Endomyocardial fibrosis associated with Schistosoma Haematobium infection

Endomyocardial fibrosis (EMF) is a form of restrictive cardiomyopathy common in the tropics and subtropics. The aetiology of EMF is unknown but helminth infestations such as schistosomiasis have been implicated. Two boys aged 8 and 10 years with EMF associated with Schistosoma haematobium, are described. The schistosomes in both cases may have been acquired from contact with contaminated water collected and stored in containers and subsequently used for bathing. Both patients were managed conservatively. Overall prognosis of EMF is poor and this report emphasizes the importance of public health  interventions in the control of schistosomiasis.Keywords: Endomyocardial fibrosis; Schistosoma haematobium; Cardiomyopathy; Ghana; Public health interventio

Osteomyelitis of the frontal bone

Osteomyelitis of the skull is a rare clinical presentation. It usually occurs as a complication of trauma or sinusitis. Its complications can be lifethreatening though the initial symptoms and signs are subtle. Early diagnosis and appropriate management to prevent CNS complications reduce morbidity and mortality significantly. Intracranial complications of sinusitis, focal infections and meningitis remain a great challenge. Mortality from complications is 20-40%. The prevalence of skull osteomyelitis is about 1.5% of all osteomyelitis

Effects of cooperation on information disclosure in mock‐witness interviews

Purpose: Forensic interviewers often face witnesses who are unwilling to cooperate with the investigation. In this experimental study, we examined the extent to which cooperativeness instructions affect information disclosure in a witness investigative interview. Methods: One hundred and thirty-six participants watched a recorded mock-crime and were interviewed twice as mock-witnesses. They were randomly assigned to one of four conditions instructing different levels of cooperativeness: Control (no instructions), Cooperation, No Cooperation, and No Cooperation plus Cooperation. The cooperativeness instructions aimed to influence how participants’ perceived the costs and benefits of cooperation. We predicted that Cooperation and No Cooperation instructions would increase and decrease information disclosure and accuracy, respectively. Results: We found decreased information disclosure and, to a lesser extent, accuracy in the No Cooperation and No Cooperation plus Cooperation conditions. In a second interview, the shift of instructions from No Cooperation to Cooperation led to a limited increase of information disclosure at no cost of accuracy. Cooperativeness instructions partially influenced the communication strategies participants used to disclose or withhold information. Conclusions: Our results demonstrate the detrimental effects of uncooperativeness on information disclosure and, to a lesser extent, the accuracy of witness statements. We discuss the implications of a lack of witness cooperation and the importance of gaining witness cooperation to facilitate information disclosure in investigative interviews

Catheter manipulation analysis for objective performance and technical skills assessment in transcatheter aortic valve implantation

Purpose Transcatheter aortic valve implantation (TAVI) demands precise and efficient handling of surgical instruments within the confines of the aortic anatomy. Operational performance and dexterous skills are critical for patient safety, and objective methods are assessed with a number of manipulation features, derived from the kinematic analysis of the catheter/guidewire in fluoroscopy video sequences. Methods A silicon phantom model of a type I aortic arch was used for this study. Twelve endovascular surgeons, divided into two experience groups, experts (n=6) and novices (n=6), performed cannulation of the aorta, representative of valve placement in TAVI. Each participant completed two TAVI experiments, one with conventional catheters and one with the Magellan robotic platform. Video sequences of the fluoroscopic monitor were recorded for procedural processing. A semi-automated tracking software provided the 2D coordinates of the catheter/guidewire tip. In addition, the aorta phantom was segmented in the videos and the shape of the entire catheter was manually annotated in a subset of the available video frames using crowdsourcing. The TAVI procedure was divided into two stages, and various metrics, representative of the catheter’s overall navigation as well as its relative movement to the vessel wall, were developed. Results Experts consistently exhibited lower values of procedure time and dimensionless jerk, and higher average speed and acceleration than novices. Robotic navigation resulted in increased average distance to the vessel wall in both groups, a surrogate measure of safety and reduced risk of embolisation. Discrimination of experience level and types of equipment was achieved with the generated motion features and established clustering algorithms. Conclusions Evaluation of surgical skills is possible through the analysis of the catheter/guidewire motion pattern. The use of robotic endovascular platforms seems to enable more precise and controlled catheter navigation

Groin wound infection after vascular exposure ( GIVE ) multicentre cohort study

Surgical site infections (SSIs) of groin wounds are a common and potentially preventable cause of morbidity, mortality, and healthcare costs in vascular surgery. Our aim was to define the contemporaneous rate of groin SSIs, determine clinical sequelae, and identify risk factors for SSI. An international multicentre prospective observational cohort study of consecutive patients undergoing groin incision for femoral vessel access in vascular surgery was undertaken over 3 months, follow‐up was 90 days. The primary outcome was the incidence of groin wound SSI. 1337 groin incisions (1039 patients) from 37 centres were included. 115 groin incisions (8.6%) developed SSI, of which 62 (4.6%) were superficial. Patients who developed an SSI had a significantly longer length of hospital stay (6 versus 5 days, P = .005), a significantly higher rate of post‐operative acute kidney injury (19.6% versus 11.7%, P = .018), with no significant difference in 90‐day mortality. Female sex, Body mass index≥30 kg/m2, ischaemic heart disease, aqueous betadine skin preparation, bypass/patch use (vein, xenograft, or prosthetic), and increased operative time were independent predictors of SSI. Groin infections, which are clinically apparent to the treating vascular unit, are frequent and their development carries significant clinical sequelae. Risk factors include modifiable and non‐modifiable variables

The disclosure-outcomes management model

In this work, we introduce the disclosure-outcomes management model, which seeks to explain intelligence interviewees’ mental representation and disclosure of information. The model views disclosure as a form of instrumental helping behavior that interviewees implement to maximize their self-interests. We theorize that interviewees cooperate by managing their disclosures in response to self-interest dilemmas. That is, interviewees compare the potential outcomes of disclosing to their self-interests and estimate the extent to which the behavior will facilitate or impede those self-interests. That is to say, an interviewee’s self-interest dilemma elicits cooperation with respect to some information but not other information. We discuss how this model fits with and advances the paradigm of intelligence interviewing research