Radiation exposure in interventional procedures

The aim of this study was to estimate radiation doses patients and staff are exposed to during interventional procedures (IPs), compare them with the international diagnostic reference levels and to develop initial National Diagnostic Reference Levels. The IP survey was undertaken as the initial task of which, retrospective data were collected from the only four Kenyan hospitals carrying out interventional radiology and cardiology procedures at the time of the study. Real-time measurement of radiation dose to patients and staff during these procedures was done. To the patients, kerma-area product (KAP) and fluoroscopy time measurements were done using an in-built KAP meter, while peak skin dose (PSD) was measured using slow Extended Dose Range (EDR2. ®) radiographic films. The staff occupational doses were measured using individual thermoluminescence dosemeters. The maximum and minimum KAP values were found to be 137.1 and 4.2 Gy cm. 2, while the measured PSD values were 740 and 52 mGy, respectively. The fluoroscopic time range was between 3.3 and 70 min. The staff doses per procedure ranged between 0.05 and 1.41 mSv for medical doctors, 0.03 and 1.16 mSv for nurses, 0.04 and 0.78 mSv for radiographers and 0.04 and 0.88 mSv for clinical staff. The measured patient PSDs were within the threshold limit for skin injuries. However, with the current few IP specialists, an annual increase in workload as determined in the study will result in the International Commission on Radiation Protection annual eye lens dose limit being exceeded by 10 %. A concerted effort is required to contain these dose levels through use of protective gear, optimisation of practice and justification

Efficacy of Bacillus clausii in reducing duration of illness in acute diarrhoea in children 6-59 months of age admitted with severe dehydration

Background: Acute infectious diarrhoea is the second commonest cause of under-five mortality in the world. It has been associated with an increased morbidity and high rate of admission into hospital due to severe dehydration. Multiple studies document that probiotics are effective in treating infectious diarrhoea in children. This study attempted to determine whether Bacillus.clausii (B.clausii) is effective in shortening acute diarrhoeal illness in under-five population with severe dehydration.Methods: In a randomized, double-blind, placebo-controlled trial, children (age range: 6 months to 5 years) with acute diarrhoea and World Health Organization (WHO) criteria of severe dehydration were administered B.clausii, twice daily, for 5 days. Routine standard care and WHO protocols of managing diarrhea and dehydration were followed in both groups. Primary outcome measure was the duration of diarrhoea.Results: In a per-protocol analysis of 90 children, the mean duration of diarrhoea in the B.clausii group (n=44) was insignificantly shorter (77.59 ± 34.10 hours) than the placebo group (n=46) (86.74 ± 40.16 hours) There was a mean difference between the groups of 9.15 hours (t (88) = 1.163, P = 0.248, 95% C.I -6.88 – 24.79). There was a significant decrease in the mean number of diarrhoeal motions on day 3 [B.clausii group 2.74±1.81 motions vs. Placebo group 3.80±2.70 motions; mean difference=1.05 motions; (t (88) = 2.169, P = 0.033, 95% C.I 0.09 – 2.02)].Conclusion: In children admitted with acute diarrhea and severe dehydration, there was no significant difference in the duration of diarrhoea and duration of hospital stay in the two groups

World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease: an evidence-based guideline

Over the past 5 years, the advent of echocardiographic screening for rheumatic heart disease (RHD) has revealed a higher RHD burden than previously thought. In light of this global experience, the development of new international echocardiographic guidelines that address the full spectrum of the rheumatic disease process is opportune. Systematic differences in the reporting of and diagnostic approach\ud to RHD exist, reflecting differences in local experience and disease patterns. The World Heart Federation\ud echocardiographic criteria for RHD have, therefore, been developed and are formulated on the basis of the best available evidence. Three categories are defined on the basis of assessment by 2D, continuous-wave,and color-Doppler echocardiography: 'definite RHD', 'borderline RHD', and 'normal'. Four subcategories of 'definite RHD' and three subcategories of 'borderline RHD' exist, to reflect the various disease patterns. The morphological features of RHD and the criteria for pathological mitral and aortic regurgitation are also defined. The criteria are modified for those aged over 20 years on the basis of the available evidence. The standardized criteria aim to permit rapid and consistent identification of individuals with RHD without a clear history of acute rheumatic fever and hence allow enrollment into secondary prophylaxis programs. However, important unanswered questions remain about the importance of subclinical disease (borderline or definite RHD on echocardiography without a clinical pathological murmur), and about the practicalities of implementing screening programs. These standardized criteria will help enable new studies to be designed to evaluate the role of echocardiographic screening in RHD control