Recurrent pannus formation causing prosthetic aortic valve dysfunction: Is excision without valve re-replacement applicable?

ABSTRACT: Prosthetic valve dysfunction at aortic position is commonly caused by pannus formation. The exact etiology is not known. It arises from ventricular aspect of the prosthesis encroaching its leaflets causing stenosis or it may remain localized causing left ventricular outflow tract obstruction without affecting valve function. The difference in location entails different approaches in management. Such a pathology requires surgical excision of the pannus with or without valve re-replacement. A recurrent pannus was observed in a female patient who needed repeated surgical intervention to excise a localized pannus without re-replacement of a well functioning prosthetic valve. Management of our case presents several questions, whether recurrence of pannus is caused by sparing the prosthetic valve, is it simply an exaggeration of an inflammatory healing process in certain individuals or is it ideal to re-replace the valve despite a well preserved function.     

Peri-operative outcomes of patients with stage IV endometriosis undergoing robotic-assisted laparoscopic surgery

We analyzed peri-operative outcomes of 80 patients who underwent robotic-assisted laparoscopic surgery and were diagnosed with stage IV endometriosis (revised American Society for Reproductive Medicine) between January 2007 and December 2010 at a tertiary gynecologic oncology referral center with a fellowship training program. Eligible women had a combination of one or more factors: pelvic mass, sub-acute or chronic pelvic pain, dysmenorrhea, dyspareunia, elevated serum CA-125, diagnosed with stage IV endometriosis at surgery with robotic-assisted gynecologic procedures using the da Vinci^? Surgical System. The mean age was 43.7?±?7.0?years, body mass index 27.5?±?7.4?kg/m², and 23 (28.9%) patients had prior endometriosis surgery. Presenting symptoms included: chronic pelvic pain (48.8%), dysmenorrhea (40.3%), and dyspareunia (33.8%). Sixty-nine (86%) patients had pelvic masses (43 unilateral and 26 bilateral). Thirty-seven (46.3%) had elevated CA-125 levels (mean 97.9?±?71.6 U/ml). Forty-eight (60%) underwent robotic-assisted laparoscopic hysterectomy (RALH)/bilateral salpingo-oophorectomy (BSO), 9 (11.3%) RALH/unilateral salpingo-oophorectomy (USO), 5 (6.3%) modified radical hysterectomy, and 10 (13%) USO or BSO only. Four (5%) had ovarian cystectomies with excision of endometriotic implants. Three (3.8%) underwent appendectomy and no patient required bowel resection. Four (5%) patients required conversion to laparotomy during the first 15 cases of this series [dense adhesions (3) and ureteral injury (1)]. Mean operative time was 115?±?46?min, blood loss 88?±?67?ml, and length of stay 1.0?±?0.4?days. There were four (5%) complications (ureteral injury, cuff abscess, cuff hematoma, re-admission for nausea and vomiting secondary to narcotics) and no transfusions. One (1.3%) patient underwent a second surgery for pain (dyspareunia). Robotic-assisted surgery for stage IV endometriosis resulted in excellent pain relief, with few laparotomy conversions or complications during a robotic learning-curve experience.     

Successful management of fungal pericarditis and endocarditis in a neonate: A case report

Neonatal fungal endocarditis is a rare but serious infection, which does not have a well-accepted management method. This is the second report of this condition in Saudi Arabia. A preterm, very low birth weight, female neonate presented with fever and shortness of breath. An echocardiogram showed moderate pericardial effusion and two masses in the heart, one in the right ventricle and the other in the inferior portion of the posterior mitral valve of the left ventricle. Blood and pericardial fluid cultures revealed an infection with Candida albicans. The patient received a 60 days course of intravenous fluconazole and amphotericin B lipid complex. At the conclusion of treatment, she was discharged in good condition with no echocardiographic evidence of pericardial effusion or fungal vegetations. Thus, a successful outcome to a serious case of fungal endocarditis was achieved through aggressive antifungal therapy with intravenous fluconazole and amphotericin B lipid complex.     

Psychometric Properties of Osteoporosis Knowledge Tool and Self-Management Behaviours Among Malaysian Type 2 Diabetic Patients

Osteoporosis is a major growing public health problem and it is clear that much needs to be done to bridge the gap between patients and practitioners. However, the educator must have a valid and reliable tool to evaluate the effectiveness of the teaching and learning that are done. Osteoporosis Knowledge Tool (OKT) provides an important strategy for healthcare professionals to start early intervention for patients who are at risk of osteoporosis. The aims of this study were to translate and examine the psychometric properties of the Malaysian version of the Osteoporosis Knowledge Tool (OKT-M) among 250 type 2 diabetes patients and to assess factors that affect diabetic patients’ osteoporosis knowledge. The OKT English version was translated and validated using the internationally accepted and recommended methodology. The sensitivity and specificity of OKT-M was calculated using receiver operating characteristic curve analysis. The face and content validity showed acceptable results. Internal consistency, test–retest reliability, mean difficulty factor and discriminatory power values were 0.72, 0.83, 0.47 ± 0.16 and 0.96, respectively. The cut-off point of the OKT-M to predict osteoporosis/osteopenia was 14 with optimal sensitivity (84.1 %) and specificity (85.5 %). Regression analysis revealed that health belief, self-efficacy and some demographic data had an impact on the OKT-M. The findings of this validation study indicate that the OKT-M is a reliable and valid tool with good psychometric properties in the Malaysian setting. The OKT-M is an appropriate tool for application in clinical setting to identify patients need for a bone health-promoting intervention regarding lifestyle behaviour changes.     

Effects of dietary saturated,monounsaturated and polyunsaturated fats on plasma lipids and lipoproteins in diabetic rats*

The effects of altering the type of dietary fat on plasma lipid and lipoprotein levels were investigated in streptozotocin‐diabetic rats fed non‐purified diets containing corn oil, olive oil, cod‐liver oil, sheep tallow and lard. After 32 days of experimental feeding, plasma levels of glucose, triglycerides, total cholesterol, low density and high density lipoprotein cholesterol were determined. Body weights and food intake were also measured. In neither animal group did the type of fat in the diet affect significantly the plasma levels of lipids and lipoproteins and their calculated ratios, and plasma glucose, body weight change or accumulative food intakes. In all studied diabetic rats, significant correlations were observed between body weight change and the following plasma variables: total cholesterol level (r = —0.37, P < 0.03), low density lipoprotein cholesterol level (r = —0.38, P<0.03) and triglycéride concentration (r = —0.36, P < 0.04). A significant positive correlation (r = 0.60, P < 0.0003) was also found between plasma levels of glucose and triglycérides. No significant correlations were noticed between accumulative food intakes and any of the studied variables. It is concluded that, in uncontrolled hyperglycemia in diabetes, the type of fat in the diet exerts little or no influence on plasma lipid and lipoprotein concentrations.     

Nutritional status of schoolgirls in Isfahan,Iran: Anthropometric and hematological measurements

Weights, heights and other anthropometric measurements are presented for seven year old schoolgirls belonging to different socioeconomic groups in Iran. It was found that measurements of the children of professional people were indistinguishable from internationally accepted standards. The measurements of girls in the lower socioeconomic strata were lower. Hematological measurements indicated lack of anemia in any of the children. Possible reasons for these findings are discussed in relation to previously published reports of nutritional problems in Iran.     

Psychological Outcomes of Intimate Partner Violence Experienced by Jordanian Working Women

This study aimed at investigating psychological health problems experienced by working women as a result of their experiences of intimate partner violence (IPV). One hundred one working women participated in the study. Results indicated that nearly half of the participants reported partner violence. Compared with nonabused women, abused women showed significantly higher levels of depressive symptoms (t (78) = ?3.4, p = .001) and stress (t (93) = ?4.8, p < .0001), while self-esteem did not differ significantly between the two groups. Acknowledgment of this problem and early recognition of the victims may result in improving the health of working women in Jordan.