Pulmonary Annulus Growth Pattern in Patients with Tetralogy of Fallot Prior to Surgical Repair.

Objectives: The size of the pulmonary valve annulus often determines the feasibility of pulmonary valve preservation at the time of intracardiac repair of Tetralogy of Fallot. Currently, there is limited available data regarding the growth pattern and the determining factors that contribute towards pulmonary valve annulus growth. Methods: This retrospective study included patients who underwent surgical repair of Tetralogy of Fallot with or without prior palliation. These patients had an echocardiogram at the time of initial diagnosis and a second echocardiogram prior to intracardiac repair. The sizes of the pulmonary annulus, the right and left pulmonary arteries with z-scores were recorded. Patients with improvement in the pulmonary annulus z-scores between the 2 echocardiographic examinations were allocated in Group I (n = 46) and Group II (n = 68) were those with no improvement. Results: A total of 114 patients were included in the study. The right and left pulmonary arteries size and z scores improved significantly between the 2 echocardiograms. Although the median size of the pulmonary annulus increased between the 2 echocardiograms (6 and 7.9 mm; P<0.001), there was no significant change in the z-score (-2.2, -2.34; P = 0.185). Multivariate logistic regression analysis showed that gender, blood group, presence of collaterals, and palliation with Blalock-Taussig shunt had no impact on the improvement in pulmonary annulus z-score. Conclusion: In Tetralogy of Fallot, the pulmonary valve annulus z-score may not change significantly prior to the intracardiac repair. Although in certain subgroups there may be an improvement, there was no specific factor that could be identified and had an influence on this improvement.

Study protocol: behaviour change intervention to promote healthy diet and physical activity in overweight/obese adults with diabetes attending health care facilities in Muscat: a cluster rendomised control trial.

BACKGROUND: Healthy behavior is an essential component in type 2 diabetes (T2D) management. Promoting healthy lifestyle is one of the priorities of primary health care in Oman. This study aims to evaluate the effectiveness of a multi-component intervention in promoting physical activity (PA) and healthy diet and its implications on body mass index and glycemic control in adults with diabetes attending primary care. METHODS: A one year 1:1 cluster randomized controlled trial will be utilized to compare the use of phone consultations, a multi component interactive phone application and pedometers with the usual diabetes care on promoting PA and healthy diet. Participants will be screened for inactivity and should be T2D, aged18-65 years, and overweight or obese. Eight primary centers will be randomly selected in each arm (n = 375). The primary outcome is the between arms differences in PA and diet scores, BMI and HbA1c over 12 months from baseline. Additionally, secondary outcomes will include cardiovascular outcomes (BP, and lipids). The trial has received ethical approval from the Omani Research and Ethical Review and Approval Committee. All eligible participants will be invited to their respected health centers to provide informed consent. DISCUSSION: This study will contribute to the integration of healthy lifestyle approach using artificial intelligence to primary diabetes care. Results from this study will be disseminated through workshops, policy briefs, and peer-reviewed publications, local and international conferences. TRIAL REGISTRATION: Trial registration number ISRCTN71889430 . Date applied: 28/11/2020. Date assigned: 01/12/2020.