Trans-radial approach for coronary angiography in an adult postoperative patient with tetralogy of Fallot with complex anatomy

2015 BMJ Publishing Group Ltd.A 42-year-old, postoperative patient with tetralogy of Fallot (TOF) with right-sided aortic arch, presented with heart failure secondary to left ventricular dysfunction, severe valvular regurgitation and residual ventricular septal defect (VSD). After initial stabilisation, he underwent successful coronary angiography through a trans-radial approach followed by aortic valve replacement, pulmonary valve and VSD repair, and was discharged home in stable condition. This case report highlights the trans-radial approach as a feasible option for coronary angiography in postoperative patients with TOF with right-sided aortic arch

EFFECTS OF ERYTHROPOIETIN ON THE SERUM AND LIVER TISSUE LEVELS OF COPPER AND ZINC IN RATS WITH OBSTRUCTIVE JAUNDICE EFEKTI ERITROPOETINA NA NIVOE BAKRA I CINKA U SERUMU I TKIVIMA JETRE KOD PACOVA SA OPSTRUKTIVNOM @UTICOM

Summary Background: Erythropoietin is an anti-apoptotic, anti-inflammatory, angiogenetic cytokine and has protective properties against oxidative stress. In this study we investigated the effects of erythropoietin on the le vels (serum and liver tissue) of copper and zinc in cholestatic rats. Methods: Thirty-two Wistar albino rats used in the study were divided into four groups -Group I: Sham; Group II: Erythropoietin; Group III: Obstruc tive Jaundice; Group IV: Obstructive Jaundice+Erythro poietin. After the first operation, rats were followed up for seven days and then operated for the second time. Rats were sacrificed by intracardiac blood taking, and the liver tissue samples were obtained immediately. Results: Erythropoietin reduces copper, and increases zinc levels in serum and liver tissues after obstructive jaundice (p<0.05). Furthermore, it has been shown that the levels of alanine aminotransferase, aspartate aminotransferase, gamma glutamyl transferase, alkaline phosphatase and total bilirubin/direct bilirubin were significantly lower in Obstructive Jaundice+Erythropoietin group than Obstructive Jaundice group. Conclusions: Erythropoietin affects the changes in copper and zinc levels, thus decrea sing the liver damage biochemically in rats with obstructive jaundice. However, further investigations are needed to discover how erythropoietin therapy might reduce target organ damage in cholestatic liver cases by affecting copper and zinc levels

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Changing Students’ Approach to Learning Physics in Postsecondary Gateway Courses

This study investigated if and how a combined set of specially developed activities can help students change their approach to learning physics. These activities included (a) reflective-writing activities, (b) critique-writing activities, and (c) reflective write-pair-share activities combined with conceptual-conflict collaborative-group exercises. Each of these activities was previously successfully tested as a stand-alone activity. This investigation was conducted at two different institutions over a three-year period. At each institution the same instructor taught students in two sections. At the first, a university with a substantial graduate school, sections were relatively large (over 100 students each) covering a typical introductory calculus-based mechanics course. At the second, a community college, there were relatively small classes (32 students each) covering a typical algebra-based introductory course in mechanics, electricity, and magnetism. The courses at the two institutions used different textbooks and had different formats. Measured data included student interviews and writing products. We developed rubrics for evaluation of the impact of the writing products and interviews of students. The main results of this study were the changes in students’ approaches to learning physics, especially as revealed in the interviews. Students who experienced the full suite of activities (a) changed their understanding of physics from solving problems to creating a network of interrelated concepts, and they also (b) modified their approach to learning physics from repetitious review to consideration of the interconnections of the subject matter and (c) related their new learning to key concepts in an overall physics framework