Radiofrequency modified maze procedure for chronic atrial fibrillation

Background We studied the effectiveness of Radiofrequency (RF) modified maze in early and late restoration of sinus rhythm in patients with rheumatic heart disease (RHD). Methods We studied 84 patients with RHD over 23.6±12.5 months after the RF modified maze and another group of 64 patients over six months after valvular surgery alone (the Non-Maze group). Any thromboembolic episodes and NYHA class of the patient were recorded. The short term survivors in sinus rhythm, underwent stress test and echocardiography for atrial transport function at 3–6 months after surgery. Results In the Maze group, sinus rhythm was restored in 60/70 patients (85.71%) immediately and sustained in 55/70 patients (78.57%) over the follow-up as against an immediate conversion rate of 5.3% (5/53 patients, p<0.001) in the Non-maze group. The additional Cardiopulmonary (CP) bypass time (p=0.13) and cross clamp time (p=0.511) needed for maze is not statistically significant. Left atrial (LA) transport function was preserved in 41/51 patients (80.4%) and Right atrial (RA) transport function in 51/51 patients (100%). Stress test showed good chronotropic response in all the 41 patients in whom it was performed. In the Maze group one patient presented with acute valve thrombosis and subsequently, succumbed to it. In the non maze group 3/55 patients (5.66%) were hospitalized for stroke. No patient needed permanent pacemaker nor was sinus node dysfunction seen. The immediate postoperative morbidity and mortality was comparable in the two groups. Conclusions The RF modified maze is safe, effective and brief without any additional risk. It restores sinus rhythm in the majority, however there is an attrition in some.     

Extensive Mongolian Spots with Autosomal Dominant Inheritance

Background

Mongolian spots are benign skin markings at birth which fade and disappear as the child grows. Often persistent extensive Mongolian spots are associated with inborn error of metabolism. We report thirteen people of the single family manifested with extensive Mongolian spots showing autosomal dominant inheritance.

Case Presentation

A one day old female child, product of second degree consanguineous marriage, born by normal vaginal delivery with history of meconium stained amniotic fluid and birth asphyxia. On examination the child showed extensive bluish discoloration of the body involving trunk and extremities in both anterior and posterior aspects associated with bluish discoloration of the tongue. A detailed family history revealed most of the family members manifested with extensive bluish discoloration of the body soon after birth which faded in the first few years of life and completely disappeared by puberty. Thus it was diagnosed to be extensive Mongolian spots with an autosomal dominant inheritance.

Conclusion

Knowledge about the natural history of extensive Mongolian spots, their inheritance and association with certain metabolic diseases mainly IEM and Mucopolysaccharidosis aids in the diagnosis and in order to improve the patient''s prognosis.     

Impact of sociodemographic factors and previous interactions with the health care system on institutional trust in three racial/ethnic groups

Objective

Our objective was to explore whether there are differences in institutional trust across racial/ethnic groups and what factors might contribute to these differences.

Methods

We studied a convenience sample of 569 adults in Chicago grocery stores who self-identified as African American, Mexican-Hispanic, or white. We measured institutional trust and dichotomized responses into “high” and “low” trust. We used chi squared tests to examine differences in institutional trust across racial/ethnic groups and stepwise multivariable logistic regression to investigate how sociodemographic factors, health care access, health care usage, and previous negative experience with the health care system modified this relationship.

Results

In unadjusted analysis, race/ethnicity was significantly associated with institutional trust (p < 0.001). In the fully adjusted model, African Americans and Mexican-Hispanics had greater odds of reporting low trust compared to whites (OR: 1.90; 95%CI, 1.13–3.17; and OR: 2.34; 95%CI, 1.43–3.81, respectively); reporting a previous negative health care experience was the only other factor significantly related to having low trust (OR: 2.84; 95%CI, 1.83–4.41).

Conclusion

We found lower institutional trust in African Americans and Mexican-Hispanics and among participants reporting previous negative health care experiences.

Practice implications

Improving health care experiences, especially for racial/ethnic minority groups, could improve institutional trust and decrease health disparities in these populations.     

A qualitative study on the adverse reactions of mass treatment for lymphatic filariasis in Orissa,India

ObjectiveTo describe the perceptions of community members and programme partners regarding severity, management and impact of adverse reactions on mass drug administration (MDA) compliance.MethodsBased on various qualitative data collected from five districts of Orissa, India, where MDA had been implemented during 2002 and 2004. The qualitative surveys included focus group discussions with community members and health workers, and semi-structured interviews with key informants in the community, medical officers at primary health centres, district level health officers and private practitioners.ResultsIt showed that many people suffered from adverse reactions, though the reactions were not serious. The paper reported different ways of management of adverse reactions at the community level. The impact of adverse reactions on MDA compliance was serious, as many people did not consume the drug due to fear of adverse reactions. The rumours of adverse reactions and news in media deterred people from consuming the tablets.ConclusionAll categories of respondents indicates the need of more information to address the problem of adverse reactions during MDA. The present paper warrants incorporating the messages on adverse reactions during health communication and social mobilization campaigns of MDA.     

The Variations of White Blood Cell Count in Lipizzan Horses

Total and differential leucocyte counts (lymphocytes, neutrophils, monocytes, eosinophils and basophils) were measured in 140 stallions, 101 mares and 25 foals of Lipizzan breed. The values fell in the normal ranges for warm‐blooded horses. Differences between mares and stallions were not significant with the exception of foals, having higher white blood cell, neutrophil, lymphocyte, monocyte and basophil values in females than in males. Foals exhibited an age‐related increase of total leucocyte count during the first 4 months of life, accompanied by a decrease in neutrophil and increase in lymphocyte and eosinophil counts. In mares and stallions, the total number of leucocytes, lymphocytes, monocytes and basophils significantly decreased but the number of neutrophils and eosinophils remained almost unchanged with age gain.     

Morphological and topographical anatomy of nutrient foramina in the lower limb long bones and its clinical importance

Background

Knowledge regarding nutrient foramina of bones is useful in surgical procedures such as microvascular bone transfer in order to preserve the circulation. The objective of the present study was to study the morphology and topography of nutrient foramina and to determine the foraminal index of the lower limb long bones to provide detailed data on such features.

Method

The study comprised examination of 206 lower limb long bones which included femora, tibiae and fibulae. The nutrient foramina were identified analysed macroscopically and the foramen index calculated. Each bone was divided into five parts and topographical analysis was performed on each section.

Results

Femora had single nutrient foramen in 47.7% of the cases, double foramen in 44.2% of the cases, triple in 3.5% of the cases and an absence of foramen in 4.6%. In the case of tibiae, 98.6% showed single foramen and in 1.4% of the cases, the foramen was absent. With respect to fibulae, 90.2% had single foramen and foramen was absent in 9.8%. The mean foraminal index was 38.9 for the femora, 32.5 for tibiae and 49.2 for fibulae. The majority (51.3%) of the foramina in the femora were located at the 2/5^th part, 98.3% of the tibiae foramina at the 2/5^th part and 60% of the fibulae at the 3/5^th part.

Conclusion

The study provides information on the morphology and topography of nutrient foramina in lower limb long bones. The double foramina were more common in femur and rare in the tibia and fibula. The foramina of the femur and tibia were commonly observed at their upper part, whereas in the fibula they were present on the lower part. This knowledge of the nutrient foramina has to be kept in mind during surgical procedures.