Background Kawasaki disease (KD) is a systemic inflammatory condition occurring predominantly in children. Coronary artery bypass grafting (CABG) is performed in the presence of inflammation and aneurysms of the coronary arteries. The objectives of our study were to assess which CABG strategy provides better graft patency and early and long-term outcomes. Methods A systematic review using Medline, Cochrane, and Scopus databases was performed in February 2020, incorporating a network meta-analysis, performed by random-effect model within a Bayesian framework, and pooled prevalence of adverse outcomes. Hazard ratios (HR) and corresponding 95% credible intervals (CI) were calculated by Markov chain Monte Carlo methods. Results Among 581 published reports, 32 studies were selected, including 1,191 patients undergoing CABG for KD. Graft patency of internal thoracic arteries (ITAs), saphenous veins (SV), and other arteries (gastroepiploic artery and radial artery) was compared. ITAs demonstrated the best patency rates at long-term follow-up (HR 0.33, 95% CI: 0.17–0.66). Pooled prevalence of early mortality after CABG was 0.28% (95% CI: 0.00–0.73%, I 2 = 0%, tau2 = 0), with 63/1,108 and 56/1,108 patients, undergoing interventional procedures and surgical re-interventions during follow-up, respectively. Pooled prevalence was 3.97% (95% CI: 1.91–6.02%, I 2 = 60%, tau2 = 0.0008) for interventional procedures and 3.47% (95% CI: 2.26–4.68%, I 2 = 5%, tau2 <0.0001) for surgical re-interventions. Patients treated with arterial, venous, and mixed (arterial plus second venous graft) CABG were compared to assess long-term mortality. Mixed CABG (HR 0.03, 95% CI: 0.00–0.30) and arterial CABG (HR 0.13, 95% CI: 0.00–1.78) showed reduced long-term mortality compared with venous CABG. Conclusions CABG in KD is a safe procedure. The use of arterial conduits provides better patency rates and lower mortality at long-term follow-up.
with complex social needs as well. Verbal feedback is positive from staff & families with formal qualitative evaluation pending.Areas for improvement are completion of pre-clinic questionnaires for best patient-centred care, and evaluation of our baseline and impacts. We need to increase referrals from most deprived areas and are exploring/piloting direct referrals from a local school, youth group and youth offending service and peer-to-peer wellness support similar to established mental health peer-to-peer support. We are excited to share progress of this novel approach as it develops.
Two (02) had ADHD, Eleven (11) had Autism Spectrum Disorder (ASD). Hypothyroidism was identified in Twelve ( 12) patients. Other medical conditions on record include, Type 1 diabetes,coeliac disease,Hirschprungs, obesity and scoliosis. All ADHD and ASD children on the data base have Intellectual disability. One child with ADHD (Diagnosed at six years of age and started on 10mg Extended release MethylPhenidate preparation is currently(13.5 yrs) on 60mg O.D. he has Circadin 6 mg for sleep on set insomnia. The young person diagnosed at the Age of 14.5yrs did not tolerate ADHD medication but tolerates Crushed Circadin Conclusion The Data base exploration in January 2022 revealed 1.6% had ADHD and 17. 2% ASD in children and young people with Down's syndrome aged 5-25 Yrs. The prevalence of ADHD and ASD in the Southend on Sea Down Syndrome data base at the Light House Child Development Center in comparison to a population based study in Sweden with 60 Down's syndrome children and young people (Ulrika Wester Oxelgren et al in Developmental Medicine & Child Neurology 2017)(ADHD 14%, ASD 47%) is very low.Limitations of the study-Number of children with ADHD is too small to comment on the variability of the type of presentation and the treatment response.A UK wide Down's Syndrome Data base review may help to ascertain the true prevalence of ADHD in Down Syndrome.
Conclusion By identifying the potential future regional and overall national demand for DHM, this study informs decisions on developing milk bank infrastructure in the UK. In the context of decision-making regarding future service design through the BAPM Framework for Practice on the use of donor human milk this year, this is timely research to inform the development of cost-effective and efficient milk banking services that can ensure equity of access nationally.
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