bluuebunny/crossref_metadata_2025 huggingface dataset:
THE TECHNOLOGY OF THE PROJECT APPROACH IN PUBLIC ADMINISTRATION AT THE LEVEL OF UNITED TERRITORIAL COMMUNITIES OF THE DECENTRALIZED SYSTEM OF TERRITORIAL ORGANIZATION OF POWER
Authors: RADCHENKO Oleksandr , CHERNOV Sergey , KOZENKO Roman
Published: July 2024

The article is devoted to the issue of project management implementation by public management bodies of the decentralized system of territorial organization of power, in particular the functional features and advantages of implementing project management tools in the activities of united territorial communities of Ukraine. It is determined that the project approach to project management today is one of the most popular ways of management in the modern world.
The relevance of the widespread introduction of project management methodology and project approach in the practice of public administration as a new culture of management and effective tools for good governance in a crisis, instability and uncertainty is substantiated, solving industrial, scientific and social problems. It was concluded that the use of project management methodology at the national level of the decentralized system of territorial organization of power is both strategic and tactical in nature. In strategic terms, the project approach makes it possible to focus the efforts of public authorities on solving urgent problems of long-term development of society in its key areas, reducing tensions in the socio-political sphere, by increasing the efficiency of public authorities to strengthen their legitimacy and resilience to internal and external threats establish a stable partnership dialogue with communities and civil society institutions. In terms of tactics, budget savings, reduction of implementation of state programs and national projects, some optimization of government structures and improved coordination of public authorities, cooperation and public-private partnerships with business entities.
Students' clinical management decisions: use of a tool to increase awareness of cost
Authors: Travis Katherine , Clithero-Eridon Amy , Crandall Cameron
Published: July 2024

Background: The overuse of medical resources is a global issue, often resulting in more harm than good. Within the United States, almost one-third of medical spending is unnecessary, with physicians being responsible for an estimated 10% of this waste, primarily through lack of care coordination and overtreatment. Identifying opportunities for cost savings while delivering quality care is a core competency requirement for all medical specialties. We took a pragmatic approach to improve medical students' decision-making in different contexts to assist them in understanding contextual factors when ordering care. Methods: This study retrospectively reviewed 193 high-value care prescriptions. Prescriptions were completed by 4th-year medical students completing a rotation in an outpatient, inpatient, or emergency room settingduring the 2020 and 2021 academic years. Indicators of interest included underlying reasons for testing, whether non-clinical effects of tests were considered, who the students discussed costs with, and whether students believed the course changed the management of the patient. Results: A majority of students described downstream effects on the healthcare system and effects related to patients, such as cost, time, transportation, stress or anxiety, missed work, and childcare. The financial cost was one of the primary considerations for patients, yet it was not routinely discussed with patients. Most students felt that the prescription tool did not change the management of the current patient. However, they did feel that the tool changed their approach to future patients with the same problem, which was the goal of this project. Conclusion: There is a need to consider the valuefor patients and the cost to the health care system when ordering tests and procedures. More workmust be done to encourage consideration and conversations about finances and socialdeterminants of health amongst all team members, including patients.
Concurrent Challenges: Multiple Myeloma and Cardiac Amyloidosis
Authors: Mehta Laveena , Patel Dixant , Budhiraja Sandeep , Ahmed Rayaz
Published: July 2024

We report a case of 56-year-old male with known case of Hypertension and Hypothyroidism presented with complaints of generalised weakness and weight loss since 8 months (approx. 40kg), tightening in and around the mouth and hoarseness of voice with dysphagia since 6 months, swelling in feet since 3 months, cough and constipation on and off since one month. The laboratory results indicated that the serum calcium (S.Ca2+) level was 14.1 mg/dl and the ionized calcium (Ca2+) level was 1.62 mmol/l. Immunoglobulins were low {IgA- 17 mg/dl (50-410 mg/dl), IgG- 386 mg/dl (650-1500 mg/dl), IgM- 20 mg/dl (60-280 mg/dl); Immunofixation electrophoresis (IFE) revealed positive result for lambda free light chain (Figure 1) and further quantitative value lambda free light chain was high (Lambda free - 2054.89 mg/l). Whole Body FDG PET Scan revealed non-FDG avid lytic lesions at multiple bone sites. In view of suspicion of Multiple Myeloma, bone marrow aspiration and trephine biopsy were done which confirmed the diagnosis of Multiple Myeloma. ECG showed low voltage QRS complexes and 2D echo revealed- Global LVEF 55-60%, Dilated LA, concentric LVH with altered myocardial echotexture, no RWMA, Grade II diastolic dysfunction present (raised LVEDP), RVSP-39mmhg (moderate PAH), findings S/O- cardiac amyloid; which was later confirmed with Cardiac MRI. Abdominal fat pad biopsy revealed area of necrosis but negative for congo red stain (amyloidosis). The patient underwent VCD (bortezomib; cyclophosphamide; dexamethasone) chemotherapy with Daratumumab. By the time of publication, the patient had received autologous stem cell transplantation and after 10 courses of VCD with Daratumumab, repeat bone marrow aspiration and histo-biopsy revealed complete remission of myeloma. The uncommon Multiple Myeloma complication in this clinical case was associated with restricted cardiomyopathy as a result of secondary cardiac amyloidosis. This is true for both Multiple Myeloma and cardiac amyloidosis. When one of these diagnoses is initially established, more investigation should be done to rule out the other illness, keeping in mind the necessity of meeting standard diagnostic criteria and the challenge of conducting an effective diagnostic workup in occasionally complex clinical situations.
Maintaining Normal Serum Ferritin Levels During Pregnancy: A Randomized Controlled Trial of Daily versus Weekly Ferrous Sulfate
Authors: Bola-Oyebamiji Sekinah B , Awowole Ibraheem O , Bolarinwa Rahman B , Adekanle Daniel A , Kuti Oluwafemi
Published: July 2024

Background:
Serum ferritin is the most reliable indication of stored iron in pregnancy, offering a noninvasive way to detect iron deficiency anemia before it occurs. Therefore, this study aimed to determine serum ferritin levels among women receiving daily versus weekly iron supplementation, with a secondary focus on comparing the proportion developing iron deficiency anemia and compli-ance rates between the two groups.Methods:
This non-blinded randomized control trial involved non-anaemic pregnant women attend-ing antenatal clinics at two Teaching Hospitals in Osun State. One hundred twenty-five subjects were recruited to receive 65mg in the control group, while another 125 subjects in the active group re-ceived three tablets (195mg) of ferrous sulfate (Fesulf) once weekly for 17 weeks from the 20th to 37th weeks of gestation. The primary outcome measure was comparing mean serum ferritin levels in both groups at 37 weeks.Results:
Among the 240 subjects analyzed, the 37-week serum ferritin level was higher in the daily group (73.26±26.67μg/L) compared to the weekly group (63.04±30.71 μg/L), p value=0.006. Four (3.36%) and 10 (8.26%) of our subjects had Iron deficiency anaemia. Nine subjects (3.75%) reported dyspepsia as a side effect. Daily 65 mg of Felsulf proved more effective than weekly 195mg in main-taining normal blood ferritin levels during pregnancy.Conclusions:
Daily iron supplementation with 65mg ferrous sulfate was more effective at main-taining adequate maternal iron concentration in this group of non-anaemic pregnant women. This dosage is recommended for routine iron supplementation in our environment.
BRECHA SALARIAL ENTRE HOMBRES Y MUJERES
Authors: López Insua Belén del Mar
Published: July 2024

Pese al tiempo transcurrido desde la consagración constitucional del derecho a la igualdad y no discriminación entre mujeres y hombres y sin dejar de reconocer los avances derivados de la regulación normativa, la realidad de las relaciones laborales está todavía lejos de ofrecer un panorama de verdadero equilibrio y de efectiva igualdad para las mujeres. Al tiempo, la reconversión productiva asociada a las ineludibles exigencias de lucha contra el cambio climático puede provocar nuevas brechas de género.  Ante este panorama, es necesario buscar las explicaciones concretas de esta preterición laboral en aras a corregir este abrupto devenir, adoptando una perspectiva propositiva capaz de introducir mejoras ad futurum.  A tal efecto, se ha llevado a cabo un análisis multifactorial de las circunstancias que inciden en las altas tasas de pobreza femenina y de precariedad laboral, el rostro femenino de los cuidados, la segregación ocupacional, el trabajo informal, el emprendimiento sin red, fórmulas de economía social, la parcialidad y la temporalidad, la siniestralidad laboral, la ordenación sexista de la clasificación profesional, la inexistente promoción vertical, las exigencias de constante disponibilidad, la mera formalidad en la corresponsabilidad, la particular problemática de los territorios rurales, el ecofeminismo o, entre otros, los dobles o triples estigmas que padecen las mujeres que acarrean una discriminación interseccional. Asimismo, se han propuesto vías de avance y buenas prácticas para la erradicación de las discriminaciones múltiples obrantes por razón de sexo y género en el contexto productivo actual apostando por el fomento del empleo de las mujeres en unas condiciones de trabajo dignas.
HACIA LA TRANSICIÓN JUSTA A TRAVÉS DE LAS FÓRMULAS DE ECONOMÍA SOCIAL, SOLIDARIA Y COOPERATIVISMO
Authors: Ordóñez Pascua Natalia
Published: July 2024

Pese al tiempo transcurrido desde la consagración constitucional del derecho a la igualdad y no discriminación entre mujeres y hombres y sin dejar de reconocer los avances derivados de la regulación normativa, la realidad de las relaciones laborales está todavía lejos de ofrecer un panorama de verdadero equilibrio y de efectiva igualdad para las mujeres. Al tiempo, la reconversión productiva asociada a las ineludibles exigencias de lucha contra el cambio climático puede provocar nuevas brechas de género.  Ante este panorama, es necesario buscar las explicaciones concretas de esta preterición laboral en aras a corregir este abrupto devenir, adoptando una perspectiva propositiva capaz de introducir mejoras ad futurum.  A tal efecto, se ha llevado a cabo un análisis multifactorial de las circunstancias que inciden en las altas tasas de pobreza femenina y de precariedad laboral, el rostro femenino de los cuidados, la segregación ocupacional, el trabajo informal, el emprendimiento sin red, fórmulas de economía social, la parcialidad y la temporalidad, la siniestralidad laboral, la ordenación sexista de la clasificación profesional, la inexistente promoción vertical, las exigencias de constante disponibilidad, la mera formalidad en la corresponsabilidad, la particular problemática de los territorios rurales, el ecofeminismo o, entre otros, los dobles o triples estigmas que padecen las mujeres que acarrean una discriminación interseccional. Asimismo, se han propuesto vías de avance y buenas prácticas para la erradicación de las discriminaciones múltiples obrantes por razón de sexo y género en el contexto productivo actual apostando por el fomento del empleo de las mujeres en unas condiciones de trabajo dignas.
PREVALENCE OF STILLBIRTH IN AYDER COMPREHENSIVE SPECIALIZED HOSPITAL, NORTH ETHIOPIA: A DESCRIPTIVE RETROSPECTIVE STUDY
Authors: Kidane Goba Gelila , Yemane Legesse Awol , Whelan Anna , Divelbess Ken , Cavanaug Erin , Ahmed Mohammednur Sumeya , Ramanathan Aparna , Berhe Zelelow Yibrah , Stephenson Mary
Published: July 2024

ABSTRACTINTRODUCTION: Stillbirth continues to confound scientists and providers, claiming 18.4 per 1000 births globally in 2015. The rate is much higher in low and middle-income countries, including Ethiopia. Stillbirth is tied to maternal age, infection, non-communicable disease, nutrition and lifestyle factors, and inadequate antenatal care. Lack of quality data, including in Demographic and Health Surveys and national vital statistic registries, limits understanding of the causes and possible solutions of stillbirth. OBJECTIVE: To assess the prevalence of stillbirth in Ayder Comprehensive Specialized Hospital. METHODS: We conducted a retrospective chart review of births from January 2014 to May 2015 at Ayder Comprehensive Specialized Hospital, the largest referral hospital in northern Ethiopia. Stillbirth was defined as birth at, or after, 28 weeks’ gestation or fetal weight >1000g without reliable dating with no observable sign of life. For the present study, the data are reported as descriptive statistics. RESULT: A total of 4,582 live births and 315 stillbirths were recorded at Ayder Comprehensive Specialized Hospital over the study period. Removing lethal congenital anomalies, we observed a corrected stillbirth rate of 54.6 per 1000 deliveries. Nearly two-thirds of stillbirths occurred intrapartum. Among stillbirths arriving at Ayder Comprehensive Specialized Hospital with positive fetal heart tone, 36 (44.4%) occurred during the second stage of labor. Nineteen percent of all stillbirths also occurred in transit from a referral institution. Nearly 40% of stillbirths were classified as “unexplained”. CONCLUSION: A significant proportion of stillbirths occurred after arrival or while in transit. Improved identification of high-risk pregnancies with expedited transfer for emergency obstetric care and improved intrapartum care could help decrease the number of stillbirths. KEYWORDS: Stillbirth, Ayder, Ethiopia, Africa
ASSESSMENT OF NEONATAL OUTCOME OF OPERATIVE VAGINAL DELIVERY AND ITS DETERMINANTS AT DILLA UNIVERSITY REFERRAL HOSPITAL, SOUTH ETHIOPIA
Authors: Feyisso Shaka Mohammed , Lubduno Aklilu , Kassa Abebe Reta
Published: July 2024

ABSTRACTINTRODUCTION: Assisting laboring women to deliver vaginally using specialized instruments is a practice that dates back several centuries. Forceps and vacuum are the most popular of the operative vaginal procedures used in medical practice. Both are associated with increased risk of neonatal morbidity when compared to normal spontaneous vaginal delivery. OBJECTIVE: This study was aimed to assess neonatal outcome of operative vaginal delivery and its determinants. METHODS: Hospital based cross sectional retrospective study of women delivered between September 2013 and August 2015 in Dilla University Referral Hospital was conducted. All records of women delivered within the specified period of time was used as a total sample size. Data was entered into SPSS version 20 for analysis. Descriptive, bivariate & multivariate logistic regression was done to assess factors associated with the neonatal outcome. RESULT: Data was collected from 216 women delivered by operative vaginal delivery of which 133 (61.6%) were delivered by vacuum, 76 (35.2%) were delivered by forceps and 7 (3.2%) by sequential use. Significant number of neonates 91(42.1%) delivered by operative vaginal delivery ended up with poor APGAR score. Birth weight of the neonate [AOR: 3.0 8, (CI: 1.16 , 8.20 )] and ind ication for operative vaginal d elivery [AOR: 2.56 (CI: 1.22, 5.38)] were found to increase the risk of poor neonatal outcome. CONCLUSIONS: Neonatal outcome with respect to APGAR score was significantly poor among operative vaginal deliveries in this study. Neonates with lower birth weight and operation done with the indication of fetal distress resulted in higher risk of poor outcome. KEYWORDS: APGAR Score; Operative vaginal delivery; Dilla University Referral Hospital
PROCESS EVALUATION OF CURRICULUM BASED SEXUAL AND REPRODUCTIVE HEALTH EDUCATION AMONG FIRST YEAR STUDENTS IN ARBA MINCH UNIVERSITY: QUALITATIVE STUDY
Authors: Boti Negussie , Hussen Sultan , Shegaze Mulugeta , Shibiru Semion , Shibiru Tamiru , Abebe Sintayehu , Godana Wanzahun , Zerhun Eshetu , Desalegn Nathan , Gebretsadik Woyinshet , Temtime Zebene
Published: July 2024

ABSTRACTINTRODUCTION: Curriculum based sexual and reproductive health education is one of the effective strategies to prevent youths from risky sexual activity. However, providing this education for youth in higher institution requires exploration from the perspective of youths, providers, and key individuals which will help improving and continuation of this education. OBJECTIVE: The aim of this study is to evaluate a process of curriculum based sexual and reproductive health education among first year students in Arba Minch University, Ethiopia. METHODS: Qualitative study was conducted among the first year Arba Minch University students. Focus group discussions were conducted with selected students’ representatives. In depth interviews were conducted with instructors who teach this course and key informant interviews were conducted with different stakeholders who participated during course curriculum developments. Interview guide was used to collect data. The data was analyzed through thematic content analysis method. RESULTS: In this study, we identified five main themes. The main themes are contents of the course which have four subthemes, mode of delivery of the course which have two subthemes, barrier for implementation with four subthemes, acceptability of the course that have two sub themes and perception on course nomenclature with two sub themes. CONCLUSION: Finding of this study revealed that this course was an important and essential course for youth. However, mode of delivery of the course, lack of coordination and lack of comprehensiveness of contents may affect effectiveness. Therefore, for better effectiveness of this course, it requires strong coordination with different stakeholder. KEYWORDS: Curriculum based sexual and reproductive health, qualitative study
PRECONCEPTIONAL TRANSABDOMINAL CERVICAL CERCLAGE: CASE REPORT OF A WOMAN WITH SIX FAILED TRANSVAGINAL CERCLAGES
Authors: Negash Abdella Mustefa , Curran Diana , Bekele Delayehu
Published: July 2024

ABSTRACT Preconception transabdominal cervicoisthmic cerclage is a safe and effective option for selected group of patients with cervical insufficiency and have failed conventional conceptional cervical cerclages or with severely damaged cervix. We present here a preconception transabdominal cervicoisthmic cerclage which was placed by laparotomy for a woman with six failed conceptional transcervical cerclages with recurrent late second trimester pregnancy losses. The woman conceived spontaneously and delivered at term with an alive male healthy new born with no maternal and fetal complications. A brief discussion of the indication, procedure and complications of Preconception transabdominal cervicoisthmic cerclage is also included. KEY WORDS: Transabdominal cerclage, Cervical insufficiency, Recurrent pregnancy loss
Educación en valores
Authors: Montoya Lunavictoria Johana Katerine
Published: July 2024

La presente investigación aborda ampliamente el estudio de la educación en valores desde un enfoque holístico, mismo que busca promover el desarrollo integral de los estudiantes, no solo en términos académicos, sino también en su crecimiento personal y social. Bajo esta perspectiva se reconoce la importancia de formar a los estudiantes en aspectos éticos, morales y emocionales, además de proporcionarles conocimientos académicos. En el texto se analizan los diversos enfoques y tensiones actuales respecto a la educación en valores. Se ciñe a un enfoque holístico, pues la educación en valores holísticos reconoce la interrelación y la interdependencia de todas las áreas de desarrollo de los estudiantes, incluyendo la dimensión física, intelectual, emocional y espiritual. El objetivo es abordar integralmente los aspectos cognitivos, emocionales y sociales de los estudiantes, promoviendo su crecimiento en todas estas áreas. En resumen, la educación en valores desde un enfoque holístico busca brindar a los estudiantes una formación integral, abarcando tanto sus aspectos académicos como su desarrollo personal, emocional y social. El presente acoge el fundamento y estudios investigativos previos, aportes al desarrollo de la tesis doctoral sobre Educación en Valores en contextos universitarios, a través de la promoción de valores fundamentales, que permitan formar ciudadanos comprometidos y conscientes de su importancia en la construcción de una sociedad justa y equitativa.
Korelasi Mengajar Variatif Guru Pendidikan Agama Kristen terhadap Prestasi Belajar Siswa SMP BOPKRI Wonosari, Yogyakarta
Authors: Ndun Yufri Yermi
Published: July 2024

One of the factors that influences student achievement is the teacher's way of teaching. Teaching methods are part of pedagogical competence which includes the quality of teacher learning which determines student understanding.  Teachers who are varied in teaching are also teachers who have the openness to want to learn about the facilities and infrastructure that exist in a school institution to support the ongoing learning process.  This research uses a descriptive method approach with the aim of obtaining certainty about the results of the relationship between teacher teaching methods and student learning achievement (N= 46 respondents).  The results of the research show that the t test result (r count) is 0.628, which if the r table is 0.291, then the t test result > t table (0.628 > 0.291) for the number of respondents (N= 46).  Based on the correlation coefficient in the criteria above, it can be stated that there is a relationship between the Variative Teaching Correlation variable for Christian Religious Education Teachers (X) and Student Learning Achievement (Y) at BOPKRI Wonosari Middle School of 0.628, which is classified as high correlation
ICT TECHNOLOGIES IN LANGUAGE TEACHING IN THE CONTEXT OF SPECIALIZED EDUCATION
Authors: Supataeva E. A.
Published: July 2024

Currently, the education system of the Kyrgyzstan is undergoing a large-scale modernization process related to updating the content, structure and quality of school education, and one of the key areas is the development of specialized education in high school. This publication is devoted to the problem of teaching the Russian language in the context of specialized education. Specialized education, due to changes in the structure, content and organization of the educational process, should more fully take into account the interests, inclinations and abilities of students, create conditions for teaching high school students in accordance with their professional interests and intentions regarding continuing education. The creation of a system of teaching Russian to high school students in general education institutions with the Kyrgyz language of instruction in the context of specialized training based on a competence-based approach required the selection of ICT learning technologies.
Digital Implementation of Chaotic Systems UsingNvidia Jetson AGX Orin and Custom DAC Converter
Authors: Emin Berkay , Yaz Mustafa
Published: July 2024

Digital implementation of chaotic systems has numerous advantages, offering higher flexibility and computational accuracy compared to traditional analog systems. This is particularly important for engineering applications. Digital solutions are also more cost-effective. In this study, the Nvidia Jetson AGX Orin board and a 16-bit converter board are used for the digital realization of chaotic systems. The Nvidia Jetson AGX Orin provides high processing power and energy efficiency, while the 16-bit converter card ensures precise data processing. This setup allows for advanced, flexible, reliable, and economical solutions, enhancing various engineering applications, such as modeling, simulation, and control of complex systems. Digital platforms also facilitate parametric investigations and optimization processes, enabling more in-depth analysis.
The Effects of Islamic Economy and Islamic Finance on Social Life
Authors: Kısacık Harun
Published: July 2024

Living together comes with both advantages and disadvantages. On the positive side, people benefit from each other by fulfilling mutual needs, such as buying goods and services that they cannot produce themselves. However, living together can also lead to conflicts, with individuals sometimes infringing on each other's rights. Islam brought significant changes to ensure justice in social life, introducing rules and innovations in economy and finance. When these Islamic principles are followed, justice and social welfare improve. This study will explore Islamic economy and finance and their effects on social life.
EXCESSIVE DRUG PRICING IN INDIAN PHARMACEUTICAL MARKET: EXPLOITATIVE PRACTICE OR AGGRESSIVE COMPETITION CONDUCT?
Authors: Raturi Prerna
Published: July 2024

Exploitative excessive pricing is one subject matter relating to Competition law that still remains a slippery slope. Application of excessive prices by a dominant firm is undeniably one of the most conspicuous form of abuse and thus, on the face of it, calls for regulation. However, different jurisdictions and their competition-regulating institutions are divided on this. A disagreement can be seen in their antitrust systems through their approaches and policies towards the same. Where on one hand certain jurisdictions believe that competition enforcement is not a suitable treatment for excessive pricing, others reckon excessive pricing to be well within the realm of competition law.1 One of the most discussed and well-known examples is of American and European competition law regimes. EU competition law and judicial precedents state that excessive pricing by a dominant firm is unlawful. However, American antitrust law does not forbid the same as a form of abuse. Article 102 (a) of TFEU prohibits such conduct by a dominant company which “directly or indirectly imposes unfair purchase or selling prices or other unfair trading conditions”. This provision not only encompasses the imposition of extremely low prices, also called predatory pricing, but also proscribes the infliction of extremely high prices by the dominant firms. Whereas, Section 2 of the Sherman Act considers only acquiring and maintaining a monopoly by engaging in an abusive conduct a felony. That is why charging of monopoly prices in the US is not only legally permitted but also considered as an essential element of the free market system.
Hybrid, Transcatheter Aortic Valve Implantation (TAVI) and Total Arterial Off-Pump Coronary Artery Bypass (OPCAB) in a Patient with Severe Aortic Valve Regurgitation – A Case Report
Authors: Cordero Alinaya , Carbon Fontini , Ybañez Erwin , Posas Fabio Enrique
Published: July 2024

BACKGROUND: Transcatheter aortic valve implantation (TAVI) has been shown to be an effective growing strategy for severe, symptomatic aortic valve stenosis (AS) in patients who are either not ideal candidates or who are at intermediate or high surgical risk for surgical aortic valve replacement. Hybrid TAVI and off-pump coronary artery bypass graft (OPCAB) have been previously reported in high-risk patients with severe AS and coronary artery disease (CAD). TAVI data for severe aortic valve regurgitation (AR) is limited and currently considered an off-label application. Reports on hybrid TAVI for severe AR and OPCAB in patients with severe co-morbid CAD are limited.

We report a hybrid TAVI and OPCAB in a 64-year-old female, with severe AR, severe left ventricular systolic dysfunction and CAD with a low take-off of the left main (LM) and porcelain aorta.

CASE REPORT: The patient is a 64-year-old morbidly obese Filipino female with porcelain aorta and post-percutaneous coronary intervention with drug-eluting stent implantation for multivessel CAD with LM involvement and was admitted for refractory heart failure. Her 2D echocardiography demonstrated a dilated left ventricle with 19% left ventricular ejection fraction (LVEF) and severe AR. Computed tomography angiography demonstrated porcelain aorta, a low take-off of the left main with good femoral access.

Hybrid TAVI with 26 mm Corevalve was done via the transfemoral approach after OPCAB of the left internal mammary artery to left anterior descending artery. Valve-in-valve transcatheter aortic valve replacement was required due to low valve implantation and severe paravalvular leak (PVL).

Follow-up echo at 22 months demonstrated no PVL, 1.6 cm2 effective orifice aortic valve area, 12.4 mmHg mean gradient and 50% LVEF. She remains asymptomatic and in functional class I.

CONCLUSION: Hybrid TAVI and OPCAB in patients with severe valvar AR, porcelain aorta and CAD represents a feasible and effective option of care. There are few reports in the literature documenting the effectiveness or feasibility of this approach for such patients.
Clinical Profile and Outcomes of Pregnant Patients with Congenital Heart Disease at the University of the Philippines Philippine General Hospital
Authors: Reyes Michael T , Capito Ronald B , Punzalan Felix Eduardo R
Published: July 2024

BACKGROUND: Recent advances in the management of congenital heart diseases (CHD) have emerged. However, most CHD patients in a developing nation like the Philippines cannot afford proper treatment. If a CHD patient then desires children, greater problems may arise during pregnancy. Hence, it may be meaningful to describe the clinical profile and management of commonly - seen CHD patients during pregnancy.

METHODS: This is a cross-sectional retrospective study of all admitted pregnant patients with CHD diagnosed by 2D-echocardiography at the University of the Philippines-Philippine General Hospital, from July 2009 to October 2011. Data on demographics, type of congenital lesion, common medications, maternal complications and pregnancy outcomes were collected and described.

RESULTS: Forty-four patients of CHD in pregnancy were included in this study. The median age of the patients was 24 years old, and the median age of gestation at the time of consult was 37 weeks. The most common reason for consult was labor (64%), with one-fourth of them in preterm labor. Majority of patients (95%) knew about their CHD prior to pregnancy, and half of them noted worsening of failure symptoms during pregnancy. The most common congenital lesions encountered were atrial septal secundum defects (37%) and patent ductus arteriosus (20%). Digoxin was the most frequently prescribed drug (27%). Infective endocarditis prophylaxis was given 55% of the time. Assisted vaginal delivery (41%) was the most common manner of delivery, with continuous epidural anesthesia (82%) as the most common route for anesthesia delivery. Maternal complications occurred in 9% and preterm birth in 25%. A third of all neonates (13) delivered were small for gestational age, and 66% of these babies had moderate to severe pulmonary artery hypertension.

CONCLUSION: Pregnancies with CHD carry significant rates of preterm births and SGA babies. Adverse events and maternal complications were observed mostly in patients with moderate to severe pulmonary hypertension. Female CHD patients should be educated about the risks of pregnancy and the benefits of prevention of pregnancy, especially in patients with moderate and severe pulmonary hypertension.

KEY WORDS: Cardiovascular disease in pregnancy; High-Risk pregnancies; Congenital Heart Disease
Pericardial Abscess: A Rare Complication of Pyogenic Liver Abscess
Authors: Lontoc Anthony N , Vilela Gilbert C , Panaligan Mario M , Gabriel Frederick , Salamanca Lilibel R
Published: July 2024

Massive pericardial effusion from rupture of a hepatic abscess is rare. We report an unusual case of a pericardial abscess caused by a poorly treated hepatic abscess. This is the case of a 60-year old male with exertional dyspnea, intermittent low back pain, occasional low-grade fever; and progressive malaise, anorexia and weight loss. One month prior to admission, an abdominal ultrasound showed a left hepatic abscess. The patient was treated with metronidazole, but had poor compliance. A later two dimensional echocardiogram with doppler showed a massive pericardial effusion with no signs of tamponade. The patient was then referred to the Philippine Heart Center. On physical examination, heart sounds were muffled. Hematology revealed leukocytosis. Electrocardiography showed sinus tachycardia, isolated premature ventricular depolarization, and low-voltage chest leads. Subxiphoid tube pericardiostomy drained one liter of purulent non-foul smelling pericardial fluid. Cytology and chemistry showed an inflammatory process. Gram staining showed pus cells and gram-positive cocci in pairs. The patient was given intravenous (IV) metronidazole 500 mg every 8 hours, and IV ampicillin 1.5 mg every 8 hours. Computerized tomography of the upper abdomen revealed a large abscess at the lateral segment of the left lobe of the liver; hepatic cortical cysts; and minimal pericardial effusion. On the 20th hospital day, the subxiphoid catheter was removed and the patient was discharged. Home medications included oral metronidazole and ampicillin-sulbactam for 2 weeks. The hepatic catheter was then subsequently removed after another 2 weeks.
The Use of Intraaortic Balloon Pump Therapy for Intractable Ventricular Tachyarrhythmia
Authors: Mendoza Charisse Sl , Gonda Von Meldrick A
Published: July 2024

The intraaortic balloon pump (IABP) is the most widely used circulatory assist device in critically ill cardiac patients. This has been useful in patients with incessant and hemodynamically unstable ventricular tachyarrhythmias.

CASE: This is a case report in which intraaortic balloon pump (IABP) was used in a patient with non-ischemic dilated cardiomyopathy, who presented with incessant ventricular tachycardia, which immediately terminated upon IABP insertion. This patient eventually received an automated implantable cardiac defibrillator.
Association Between Heart Rate Recovery and Body Mass Index Among Non-Ischemic Patients in Sinus Rhythm Undergoing Treadmill Stress Test in a Tertiary Hospital
Authors: Agdamag Peeble Narita G , Cheng Federick
Published: July 2024

Introduction: Obesity is an independent risk factor for cardiovascular disease. It is hypothesized that the increased risk is due to its link to autonomic parasympathetic dysfunction. This fall in parasympathetic tone can be assessed by heart rate recovery measured during the first one minute after exercise.

Objective: To determine the association between heart rate recovery and body mass index (BMI).

Methods: This was a cross-sectional study that included all consecutive adult patients who underwent treadmill stress test in a tertiary hospital from March to October 2015. A total of 2,989 subjects were included in the final analysis. The main outcome measure was heart rate recovery (HRR).

Results: Univariate analysis of BMI and HRR showed a significant association (P<0.001). Multivariate analysis adjusting for clinical and exercise variables showed that the association remained significant. Smoking history (P=0.021), family history of cardiovascular heart disease (P=0.015), the presence of hypertension (P<0.001), diabetes mellitus (P=0.009, age (P=0.005), baseline heart rate (P<0.001) and age (P=0.005) all showed a negative correlation with HRR. Maximum heart rate achieved (P<0.001) showed a positive correlation with HRR.

Conclusion: Increasing BMI was significantly associated with a decrease in HRR, as well as smoking, family history of cardiovascular heart disease, hypertension, diabetes mellitus, age and higher baseline heart rate. Maximum heart rate achieved was positively correlated with HRR.
Aldosterone Antagonists in the Prevention of Atrial Fibrillation in Adult Patients with Congestive Heart Failure: A Meta-analysis of Randomized Controlled Trials
Authors: Cosare Joanne A , Esposo Evelyn A
Published: July 2024

BACKGROUND: Onset of atrial fibrillation (AF) is related to congestive heart failure (CHF) severity. The renin angiotensin-aldosterone system activates the mineralcorticoid receptor in patients with CHF, increasing the concentration of aldosterone and cortisol levels. Prolonged, these may cause deleterious effects leading to arrhythmia, worsening of CHF and mortality. Aldosterone antagonists may influence the atrial fibrosis and remodeling, which may prevent the onset of AF in patients with CHF.

METHODS: Randomized, double-blind trials were searched from PUBMED, Medline, Embase and Cochrane on the effect of aldosterone antagonists (i.e., spironolactone, eplerenone, or canrenone) vs placebo on the prevention of AF, worsening CHF and deaths from cardiovascular causes. Selected studies were subjected to meta-analysis on the effects on incidence of new-onset AF, death from cardiovascular causes, hospitalization from CHF, and hypokalemia.

RESULTS: Four randomized trials were selected, for a total of 5,114 patients were identified and extracted. Aldosterone antagonists reduced the incidence of new-onset AF by 42% (relative risk [RR] 0.58; 95% CI 0.40, 0.85; p=0.005) vs placebo. Mortality from cardiovascular causes was reduced by 21% (RR 0.79; 95% CI 0.65, 0.96; p=0.002). The risk of hospitalization from CHF was reduced by 37% (RR 0.63; 95% CI 0.53, 0.76; p=0.00001).

CONCLUSION: The additional of aldosterone antagonists to the treatment of CHF significantly reduced the risk of new-onset AF, hospitalization from CHF, and deaths from cardiovascular causes.
Commentary on “The Management of Atrial Fibrillation in the Philippines: A State-of-the-Art Review”
Authors: Pestaño Noemi S
Published: July 2024

The 2022 annual report of the Asia Pacific Heart Rhythm Society reported that the prevalence of atrial fibrillation (AF) in the Philippines from 2018 to 2021 was between 0.20%-0.40%.1

This prevalence is expected to inflate unless measures are adapted for its early screening, diagnosis and compendious management. Through the years, approaches to the management of atrial fibrillation have undergone evolutionary change. Dr. Erdie Fadreguilan has discussed the evidences in his article “The Management of Atrial Fibrillation in the Philippines: A State-of-the-Art Review”. It underscores the succinct strategies to curtail the progression of paroxysmal AF to persistent one and attenuate the complications caused by AF.
Outcomes of Valve-in-Valve Transcatheter Aortic Valve Implantation Versus Conventional Redo Surgical Aortic Valve Replacement in Patients With Aortic Bioprosthetic Valves: A Meta-analysis
Authors: Chan Keith Andrew L , Chio Francisco L , Alcazar Jeremy Anne A , Buaya Carlo Andrew A , Gallardo Elaine L
Published: July 2024

BACKGROUND: Studies have demonstrated earlier valve degeneration in patients with bioprosthetic aortic valves (AVs), necessitating redo surgical aortic valve replacement (SAVR). Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) is a novel, off-label technique that offers a feasible alternative to SAVR. 

OBJECTIVES: The aim of this study was to determine outcomes of patients with bioprosthetic AVs undergoing ViV-TAVI versus redo SAVR, namely, primary clinical outcomes (procedural and 30-day all-cause mortality), secondary clinical outcomes (30-day myocardial infarction, stroke, acute kidney injury, permanent pacemaker insertion), and echocardiographic parameters (mean postoperative AV gradient, postoperative AV gradients >20 mm Hg, and paravalvular leaks).  

STUDY SELECTION: Criteria included studies having (a) human subjects, (b) recently conducted studies (publication date within 5 years from analysis), (c) patients with prior SAVR   with a bioprosthetic valve, (d) both a ViV-TAVI compared against a redo SAVR arm, (e) follow-up period of 12 or more months, and (f) reported the specified outcomes.  

RESULTS: The analysis included five studies (total: 533 [ViV-TAVI: 249, redo SAVR: 284]). Preoperative risk scores were higher in the ViV-TAVI arm (EuroSCORE: 13 ± 10.4 to 27.4 ± 18.7; Society of Thoracic Surgeons [STS]: 7.4 ± 4.9 to 7.5 ± 3) compared with the redo SAVR arm (EuroSCORE: 8.9 ± 6.5 to 16.8 ± 9.3; STS: 4.4 ± 4.4 to 7.7 ± 3.4). There was no statistically significant difference for procedural and 30-day all-cause mortality. There were also no significant differences in any of the secondary clinical outcomes. Mean postoperative AV gradients had no significant differences between arms, but cases with postoperative AV gradients >20 mm Hg (odds ratio [OR], 5.26; 95% confidence interval [CI], 3.03–9.14; P < 0.00001) and paravalvular leaks (OR, 4.27; 95% CI, 2.01–9.07; P = 0.0002) were significantly higher in the ViV-TAVI group. 

CONCLUSION: Valve-in-valve transcatheter AV implantation is a novel technique being increasingly performed, with procedural and 30-day mortality rates comparable to redo SAVR, even in patients with high preoperative risk. However, its strongest limitation is postoperative valve hemodynamics, with redo SAVR still having a superior postoperative hemodynamic profile. 

KEYWORDS: valve-in-valve transcatheter aortic valve implantation, ViV-TAVI, bioprosthetic aortic valves
Clinical and Angiographic Profile of Patients Undergoing Coronary Angiography at the Tertiary Hospital—A 19-Year Retrospective Observational Study
Authors: Tan Katherine Ann N , de Guzman Wilson L. Tan , Mendoza Clarissa M
Published: July 2024

INTRODUCTION: Coronary artery disease (CAD) is one of the leading causes of death globally.  Studies have shown association of CAD and its risk factors; however, data on association of  these risk factors and severity of CAD as seen in angiography in our local setting are still limited. 

OBJECTIVE: The aims of this study were to determine the clinical and angiographic profile  of patients who underwent coronary angiography, to correlate cardiovascular risk factors to  their angiographic findings, and to compare the trend of risk factors and angiography findings  between decades. 

METHODS: This is a retrospective observational study of patients aged 18 years or older,  of either sex, who underwent coronary angiography at a tertiary hospital from 2001 to 2019.  Pertinent risk factors were correlated with angiography findings to determine predictors for  significant CAD. 

RESULTS: The mean age of the patients was 58.6 years. There were more males (66%) than  females. The risk factors for the likelihood of significant CAD are older age (4.98% more for every  year increase in age), male sex (2.63 times), and diabetes mellitus (47.64%). The majority of the  patients had right dominant circulation, and significant lesions were more commonly seen in the  left anterior descending artery. There were statistically significant more patients with hypertension,  diabetes, and obesity in the present decade compared with the past. 

CONCLUSION: Increased age, male sex, and diabetes are associated with significant CAD in  the local setting. Diabetes must be aggressively controlled early to prevent the development of  significant CAD. 

KEYWORDS: coronary artery disease, risk factors, profile, coronary angiography
Prevalence, Predictors and Survival Outcome of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement: A Single-Center Experience
Authors: Dong-as Darien Ann M , Posas Fabio Enrique B , Valencia Ofelia N
Published: July 2024

INTRODUCTION: Prosthesis-patient mismatch (PPM) after surgical or transcatheter aortic valve  replacement (SAVR or TAVR, respectively), remains a significant concern in large registries and  has potentially affected clinical outcomes including mortality. This study aimed to determine the  prevalence, predictors and survival outcome of patients with and without PPM post-TAVR at St.  Luke’s Medical Center–Global City (SLMC-GC), Philippines. 

METHODS: This was a retrospective cohort analysis among patients who underwent TAVR at  SLMC-GC between 2012 and 2018. We reviewed the procedural and follow-up records of patients  from the TAVR clinic at SLMC-GC and identified those with PPM. The prevalence of PPM was  computed and the characteristics and survival of those with and without PPM were compared. 

RESULTS: There were 133 patients included in the study. Severe and moderate PPM were  observed in 4.5% and 11.3% of patients, respectively. No clinical, procedural or echocardiographic  characteristic was identified as a significant independent predictor of PPM post-TAVR. The  estimated mean survival of patients using the Kaplan–Meier method was 64.9 months (95%  CI 52.7, 77.2 months) in the PPM group vs 62.1 months (95% CI 55.9, 68.4 months; log-rank  p=0.72), which were not significantly different between groups. 

CONCLUSION: The incidence of moderate to severe PPM post-TAVR in our institution was  15.8%. The clinical, procedural and echocardiographic characteristics of patients with and without  PPM post-TAVR did not significantly differ between groups. PPM has no significant impact on  mortality among post-TAVR patients in Filipinos. 

KEYWORDS: Prosthesis-patient mismatch, Transcatheter aortic valve replacement, effective orifice  area, Philippines
A Case Series of Two Traumatic Iatrogenic Radial Arteriovenous Fistulae as Complication of Transradial Coronary Angioplasty
Authors: Garcia Mark Gavin M , Cruz Michael Anthony A. Dela , Catalan Francis L , Miranda Ariel A
Published: July 2024

BACKGROUND: Since the introduction of transradial access as a site for coronary angiogram or angioplasty, the rates of vascular complications have significantly improved. Because of this, the procedure has become increasingly preferred due to reduced morbidity rates and lower procedural cost. Complications—specifically, arteriovenous fistulae—have become rarer with the use of the transradial approach. This case series presents two cases of traumatic iatrogenic radial arteriovenous fistula as a complication of transradial coronary angioplasty, as well as their management.

Case 1: A 59-year-old male who underwent coronary angioplasty due to left anterior descending coronary artery stenosis was noted to have a tender and pulsating mass proximal to the puncture site that started two weeks after the procedure. Bruit was noted on auscultation. A small fistula formation on the distal radial artery, draining to the connecting vein, was noted on ultrasound. Initial compression of the fistula was done for one week with no observable improvement, so the patient underwent surgical repair.

Case 2: A 52-year-old female underwent successful coronary angioplasty. Successful hemostasis by compression of a transradial band (TR) over the access site was achieved post-percutaneous coronary intervention. Two weeks after the procedure, the patient complained of a palpable pulsatile mass on her right wrist. Duplex scan of the right forearm showed a small arteriovenous fistula connecting the radial artery to a deep branch of the radial vein. The fistula and swelling spontaneously resolved after compression with TR band for 48 hours.

Conclusion: Traumatic iatrogenic radial arteriovenous fistula is a rare complication of a cardiac catheterization procedure using a transradial access approach. Conservative manual compression may be the initial treatment option, but surgical repair may be considered in the presence of hemorrhage, hemodynamic instability, painful limb ischemia, non-healing ulcers and functional impairment.

Keywords: radial arteriovenous fistula, coronary angioplasty, transradial compression, surgical ligation.