Journal of Humanitarian Cardio Vascular Medicine最新文献

{"title":"POST HOC ANALYSIS ON THE INCIDENCE OF CONGENITAL HEART DISEASE IN BAKU-AZERBAIJAN CALCULATED BY A PROSPECTIVE EPIDEMIOLOGY STUDY","authors":"A. Petropoulos","doi":"10.12681/jhcvm.33148","DOIUrl":"https://doi.org/10.12681/jhcvm.33148","url":null,"abstract":"Background: The incidence of Congenital Heart Disease (CHD)in Azerbaijan was firstly published following  a prospective study, using Echo-2D as a study method, in 2019. \u0000Aim:  Of this post hoc analysis of the first ever prospective epidemiology study that calculated incidence and types of CHD in Baku, Azerbaijan, is to verify the forms of diseases that will have and early clinical impact on the patients and the health system of the country. \u0000Population-method: From June 2016 to August 2018, 2570, term neonates were screened in 2 major state maternity hospitals in Baku. Their screening was randomized to equal females/males with not known previous obstetric alert regarding CHD. Scanning was done by two teams of pediatric cardiologists by using echo-2D. Each team was ‘blinded’ to the findings of each other. All scans were recorded, and a third senior physician reevaluated them. \u0000Results: From 2570 term neonates of the general population, they detected 47 CHD’s. From them, 17 were critical and severe-CHD and 7/47(14.9%) were  of moderate complex. 17/47 (36.2%) were cyanotic and 30/47(63.8%) were non-cyanotic. The incidence of simple CHD was 25/47(53.2%). Analysis of the specific anatomy is presented in table1. The estimated incidence was 1.83%.  As this incidence has been among the highest reported a post hoc analysis has clarified and presented an important clinical rate of 1.48% after redacting minimal defects without any clinical significance, as minor PDA’s, ASD II, VSD’s. A post hoc calculation of BAov, revealed an anatomical BAov incidence of 1.65% and a functional BAov incidence of 1.4%. \u0000Conclusions: This first-ever prospective epidemiology study in Azerbaijan involving a cohort equal to 1.65% of the annual living births of the country, estimated a high incidence of CHD. This is among the highest reported globally.  The amount of critical and severe CHD after the post hoc analysis increased from 46.8% to 55.3%. The incidence of cyanotic CHD after the post hoc analysis increased from 36.2% to 42.1%.  These high numbers are possibly related to an isolated population and conjugated marriage customs of the country. As this represented a state population health burden a post hoc analysis based on clinical important CHD minimized the calculated index nearby 20%.","PeriodicalId":150865,"journal":{"name":"Journal of Humanitarian Cardio Vascular Medicine","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132000135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Review of sustainable Paediatric Cardiac Surgery Program based on Humanitarian Principles at Govt. Medical College, Goa","authors":"J. Kolwalkar, R. Agarwal, Shirish Borkar, Vidya Sunil, Madhan Vijay","doi":"10.12681/jhcvm.30447","DOIUrl":"https://doi.org/10.12681/jhcvm.30447","url":null,"abstract":"Introduction:  Paediatric cardiac surgery and paediatric cardiology set-up is an arduous task, in developing countries, like India (4). Access to advanced cardiac care is unavailable in majority of developing countries (5). Due to high fertility rates in India, the annual estimate of CHD is approximately 150,000–200,000 children per year (6, 10). Of these, approximately a third to a quarter (∼50,000) would need early intervention to survive the first year of life (7, 10).  Goa is a small state of India situated along the western coast of Indian peninsula. Goa medical college (GMC) is the only tertiary level institute, providing medical facilities in the state. There were no cardiology or cardiac surgical facilities available at GMC, prior to 2014. The cardiac surgical unit at Goa Medical College was started in April 2014. It provides cardiac surgical services absolutely free of cost to all the citizens of the state. Initially only adult cardiac surgical cases were being performed, but from September 2014, we initiated the paediatric cardiac surgical program, for which we availed the facility of a paediatric cardiac surgeon. Materials and Methods: From 26th Sep 2014 to 11th Jan 2020, we operated a total of 90 cases, during 18 visits of the visiting paediatric cardiac surgeon, who operated an average of 5 cases per visit. Mean age of operated children was 3.2 years. We operated 34 cases of VSD’s, 26 cases of TOF, 8 cases of Tricuspid atresia, 9 cases of ASD, 3 cases of MV repair, 1 case of ASD+PS, 5 cases of TAPVC, 3 PA banding & PDA ligation and one permanent pacemaker implantation. Patients were managed initially in a 5 bedded ICU and after extubation were shifted to a step-down ICU for further recovery. Results: The average duration of ventilation was 36hrs and average length of ICU stay was 5 days. Mean CPB time was 92.46 mins and mean aortic cross clamp time was 59.5 mins. Overall mortality was 5.55%. One patient underwent a redo MV repair, as there was moderate residual MR in post operative period. Conclusion: This model of cardiac surgical program has worked well for the state of Goa and has benefitted lot of people from within the state as well as neighbouring states, where easy and affordable access to cardiac surgical facilities are missing. It has produced excellent outcomes for adult cardiac surgery and has encouraged us to extend the facility to paediatric population. Gradually, our local team is getting confident to do these paediatric cases. \u0000Keywords: Congenital heart disease, India, Goa medical college (GMC), Paediatric cardiac surgical care.","PeriodicalId":150865,"journal":{"name":"Journal of Humanitarian Cardio Vascular Medicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128813931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rural Cardiac Screening: Leveraging Technology from a Previously Established Echocardiographic Network","authors":"T. Johnson, E. Skipper, F. Robicsek","doi":"10.12681/jhcvm.30428","DOIUrl":"https://doi.org/10.12681/jhcvm.30428","url":null,"abstract":"Objectives:  The authors review the history of two cardiac programs in Guatemala and Belize that were initiated by the late Dr. Francis Robicsek.  Building upon his legacy, the aim of the rural cardiac screening program is to further extend the reach to those individuals disenfranchised from cardiac services. \u0000Methods:  Complementary to the Nan Van Every Cardiology Diagnostic Network, screening stations are organized once a year at two cardiac echo stations in Guatemala and two clinics in Belize. Demographic information and medical history are collected; limited physical and diagnostic tests performed; and results are reviewed by a cardiologist and relayed to the participant. Participants with a suspected heart issue are referred to one of the cardiology and cardiac programs in Guatemala or Belize for in-depth evaluation.  Education on cardiovascular diseases, signs, symptoms, and risk factors is provided, as well as healthy lifestyle habits.  \u0000Results:  Building upon successful cardiac programs in low resource settings lends the ability to expand the cardiovascular screening and awareness reach. Heart disease is brought to the forefront in communities where there is no previously known access and clinicians are educated to identify heart problems. \u0000Conclusion: The success of Unidad de Cirugía Cardiovascular de Guatemala (UNICAR) in Guatemala City, and the cardiology and cardiac surgical programs at Karl Heusner Memorial Hospital Authority in Belize, and the Nan Van Every Cardiology Diagnostic Network, are the cornerstones to scaling the expansion and encounter individuals who have little, if any, knowledge about cardiac diseases, signs, symptoms and prevention.","PeriodicalId":150865,"journal":{"name":"Journal of Humanitarian Cardio Vascular Medicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131363698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"27 YEARS OF CARDIAC SURGERY IN AFRICA, The experience of La Chaîne de l’Espoir","authors":"S. Chauvaud","doi":"10.12681/jhcvm.30433","DOIUrl":"https://doi.org/10.12681/jhcvm.30433","url":null,"abstract":"Pediatric  cardiac surgery is challenging in low incombe countries such as in Africa. La Chaîne de l'Espoir is a french NGO devoted to health care of poor and sick children. \u0000This article presents the actions La Chaîne de l'Espoir. It introduces in particular the transfer to France system of sick children from developing countries for surgical care, the growing tele-expertise program in cardiac ultrasound, as well as the main stages of the activity in Africa since the creation of the NGO involving seven centers allocated in different countries of the continent.","PeriodicalId":150865,"journal":{"name":"Journal of Humanitarian Cardio Vascular Medicine","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129750704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Care in Belize: Building a Local, Sustainable Program from “Square One”","authors":"E. Skipper, T. Johnson, Francis R","doi":"10.12681/jhcvm.30193","DOIUrl":"https://doi.org/10.12681/jhcvm.30193","url":null,"abstract":"Objectives:  The authors explore building a sustainable cardiac program in Belize from ground zero.   \u0000Methods:  Leveraging previously proven experience and expertise of Francis Robicsek, MD PhD in Guatemala, the authors outline the steps taken to duplicate the program. \u0000Results:  A 5-year commitment timeline between the supporting organization and the host medical facility in Belize is the first step toward achieving sustainability. We are already seeing results through advance training and hiring of healthcare providers. \u0000Conclusion:  “Give a man a fish and you feed him for a day.  Teach a man to fish and you feed him for a lifetime.”(1)  Our role is to provide assistance and support, so that we leave competent and skilled medical professionals behind to assess, diagnose and treat current and future generations.","PeriodicalId":150865,"journal":{"name":"Journal of Humanitarian Cardio Vascular Medicine","volume":"234 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123737061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Critical Congenital Heart Disease During Surgical Mission Trips to Low-Middle Income Countries. What to Expect","authors":"M. Cardarelli, I. Polivenok, Vladimir Chadikovski, Ahmed Aboodi, Aqueel Mindel, Elena Koroson, Naema Goobha, W. Novick","doi":"10.12681/jhcvm.30111","DOIUrl":"https://doi.org/10.12681/jhcvm.30111","url":null,"abstract":"Background \u0000The incidence of congenital heart disease (CHD) is about 8 per 1000 live births. About 20% of those patients diagnosed with CHD will present early after birth with Critical Congenital Heart Disease (CCHD) necessitating a catheter or surgical intervention during the neonatal period. This is based on Western literature and Western countries. Little is known about the actual prevalence of CCHD at the time of clinical assessment and treatment during surgical missions in low and middle income countries (LMICs). \u0000Methods \u0000This is a retrospective study and it compares prevalence of CCHD at time of presentation for surgery in LMICs \u0000to published data for similar cohorts in the USA. We discuss potential causes for epidemiological discrepancies \u0000Proportions were compared using OR and 95% CI. Significance was set at p<0.01. We chose to classify our patients considering the number of ventricles (1or 2) combined with the existence of Aortic Arch obstruction (Yes/No) resulting in a CCHD classification with 4 categories \u0000Results \u0000Between Feb 2008 - June 2019 we operated 6115 patients in 27 countries. Of those, 243 Neonates were presented to our cardiologists \u0000after excluding simple PDA ligations in Preterm newborns and 239 neonates were surgically treated for their CCHD \u0000(4% of the total). overall surgical mortality among the 243 neonates operated in LMIC for their CCHD was 19.7% (n=48). Main discrepancies were in Classes 1 represented by  63% of our treated CCHD (p<.0001) while Class 4 neonates represented only 4.2% of our total (p<.0001). When compared to Western prevalence, Transposition of the Great Arteries was over-represented while some cyanotic (ToF) and non-cyanotic diagnosis (Critical Aortic Stenosis) were under-represented. \u0000Conclusions \u0000Patients diagnosed and treated for CCHD in LMICs during humanitarian missions represent but a very small fraction of the total number of  patients born with CCHD in those countries.  \u0000Discrepancies in specific diagnoses and prevalence between LMIC and their high-income counterparts are likely multifactorial, and management should be adapted to the conditions of each country and health system. \u0000Proper prenatal diagnosis, specialized critical neonatal transportation systems, countrywide availability of Prostaglandins and at least one highly functioning heart center are some of the most basic needs required in order to revert the current natural history of CCHD in countries with limited resources settings.","PeriodicalId":150865,"journal":{"name":"Journal of Humanitarian Cardio Vascular Medicine","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126045071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New Knowledge from Research – Can Global Congenital Cardiac Surgery Play a Part? A Call for International Collaboration","authors":"Jeevan Jeevan Francis, Joseph George, S. Stoica","doi":"10.12681/jhcvm.30091","DOIUrl":"https://doi.org/10.12681/jhcvm.30091","url":null,"abstract":"Over 1.3 million babies are born each year with congenital heart defects (CHD), with the highest incidence in low-income countries (LIC) and low-middle income countries (LMICs) (Fanaroff., 2012). The Lancet Commission on Global Surgery found that surgically treatable conditions make up 28-32% of the total global burden of diseases, of which most are cardiovascular diseases (Meara et al., 2015). Currently, high-income countries (HICs) undertake mission trips to LICs and LMICs to provide surgical care for those who otherwise would not have access. These trips also provide an opportunity to train the local surgical teams. It has been proposed that there should be a shift in thinking from ‘humanitarian surgery’ to ‘global surgery’, as this benefits both the provider and the receiver. With this change, we should address several limitations in our current infrastructure, including but not limited to, the lack of international research collaboration, the need for globalising and scaling up the paediatric cardiac surgical workforce, offsetting greenhouse gas emissions from mission trips, and opportunities for mentorship and training in LICs.","PeriodicalId":150865,"journal":{"name":"Journal of Humanitarian Cardio Vascular Medicine","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130421276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ten years follow-up under atorvastatin therapy of patients with carotid artery stenosis: the prognostic impact of oxidised low-density lipoprotein on carotid plaque progression and restenosis.","authors":"A. Polydorou, Konstantinos D. Alexopoulos, V. Polydorou, E. Skopelitis, Xanthula Κougiali, N. Liasis, T. Demesticha, M. Piagkou, V. Protogerou, Dimitris Filippou, Eleni Velissariou, George Dimakopulos, T. Troupis","doi":"10.12681/jhcvm.30181","DOIUrl":"https://doi.org/10.12681/jhcvm.30181","url":null,"abstract":"Background: Atorvastatin reduces oxidized low-density lipoprotein (oxLDL) levels and reduces the rate of plaque progression in patients with and without prior carotid angioplasty. The aim of our study was to investigate the durability of this effect and to explore possible prognostic impact of oxLDL levels on carotid stenosis and plaque stability.\u0000            Methods: 106 patients (71 males, mean age 64.82±7.26 years) were studied. They were divided into two groups. Group 1 including patients with carotid stenosis >70% (n=50) who underwent carotid angioplasty prior to enrolment. Group 2 included those with <70% stenosis who were treated medically and were given atorvastatin with dose adjusted to maintain LDL cholesterol <100mg/dl. Anthropometrics, complete lipid profile, oxLDL and ultrasonography were performed at baseline, 1, 3, 6, 12 months and yearly thereafter for 10 years.\u0000            Results: oxLDL levels significantly decreased from 53.3±10.91 mg/dl at baseline to 8.31±2.08 mg/dl at 12 months (p<0.001) and remained stable until the 10th year. In group 1, restenosis (>70%) was noticed in four patients, yet no further intervention was needed due to plaque morphology (echo-grade IV). In group 2, carotid stenosis was initially reduced (6th month – 4th year) and later relapsed (5th – 10th year), yet plaque morphology was recorded as type III or IV in almost all patients of group 2 (53=95%), indicating a significantly lower risk for stroke.\u0000            Conclusion: Atorvastatin treatment to a target of LDL <100 mg/dl in patients with carotid stenosis is associated with marked and durable reduction of lipid levels, especially oxLDL and LDL and reduction in the rate of stenosis progression, improved plaque stability and decreased stroke risk.","PeriodicalId":150865,"journal":{"name":"Journal of Humanitarian Cardio Vascular Medicine","volume":"112 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129652010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost Effectiveness Analysis: Small Country Pediatric Cardiac Surgery Program Development","authors":"M. Cardarelli, Vladimir Chadikovski, W. Novick","doi":"10.12681/jhcvm.30093","DOIUrl":"https://doi.org/10.12681/jhcvm.30093","url":null,"abstract":"Abstract \u0000  \u0000Background \u0000The cost-effectiveness of sending children abroad for treatment of their congenital heart disease (CHD) in small population countries versus developing a local program should be carefully considered. We investigated the cost-effectiveness analysis of developing such program in a small Eastern-European country. \u0000Methods \u0000Calculated costs during different stages in the development of a program in North Macedonia were obtained from the Ministry of Health. All patients diagnosed and surgically treated between 2010 and 2017 were included along 3 distinctive periods. \u00002010-2012 - Outsourcing (All patients sent abroad for surgical treatment) \u00002013-2016 - Foundational (Program development with assistance from a global charity organization) \u00002017 - Tutelage Period (Semi-Independent program) \u0000Cost-Effectiveness is provided in US$ per Disability Adjusted Life Years (DALY) as unit of health value. \u0000Results \u0000Between January 2010 and December 2017, a total of 384 patients diagnosed with CHD underwent surgical treatment at government expense. The breakdown was: 125; 204 and 55 patients in each period.The cost-effectiveness of the intervention was $315; $297 and $251 per DALY averted respectively. \u0000Conclusions \u0000Surgical treatment of patients born with CHD is a highly cost-effective intervention irrespective of the approach taken. Even after accounting for the initial capital investment costs, the development of a local pediatric cardiac surgery program seems to be slightly more cost-effective than outsourcing. \u0000 ","PeriodicalId":150865,"journal":{"name":"Journal of Humanitarian Cardio Vascular Medicine","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126576727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health inequalities between the developing and developed world as one of the persistent challenges of our globalizing world","authors":"A. Kalangos","doi":"10.12681/jhcvm.30321","DOIUrl":"https://doi.org/10.12681/jhcvm.30321","url":null,"abstract":"","PeriodicalId":150865,"journal":{"name":"Journal of Humanitarian Cardio Vascular Medicine","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117107944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}