Dyadic lived experiences of ventricular assist device in a crisis torn country

Funding Acknowledgements

Type of funding sources: None.

Dyadic lived experiences of ventricular assist device in a crisis torn country

Background

 Patients with Heart Failure benefit from advanced treatment modalities like the Left Ventricular Assist Device [VAD]. Literature has addressed the complexity of the VAD experience in terms of lifestyle changes and adaptive processes affecting dyads, patients and their caregivers 1,2. In Lebanon, a knowledge gap on the experiences of dyads after VAD implantation is identified. Dyads in Lebanon are challenged by the country’s political and economic instability. It is thus imperative to explore VAD dyadic lived experiences in a country with limited resources and aggravated crises. 

Purpose

 This study aims to explore the lived experiences of VAD dyads and gain insight on how they adapt to their new life with the VAD.

Methods

 Following a qualitative phenomenological design, we interviewed 5 patients [3:2, Male: Female] along with their identified caregivers [1:4, Male: Female]. Transcription was completed verbatim in Arabic. Back translation to English was completed independently by the researchers. Colaizzi’s descriptive phenomenological method guided the thematic analysis.

Results

 4 out of 5 dyads reported a complementary care approach where both members of the dyad counterpart each other in caring for the VAD patient. One dyad had a caregiver oriented approach. Two themes emerged capturing determinants that impact adaptation to a life with a VAD. 

Theme I

Challenges to the VAD experience, personal and contextual. Patients perceived body image alterations as a barrier for intimacy. Spousal caregiver role was problematic. With patients’ heightened sensitivity, spouses dwelled on the need for vigilance with every act. Initially, the presence of the VAD was coupled with dyadic anticipated concern on adaptation and caregiving. Patients complained about the weight of the VAD. Contextual challenges centered around the economic crisis resulting in supply cutoffs and inflated prices for daily VAD care supplies. Along with the medical bills’ steep rise, dyads had to endure electrical supply shortage. 

Theme II

Facilitators to the VAD experience, personal and cultural. Dyads considered the need for VAD placement to be determined by God’s will. Faith assisted them to cope and accept their lifestyle changes. Mental wellbeing promoted high spirits and positively impacted their recovery. In line with the collectivistic culture, support from the family and social circle elevated morale. One of the patients who was unmarried described the lack of responsibilities as a facilitator for acceptance of the VAD. 

Conclusion

This is one of the first studies to address the paucity of knowledge on how dyads experience their new life following VAD implantation. The unstable living conditions add to the complexity of the VAD experience. The identified challenges and facilitators inform healthcare professionals on means to support VAD patient caregiver dyads.

Eosinophilic oesophagitis: relationship of quality of life with clinical, endoscopic and histological activity

BACKGROUND

Knowledge about determinants of quality of life (QoL) in eosinophilic oesophagitis (EoO) patients helps to identify patients at risk of experiencing poor QoL and to tailor therapeutic interventions accordingly.

AIM

To evaluate the impact of symptom severity, endoscopic and histological activity on EoE-specific QoL in adult EoE patients.

METHODS

Ninety-eight adult EoE patients were prospectively included (64% male, median age 39 years). Patients completed two validated instruments to assess EoE-specific QoL (EoO-QoL-A) and symptom severity (adult EoE activity index patient-reported outcome) and then underwent esophagogastroduodenoscopy with biopsy sampling. Physicians reported standardised information on EoE-associated endoscopic and histological alterations. The Spearman's rank correlation coefficient was calculated to determine the relationship between QoL and symptom severity. Linear regression and analysis of variance was used to quantify the extent to which variations in severity of EoE symptoms, endoscopic and histological findings explain variations in QoL.

RESULTS

Quality of life strongly correlated with symptom severity (r = 0.610, P < 0.001). While the variation in severity of symptoms, endoscopic and histological findings alone explained 38%, 35% and 22% of the variability in EoE-related QoL, respectively, these together explained 60% of variation. Symptom severity explained 18-35% of the variation in each of the five QoL subscale scores.

CONCLUSIONS

Eosinophilic oesophagitis symptom severity and biological disease activity determine QoL in adult patients with eosinophilic oesophagitis. Therefore, reduction in both eosinophilic oesophagitis symptoms as well as biological disease activity is essential for improvement of QoL in adult patients. Clinicaltrials.gov number, NCT00939263.

Dietary therapy can reverse esophageal subepithelial fibrosis in patients with eosinophilic esophagitis: a historical cohort

BACKGROUND

Fibrosis of the esophageal lamina propria is a known complication of eosinophilic esophagitis (EoE). To date, therapy with topical corticosteroids has been shown to reverse esophageal fibrosis in some patients; however, there is little evidence to suggest that dietary therapy can also reverse it. Our aim was to examine whether dietary therapy alone can reverse esophageal fibrosis in children with EoE.

METHODS

We performed a historical cohort study based on children with EoE who had esophageal fibrosis on pretreatment biopsies using trichrome staining. Post-treatment biopsies were analyzed for fibrosis reversal, and results were compared between patients treated with dietary restriction and those that received topical steroids. Clinical characteristics (age, symptoms, duration of symptoms prior to therapy, treatment type, and duration of therapy) were recorded. Histological markers (eosinophil numbers and eosinophilic degranulation in both epithelium and lamina propria, basal zone hyperplasia, and the presence of eosinophilic microabscesses in the epithelium) were examined by reviewing hematoxylin and eosin-stained biopsies and by immunohistochemical staining. These were examined as potential predictors for fibrosis reversal.

RESULTS

Fibrosis resolved following both dietary restriction and topical steroids (3/17 and 5/9 patients respectively, P = 0.078). Post-treatment symptom resolution and decreased intraepithelial eosinophil numbers were found to be the only significant predictors of fibrosis resolution.

CONCLUSIONS

Dietary restriction alone, similar to topical steroids, can reverse fibrosis in children with EoE.

Intraocular lens materials and styles: a review

Biomaterial science has lead to the development of a variety of foldable intraocular lens (IOL) biomaterials. This literature review examines these lenses from both a basic science and a clinical perspective. By most parameters, hydrogel, soft acrylic and silicone IOL are better than polymethylmethacrylate (PMMA) lenses. Plate haptic silicone IOL have the lowest incidence of cystoid macula oedema and posterior capsule opacification, but these lenses require an intact anterior capsularhexis and posterior capsule. Yttrium aluminium garnet (YAG) laser capsulotomy must be delayed at least 3 months to avoid posterior lens dislocation. Silicone has the lowest threshold for YAG laser damage of all IOL materials and also adheres irreversibly to silicone oil with subsequent optical impairment. Three piece silicone IOL with polypropylene haptics have a higher incidence of decentration, pigment adherence and capsule opacification compared with PMMA haptics. Hydrogel lenses are very biocompatible and resistant to YAG laser damage, but pigment adheres to the surface more readily than PMMA. Soft acrylic IOL unfold slowly, resulting in controlled insertion, but it is possible to crack the lens and some lenses develop glistenings due to water accumulation. There are significant socioeconomic implications to the large differences in posterior capsule opacification rates between the various biomaterials and the lens styles.

220 cases of distal hypospadias: results of MAGPI and Duplay procedures. Respective place of glanduloplasty and urethroplasty

220 distal hypospadias have been operated over a period of 10 years: 53 glandular, 144 coronal and 23 anterior penile subcoronal hypospadias with no chordee. Although with 131 MAGPI procedures we had only 3 urethral complications (one fistula, one total and one partial disunion), it does not seem to be a well adapted procedure for the correction of coronal and anterior penile hypospadias: the new meatus is not exactly apical, the glans remains short on its inferior side, and we often noticed a distal curvature at the end of the intervention. The urethroplasty technique that we performed 89 times avoids these disadvantages: the urethra is reconstructed in 2 layers as far as the summit of the glans according to Duplay's procedure, the urethrocutaneous adhesions are freed down the penis, the distal thin urethra is covered by an intermediate layer and the shortage of ventral skin is compensated for by the formation of a circular esthetic mucous annulus. There have been no complications with glandular hypospadias (7 cases), 4 with coronal hypospadias (64 cases) and 4 with anterior penile hypospadias (18 cases). While the MAGPI procedure remains an excellent technique for the correction of glandular hypospadias, the Duplay's procedure is better adapted for the correction of coronal hypospadias, in spite of the occurrence of more frequent (easily treated) fistula (6.25%). The juxta coronal position of some anterior penile hypospadias is still better repaired by the Mathieu's or the Snyder's procedures.

The formation of the area centralis of the retinal ganglion cell layer in the chick

In adult domestic chickens, the neurones in the retinal ganglion cell layer are very unevenly disposed such that there is a sixfold increase in neurone density from the retinal edge to the retinal centre. The formation of the high ganglion-cell-density area centralis was studied on chick retinal wholemounts from the 8th day of incubation (E8) to 4 weeks after hatching (4WAH). The density of viable neurones and the number and the distribution of pyknotic neurones in the ganglion cell layer were estimated across the whole retina. Between E8 and E10, the distribution of neurones in the ganglion cell layer was anisodensitic with 53,000 mm-2 in the centre compared to 34,000 mm-2 in the periphery of the retina. Thereafter, a progressively steeper gradient of neurone density developed, which decreased from 24,000 mm-2 in the retinal centre to 6000 mm-2 at the retinal periphery by 4WAH. Neuronal pyknosis in the ganglion cell layer was observed between E9 and E17. From E11 onwards, consistently more pyknotic neurones were found in the peripheral than in the central retina. It was estimated that over the period of cell death approximately twice as many neurones died per unit area in the retinal periphery than in the centre. Retinal area measurements and estimation of neurone densities in the ganglion cell layer after the period of neurone generation and neurone death indicated differential retinal expansion, with more expansion in the peripheral than in the central retina. These observations allow us to conclude that the formation of the area centralis of the chick retina involves (1) slightly higher cell generation in the retinal centre, (2) higher rate of cell loss in the retinal periphery and (3) differential retinal expansion.