Subsequent kidney transplant after pediatric heart transplant: Prevalence and risk factors.

Pediatric heart failure and transplantation carry associated risks for kidney failure and potential need for kidney transplant following pediatric heart transplantation (KT/pHT). This retrospective, United Network of Organ Sharing study of 10,030 pediatric heart transplants (pHTs) from 1987 to 2020 aimed to determine the incidence of waitlisting for and completion of KT/pHT, risk factors for KT/pHT, and risk factors for nonreceipt of a KT/pHT. Among pHT recipients, 3.4% were waitlisted for KT/pHT (median time of 14 years after pHT). Among those waitlisted, 70% received a KT/pHT, and 18% died on the waitlist at a median time of 0.8 years from KT/pHT waitlisting (median age of 20 years). Moderate-high sensitization at KT/pHT waitlisting (calculated panel reactive antibody, ≥ 20%) was associated with a lower likelihood of KT/pHT (adjusted hazard ratio, 0.67; 95% confidence interval, 0.47-0.95). Waitlisting for heart transplantation simultaneously with kidney transplant (adjusted hazard ratio, 3.73; 95% confidence interval, 2.01-6.92) was associated with increased risk of death on the KT/pHT waitlist. While the prevalence of KT/pHT is low, there is substantial mortality among those waitlisted for KT/pHT. These findings suggest a need to consider novel risk factors for nonreceipt of KT/pHT and death on the waitlist in prioritizing criteria/guidelines for simultaneous heart-kidney transplantation.

Evolution of Cardiovascular Findings in Multisystem Inflammatory Syndrome in Children (MIS-C) Across COVID-19 Variants: Common Trends and Unusual Presentations.

Multisystem inflammatory syndrome in children (MIS-C) is a rare condition following COVID-19 infection. Cardiac involvement is common and includes left ventricular systolic dysfunction, cardiac marker elevation, electrocardiogram (ECG) changes, and coronary artery dilation. This single-center retrospective cohort study compares cardiovascular disease between three major SARS-CoV-2 variants and describes the evolution of findings in medium-term follow-up. Of 69 total children (mean age 9.2 years, 58% male), 60 (87%) had cardiovascular involvement with the most common features being troponin elevation in 33 (47%) and left ventricular dysfunction in 22 (32%). Based on presumed infection timing, 61 patients were sorted into variant cohorts of Alpha, Delta, and Omicron. Hospitalization was longer for the Delta group (7.7 days) vs Alpha (5.1 days, p = 0.0065) and Omicron (4.9 days, p = 0.012). Troponin elevation was more common in Delta compared to Alpha (13/20 vs 7/25, p = 0.18), and cumulative evidence of cardiac injury (echocardiographic abnormality and/or troponin elevation) was more common in Delta (17/20) compared with Alpha (12/25, p = 0.013) or Omicron (8/16, p = 0.034). Forty-nine (77%) of the original cohort (n = 69) had no cardiac symptoms or findings beyond 3 months post-hospitalization. Cardiac MRI was performed in 28 patients (between 3 and 6 months post-hospitalization) and was normal in 25 patients (89%). The differences in the variant cohorts may be due to alteration of the immune landscape with higher severity of COVID-19 infection. Despite overall reassuring cardiac outcomes, it is important to note the variability of presentation and remain vigilant with future variants.

Alocasia odora-mediated synthesis of silver nanoparticles, their cytotoxicity, and virucidal potential.

Silver nanoparticles (AgNPs) have various applications in the biomedical field and are considered excellent microbicidal agents. Moreover, biological synthesis of AgNPs using medicinal plants further improves the medicinal applicability of these plants. In this study, the aqueous extract of Alocasia odora rhizome (RE) and Alocasia odora stem (SE) were used to synthesize stem aqueous extract-AgNPs (SNP) and rhizome aqueous extract-AgNPs (RNP). Furthermore, RNP and SNP were evaluated for their virucidal potential. The synthesis of SNP and RNP was monitored using a UV spectrophotometer by observing their surface plasmon resonance peak. In addition, scanning electron microscopy (SEM) gave further insight into their morphology and particle size, whereas energy-dispersive X-ray spectroscopy (EDX) confirmed the presence of silver ions. Interestingly, Fourier-transform infrared spectroscopy (FTIR) analysis of AgNPs revealed that phytomolecules acted as capping and stabilizing agents for SNP and RNP. The in vitro cytotoxicity of SNP and RNP was further analyzed using MTT assay on the U87-MG human glioblastoma cancer cell line and SNP found to be the most cytotoxic (43.40 µg/ml) among all. Besides that, SNP has also found to show the maximum cytopathic effects (CPE) against dengue virus type 2 (DENV-2) on Huh-7 cell line. As a result of the observations, it can be concluded that they can become a promising antiviral drug candidate and thus merit further testing. KEY POINTS: • AgNPs were successfully synthesized through Alocasia odora aqueous extract. • AgNPs were more cytotoxic on the U87-MG cell line than the extract alone. • AgNPs have shown significant reduction in the dengue viral infection than the extract alone.

Hijamah (Cupping Therapy) for Pain Management in Patients with Cervical Spondylosis.

Background: Cervical spondylosis is the most common cervical spine disorder which is clinically manifested by axial neck pain, stiffness, and limited movement and sometimes it is accompanied by tingling and radicular symptoms in the upper extremities. Pain is the most frequent complaint for which patients, suffering from cervical spondylosis, consult physicians. In conventional medicine, pain and other symptoms of cervical spondylosis are controlled by systemic and local use of non-steroidal anti-inflammatory drugs (NSAIDs), however long-term use of such medicines produces adverse effects like dyspepsia, gastritis, gastroduodenal ulcer and bleeding. Methods: We searched articles for neck pain, cervical spondylosis, cupping therapy, Hijama, etc. from various databases, including PubMed, Google Scholar, and MEDLINE. We also searched for these topics in the books of Unani medicine available in HMS Central Library, Jamia Hamdard, New Delhi, India. Results: This review elucidated that in Unani medicine several non-pharmacological regimens known as Ilaj bi'l Tadbir (Regimenal therapies) are advised in the management of painful musculoskeletal disorders. Hijama (cupping therapy) stands out among all these regimens and in most of the classical Unani literature, Hijama is suggested as one of the best regimens for the management of pain in Waja' al-Mafasil including Waja' al-'Unuq (cervical spondylosis). Conclusion: On going through the classical texts of Unani medicine and published research papers, it may be concluded that Hijama is a safe and effective non-pharmacological treatment for the management of pain due to cervical spondylosis.

Captive Black Mamba (Dendroaspis Polylepis) Bite Leading to Respiratory Failure.

BACKGROUND: Of the 8000-10,000 snake envenomations evaluated in U.S. emergency departments (ED) annually, approximately 1% are due to non-native snakes. We describe a 26-year-old man who was bitten by his captive black mamba (Dendroaspis polylepis) as he was packing it up for transport to another snake collector. CASE REPORT: The patient presented to the ED 1 h after being bitten on the forearm, complaining of left arm pain, oral paresthesias, and dyspnea. His vital signs: heart rate 96 beats/min, blood pressure 167/101 mm Hg, temperature 36.7°C (97.9°F), respiratory rate 20 breaths/min, and room air oxygen saturation 100%. Two mildly tender puncture wounds without swelling or ecchymosis were found on the posterior aspect of the forearm. Over the ensuing 30 min his dyspnea worsened, and he developed objective weakness. He was intubated and placed on mechanical ventilation. He was treated with atropine 2 mg for bronchorrhea. Five vials of South African Vaccine Producers (Johannesburg, South Africa) polyvalent antivenom were administered 2.5 h post-bite and the patient was admitted to the intensive care unit. He was extubated 18 h post-envenomation and discharged the following day. He has remained asymptomatic since leaving the hospital. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The primary manifestations of D. polylepis envenomings are neurological. Initial signs may include paresthesias, dysarthria, dysphagia, and ptosis. Progressive descending paralysis leading to respiratory failure develops within 60 min. Muscarinic features are frequently observed. Cardiotoxicity and hematologic laboratory abnormalities may be present. Although pain is common, significant local tissue injury does not occur. In addition to supportive care, several non-native antivenoms are indicated for D. polylepis envenomations. Black mamba envenomings differ from the native snakebites with which U.S. physicians are familiar. Rapid, progressive neurological toxicity and muscarinic features are most common. Treatment consists of supportive care and appropriate antivenom administration.

Machine Learning Informs RNA-Binding Chemical Space.

Small molecule targeting of RNA has emerged as a new frontier in medicinal chemistry, but compared to the protein targeting literature our understanding of chemical matter that binds to RNA is limited. In this study, we reported Repository Of BInders to Nucleic acids (ROBIN), a new library of nucleic acid binders identified by small molecule microarray (SMM) screening. The complete results of 36 individual nucleic acid SMM screens against a library of 24 572 small molecules were reported (including a total of 1 627 072 interactions assayed). A set of 2 003 RNA-binding small molecules was identified, representing the largest fully public, experimentally derived library of its kind to date. Machine learning was used to develop highly predictive and interpretable models to characterize RNA-binding molecules. This work demonstrates that machine learning algorithms applied to experimentally derived sets of RNA binders are a powerful method to inform RNA-targeted chemical space.

Interference Management with Reflective In-Band Full-Duplex NOMA for Secure 6G Wireless Communication Systems.

The electromagnetic spectrum is used as a medium for modern wireless communication. Most of the spectrum is being utilized by the existing communication system. For technological breakthroughs and fulfilling the demands of better utilization of such natural resources, a novel Reflective In-Band Full-Duplex (R-IBFD) cooperative communication scheme is proposed in this article that involves Full-Duplex (FD) and Non-Orthogonal Multiple Access (NOMA) technologies. The proposed R-IBFD provides efficient use of spectrum with better system parameters including Secrecy Outage Probability (SOP), throughput, data rate and secrecy capacity to fulfil the requirements of a smart city for 6th Generation (6thG or 6G). The proposed system targets the requirement of new algorithms that contribute towards better change and bring the technological revolution in the requirements of 6G. In this article, the proposed R-IBFD mainly contributes towards co-channel interference and security problem. The In-Band Full-Duplex mode devices face higher co-channel interference in between their own transmission and receiving antenna. R-IBFD minimizes the effect of such interference and assists in the security of a required wireless communication system. For a better understanding of the system contribution, the improvement of secrecy capacity and interference with R-IBFD is discussed with the help of SOP derivation, equations and simulation results. A machine learning genetic algorithm is one of the optimization tools which is being used to maximize the secrecy capacity.

A review: Surveillance of lumpy skin disease (LSD) a growing problem in Asia.

Lumpy skin disease (LSD) is a viral disease caused by lumpy skin disease virus (LSDV), a member of Capripoxvirus, genus of Poxviridae family. It is a transboundary infection of monetary significance that primarily affects water buffaloes and cattle. LSD was known to be once endemic in Saharan regions of Africa but later on reported in central Asian and neighboring countries of Pakistan like, India, Iran and China. It is a vector borne disease and arthropods are believed to be the main perpetrators. It is discernible by its high morbidity and low mortality. Characteristic lumps on skin and high fever are considered as major signs while reduced milk production, infertility, early embryonic death and anorexia are some of the salient clinical manifestations of the disease. Additionally, nodules on mucosa of oro-pharynx, udder, genitalia and rectum are usually observed on examination. This article summarizes LSD outbreaks across Asia during last fifteen years. It is a general consensus amongst the veterinary community that disease is endemic in Pakistan as it shares borders with India, Iran and China where recent outbreaks are reported. Historically Pakistan is free of LSD, however it is at high risk of a LSDV outbreak as neighboring regions are becoming endemic. Vaccination, strict quarantine measures, limited movement of livestock along with vector control could be effective for preventing the spread of the disease. This review aims to summarize the latest developments in the epidemiology of LSD with the focus on transboundary spread, possible emergence and economic implications on Pakistan.

Toward a Multivariate Prediction Model of Pharmacological Treatment for Women With Gestational Diabetes Mellitus: Algorithm Development and Validation.

BACKGROUND: Successful management of gestational diabetes mellitus (GDM) reduces the risk of morbidity in women and newborns. A woman's blood glucose readings and risk factors are used by clinical staff to make decisions regarding the initiation of pharmacological treatment in women with GDM. Mobile health (mHealth) solutions allow the real-time follow-up of women with GDM and allow timely treatment and management. Machine learning offers the opportunity to quickly analyze large quantities of data to automatically flag women at risk of requiring pharmacological treatment. OBJECTIVE: The aim of this study is to assess whether data collected through an mHealth system can be analyzed to automatically evaluate the switch to pharmacological treatment from diet-based management of GDM. METHODS: We collected data from 3029 patients to design a machine learning model that can identify when a woman with GDM needs to switch to medications (insulin or metformin) by analyzing the data related to blood glucose and other risk factors. RESULTS: Through the analysis of 411,785 blood glucose readings, we designed a machine learning model that can predict the timing of initiation of pharmacological treatment. After 100 experimental repetitions, we obtained an average area under the receiver operating characteristic curve of 0.80 (SD 0.02) and an algorithm that allows the flexibility of setting the operating point rather than relying on a static heuristic method, which is currently used in clinical practice. CONCLUSIONS: Using real-time data collected via an mHealth system may further improve the timeliness of the intervention and potentially improve patient care. Further real-time clinical testing will enable the validation of our algorithm using real-world data.

Simulation and Active Learning Decreases Training Time of an Emergency Triage Assessment and Treatment Course in Pilot Study in Malawi: Implications for Increasing Efficiency and Workforce Capacity in Low-Resource Settings.

OBJECTIVES: The aim of the Emergency Triage Assessment and Treatment (ETAT) plus trauma course is to improve the quality of care provided to infants and children younger than 5 years. The curriculum was revised and shortened from 5 to 2.5 days by enhancing simulation and active learning opportunities. The aim of this study was to examine the feasibility and value of the new short-form ETAT course by assessing postcourse knowledge and satisfaction. METHODS: We delivered the short-form ETAT course to a group of interdisciplinary health workers in Malawi. Precourse and postcourse knowledge was assessed using a standardized 20 questions short answer test used previously in the 5-day courses. A 13-statement survey with 2 open-ended questions was used to examine participant satisfaction. RESULTS: Participants' postcourse knowledge improved significantly (P < 0.001) after the shorter ETAT course. Participants reported high levels of satisfaction with the short-form ETAT. CONCLUSIONS: Simulation and other active learning strategies reduced training time by 50% in the short-form ETAT course. Participants with and without previous ETAT training improved their knowledge after participating in the short-form ETAT course. Reduced training time is beneficial in settings already burdened by scarce human resources, may facilitate better access to in-service training, and build capacity while conserving resources in low-resource settings.

Oral Health-related Knowledge and Assessment of Oral Health Status of Diabetic Patients Attending Dental Clinic at College of Dentistry, Hail, Kingdom of Saudi Arabia.

AIM: This study was aimed to evaluate the oral health status and knowledge of diabetic and nondiabetic patients attending dental clinic at College of Dentistry, Hail, the Kingdom of Saudi Arabia. MATERIALS AND METHODS: It was an observational cross-sectional study. Using nonprobability convenient sampling technique, data were collected from 202 respondents. A total of 202 diabetic and nondiabetic patients were screened for the study. Data were collected by interview using the structured, self-administered questionnaire, and assessment of oral health status was done by clinical examination. The collected data were analyzed using IBM SPSS software. The data were displayed as numbers and percentages and association among the variable of interests was measured using Pearson Chi-square. RESULTS: Of the 202 patients, 102 (50.6%) were males and 100 (49.4%) were females. Majority of the patients, 71 (35.2%) were in the age-group of 30-40 years. In all, 128 (63.4%) participants knew the effect of diabetes mellitus (DM) on oral health, 167 (82.7%) knew that diabetic patients needed special healthcare, 152 (75.25%) had never spoken to their doctors about oral health, and 164 (81.19%) had never spoken to their dentists regarding diabetes. CONCLUSION: The complications associated with oral health are more common in diabetic patients when compared to the nondiabetic patients. This is the case in both male and female patients visiting the College of Dentistry in the Hail region. CLINICAL SIGNIFICANCE: Diabetes mellitus is associated with increased susceptibility to oral infections especially periodontal disease. Role of a general dentist in diagnosis and raising patient awareness toward DM and its effects on oral health need to be emphasized.

Intranasal Immunization with the Commensal Streptococcus mitis Confers Protective Immunity against Pneumococcal Lung Infection.

Streptococcus pneumoniae is a bacterial pathogen that causes various diseases of public health concern worldwide. Current pneumococcal vaccines target the capsular polysaccharide surrounding the cells. However, only up to 13 of more than 90 pneumococcal capsular serotypes are represented in the current conjugate vaccines. In this study, we used two experimental approaches to evaluate the potential of Streptococcus mitis, a commensal that exhibits immune cross-reactivity with S. pneumoniae, to confer protective immunity to S. pneumoniae lung infection in mice. First, we assessed the immune response and protective effect of wild-type S. mitis against lung infection by S. pneumoniae strains D39 (serotype 2) and TIGR4 (serotype 4). Second, we examined the ability of an S. mitis mutant expressing the S. pneumoniae type 4 capsule (S. mitis TIGR4cps) to elicit focused protection against S. pneumoniae TIGR4. Our results showed that intranasal immunization of mice with S. mitis produced significantly higher levels of serum IgG and IgA antibodies reactive to both S. mitis and S. pneumoniae, as well as enhanced production of interleukin 17A (IL-17A), but not gamma interferon (IFN-γ) and IL-4, compared with control mice. The immunization resulted in a reduced bacterial load in respiratory tissues following lung infection with S. pneumoniae TIGR4 or D39 compared with control mice. With S. mitis TIGR4cps, protection upon challenge with S. pneumoniae TIGR4 was superior. Thus, these findings show the potential of S. mitis to elicit natural serotype-independent protection against two pneumococcal serotypes and to provide the benefits of the well-recognized protective effect of capsule-targeting vaccines.IMPORTANCEStreptococcus pneumoniae causes various diseases worldwide. Current pneumococcal vaccines protect against a limited number of more than 90 pneumococcal serotypes, accentuating the urgent need to develop novel prophylactic strategies. S. pneumoniae and the commensal Streptococcus mitis share immunogenic characteristics that make S. mitis an attractive vaccine candidate against S. pneumoniae In this study, we evaluated the potential of S. mitis and its mutant expressing pneumococcal capsule type 4 (S. mitis TIGR4cps) to induce protection against S. pneumoniae lung infection in mice. Our findings show that intranasal vaccination with S. mitis protects against S. pneumoniae strains D39 (serotype 2) and TIGR4 (serotype 4) in a serotype-independent fashion, which is associated with enhanced antibody and T cell responses. Furthermore, S. mitis TIGR4cps conferred additional protection against S. pneumoniae TIGR4, but not against D39. The findings highlight the potential of S. mitis to generate protection that combines both serotype-independent and serotype-specific responses.

Novel SWIPT Schemes for 5G Wireless Networks.

In this paper, we present a few novel simultaneous wireless information and power transfer (SWIPT) schemes that can be effectively used in various 5G wireless network implementations. First, we study the possibility of integrating distributed energy beamforming with the data rate fairness beamforming in a cooperative communication system with multiple cooperative relays and multiple destination users communicating simultaneously. We show that the system exploits significant performance gain using such a joint energy and data rate fairness beamforming scheme. Further, we propose an enhanced version of the SWIPT scheme, the energy-efficient modulation-based non-orthogonal multiple access (M-NOMA) SWIPT scheme, and observe its system efficiency in terms of more harvested energy. Finally, we consider an energy-harvesting SWIPT scheme where the channel response is estimated using the energy-harvesting signal as pilots superimposed on the information signal. For such a scheme, we compute the optimum transmit power ratio between the pilot and information signals under varying SNR conditions and improve the accuracy of the decoding process at the reception.

At the coalface of collaborative mental health care: A qualitative study of governance and power in district-level service provision in South Africa.

Globally, there is an urgency to address fragmented mental health systems, especially in low-to-middle income countries. State and non-state mental health service collaboration is a central strategy to strengthen care. The study was undertaken to analyse the power in governance processes of public mental health service provision. Semi-structured interviews were conducted with state and non-state actors in mental health care in a South African district. Transcriptions were thematically analysed using the Framework for Assessing Power in Collaborative Processes. Findings suggested that collaborative processes were significantly state-owned, in terms of funding models, administrative and legislative jurisdiction, and state hierarchical referral structure. No formal agreements were in place, elevating the importance of key network actors to bring less-endowed NGOs into the service network. Fragmentation between the Departments of Health and Social Development was telling in district forums. Resistance to power structures unfolded, some participants sidestepping traditional hierarchies to leverage funding and support. The paper highlights the complexities and different facets of power in integrated mental health care in a South African district, adding to growing literature on the social mechanisms that influence collaboration.

Corneal Confocal Microscopy Detects Corneal Nerve Damage in Patients Admitted With Acute Ischemic Stroke.

BACKGROUND AND PURPOSE: Corneal confocal microscopy can identify corneal nerve damage in patients with peripheral and central neurodegeneration. However, the use of corneal confocal microscopy in patients presenting with acute ischemic stroke is unknown. METHODS: One hundred thirty patients (57 without diabetes mellitus [normal glucose tolerance], 32 with impaired glucose tolerance, and 41 with type 2 diabetes mellitus) admitted with acute ischemic stroke, and 28 age-matched healthy control participants underwent corneal confocal microscopy to quantify corneal nerve fiber density, corneal nerve branch density, and corneal nerve fiber length. RESULTS: There was a significant reduction in corneal nerve fiber density, corneal nerve branch density, and corneal nerve fiber length in stroke patients with normal glucose tolerance (P<0.001, P<0.001, P<0.001), impaired glucose tolerance (P=0.004, P<0.001, P=0.002), and type 2 diabetes mellitus (P<0.001, P<0.001, P<0.001) compared with controls. HbA1c and triglycerides correlated with corneal nerve fiber density (r=-0.187, P=0.03; r=-0.229 P=0.01), corneal nerve fiber length (r=-0.228, P=0.009; r=-0.285; P=0.001), and corneal nerve branch density (r=-0.187, P=0.033; r=-0.229, P=0.01). Multiple linear regression showed no independent associations between corneal nerve fiber density, corneal nerve branch density, and corneal nerve fiber length and relevant risk factors for stroke. CONCLUSIONS: Corneal confocal microscopy is a rapid noninvasive ophthalmic imaging technique that identifies corneal nerve fiber loss in patients with acute ischemic stroke.

Visible-Light Photoreduction of CO2 to CH4 over ZnTe-Modified TiO2 Coral-Like Nanostructures.

Rapidly depleting fossil fuels and the related environmental issues are two alarming global concerns the world is facing today. To address these issues efficiently, future energy requirements need to be fulfilled by renewable and environmentally friendly resources. In this context, we report the ZnTe-modified TiO2 photocatalysts with varying amounts of ZnTe (1.96, 16, and 65 %) for the photoreduction of carbon dioxide into methane under visible light. The hydrothermally synthesized photocatalysts have been characterized by using various techniques, such as X-ray diffraction, scanning electron microscopy coupled with energy-dispersive X-ray spectroscopy, transmission electron microscopy, UV/Vis spectroscopy, X-ray photoelectron spectroscopy and Brunauer-Emmett-Teller (BET) analysis for surface-area measurements. The photocatalyst with 1.96 % ZnTe shows the best results, which are attributed to its high BET specific surface area and the formation of a heterojunction at the interface, which can facilitate efficient charge transfer.

Development of profound Chiari I malformation and cerebellar tissue loss and resolution following shunting of posterior fossa extra-axial cyst. Case report.

INTRODUCTION: Chiari I malformation can be due to a multitude of etiologies such as craniosynostosis or hydrocephalus. A posterior fossa extra-axial cyst (PFEAC) appears to be an extremely rare cause of this form of hindbrain herniation. CASE REPORT: Herein, we report a case of PFEAC that presented with no Chiari I malformation and then presented months later with a significant Chiari I malformation. Following shunt placement of a PFEAC, striking reversal of the Chiari malformation as well as reconstitution of the cerebellum was noted. CONCLUSIONS: Patients with PFEAC might develop a Chiari I malformation and this might be treated with shunting of the PFEAC alone.

Tricuspid Atresia with Non-compaction: An Early Experience with Implications for Surgical Palliation.

Left ventricle non-compaction (LVNC) has worse outcomes when associated with congenital heart defects (CHD). The co-occurrence and outcomes of LVNC with tricuspid atresia (TA) are not well described. Our study aims to determine the prevalence of LVNC with functionally single ventricle due to TA, and to describe the early outcomes of surgical palliation. A retrospective database search for patients (n = 167,566) and echocardiograms (n = 44,053) was performed in order to collect clinical, echocardiographic, and hemodynamic data of pediatric patients with TA and LVNC at St. Louis Children's Hospital, Missouri, USA, from January 1, 2008, to August 31, 2013. The prevalence of TA and LVNC was 0.015 and 0.08%, respectively. Eight patients with TA had LVNC (32%, group 1). Seventeen patients had only TA (68%, group 2). Five patients from group 1 and 8 patients from group 2 were surgically palliated with the Fontan procedure. They exhibited similar remodeling indices, and hemodynamics (median LV end-diastolic pressure ≤10 mmHg; median mean pulmonary artery pressure ≤15 mmHg) that allowed for completion of the Fontan procedure. All Fontan patients were in New York Heart Association class I after a 3-year (median) follow-up period. Our data show that TA with LVNC patients, who have acceptable cardiac remodeling indices, LV systolic function, and hemodynamics (LVEDP ≤ 10 mmHg, mean pulmonary artery pressure ≤ 15 mmHg) can have successful completion of the Fontan procedure and positive early outcomes.

Twelve tips for undertaking reflexive global health experiences in medicine.

BACKGROUND: While interest and opportunities for global health experiences (GHE) continue to grow, the preparation of students and health professionals alike to engage in these GHEs remains limited. AIMS: This article provides tips for reflexivity prior to undertaking a GHE and suggests ways to debrief the experience in order to ensure that trainees and professionals that engage in GHEs can both help their intended communities and also get the most out of the experience. METHODS: The authors conducted a scoping review using Medline, PubMed and Google scholar using searching the terms: global health, global health experience, global health research, and international medical elective. We supplemented this search with our own experiences working with international partners. CONCLUSIONS: GHEs should be undertaken with reflexivity prior to, during and subsequent to the experience in order to ensure that all collaborators in the partnership meet their intended goals.

Skull Base and Cervical Spine Involvement in Jansen Syndrome: Case Report.

INTRODUCTION: Metaphyseal chondrodysplasia, Jansen type (JMD), is a rare form of endochondral ossification resulting in short limbs and dwarfism. CASE REPORT: A child presented with JMD and was found to have involvement of the cervical spine. Conservative treatment was given to the patient who at the long-term follow-up continues to have no neurological findings or cervical spine instability. CONCLUSIONS: To our knowledge, this case represents the first report of involvement of the superior cervical spine in a patient with JMD. Clinicians should be aware of this potential albeit rare finding.