57. Aortic valve replacement with sutureless valve and mitral valve repair in patient with infected aortic homograft

The approach of implanting aortic sutureless valve inside the calcific homograft is suitable in redo surgery especially if associated with mitral valve surgery. Aortic valve replacement in patients who have undergone previous aortic root replacement with an aortic homograft remains a technical challenge because of homograft degeneration and the need for a redo Bentall operation. We report a case of redo aortic valve replacement (valve in valve) with a sutureless valve and mitral valve repair by miniband annuloplasty in a female patient aged 64years old who underwent aortic valve replacement with homograft 14years ago and presented by sever aortic valve regurge and sever mitral valve regurge because of infective endocarditis. This technique allows rapid aortic valve replacement in a heavily calcified aortic root. It also avoids aortic valve size affection after mitral valve repair by ordinary methods especially in patients with small aortic annulus. This technique is particularly suitable in redo procedures for homograft degeneration, it avoids performing a redo Bentall operation with its known problems as well as to avoid patient prosthesis mismatch

A REVIEW OF THE THERAPEUTIC CHARACTERISTICS OF CAMEL URINE

Background: The therapeutic use of camel urine has been known for centuries, with evidence of its use for medicinal purposes found in early folklore. It has been used to cure different diseases; however, the significant therapeutic benefits of urine have yet to undergo rigorous scientific evaluation. In this review, a summary of the scientific evidence that supports these therapeutic actions has been presented. Materials and methods: A literature search of different electronic databases including PubMed, Medline, SCOPUS, Web of Knowledge, and Google Scholar were conducted to identify published studies exploring the therapeutic effects of camel urine. ‘Camel’ and ‘Urine’, ‘Medicinal properties’, ‘Natural products’ were entered into the databases as key words. Reference lists of published reviews retrieved by the search were also searched to identify relevant papers. Result: There have been several laboratory and limited clinical studies providing evidence of the therapeutic effects of camel urine in the treatment of cancer, viral hepatitis and other viral, bacterial and parasitic infections. Therapeutic uses in the cardiovascular system have also been discovered, with regard to platelet and fibrinolytic actions. Conclusion: The exploration of the use of camel urine is of great interest to determine the efficacy of this practice, as well as the safety of the patients being treated. This review presented the benefits of camel urine, which were commonly drawn from small laboratory studies. Therefore, many more preclinical and clinical studies are needed to examine the efficacy and safety of the use of camel urine in in the treatment of disease

2. Minimally invasive mitral valve surgery why do you take the risks?

During recent years, minimally invasive mitral valve surgery (MIMVS) become the preferred method of mitral valve repair and replacement in many institutions worldwide with excellent results, in spite of there is no clear difinition of minimally invasive surgery and we do not have efficient studies about the risks of MIMVS comparing to conventional mitral valve surgery. Many studies are needed to clarify the need for either conventional or minimally invasive mitral valve surgery instead of personal preference. The patient’s demographic profile, intraoperative data and postoperative outcomes of patients undergoing minimally invasive mitral valve surgery were retrospectively collected from our database from May 2011 to April 2014. We will present early and mid-term outcomes of patients undergoing minimally invasive mitral valve surgery in our institution. Seventy consecutive patients (45 male and 25 female), age 35±12 years, underwent MIMVS surgery. Mean preoperative New York Heart Association function class was 2.6±0.7. Mean ejection fraction was 50±8. Cardiopulmonary bypass was instituted through femoral cannulation (28 of 70, 40%), or direct aortic cannulation (42 of 70, 25%). Aortic cross-clamp used in (66 of 70, 94.2%). Without aortic cross-clamp in (4 of 70, 5.7%), mitral valve repair has been done in (52 of 70, 74.2%), mitral valve replacement (18 of 70, 25.7%). Concomitant procedures included AF ablation (24 of 70, 34.2%), and tricuspid valve repair (33 of 70, 47.1%). No mortality recorded, residual mitral regurge was found in (6 of 70, 8.5%) during 1 year follow up. Cardiopulmonary bypass, and “skin to skin” surgery were 95±35 and 250±74min, respectively. 4 patients (5.7%) underwent reexploration for bleeding and (57 of 70, 81.4%) did not receive any blood transfusions. Six patients (8.5%) sustained face oedema. Mean length of hospital stay was 7±3.8days. 18 patients (25.7%) did not feel any interest regarding cosmotic advantage over conventional surgery. Minimally invasive mitral valve surgery is an excellent alternative to conventional mitral valve surgery in most cases however comparing to conventional mitral surgery it shows long bypass time, long cross clamp time, difficult reexploration for bleeding and multiple body incisions

Central versus Peripheral Postcardiotomy Veno-Arterial Extracorporeal Membrane Oxygenation: Systematic Review and Individual Patient Data Meta-Analysis

Background: It is unclear whether peripheral arterial cannulation is superior to central arterial cannulation for postcardiotomy veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Methods: A systematic review was conducted using PubMed, Scopus, and Google Scholar to identify studies on postcardiotomy VA-ECMO for the present individual patient data (IPD) meta-analysis. Analysis was performed according to the intention-to-treat principle. Results: The investigators of 10 studies agreed to participate in the present IPD meta-analysis. Overall, 1269 patients were included in the analysis. Crude rates of in-hospital mortality after central versus peripheral arterial cannulation for VA-ECMO were 70.7% vs. 63.7%, respectively (adjusted OR 1.38, 95% CI 1.08–1.75). Propensity score matching yielded 538 pairs of patients with balanced baseline characteristics and operative variables. Among these matched cohorts, central arterial cannulation VA-ECMO was associated with significantly higher in-hospital mortality compared to peripheral arterial cannulation VA-ECMO (64.5% vs. 70.8%, p = 0.027). These findings were confirmed by aggregate data meta-analysis, which showed that central arterial cannulation was associated with an increased risk of in-hospital mortality compared to peripheral arterial cannulation (OR 1.35, 95% CI 1.04–1.76, I2 21%). Conclusions: Among patients requiring postcardiotomy VA-ECMO, central arterial cannulation was associated with an increased risk of in-hospital mortality compared to peripheral arterial cannulation. This increased risk is of limited magnitude, and further studies are needed to confirm the present findings and to identify the mechanisms underlying the potential beneficial effects of peripheral VA-ECMO

Letter: The Impact of the Coronavirus (COVID-19) Pandemic on Neurosurgeons Worldwide

This article is made available for unrestricted research re-use and secondary analysis in any form or be any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.The aim of our study was to explore the impact of this pandemic on neurosurgeons with the hope of improving preparedness for future crisis. We created a 20-question survey designed to explore demographics (nation, duration and scope of practice, and case-burden), knowledge (source of information), clinical impact (elective clinic/surgery cancellations), hospital preparedness (availability of personal protective equipment [PPE] and cost of the supplies), and personal factors (financial burden, workload, scientific and research activities). The survey was first piloted with 10 neurosurgeons and then revised. Surveys were distributed electronically in 7 languages (Chinese, English, French, German, Italian, Portuguese, and Spanish) between March 20 and April 3, 2020 using Google Forms, WeChat used to obtain responses, and Excel (Microsoft) and SPSS (IBM) used to analyze results. All responses were cross-verified by 2 members of our team. After obtaining results, we analyzed our data with histograms and standard statistical methods (Chi-square and Fisher's exact tests and logistic regression). Participants were first informed about the objectives of our survey and assured confidentiality after they agreed to participate (Helsinki declaration). We received 187 responses from 308 invitations (60.7%), and 474 additional responses were obtained from social media-based neurosurgery groups (total responses = 661). The respondents were from 96 countries representing 6 continents (Figure ​(Figure11A-​A-11C)

A test-teach-test approach to support first year undergraduate pharmacy students with pharmaceutical calculations.

Mastering pharmaceutical calculations is an essential skill for healthcare professionals, particularly given the potential harm to patients if performed incorrectly.(Ancker and Kaufman 2007; Taylor and Byrne-Davis 2016). To determine if a test-teach-test approach to teaching pharmaceutical calculations increases the knowledge and confidence of first year undergraduate pharmacy students (PS). The study population was all first year PS (N=140) at one UK university. The study was in three phases. Phase one - a survey. PS listed calculation topics they struggled with. They also indicated their preferred learning methods. Phase two was a teaching session, using phase one data. Participants sat a 10-question calculation test (T1) for 25 minutes. They then had a one-hour teaching session that incorporated their preferred learning methods. After this, they sat another 10-question calculation test (T2), covering the same topics, again over 25 minutes, to determine if scores improved. Following phase two, phase three was an evaluation survey to determine if student confidence had improved. Ethical approval was obtained. Data were analysed in Excel and SPSS. Paired t-test was used to compare mean test scores (p<0.05). Response rate: 62.1% (N=87/140). Topics struggled with included displacement volume, infusion rate, equivalent doses. Preferred learning methods included use of videos and drawings. Paired sample t-test indicated a significant improvement in student knowledge (t1 mean=3.7/10, t2 mean=6.8/10; t(86)=-12.05 (p<0.01)). Almost all (98.9%, N=86/87), stated that their confidence in calculations had improved following the session, with 38.0% (N=33/87) noting a significant improvement. Furthermore, there was an uplift in the proportion of students who stated that they felt they had a high level of understanding of the taught topics. A test-teach-test approach for teaching pharmaceutical calculations not only increases PS knowledge but also their confidence. Taking students’ preferred learning methods into account may also increase engagement and understanding

55. Coronary artery bypass graft for cardiogenic shock post STEMI patients

Cardiogenic shock (CS) complicating AMI continues to have a high mortality of 60–80% despite early revascularization and adjunctive therapies. AMI-CS complicates 5–7% of cases of STEMI and is a leading cause of hospital death AMI. We studied the outcome of CABG for AMI-CS patients. From 10-2013 to 9-2015, 24 patients with post STEMI cardiogenic shock were admitted and underwent emergency CABG. Mean pre-operative ejection fraction (EF) was 29.7 ± 8.4%. 8 patients were on IABP pre-operatively. Operative mortality rate was 21%. Survival rate was 79% and mean follow-up of 10.21 ± 4.8 months. CABG should be considered for patients with AMI complicated by cardiogenic shock when PCI can not be done

The use of the NDDI-E in Arabic to identify symptoms of depression of moderate or greater severity in people with epilepsy

The aims of the current study were to translate and to validate the NDDI-E to the Arabic language to be used as a screening instrument to identify moderately severe symptoms of depression in people with epilepsy. The English version of the NDDI-E was translated to Arabic and back translated to English by two independent translators. A total of 51 patients, aged 18–56years old, with a diagnosis of epilepsy, completed the Arabic versions of the Beck Depression Inventory (BDI-II) and the NDDI-E. Patients with BDI scores >20 were considered to be suffering from moderately severe depressive symptoms. Cutoff scores, sensitivity, specificity, and positive and negative predictive values of the NDDI-E to identify symptomatic patients on the BDI were calculated. A sensitivity of 93.33% and a specificity of 94.44% were found with NDDI-E total scores >15. The positive predictive value was 87.5%, and the negative predictive value was 97.14%. Spearman's rank correlation between the BDI and the NDDI-E was high (r=.78, p=0.000, N=51). Internal consistency was at 0.926 (Cronbach's alpha). The Arabic version of the NDDI-E appears to be a reliable and sensitive instrument in the identification of moderately severe or severe depressive symptoms in people with epilepsy, and it can be used with all Arabic-speaking patients. •High correlation between the Arabic versions of the NDDI-E and the BDI•The NDDI-E Arabic version could differentiate between patients with and without depression.•A cutoff point of 15 was identified as the potentially more accurate value.•The NDDI-E Arabic version is a reliable tool to be used in Saudi Arabia.•The NDDI-E Arabic version can be used for all Arabic-speaking patients

Communication between expatriate physicians and patients in Saudi Arabia-A qualitative study

Over two-thirds of physicians in Saudi Arabia are expatriates who received their medical education outside the country. This qualitative study explores the impact of this situation for these physicians and their Saudi patients. The study focusses on communication between nonSaudi physicians and their Saudi patients in the context of medical consultations in Saudi outpatient clinics. Using an approach informed by Interpretive Description and Ethnography, interviews were conducted with seven non-Saudi physicians and eight Saudi patients. A preliminary focus group was conducted with five key hospital personnel to ascertain their views and to inform them about the study. Data was collected between June and September 2016, and analysed applying an iterative interpretive process to develop a thematic description of patient and physician experiences. Patient experiences provide an account of what it is like for them to meet with a physician who does not share their language and culture. Analysis of patients’ data revealed two main themes along with associated sub-themes. Theme One - Encountering Difference - was characterised by sub-themes of Being Different, Being Disconnected, and Being Culturally Acknowledged . Theme Two -Absence of Partnering - encompasses sub-themes of Being Powerless , Being Unnoticed and Neglected, Reluctant to Trust , and Being Denied Adequate Time . This theme highlights the lack of reciprocity and partnering that the patients experienced during their medical consultation, which ultimately prevented the establishment of a rapport and effective communication with the physician. Non-Saudi physicians’ experiences highlight challenges they face in providing healthcare and advice in a foreign country and culture. Their experiences are characterised by Theme One – An Absence of Trust with sub-themes of Being a Stranger and Being Fearful . This theme demonstrated the lack of mutual trust from the physicians’ perspective. Theme Two – Being Constrained in Practice illustrates that language difference, as well as the conflict with specific cultural customs and values which limited the physicians’ ability to practice freely and communicate with patients effectively, constrained their professional practice. This second theme was characterised by sub-themes of Struggling to Connect, Gender Sensitivity , and Organizational Constraints . The third and final theme – Being Aware and Responsive to the Patients’ Culture – highlights how the physicians’ knowledge of the patients’ culture and, more importantly, being able to incorporate this in the consultation, made a difference to physicianpatient communication and interaction. The patient and physician shared experiences can be understood, conceptualised, and characterised by the perception of differences, manifested through the concepts of othering, scepticism, constraint, and impasse. These four inter-related concepts highlight the essential nature of the intercultural encounter in the context of Saudi Arabian healthcare. The significance of the study lies in its illumination of the complex nature of intercultural communication in the context of seeking and providing care in Saudi outpatient clinics. The study reveals the fundamental and significant role of culture, and how communication between patient and physician may be impeded or enhanced. Improving communication outcomes for patients and physicians involves building trust, providing information and support, and modifying organisational structural processes that constrain the relationship. This study is the first to explore the experiences of both patients and physicians in the context of intercultural healthcare consultations in Saudi Arabia. It provides insights that will inform conversations on how to protect vulnerable patients, ways to improve patient satisfaction, ways to improve health provider communication practice and satisfaction with the potential to reduce workforce turnover, as well as systems reform