The debate between pro- and anti-international adoption advocates relies heavily on rhetoric and little on data analysis. To better understand the state of orphans and potential adopters in this debate, we utilize the National Survey of Family Growth (NSFG) and the Demographic and Health Surveys (DHS) to study who adopts internationally and the status of orphaned children in sub-Saharan Africa. According to NSFG data adopters are church going, highly educated, stable families aware of the challenges faced by international adoption, with high rates of infertility and rates of child abuse half the population average. According to the DHS data, orphans in sub-Saharan Africa suffer from significantly higher deprivation, reduced schooling and increased levels of stunting and underweight reported than their cohort. Using this data, we estimate conservatively that that 1 50 000 orphans from our sample of sub-Saharan African countries died from their 5-year birth cohort. Given the large number of families seeking to adopt and the high number of orphan deaths, it seems counterproductive to restrict international adoptions given the significantly lower risks faced by children in adopted families compared with remaining orphaned.
A 36-year-old man was admitted to the hospital for heart failure symptoms. He had initially presented to the emergency room 3 months prior to admission for shortness of breath and a low-grade fever. At that time, he was diagnosed with possible pneumonia and started on antibiotics. Despite this, his symptoms progressed over the next few months. At presentation, he experienced dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, and lower extremity edema.The patient's past medical history was significant for obstructive sleep apnea and 15 pack-year smoking. On presentation, his examination was significant for an early diastolic murmur in the right upper sternal border, right upper quadrant tenderness, and pitting edema. Laboratory reports were significant for elevated brain natriuretic peptide 1629 and a mild increase in the liver function parameters.An echocardiogram revealed a linear structure, which seemed to arise from the sinus of Valsalva, prolapsed into the aortic valve orifice during diastole and flapped back into the aortic root during systole. The prolapsing of this linear structure into the aortic valve orifice during diastole prevented aortic valve closure and resulted in severe aortic insufficiency. The aortic valve was tricuspid, and the cusps appeared otherwise structurally normal (Figures 1 and 2; Movies I-IV in the online-only data supplement). The linear structure was concerning for an aortic dissection, and the patient had a computed tomography of the aorta that confirmed a Stanford type A/Debakey type 2 dissection ( Figure 3). He successfully underwent emergent surgery with aortic valve replacement with a composite mechanical valve conduit and hemi-arch repair using a Gelweave graft.
DisclosuresNone.
Our study confirms that percutaneous ASD closure in adults with moderate pulmonary hypertension and RV dilation is safe and effective with reverse remodeling and better functional capacity. Prospective studies are needed to evaluate efficacy of percutaneous ASD closure in adults with large defects, higher shunt ratios, and severe pulmonary hypertension.
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