Clinical and echocardiographic patterns of congenital heart diseases in adults in Karbala Province, Iraq

Objective To determine the patterns of congenital heart diseases in adults in Karbala province. Methods A total of 85 patients aged more than 16 years were examined at Al-Hussain Medical City and Al-Hindiya General Hospital from June 2006 to December 2014. History, physical examination, electrocardiograms and transthoracic echocardiograms were done for them. Results Seventy-eight of patients were less than 30 years old and two patients were more than 50 years old. Atrial septal defect was the most common primary diagnosis (28 patients) followed by pulmonary stenosis (22 patients) and ventricular septal defect (18 patients). Seven patients had patent ductus arteriosus and five patients had tetralogy of Fallot. Three patients had dextro-transposition of the great arteries and three had atrioventricular septal defect. There was one patient in each of the other categories (single ventricle, Ebstien anomaly, coarctation of aorta, subaortic ridge and bicuspid aortic valve). Conclusion Atrial septal defect was the most common primary diagnosis. The percentage of patients with coarctation of aorta and aortic valve diseases was much less than in other studies. The ages of study patients were less than the patients in Western countries especially patients with tetralogy of Fallot, dextro-transposition of the great arteries, atrioventricular septal defect and single ventricle and coarctation of aorta. Keywords congenital heart disease, echocardiographic, karbal

Fibromuscular dysplasia presenting as a renal infarction: a case report

<p>Abstract</p> <p>Introduction</p> <p>Fibromuscular dysplasia is a non-atherosclerotic, non-inflammatory disease that most commonly affects the renal and internal carotid arteries.</p> <p>Case presentation</p> <p>We present the case of a 44-year-old Caucasian man who was admitted with complaints of loin pain and hypertension. A computed tomography scan of the abdomen revealed a right renal infarction with a nodular aspect of the right renal artery. Subsequent renal angiography revealed a typical 'string of beads' pattern of the right renal artery with thrombus formation. Oral anticoagulation was started and the secondary hypertension was easily controlled with anti-hypertensive drugs. At follow-up, our patient refused percutaneous transluminal renal angioplasty as a definitive treatment.</p> <p>Conclusions</p> <p>Fibromuscular dysplasia is the most common cause of renovascular hypertension in patients under 50 years of age. Presentation with renal infarction is rare.</p> <p>In fibromuscular dysplasia, angioplasty has been proven to have, at least for some indications, an advantage over anti-hypertensive drugs. Therefore, hypertension secondary to fibromuscular dysplasia is the most common cause of curable hypertension.</p

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Management of Renal Artery Stenosis - an Update

The role of the renal vasculature in eliciting renovascular hypertension (RVH) was established in 1934, when Goldblatt et al. [1] in a classical experimental study demonstrated that partial obstruction of the renal artery increased mean arterial blood pressure (BP). The pathophysiology of renal artery stenosis (RAS) is incompletely understood but has been postulated to be related to increased afterload from neurohormonal activation and cytokine release [2]. Atherosclerotic RAS (ARAS) is increasingly diagnosed in the expanding elderly population, which also has a high prevalence of arterial hypertension. There is still considerable uncertainty concerning the optimal management of patients with RAS. Many hypertensive patients with RAS have co-existing essential hypertension and furthermore, it is often difficult to determine to what degree the RAS is responsible for the impairment of renal function. There are three possible treatment strategies: medical management, surgery, or percutaneous transluminal renal angioplasty (PTRA) with or without stent implantation. The use of stents has improved the technical success rate of PTRA and also led to lower risk of restenosis, in particular for ostial RAS. PTRA with stenting has therefore replaced surgical revascularisation for most patients with RAS and has led to a lower threshold for intervention. The treatment of choice to control hypertension in fibromuscular dysplasia (FMD) is generally accepted to be PTRA [3]. In ARAS, on the other hand, the benefits with PTRA are less clear [4] and the challenge to identify which patients are likely to benefit from revascularisation remains unknown

Findings in multi-detector row CT with portal phase enhancement in patients with mesenteric venous thrombosis.

There exists no systematic evaluation on the findings in multi-detector row computed tomography (MDCT) with portal phase enhancement in patients with mesenteric venous thrombosis (MVT). Patients with MVT between 2004 and 2006 were identified at Malmö University Hospital, Sweden. Thirty patients had MVT. Median age was 58 years (interquartile range, 46-72), and 57% (17) were men. MDCT with portal phase enhancement showed MVT in 19 out of 20 investigated patients at first evaluation, even though there was clinical suspicion in only one, and conservative management was possible in 19 (95%). Central and peripheral MVT was seen in 20 (100%) and six (30%) cases, respectively. Extra-hepatic and intra-hepatic portal and splenic vein thrombosis was seen in 17 (85%), nine (45%) and 15 (75%) cases, respectively. Venous collaterals were visible in 12 (60%) cases. The most frequent extra-vascular pathologies were mesenteric oedema (50%), ascites (40%), small bowel wall oedema (25%) and local small bowel wall dilatation (20%). The vascular findings in MVT are more pronounced than the intestinal findings in MDCT with portal phase enhancement, and evaluation of the mesenteric vessels should be included in routine MDCT scans for unclear acute abdomen

Acute Stent Thrombosis: Should Preventative Measures Start in the Emergency Department?

Stent thrombosis is a potentially life threatening condition caused by several factors or a combination factors, such as resistance to platelet agents and type of anticoagulation used as well as stent types. We report a case of acute thrombosis and discuss potential areas of intervention with literature review

Aktivitas Meronce dengan Media Tangkai Ubi Kayu terhadap Kemampuan Berhitung Permulaan Anak

Kegiatan meronce dengan media tangkai ubi kayu pada kemampuan berhitung, awal anak merupakan penelitian yang bertujuan untuk meningkatkan kemampuan anak melalui kerja sama dengan orang tua anak dan untuk meningkatkan pelaksanaan perencanaan program dengan lebih tepat lebih baik membuat sesuatu yang baru atau memodifikasi yang sudah ada. Teknik pengumpulan datanya adalah dokumentasi dan untuk analisis datanya menggunakan metode analisis isi. Hasil analisis bertujuan bahwa kegiatan meronce dengan media tangkai ubi kayu bermanfaat untuk meningkatkan perkembangan otak terkait kemampuan berhitung yaitu pembelajaran konsep bilangan

Interdisciplinary open science: what are the implications for educational technology research?

Evidence-based educational practice and policy relies on educational research to be accessible and reliable. For educators, creating the next generation of critical thinkers, collaborators, and effective communicators, is a complex educational problem, requiring a delicate marriage of methods and approaches for understanding the mind, behaviour, and social context of the learner in the digital age. As such, educational technology research plays an important role for informing practice and policy. However, reaching across the boundaries of research, policy, and practice, is inherently challenging, and can invoke unintended consequences. Miscommunications, and mistakes, are inevitable in interdisciplinary and applied science, but advances in technology now make it possible to openly share and translate educational technology research for policy and practice. Our aim in this paper is to describe how the emerging set of practices and philosophies within the Open Science movement can make educational technology research more transparent and aid translating it into practice