The Greeks and Romans reproached the Phoenicians for the sacrifice of infants, and the excavation of cremated infants at 'Tophets' (named after the sacrificial site in Jerusalem mentioned in the Bible) seems to bear this out. However, the argument for infant sacrifice depends largely on a skewed age profile, and age is not easy to determine. The authors approach this problem with a battery of new techniques, showing that in the Tophet of Carthage the majority of the infants died between one and one and a half months. Sacrifice was thus very probable.

The recent article on the Carthage Tophet infants by Schwartz et al. (2012) takes issue with our paper (Smith et al. 2011) that claims the Carthaginians practiced infant sacrifice. Both studies were carried out on the same sample of cremated infant remains excavated by the ASOR Punic project between 1975 and 1980 (Stager 1982). We examined the contents of 334 urns while Schwartz et al. (2012) examined the same sample plus an additional fourteen urns (N = 348). We differed, however, in our conclusions regarding the age distribution of the infants and the extent to which it supported or refuted claims that Tophet infants were sacrificed. This note explains why we think that Schwartz et al. (2012) erred in their age assessments and introduces additional evidence to show that the age distribution of the Tophet infants supports our contention of infant sacrifice.

Background and Objectives:Heart failure (HF) is a severe obesity-related comorbidity. Many patients with end-stage HF eventually require cardiac transplantation for long-term survival. These patients may be precluded from enrollment in heart transplant programs secondary to morbid obesity. We propose a pathway involving sleeve gastrectomy (SG) for patients with morbid obesity and HF to afford cardiac transplantation eligibility.Methods:Three patients with HF and morbid obesity underwent implantation of a left ventricular assist device (LVAD) and SG at an academic tertiary care institution in Washington, DC. This retrospective review from April 2012 through January 2017 examines the perioperative course of these 3 patients with regard to bariatric and cardiac indices, including ejection fraction (EF), HF classification, comorbid diseases, and percentages of total weight loss (%TWL) and excess weight loss (%EWL).Results:All three patients underwent LVAD placement as a bridge to transplant but were excluded from cardiac transplantation secondary to body mass index (BMI) and were referred for bariatric surgery. All have demonstrated considerable weight loss, with average decrease in BMI of 19 points, 39% TWL, and 81% EWL at a mean of 44 months after SG. Two patients have gone on to receive heart transplants, with near normalization of their EF.Conclusion:LVAD and SG constitute a feasible pathway to cardiac transplantation in morbidly obese patients with end-stage HF. LVAD permits temporary cardiac support, whereas SG assists in efficacious weight loss. We explore SG as a durable weight loss option in patients with HF, with LVAD to improve eligibility for orthotopic cardiac transplantation.

Introduction In the past decade, there has been an increasing amount of published information regarding erectile dysfunction (ED) and heart failure (HF) in economically advanced, westernized populations. However, there is a paucity of data regarding ED and HF in developing countries. The country of Georgia is categorized as a lower-middle-income country (LMIC) with an emerging and developing economy. Aim To examine the prevalence of ED in patients with HF from a developing and LMIC and assess the association with depression. Methods We conducted an observational, cross-sectional study that included male patients 18 years of age or older with an ejection fraction ≤40% by echocardiogram in a heart failure disease management program in Tbilisi, Georgia. The Sexual Health Inventory for Men (SHIM) survey was used to categorize men according to degree of ED. Baseline clinical characteristics known to be associated with ED, such as New York Heart Association functional classification, were also documented. Main Outcome Measures The SHIM survey and the nine-question Patient Health Questionnaire. Results The prevalence of ED was found to be 61.7%. Patients with ED were generally older, had more peripheral vascular disease, and had greater levels of depression than those without ED. Conclusions There is a high prevalence of ED in patients with HF living in Tbilisi, Georgia. In comparison to previously published data on HF populations, our Georgian population showed lesser degrees of ED. More research is needed to better explain the causality for lower prevalence of ED, but explanations may include lower degrees of diabetes and aspects of treatment such as beta-blocker medication. Health care providers in LMICs should screen all of their male HF patients for ED and provide appropriate therapy.

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