Pediatric Resident Attitudes and Knowledge of Critical Congenital Heart Disease Screening

This study aimed to understand the knowledge, attitudes and confidence level related to critical congenital heart disease (CCHD) screening among pediatric residents. Pediatric residents were assessed via an anonymous survey related to CCHD guidelines and procedures as set out by the New York State Department of Health. The survey was emailed to pediatric residents at a large academic institution. A teaching intervention was performed after the initial survey, which was followed by an identical after-intervention survey. Forty-two residents responded to the pre-intervention survey (n = 42), and forty post-intervention (n = 40). The mean composite knowledge score was 76 % pre-intervention and 92 % post-intervention, p < .001. Pre-intervention only 12 % of the respondents could answer all the questions correctly which increased to 60 % post-intervention. Confidence among residents regarding guidelines increased from 38 to 95 % post-intervention, p < .001. There was a positive correlation between the residents who felt confident of the guidelines and who answered correctly, r = .514, p < .001, n = 82. There was no significant difference between knowledge, attitudes or confidence level scores by year of training or the gender of the residents. Our study demonstrated a significant gap of knowledge among residents related to CCHD screening mandated by New York State health law. There was also a corresponding lack of confidence demonstrated by the residents in the guidelines. These data suggest that residents would benefit from further education on the proper implementation of a CCHD screening program. Further multicenter studies are warranted to assess similar gaps in other residency training programs in New York and wherever these screenings guidelines have been adopted.     

Alignment in knee flexion position during navigation-assisted total knee arthroplasty

Purpose

The aim of this study was to demonstrate the lower limb alignment in knee flexion position after navigation-assisted total knee arthroplasty using the gap technique and to identify the correlative factors.

Methods

One hundred and twenty consecutive osteoarthritic knees (120 patients) were prospectively enrolled for intraoperative data collection. All TKA surgeries were performed using the navigation system (OrthoPilot?, version 4.0; B. Braun Aesculap, Tuttlingen, Germany). Before and after final prosthesis implantation, the lower limb navigation alignment in both knee extension (0°) and knee flexion (90°) position was recorded. The knee flexion alignment was divided into three groups: varus, neutral and valgus alignment. To determine the factors of the alignment in knee flexion position, preoperative demographics, radiologic and intraoperative data were obtained. Pearson’s correlation (r) analysis was performed to find the correlation. The Knee Society Score and Western Ontario and McMaster Universities Osteoarthritis Index were compared between groups.

Results

Although all postoperative extension alignment was within neutral position (between ?2° and +2°), postoperative knee flexion alignment was divided into three groups: varus (≤?3°), 24 cases (20 %); neutral (between ?2° and +2°), 85 cases (70.8 %) and valgus (≥+3°) alignment, 11 cases (9.2 %). There were a good correlation of alignment in knee flexion position with the rotation of femoral component relative to posterior condylar axis (r = ?0.502, p = 0.000) and weak correlations with posterior femoral cut thickness (lateral condyle) (r = 0.207, p = 0.026), medial flexion (90°) gap after femoral component rotation adjustment (r = 0.276, p = 0.003). Other variables did not show correlations. There were no statistical clinical differences between varus, neutral and valgus knee flexion alignment groups.

Conclusion

About 30 % of the cases showed malalignment of more than 3° in knee flexion position although with neutral alignment in extension position. The knee flexion alignment had a good correlation with the rotation of femoral component relative to posterior condylar axis. Neutral alignment in knee flexion position may be adjusted by femoral component rotation especially by the use of navigation system.

Level of evidence

IV.

     

COPD-associated miR-145-5p is downregulated in early-decline FEV1 trajectories in childhood asthma

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Role of doctors in prevention of torture

Torture is taking place since time immemorial. Doctors can take important part in elimination of this social evil. Torture is deliberate, systematic or wanton infliction of physical or mental suffering by one or more persons to force another person or torture victim to make confession or giving information. Torture happens to occur in 3 forms--physical, mental and/or sexual. Doctors working in prisons, police or paramilitary/military forces are most likely to confront with torture and they should follow the medical ethics, codes and conventions in true sense. MCI, IMA, WMA should play their role in educating, motivating and supporting doctors in confronting torture. NHRC and IMA should co-operate each other to protect human rights.     

Irreversible Pulmonary Hypertension Associated with the use of Interferon Alpha for Chronic Hepatitis C

The interferons are a complex group of virally induced proteins produced by activated macrophages and lymphocytes, which have become the mainstay of therapy for hepatitis C infection. Sustained viral response (SVR) rates in noncirrhotic patients vary from 40–80% with interferon-based therapy. This, along with transplantation, has drastically changed the course of hepatitis C virus (HCV) infection over the last two decades. Numerous side effects associated with interferon therapy have been reported. These range from transient flu-like symptoms to serious effects such as cardiac arrhythmias, cardiomyopathy, renal and liver failure, polyneuropathy, and myelosuppression. Pulmonary side effects including pneumonitis, pulmonary fibrosis, and reversible pulmonary hypertension have been reported. Herein, we present four cases in which irreversible pulmonary hypertension was diagnosed after prolonged treatment with interferon alpha. In each case, other causes of pulmonary hypertension were systematically eliminated. Pulmonary artery hypertension, which may be irreversible, should be considered in patients being treated with interferon alpha who present with exertional dyspnea and do not have a readily identifiable inflammatory or thromboembolic cause.