistry education plays a central role in solving the world's pressing societal issues by equipping and inspiring chemists. However, chemistry education and research in the least developed countries (LDCs) is challenging due to a lack of physical infrastructure and human resources. Among a range of issues and challenges, food and herbal adulteration, microplastics pollution, and chemical hazards are more common in the LDCs, and these issues would impede the achievement of the United Nations sustainable development goals (SDGs). These societal issues are frequently highlighted in the academia and social media of the LDCs, and we believe that at least some aspects of these issues could be solved by advancement in chemistry education and research. However, the current chemistry education and research efforts are inadequate to address these societal issues in these countries. In this article, we have summarized the present scenario and offered examples where developments in chemistry education, particularly advancement in analytical techniques and methods, will provide technological solutions to these issues. Our analysis revealed that sophisticated analytical laboratories are unavailable or unaffordable in the LDCs. The governments of these countries are facing extreme challenges in their pursuit of sustainable development primarily due to a lack of financial resources and shortage of skilled personnel. Revised chemistry curricula and sophisticated analytical testing facilities are urgently required in higher education institutions (HEIs) in the LDCs in helping society achieve the SDGs. A concerted effort between policymakers, chemical societies, funding agencies, chemists, and industries is required to advance chemistry education.     

Metabolic changes enhance the cardiovascular risk with differentiated thyroid carcinoma--a case control study from Manipal Teaching Hospital of Nepal

Objective: To evaluate several metabolic changes in patients with differentiated thyroid carcinoma (DTC )which enhance cardiovascular risk in the western region of Nepal. Materials and Methods: This hospital basedcase control study was carried out using data retrieved from the register maintained in the Department ofBiochemistry of the Manipal Teaching Hospital, Pokhara, Nepal between 1st January, 2009 and 31st December,2011. The variables collected were age, gender, BMI, glucose, insulin, HbA1C, CRP, fibrinogen, total cholesterol,triglycerides, HDL, LDL, VLDL, f-T3, f-T4, TSH. One way ANOVA was used to examine statistical significanceof differences between groups, along with the Post Hoc test LSD for comparison of means. Results: fT3 valueswere markedly raised in DTC cases (5.7±SD1.4) when compared to controls (2.2±SD0.9). Similarly, fT4 valueswere also moderately raised in cases of DTC (4.9±SD1.3 and 1.7 ±SD0.9). In contrast, TSH values were loweredin DTC cases (0.39±SD0.4) when compared to controls (4.2 ±SD 1.4). Mean blood glucose levels were decreasedwhile insulin was increased and HDL reduced (39.5±SD4.7 as compared to the control 43.1±SD2.2). Conclusion:Cardiovascular risk may be aggravated by insulin resistance, a hypercoagulable state, and an atherogenic lipidprofile in patients with differentiated thyroid cancer.