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Echo-guided percutaneous procedures have been reported reliable and advantageous. However, the learning curve is difficult for junior doctors. We aimed to evaluate the safety and efficacy of a novel guidewire (Panna wire) in percutaneous atrial septal defect closure under transthoracic echocardiography guidance only.

The Panna wire is designed for echo-guide procedure with a retractable spindle-shaped tip. A multicenter, randomized, controlled trial was conducted to evaluate the safety and efficacy of the Panna wire versus the conventional guidewire for junior doctors with <100 cases experience. The primary outcome was operative success rate. The secondary outcomes were incidence of major adverse events, operation time, time needed to enter the left atrium, number of arrhythmia episodes, number of misguidance to tricuspid valve, and incidence of peripheral vascular complications.

Between July 2018 and September 2019, 100 patients with atrial septal defect were randomized to either the Panna wire grou. Unique identifier NCT04096924.Prevalent risks in meat value-chains of sub-Saharan African (SSA) countries are increasingly attributed to microbial rather than chemical hazards. KG-501 Resource constraints and lack of capacity has limited the utilization of risk assessment tools in the instituting of food controls to mitigate the risks. The review sought to bring to light the focus of risk assessment studies in SSA while generating evidence of feasible options to further the contribution of this component in risk mitigation. The informal street vending sector emerges as a priority in the meat value chain with a vendor population that are unwilling to abandon it. Campylobacter and Staphylococcus aureus are prevalent risks that have bedeviled this sector. However, limited risk assessment studies with capacity to inform proper food controls for the sector have been done. Evidence in place indicate that the incorporation of qualitative aspects in quantitative approaches serve as less-costly and effective ways of generating risk estimates. Limitations of capacity and gaps in epidemiological data are also circumvented. Considering that the street-vending sector is robust and its dynamics of operation are not fully in the picture of policy actors; incorporation of a participatory approach that combines qualitative and quantitative aspects of risk assessment is highly recommended.The relationships between polymorphisms in pro-inflammatory cytokines and the risk of inflammatory bowel disease (IBD) remain discrepant. Therefore, the authors conducted a meta-analysis to robustly explore relationships between polymorphisms in pro-inflammatory cytokines and the risk of IBD by integrating the results of previous works. Medline, Embase, Wanfang, VIP and CNKI were searched throughly for eligible studies, and 35 genetic association studies were finally included in this meta-analysis. We noticed that genotypic frequencies of IL-1B rs1143627, IL-6 rs1800795 and IL-8 rs4073 polymorphisms among cases with IBD and population-based controls differed significantly. Moreover, we found that genotypic frequencies of IL-1B rs1143627 and IL-6 rs1800795 polymorphisms among cases with IBD and population-based controls of Caucasian origin differed significantly, whereas genotypic frequency of IL-8 rs4073 and IL-18 rs187238 polymorphisms among cases with IBD and population-based controls of Asian origin also differed significantly. Furthermore, we also noticed that genotypic frequency of IL-18 rs187238 polymorphism among cases with Crohn's disease (CD) and population-based controls differed significantly. In conclusion, this meta-analysis demonstrated that IL-1B rs1143627 and IL-6 rs1800795 polymorphisms were significantly associated with the risk of IBD in overall population and Caucasians. Moreover, IL-8 rs4073 polymorphism was significantly associated with the risk of IBD in overall population and Asians. In addition, we also noticed that IL-18 rs187238 polymorphism was significantly associated with the risk of CD, and IL-18 rs1946518 polymorphism was significantly associated with the risk of IBD in Asians.
Although intravenous (IV) bisphosphonates are first-line medications for the management of hypercalcemia, studies examining their use in patients with preexisting renal dysfunction are limited.

The objective of this study is to describe the safety and efficacy of pamidronate and zoledronic acid in the treatment of hypercalcemia in patients with baseline renal dysfunction.

A retrospective analysis was conducted of IV pamidronate and zoledronic acid in adult patients with hypercalcemia and creatinine clearance (CrCl) <60 mL/min. The primary endpoint was incidence of all-grade serum creatinine (SCr) elevations. Secondary endpoints included refractory hypercalcemia, hypocalcemia, osteonecrosis of the jaw (ONJ), corrected serum calcium (CSC) decrease ≥1.0 mg/dL by day 7 of bisphosphonate administration, and normalization of CSC ≤10.5 mg/dL by days 10 and 30.

A total of 113 patients were included (n = 55 pamidronate, n = 58 zoledronic acid). The primary endpoint of all-grade SCr elevation occurred in 28 (24.8%) patients. Grades 3/4 SCr elevations occurred in 10.9% of patients treated with pamidronate and 1.7% of patients receiving zoledronic acid. Approximately 16% and 14% of patients developed grades 1 and 2 hypocalcemia, respectively, and there were no cases of ONJ. Overall, 64.6% of patients achieved normalization of CSC by day 10, and there were no statistical differences between bisphosphonate type and renal function.

The analysis suggests an association between IV bisphosphonates and increased rates of SCr elevations among patients with preexisting renal dysfunction. Future prospective studies are necessary to elucidate these findings.
The analysis suggests an association between IV bisphosphonates and increased rates of SCr elevations among patients with preexisting renal dysfunction. Future prospective studies are necessary to elucidate these findings.
Following a very rapid and significant uptake of metropolitan telepsychiatry in private practice in Australia during COVID-19, practical questions remain How long should psychiatrists continue telepsychiatry? Are there benefits of continuing reduced COVID-19 risks to patient and psychiatrist, and flexibility of appointments? Will the Medicare Benefits Schedule (MBS) telehealth items be retained? How does metropolitan telepsychiatry fit into the overall mix of public and private services? This is an important debate.

Private psychiatrists may continue to offer the majority of care, where practical, via telepsychiatry to reduce COVID-19 exposure risks, as well as allow for the realities of practice management for pandemic public health measures. However, consideration has to be given to the potential drawbacks for patients with sight, hearing and illness-related disabilities or risks, when in-person consultation is required. There are also risks some patients may not benefit from telepsychiatry due to the nature of their illness, and will patients feel rapport is lost? However, the retention of COVID-19 MBS telehealth items is needed for ongoing flexible and comprehensive private practice psychiatry.
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