Congenital Hyperlipidemia in Infants for Congenital Cardiac Surgery.

Infants with concurrent severe hypertriglyceridemia and complex congenital heart disease are a rare occurrence and can have life-threatening consequences when undergoing surgical intervention. This case series outlines two instances involving infants undergoing total anomalous pulmonary venous connection repair and surgical closure of a ventricular septal defect. The study explores troubleshooting the effects of hypertriglyceridemia on perioperative outcomes.

Profesionales de la salud para el nuevo siglo: transformando la educación para fortalecer los sistemas de salud en un mundo interdependiente / Health professionals for a new century: transforming education to strengthen health systems in an interdependent world

Hace 100 años, diversos estudios sobre la educación de los profesionales de la salud dieron lugar a reformas innovadoras. Los nuevos retos del siglo xxiobligan a rediseñar nuevamente la educación profesional en salud. La Comisión sobre la Educación de los Profesionales de la Salud para el Siglo XXI se reunió para desarrollar una visión compartida y una estrategia común para la educación en medicina, enfermería y salud pública. Esta comisión ofrece una visión que llama a una nueva era de la educación profesional que promueva un aprendizaje transformativo y domine el poder que genera la interdependencia en la educación. Así como las reformas de principios del Siglo XX se apoyaron en la teoría microbiana de la enfermedad y las ciencias médicas modernas, esta comisión cree que el futuro será moldeado por la adaptación de competencias a contextos específicos basándose en el poder de los flujos globales de información y conocimiento. Materializar esta visión requerirá de reformas en la instrucción y el desarrollo institucional, guiadas por los dos resultados que se persiguen: el aprendizaje transformativo y la interdependencia en la educación. Sobre la base de estas nociones esenciales, la comisión ofrece diez recomendaciones específicas. La puesta en práctica de estas reformas requerirá de acciones que faciliten su implantación, entre las que destacan la movilización del liderazgo, la expansión de la inversión en educación profesional en salud, el alineamiento de los procesos de acreditación y el fortalecimiento del aprendizaje global. La implantación de estas recomendaciones deberá contar asimismo con el impulso de un movimiento global que involucre a todos los actores como parte de un esfuerzo concertado para fortalecer los sistemas de salud

100 years ago, a series of studies about the education of health professionals sparked groundbreaking reforms. The challenges of the 21st century demand a new redesign of professional health education. The Commission on Education of Health Professionals for the 21st Century came together to develop a shared vision and a common strategy for postsecondary education in medicine, nursing, and public health. The Commission provides a vision that calls for a new era of professional education that advances transformative learning and harnesses the power of interdependence in education. Just as reforms in the early 20th century were advanced by the germ theory and the establishment of the modern medical sciences, so too the Commission believes that the future will be shaped by adaptation of competencies to specific contexts drawing on the power of global flows of information and knowledge. Undertaking of this vision requires a series of instructional and institutional reforms, which are guided by the two expected outcomes, transformative learning and interdependence in education. On the basis of these core notions, the Commission offers 10 specific recommendations. The implementation of these recommendations require a series of enabling actions, including the mobilization of leadership, the enhancement of investments in health education, the alignment of the accreditation processes, and the strengthening of global learning. These recommendations also demand the support of a global movement engaging all stakeholders as part of a concerted effort to strengthen health systems

An assessment of progress towards universal health coverage in Brazil, Russia, India, China, and South Africa (BRICS).

Brazil, Russia, India, China, and South Africa (BRICS) represent almost half the world's population, and all five national governments recently committed to work nationally, regionally, and globally to ensure that universal health coverage (UHC) is achieved. This analysis reviews national efforts to achieve UHC. With a broad range of health indicators, life expectancy (ranging from 53 years to 73 years), and mortality rate in children younger than 5 years (ranging from 10·3 to 44·6 deaths per 1000 livebirths), a review of progress in each of the BRICS countries shows that each has some way to go before achieving UHC. The BRICS countries show substantial, and often similar, challenges in moving towards UHC. On the basis of a review of each country, the most pressing problems are: raising insufficient public spending; stewarding mixed private and public health systems; ensuring equity; meeting the demands for more human resources; managing changing demographics and disease burdens; and addressing the social determinants of health. Increases in public funding can be used to show how BRICS health ministries could accelerate progress to achieve UHC. Although all the BRICS countries have devoted increased resources to health, the biggest increase has been in China, which was probably facilitated by China's rapid economic growth. However, the BRICS country with the second highest economic growth, India, has had the least improvement in public funding for health. Future research to understand such different levels of prioritisation of the health sector in these countries could be useful. Similarly, the role of strategic purchasing in working with powerful private sectors, the effect of federal structures, and the implications of investment in primary health care as a foundation for UHC could be explored. These issues could serve as the basis on which BRICS countries focus their efforts to share ideas and strategies.

Impact of omega-6 fatty acids on cardiovascular outcomes: A review.

Poly unsaturated fatty acids (PUFAs) have usually been associated with beneficial health effects on early life and later life disease such as cardiovascular diseases (CVD). Emerging evidence, however, suggests that PUFA species (n-3, n-6) have differential health effects. N-6 PUFAs, in particular, have sparked a scientific debate regarding their role in human physiological processes. Current dietary recommendations for n-6 fatty acids have been based on animal studies, insufficient epidemiological evidence and mixed PUFA interventions, therefore, require reconsideration. This review has analyzed human epidemiological and interventional studies, published in the last five years, focusing on n-6 fatty acids' impact on CVD outcomes (CVD events, blood lipids, blood pressure, inflammation, oxidative stress/atherosclerosis). The evidence is mixed, with differential effects within the n-6 fatty acid series. These outcomes are also dependent on ethnicity and background health status. Further, data from developing countries are sparse, thus, well designed intervention trials and population based studies in developing country settings on specific n-6 fatty acid intake and health effects are desired.

Surgical removal of a left ventricular myxoma in an infant.

Left ventricular (LV) myxoma is particularly rare in children and has not been reported in infants. A five-month-old baby presented with a myxoma arising from the anterior, lateral, and superior aspect of the LV, causing severe left ventricular outflow tract obstruction. The LV was accessed through the conal septum after opening the right ventricular outflow. The child had transient complete heart block in the postoperative period. There was no recurrence of tumor at the nine-month follow-up.

Local steroid therapy as the first-line treatment for boys with symptomatic phimosis - a long-term prospective study.

AIM: Phimosis is a common paediatric urological disorder and often necessitates circumcision. We prospectively evaluated local steroid therapy (LST) as the first choice therapy for such children. METHODS: Two hundred and sixty symptomatic boys up to 15 years of age (mean 34 months) with phimosis were started on betamethasone dipropionate (0.05%) application on gently stretched prepuce twice a day. Follow-up visits were arranged at the end of weeks 1, 2 and 4 and 6 months. Grade of phimosis was objectively graded. RESULTS: Ninety one percent of the boys showed a successful outcome at the end of 4 weeks; 72% responded in first week, further 16% responded in week 2, and only 2.6% achieved alleviation of phimosis on further application of LST beyond 2 weeks. Fourty two (17.8%) boys had a recurrence of phimosis on a long-term follow-up (mean - 25.4 months, range 6-48 months); thus, the long-term success rate was 77%, while 60 (23%) boys underwent surgery. CONCLUSION: Local steroid therapy is safe and successful in alleviating symptomatic tight foreskin in a large majority of children. The response can be seen as early as 1 week; most of the children respond by week 2 and continuing therapy further may not be very effective.

An international randomised placebo-controlled trial of a four-component combination pill ("polypill") in people with raised cardiovascular risk.

BACKGROUND: There has been widespread interest in the potential of combination cardiovascular medications containing aspirin and agents to lower blood pressure and cholesterol ('polypills') to reduce cardiovascular disease. However, no reliable placebo-controlled data are available on both efficacy and tolerability. METHODS: We conducted a randomised, double-blind placebo-controlled trial of a polypill (containing aspirin 75 mg, lisinopril 10 mg, hydrochlorothiazide 12.5 mg and simvastatin 20 mg) in 378 individuals without an indication for any component of the polypill, but who had an estimated 5-year cardiovascular disease risk over 7.5%. The primary outcomes were systolic blood pressure (SBP), LDL-cholesterol and tolerability (proportion discontinued randomised therapy) at 12 weeks follow-up. FINDINGS: At baseline, mean BP was 134/81 mmHg and mean LDL-cholesterol was 3.7 mmol/L. Over 12 weeks, polypill treatment reduced SBP by 9.9 (95% CI: 7.7 to 12.1) mmHg and LDL-cholesterol by 0.8 (95% CI 0.6 to 0.9) mmol/L. The discontinuation rates in the polypill group compared to placebo were 23% vs 18% (RR 1.33, 95% CI 0.89 to 2.00, p = 0.2). There was an excess of side effects known to the component medicines (58% vs 42%, p = 0.001), which was mostly apparent within a few weeks, and usually did not warrant cessation of trial treatment. CONCLUSIONS: This polypill achieved sizeable reductions in SBP and LDL-cholesterol but caused side effects in about 1 in 6 people. The halving in predicted cardiovascular risk is moderately lower than previous estimates and the side effect rate is moderately higher. Nonetheless, substantial net benefits would be expected among patients at high risk. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12607000099426.

Jeune syndrome with neonatal cholestasis.

Jeune syndrome or Asphyxiating Thoracic Dystrophy presenting clinically with hepatic manifestations is rarely seen. Very few cases of liver involvement have been reported antemortem. The authors report a three-month-old child with Jeune syndrome who presented with prolonged neonatal cholestasis and normal stools.