Factors Affecting Outcomes in Acute Type A Aortic Dissection: A Systematic Review.

Acute type A aortic dissection is a clinical emergency and is associated with significant morbidity and mortality rates if not managed promptly in specialised and high-volume centres. The mortality rate is increased by 1% for each hour delay in management; however, with advancement in clinical practice, diagnostic imaging and clinician awareness, this has been dramatically reduced to below 30% in most international centres. Not only timing of recognition of the pathology, but also other factors can significantly affect outcomes of such critical pathology. This includes, but is not limited to, age, extent of the pathology, existence of connective tissue disorders, hypertension, diabetes mellitus and surgeon experience. This narrative review will focus on current clinical practice and the evidence behind optimising each factor to minimise adverse outcomes in such high-risk cohort.

Acute Severe Heart Failure in Paediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2: A Case Report.

A 17-year-old boy presented during the COVID-19 pandemic in late 2021 with intractable fevers and hemodynamic instability with early gastrointestinal disturbances, resembling features of the pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. Our patient required intensive unit care for persistently worsening signs of cardiac failure; initial admission echocardiography demonstrated severe left ventricular dysfunction with an estimated ejection fraction of 27%. Treatment with intravenous IgG and corticosteroids showed a rapid improvement in symptoms, but further specialist cardiological input was required for heart failure in the coronary care unit. Substantial improvement in cardiac function was shown on echocardiography before discharge, initially to left ventricular ejection fraction (LVEF) 51% two days after the commencement of treatment and then to >55% four days later, and on cardiac MRI. An echocardiogram one month post-discharge was normal, and the patient reported complete resolution of heart failure symptoms by four months in addition to full restoration of functional status.

Postpartum Insertion Of Intrauterine Contraceptive Device: A Safe And Effective Contraception.

Background: The incidence of maternal mortality and morbidity related to the termination of unwanted pregnancy in Pakistan is rising at an alarming rate. Instant Postpartum insertion of intrauterine contraceptive device (PPIUCD) is an effective contraceptive measure to reduce unexpected pregnancy and its associated complications in developing countries like Pakistan. Methods: The current study was conducted in a public sector hospital in Karachi with a total of 7314 pregnant women counselled for insertion of PPIUCD antenatally. Out of which 5682 women agreed to the insertion and 1632 refused the procedure, mostly due to unfamiliarity with PPIUCD insertion. PPIUCD was inserted within 48 hours of delivery in 1441 patients and they were followed for 6 months onwards. Results: Total postpartum insertions were 1441 which was found to be an effective measure with the continuation rate of 91% among 785 followed up cases. Postpartum IUCD insertion was found as an effective, satisfactory and convenient practice for the women of developing countries like Pakistan, to get an on-time appropriate contraceptive measure. Conclusion: : PPIUCD was found to have high retention and low expulsion rate and its efficacy can be improved further by proper training and skills of healthcare professionals. In this regard, appropriate strategies should be formulated and implemented at the statutory level by increasing social awareness and practice of using PPIUCD by health care providers to reduce undesired pregnancies.