Effects of community health interventions on under-5 mortality in rural Guinea-Bissau (EPICS): a cluster-randomised controlled trial.

Background: Evidence suggests that community-based interventions that promote improved home-based practices and care-seeking behaviour can have a large impact on maternal and child mortality in regions where rates are high. We aimed to assess whether an intervention package based on the WHO Integrated Management of Childhood Illness handbook and community mobilisation could reduce under-5 mortality in rural Guinea-Bissau, where the health service infrastructure is weak.

Methods: We did a non-masked cluster-randomised controlled trial (EPICS) in the districts of Tombali and Quinara in Guinea-Bissau.

The EPICS Trial: Enabling Parents to Increase Child Survival through the introduction of community-based health interventions in rural Guinea Bissau.

Background: Guinea-Bissau is a small country in West Africa with a population of 1.7 million. The WHO and UNICEF reported an under-five child mortality of 203 per 1000, the 10th highest amongst 192 countries.

Kissing ulcer of the aortic wall in a patient with aortic valve endocarditis.

In patients with aortic valve endocarditis, lesion of the mitral valve leaflets caused by jet strike or vegetation touch (kissing) is a well-described complication. We present a case of infectious aortic ulcer caused by aortic valve vegetation kissing. A 72-year-old woman who underwent operation for Streptococcus viridans aortic valve endocarditis presented with a "kissing ulcer" in the aortic wall disclosed by intraoperative transesophageal echocardiography.

[Aortic native valve endocarditis complicated with aorto-right atrial fistula].

Aorto-cavitary fistulous tract formation is an uncommon but extremely serious complication of infective endocarditis, which is associated with high risk of in' hospital mortality, despite recent therapeutic and diagnostic advances. The authors report a case of native aortic valve infective endocarditis complicated with perivalvular abscess and fistulae to the right atrium.

Stuck leaflet of bileaflet prosthesis in mitral position - five cases to make us think.

Objectives: We present five cases of mitral bileaflet prosthesis dysfunction as a result of a stuck leaflet in closed position, diagnosed at surgery or during the first postoperative year.

Methods And Results: The diagnosis was made by echocardiography and could be confirmed by fluoroscopy in three patients. All cases had in common an early occurrence and the presence of a clean prosthesis by transesophageal echocardiography (TEE).

Mitral valve regurgitation--quantification by Doppler echo (quantitative versus semi-quantitative methods).

Quantification of mitral regurgitation is still a controversial issue. Because quantitative analysis using the volumetric method is time-consuming, semi-quantitative analysis based on the characteristics of the regurgitant jet in the left atrium is the method used in daily clinical practice, despite its recognized limitations. In the last ten years various papers have proposed the PISA method as an alternative to the volumetric one, as the same quantitative parameters--regurgitant volume (RV) and effective regurgitant orifice (ERO)--can be obtained with a small number of measurements.