Circular areas of erythema on the mid forehead

Cupping is well known as a complementary treatment and remains in use for many ailments, including dermatological conditions. We report a case who presented with a skin lesion on her forehead.peer-reviewe

“Bendy” stents help negotiate hairpin intracardiac curves

Simple transposition of the great arteries (TGA) occurs in 0.2 per 1000 live births. The condition is surgically repaired in the neonatal period by the arterial switch procedure (ASO) sometimes preceded by an atrial septostomy. The ASO involves transecting the great arteries and relocating them to the appropriate ventriculo-arterial (VA) connection with attachment of the disconnected coronary arteries to the aorta. In the process, the attachment of the pulmonary artery to the right ventricle involves the Le Compte manoeuvre and to achieve this the pulmonary arteries must be fully mobilised and sometimes the main pulmonary artery may require patch augmentation as well. Nevertheless, pulmonary artery stenosis (PAS) is one of the potential problems with the ASO. However, with improved surgical techniques, this has dropped from around 15% in the 1980s to less than 3%. Apart from surgical revision when PAS occurs, there are interventional options which include angioplasty and/or stent insertion. The latter is preferred in small children and works well in around 60% but may require repeat procedures. In older patients or when angioplasty fails, stent insertion can be considered. These procedures may involve negotiating tight bends in order to reach the site of stenosis. The passage of non-premounted stents may be problematic in such situations, especially with longer stents and tighter bends as they tend to slip off balloon. We describe several techniques that may facilitate such interventions, and these were utilised in an adolescent patient who had had ASO for TGA in the neonatal period. These included manually giving the mounted stent a slight bend in order to help the balloon-stent assembly negotiate hairpin bends.peer-reviewe

Right ventricular outflow tract stenting : effective palliation for Fallot’s tetralogy

Traditionally, the management of infants with Fallot’s tetralogy (TOF) with excessively reduced pulmonary flow and cyanosis has been palliation until or unless complete repair is feasible. Palliation involves a procedure that augments pulmonary flow. Most series recognise two subgroups of patients at high risk even in the current era: the cyanotic neonate/infant with small pulmonary arteries and those with complex anatomical variants of tetralogy and/or significant comorbidities such as additional congenital heart lesions (e.g associated Atrio Ventricular Septal Defect) or other congenital anomalies. There is an argument for palliation of these high-risk groups to allow for future potentially more effective elective repairpeer-reviewe

Back trauma resulting in commotio cordis

Commotio cordis (Latin: "agitation of the heart") is a dysrhythmia provoked by praecordial trauma during the early part of cardiac repolarisation. Recorded rhythms include ventricular tachycardia/fibrillation, bradyarrhythmias, idioventricular rhythm, complete heart block and asystole. The quoted fatality rate is 65% even with prompt CPR and defibrillation, and exceeds 80% in the absence of such interventions. Above a certain threshold of trauma/impact, structural cardiac damage may also occur (contusio cordis).peer-reviewe

Aortic stenting for neonatal coarctation of the aorta : when should this be considered?

Aortic coarctation (CoA) constitutes the fifth most common congenital heart defect (1 in 2500 live births). This lesion comprises 5-8% of congenital heart disease and has variable severity and mode of presentation. Critical coarctation in newborns usually presents with severe narrowing of the upper thoracic aorta below the isthmus and adjacent to the arterial duct, and is dependent on duct patency for survival. Rapid deterioration of the patient usually results from spontaneous closure of the patent arterial duct (PDA). This deterioration is in part due to reduced renal perfusion resulting in fluid and acid retention causing heart failure and metabolic acidosis. This may be alleviated by the administration of intravenous prostaglandin, with temporary improvement of distal aortic blood flow, and overall condition. The treatment of choice is surgical resection with the ‘extended end-to-end’ technique. We present a case of a severely ill newborn with complex coarctation, multiorgan failure, disseminated intravascular coagulation and oedema, who was treated with emergency stenting on the tenth day of life. This was followed by surgical stent removal and repair of the arch on the 29th day of life. We followed the strategy of minimally invasive interventional bridging of a borderline patient with regard to the experience of stenting of native coarctations in older patients, or complex recurrent stenosis of previously surgically treated childrenpeer-reviewe

A Review of Drowning Prevention Interventions for Children and Young People in High, Low and Middle Income Countries.

Globally, drowning is one of the ten leading causes of child mortality. Children aged <5 years are particularly at risk, and children and young people continue to be overrepresented in drowning statistics. Accordingly, evidence informed interventions to prevent children drowning are of global importance. This review aimed to identify, assess and analyse public health interventions to reduce child drowning and investigate the use of behavioural theories and evaluation frameworks to guide child drowning prevention. Thirteen databases were searched for relevant peer reviewed articles. The systematic review was guided by the PRISMA criteria and registered with PROSPERO. Fifteen articles were included in the final review. Studies were delivered in high, middle and low income countries. Intervention designs varied, one-third of studies targeted children under five. Almost half of the studies relied on education and information to reduce drowning deaths, only three studies used a multi-strategy approach. Minimal use of behavioural theories and/or frameworks was found and just one-third of the studies described formative evaluation. This review reveals an over reliance on education and information as a strategy to prevent drowning, despite evidence for comprehensive multi-strategy approaches. Accordingly, interventions must be supported that use a range of strategies, are shaped by theory and planning and evaluation frameworks, and are robust in intervention design, delivery and evaluation methodology. This approach will provide sound evidence that can be disseminated to inform future practice and policy for drowning prevention

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially