Off-Pump Coronary Artery Bypass Grafting; is it Still Relevant?

Off-pump Coronary Artery Bypass Grafting (OPCAB) experienced a resurgence in the 1980s -2000s and developed steadily with improvement of the instrumentation and techniques. However questions about graft patency and long-term survival of OPCAB patients still exist. This review attempts to explore the current relevance of OPCAB.

Role of Food Handlers in Norovirus Outbreaks in London and South East England, 2013 to 2015.

Outbreaks caused by norovirus infection are common and occur throughout the year. Outbreaks can be related to food outlets either through a contaminated food source or an infected food handler. Both asymptomatic and symptomatic food handlers are potentially implicated in outbreaks, but evidence of transmission is limited. To understand potential food handler transmission in outbreak scenarios, epidemiological and microbiological data on possible and confirmed norovirus outbreaks reported in London and South East England in a 2-year period were reviewed. One hundred eighty-six outbreaks were associated with a food outlet or registered caterer in this period. These occurred throughout the year with peaks in quarter 1 of study years. A case series of 17 outbreaks investigated by the local field epidemiological service were evaluated further, representing more than 606 cases. In five outbreaks, symptomatic food handlers were tested and found positive for norovirus. In four outbreaks, symptomatic food handlers were not tested. Asymptomatic food handlers were tested in three outbreaks but positive for norovirus in one only. Environmental sampling did not identify the causative agent conclusively in any of the outbreaks included in this analysis. Food sampling identified norovirus in one outbreak. Recommendations from this study include for outbreak investigations to encourage testing of symptomatic food handlers and for food and environmental samples to be taken as soon as possible. In addition, sampling of asymptomatic food handlers should be considered when possible. However, in light of the complexity in conclusively identifying a source of infection, general measures to improve hand hygiene are recommended, with specific education among food handlers about the potential for foodborne pathogen transmission during asymptomatic infection, as well as reinforcing the importance of self-exclusion from food handling activities when symptomatic.

A case of esophagopericardial fistula as a complication of upper gastro-intestinal endoscopy.

A case of suppurative pericarditis from an esophagopericardial fistula (EPF) following the upper gastrointestinal endoscopy (UGIE). A 38-year-old schizophrenic male patient with gastro-esophageal reflux disease (GORD) and previously dilated esophageal stricture was presented with acute retrosternal chest pain. The patient pulled out the endoscope during UGIE the previous day. A barium swallow (BS) post endoscopy was normal. The patient was initially hemodynamically stable and cardiac evaluation was normal. The patient subsequently developed features of cardiogenic shock. Echocardiography confirmed pericardial effusion and pericardial aspiration yielded pus. Surgical drainage with pericardial tube insertion was done. Pericardial biopsy revealed acute suppurative inflammation with food particles. The patient continued with antibiotics and pericardial drainage for 14 days and repeat BS and chest computerized tomography scan revealed no EPF. The patient was discharged 24 days after the presentation and remained well at follow-up. A rare, serious complication of UGIE which may be easily missed and is associated with a high mortality with delayed treatment.

Rationale and design of the MEMA kwa Vijana adolescent sexual and reproductive health intervention in Mwanza Region, Tanzania.

Large-scale innovative, integrated, multifaceted adolescent sexual and reproductive health (ASRH) interventions are urgently needed in sub-Saharan Africa. Implementation through schools and health facilities may maximize intervention coverage and sustainability, however the impact of the use of these structures on intervention content and delivery is not well documented. This paper describes the rationale and design of a large-scale multifaceted ASRH intervention, which was developed and evaluated over three years in rural communities in Mwanza Region, North West Tanzania. The intervention comprised community mobilization, participatory reproductive health education in primary schools, youth-friendly reproductive health services and community-based condom provision for youth. We examine the effect of socioeconomic, cultural and infrastructural factors on intervention content and implementation. This paper demonstrates the means by which such interventions can be feasibly and sustainably implemented to a high standard through existing government health and school structures. However, the use of these structures involves compromise on some key aspects of intervention design and requires the development of complementary strategies to access out-of-school youth and the wider community.

Epidemiology of non-trauma surgical deaths.

BACKGROUND AND OBJECTIVES: It is established that 70 % of morbidity and 75 % of mortality in the surgical accident and emergency (A and E) are due to trauma. However, non-trauma deaths still are an important entity requiring a specific study to highlight their pattern, and institute improvement strategies to lower death rates. METHODOLOGY: A retrospective analysis among non-trauma surgical deaths that occurred in the A and E Department of the University of Ilorin Teaching Hospital, Ilorin, Nigeria, over 24 months was done. Data collected included age, sex, interval between onset of illness and presentation, clinical features, occurrence of prior hospital visit, investigations done, cadre of surgeons that reviewed the patients and the interventions done as part of treatment before death. RESULTS: 4164 patients visited the A and E, 2916 (70%) were trauma, 1251 (30%) were non-trauma conditions. There were 171 deaths, 129 (75.4%) were trauma deaths while 42 (24.6%) were non-trauma deaths. Thirty (71.4%) of the 42 had complete information for analysis. Age range was 2-95 years (mean 42.7 +/- 21.8 years) comprising 18 males and 12 females. Patients with generalized peritonitis were in the majority 8 (26.7 %) comprising typhoid perforation 4, ruptured appendix 2 and perforated peptic ulcer 2. Terminal malignancies followed closely with 6 deaths (20.0%), 3 from urological causes (2 prostatic and 1 bladder cancer), acute gastrointestinal bleeding 3 (10%), intestinal obstruction 1 (3.3 %) and others. Nineteen patients (63.3%) had visited a previous hospital where they had spent <48 hrs (4 patients), 48hrs -1 week (4 patients) and >1 week (2 patients), undocumented (9 patients). Less than 40% of the patients were able to do the requested investigations (electrolytes, X-rays and ultrasound) or got the desired interventions (blood and antibiotics) CONCLUSION: Non-trauma deaths account for a quarter of the deaths in the A and E, generalised peritonitis and advanced malignancies were the main conditions responsible and characterized by late presentation, having spent a considerable time in a previous private hospitals.