PCV62 Annual Medication Cost Attributed To Each Kind Of Treatment Of Patients Subjected To Crmds Implantation

Le gouvernement de la Dominique a adopté une politique vigilante sur 1importation et l'utilisation de pesticides. Dans ce pays, ure Office de contrôle des pesticides octroie des licences d'importation aux firmes agrochimiques tandis que le rninistere de l'Agriculture organise des Sessions de formation destinées aux agriculteurs et portant sur 1utilisation de ces produits. En outre, ure programme d'analyse régulière des sols a été mis en place pour détecter la présence de résidus de pesticides. Comme la rnajorité des pays ACP, la Dominique dépend de l’agriculture pour nourrir sa population et générer des devises à l'ëxportation. Dans cette agriculture, la banane est un des piliers de L’économie agriccolle nationale; il est indéniable que La cornpétiton sur le marché européen va s'accroitre lurs de la creation effective-du rnarché unique en I992-. Pour' assurer leur avenir, les agriculteurs de la Dominique souhaitent maintenir to quantité et la qualité de la production de bananes mais aussi diversifier leurs exportations grâce au développement de la production de fruits, de légumes et de fleurs. Dans cette optique, 1utilisation croissante de pesticides est inévitable et suppose donc une grande, vigilance quant à leur utilisation. Dans la Dominique, le relief est escarpé, les pluies abondantes, les sols volcaniques : tous ces facteurs fàvorisent le ruissellement et le lessivage des sols.'Le risque de pollution des nappes phréatiques est donc potëntiellement important , notamment dans les:régions bananières 'ou les paysans ont recours aux nematicidés. Pour minimiser ces- risques, seuls les produits agrochimiques testés sort autorisés à l’importation et Ieur utilisation est contrôlée par le ministère de 1Agriculture. Ce dernier incite par ailleurs les groupements paysans à suivre des sessions régulières de formation ou ure enseignement est dispensé portant sur le mélange et l’epandagé des produits chimiques, sur 1utilisation de vêtements de protection et sur le stockage des denrées selon les normes de sécurité. Parallèlement, un programme de détection des, résidus de pesticides a été lancé dernièrement, grâce à 1appui de la FAO qui fournit des -équipements de chromatographie par gaz liquide. Les agriculteurs de la Dominique ont compris 1importance de ces formations et la majorité d'entre, eux sont aujourd’hui conscients de la nécessite d’exporter des produit de qualité,et de 1importance d'une utilisation maîtrisée des pesticides .Les épandages «excessifs» (en particulier, surdosage et mélanges inadéquats), fréquents dans de nombreux pays, sont extrêmement rares à la Dominique .Dans ce pays, on utilise les pesticides avec prudence et économie : alors, le risque est minime pour les agriculteurs les consommateurs et 'l'environnement. Pour plus de détails : Colin Bulley Chief Technical Officer Ministry of Agriculture Roseau DOMINIQUELe gouvernement de la Dominique a adopté une politique vigilante sur 1importation et l'utilisation de pesticides. Dans ce pays, ure Office de contrôle des pesticides octroie des licences d'importation aux firmes agrochimiques tandis que le..

Hepatic Abscess 6 years after ERCP

Backround : ERCP combined with the insertion of biliary endoprosthesis is considered a daily practice endoscopic intervention for the treatment of choledocholithiasis. Nevertheless, retained biliary stents for a prolonged period without follow up may cause serious complications. Case presentation : We present the case of a 62-year-old man who was hospitalized with symptoms of vomiting, abdominal pain, fatigue and fever. Clinical examination and laboratory results were indicative of an intra abdominal infection. Ultrasound and CT scans were performed, identifying a 17x11.3x7.7 cm. The cause of this lesion was a retained stent in the common bile duct which was placed 6 years ago via endoscopic retrograde cholangiopancreatography. The patient did not attend his follow up appointments after his initial ERCP. Patient’s clinical status deteriorated, and an urgent ERCP was performed replacing the retained stent, followed by ultrasound-guided pigtail stent insertion into the hepatic abscess and administration of antibiotics intravenously. Patient’s clinical condition was improved and after two months of surveillance complete resolution of the hepatic abscess was achieved. Conclusion : The insertion of biliary stents is common endoscopic technique, but close follow up is of outmost importance

Probing oral anticoagulation in patients with atrial high rate episodes: Rationale and design of the Non-vitamin K antagonist Oral anticoagulants in patients with Atrial High rate episodes (NOAH-AFNET 6) trial.

Oral anticoagulation prevents ischemic strokes in patients with atrial fibrillation (AF). Early detection of AF and subsequent initiation of oral anticoagulation help to prevent strokes in AF patients. Implanted cardiac pacemakers and defibrillators allow seamless detection of atrial high rate episodes (AHRE), but the best antithrombotic therapy in patients with AHRE is not known. RATIONALE: Stroke risk is higher in pacemaker patients with AHRE than in those without, but the available data also show that stroke risk in patients with AHRE is lower than in patients with AF. Furthermore, only a minority of patients with AHRE will develop AF, many strokes occur without a temporal relation to AHRE, and AHRE can reflect other arrhythmias than AF or artifacts. An adequately powered controlled trial of oral anticoagulation in patients with AHRE is needed. DESIGN: The Non-vitamin K antagonist Oral anticoagulants in patients with Atrial High rate episodes (NOAH-AFNET 6 ) trial tests whether oral anticoagulation with edoxaban is superior to prevent the primary efficacy outcome of stroke or cardiovascular death compared with aspirin or no antithrombotic therapy based on evidence-based indications. The primary safety outcome will be major bleeding. NOAH-AFNET 6 will randomize 3,400 patients with AHRE, but without documented AF, aged ≥65 years with at least 1 other stroke risk factor, to oral anticoagulation therapy (edoxaban) or no anticoagulation. All patients will be followed until the end of this investigator-driven, prospective, parallel-group, randomized, event-driven, double-blind, multicenter phase IIIb trial. Patients will be censored when they develop AF and offered open-label anticoagulation. The sponsor is the Atrial Fibrillation NETwork (AFNET). The trial is supported by the DZHK (German Centre for Cardiovascular Research), the BMBF (German Ministry of Education and Research), and Daiichi Sankyo Europe. CONCLUSION: NOAH-AFNET 6 will provide robust information on the effect of oral anticoagulation in patients with atrial high rate episodes detected by implanted devices

Current Status of Endovascular Training for Cardiothoracic Surgery Residents in the United States

Background Endovascular interventions for cardiovascular pathology are becoming increasingly relevant to cardiothoracic surgery. This study assessed the perceived prevalence and efficacy of endovascular skills training and identified differences among training paradigms. Methods Trainee responses to questions in the 2016 In-Service Training Examination survey regarding endovascular training were analyzed based on the four different cardiothoracic surgery training pathways: traditional 2- and 3-year thoracic, integrated 6-year, and combined 4+3 general and thoracic residency programs. Results The duration of endovascular training was substantially different among programs, at a median of 17 weeks for integrated 6-year, 8.5 weeks for 3-year, 6 weeks for 4+3, and 4 weeks for 2-year residency (p < 0.0001). After adjusting for year of training and program type, the duration of endovascular rotations was significantly associated with self-assessed comfort with catheter-based skills (p < 0.0001). Eighty-two percent of residents rotated with trainees from other specialties, and 58% experienced competition for cases. Residents reported greater exposure to transcatheter aortic valve replacement than to thoracic endovascular aortic repair, cardiac catheterization, percutaneous closure of atrial septal defect, and transcatheter mitral valve surgery (p < 0.0001). A significant proportion of responders reported feeling uncomfortable performing key steps of transcatheter aortic valve replacement (52%) or thoracic endovascular aortic repair (49%). Conclusions Considerable heterogeneity exists in endovascular training among cardiothoracic surgery training pathways, with a significant number of residents having minimal to no exposure to these emerging techniques. These findings highlight the need for a standardized curriculum to improve endovascular exposure and training

Characteristics of cardiothoracic surgeons practicing at the top-ranked US institutions

BACKGROUND: We aimed to determine which factors distinguish cardiothoracic (CT) surgeons practicing at the top-ranked US institutions from their peers. METHODS: Using online resources, we collected demographics, training information and academic metrics of 694 cardiac (n=489; 70%) and thoracic (n=205; 30%) surgeons practicing at 57 preeminent US institutions, including those with the highest US News & World Report ranking ("top CT centers"). RESULTS: Two hundred and ninety-nine (43.1%) CT surgeons were practicing at the 18 "top CT centers" and had higher academic productivity (publications, citations) than their peers. While there was no difference in the proportion of international medical graduates (IMGs) (21.4% overall) or of surgeons with a PhD degree (9.4% overall) across institutions, the "top CT centers" had a higher proportion of faculty who received their entire CT training abroad (10.4% vs. 5.8%; P=0.038) or at highly-ranked US institutions. Those who published more during their early career years (residency, fellowship and first 5 years as faculty) were more likely to attain academic (professorship) and institutional leadership (division/department chair) positions and to practice at the "top CT centers". Women represented a minority (7.3% overall; 5.1% of cardiac vs. 12.7% of thoracic surgeons, P<0.001), but with growing prevalence among younger faculty and without differences across institutions. CONCLUSIONS: CT surgeons of the best US centers have a more international background and received their training at highly-ranked institutions. Early academic productivity is associated with life-long career achievements, with special importance of the first 5 years as faculty. Women represent a growing proportion of the CT surgical workforce