Willingness to pay for a quality-adjusted life year: a systematic review with meta-regression

The European Journal of Health Economics - The use of a threshold for cost-utility studies is of major importance to health authorities for making the best allocation decisions for limited...     

A 25-year experience with Carpentier-Edwards Perimount in the mitral position

Data of 401 patients who underwent mitral valve replacement with the Carpentier-Edwards Perimount bioprosthesis between 1984 and 2009 were evaluated. Their mean age was 68.1 ± 10.4 years (range, 22-90 years) and 54.9% were female. The most common etiology was degenerative disease (33.2%) and 62.1% of patients had mitral insufficiency. Follow-up was 3,178 patient-years, and 96.8% complete; the mean follow-up was 8.9 ± 3.1 years. Overall survival at 25 years was 10.2% ± 3%. Late mortality was 2.48% per patient-year, and valve-related deaths occurred at 1.62% per patient-year. The actuarial freedom from reoperation due to structural valve deterioration at 20 years was 24.3% ± 2% for degenerative disease and 15% ± 1.4% for non-degenerative disease. For degenerative valve disease, the freedom from structural valve deterioration at 18-years was 39% ± 1% for recipients <60-years old and 66% ± 2% for those ≥60-years old. Our data confirm the excellent durability and low mortality associated with the Carpentier-Edwards Perimount for mitral valve replacement. The rate of calcification of the valve was unrelated to degenerative valve disease, but our findings suggest that this prosthesis gives better results in recipients ≥60-years old than in younger patients.     

Hybrid intra-operative pulmonary artery stenting in congenital heart disease

Objective

Percutaneous branch Pulmonary Artery (PA) stenting can be challenging, especially when associated with stenosis of the Right Ventricular Outflow Tract (RVOT), after previous angioplasty or with complexity of PAs branches. Surgical patch enlargement of Pas alone can be disappointing in these situations. A hybrid-approach, with PA stenting during surgery, may be an alternative to optimize surgical management in complex pulmonary artery stenosis.

Methods

In a 2 year period, 14 consecutive patients with PA stenosis associated with congenital heart disease underwent intraoperative PA stenting. We retrospectively analyzed clinical data, procedural details and outcomes of all patients.

Results

14 patients (1 female), underwent hybrid stenting of the PA. The median age was 6.9 years (range 6 days to 28 years). Primary cardiac diagnoses were pulmonary atresia (n?=?7), tetralogy of Fallot (n?=?5) and other (n?=?2). The left PA was stented in 4 patients, the right in 1 patient and both in 8 patients, for a total of 21 stents. The median maximal balloon diameter was 12 mm (range 6 to 25 mm). Concomitant surgical procedures were RVOT reconstruction with PA patch angioplasty (n?=?8), pulmonary valve replacement (n?=?3) and other (n?=?3). Active suture fixation of the proximal stent was performed in each case. No complications occurred during stent implantation, and no significant cardiac complications occurred perioperatively. The median length of stay in the intensive care unit was 2 days (range 2 to 7 days). The mean follow-up was 9.8 months (range 1 to 19 months). Echocardiography at discharge showed good results in PA branches: the mean peak gradient was 3.8 mmHg (range 0 to 14 mmHg). Most patients showed significant fall in right ventricular systolic pressure after the procedure. No stent needed repeat dilatation.

Conclusion

Hybrid PA stenting during surgery for congenital heart disease in cases of complex branch PA stenosis is an alternative to traditional angioplasty. The procedure is safe and effective, and ameliorates right-ventricular dysfunction.

     

Effects of a caffeine-free Cola nitida nuts extract on elastase/alpha-1-proteinase inhibitor balance

In an infection, polymorphonuclear neutrophils (PMN) become activated and they produce oxidizing compounds and elastase in the extracellular medium. Alpha-1-proteinase inhibitor (alpha1PI), a protease inhibitor which is inactivated by oxidants, is the main endogenous inhibitor of elastase helping to limit excessive elastase activity. This study evaluates the ability of a plant extract, Cola nitida nuts, to protect alpha1PI from inactivation by oxidizing compounds as reactive oxygen species. On the one hand, we have evaluated the direct effect of cola nut extract on neutrophil elastase, and on the H(2)O(2) and myeloperoxidase (MPO)-H(2)O(2) system via cell-free systems. Results showed that cola nut extract scavenges H(2)O(2) and therefore protects alpha1PI from HOCl which is produced from the MPO-H(2)O(2) system. Experiments also showed that cola extract has the capacity to limit elastase activity. On the other hand, we have worked on cellular systems including isolated PMN with the aim to study the effect of cola extract on PMN metabolism. PMN were stimulated with PMA, calcium ionophore or fMLP. Each stimulant possesses its own stimulation pathway. According to the inhibitory concentration obtained at 50%, the results on cellular systems led to the conclusion that cola extract can reduce elastase liberation from PMN. It can then be concluded that cola nut extract can protect alpha1PI from inactivation, and has an effect both on elastase liberation and elastase activity. The cola nut extract effect is rather biased towards a reduction in elastase release, thus limiting the injurious effects caused by this enzyme.     

Re‐emergence of genotype I of African swine fever virus in Ivory Coast

In July 2014, an outbreak of severe haemorrhagic disease in a domestic pig population, was reported in San‐Pedro, the second seaport city of Ivory Coast. Animals of all age groups developed clinical signs consistent with African swine fever (ASF). Tissue and serum samples from dead pigs were sent to the laboratory for diagnostic confirmation and molecular characterization based on the partial B646L (p72), the full E183L (p54) gene and the central variable region of the B602L gene. The PCR results confirmed the outbreak of ASF. Phylogenetic analyses based on p72 and p54 sequences showed that the San‐Pedro 2014 outbreak virus strain belongs to p72 genotype I. The Analysis of the tetrameric amino acid repeat regions of the B602L gene showed two repeat signatures which differ by an extra A = CAST in the second signature. The ASFV sequence of the San‐Pedro 2014 outbreak strain is closely related to historical and recent ASFV strains collected in Angola and Cameroon whose ships have repeatedly visited the seaport of San‐Pedro from March to June 2014. The 2014 viruses are distinct from the strains involved in the previous ASF wave in 1996 in Ivory Coast.     

Prophylaxie antirétrovirale après expositions non professionnelles au VIH à Abidjan (Cote d’Ivoire)

Objective

The aim of this study was to assess the tolerability and adherence to all non-occupational post-exposure prophylaxis (PEP) for cases of HIV exposure in Abidjan.

Method

We retrospectively studied all post-exposure prophylaxis for non-occupational exposures to HIV prescribed from January 1st, 2000 to December 31st, 2007 in the Abidjan infectious diseases department. We analyzed the types of exposure, socio-demographic characteristics of patients, antiretroviral therapy regimens, adherence and tolerability, duration of the treatment, and post-exposure follow-up.

Results

Over these eight years, we managed 128 consultations for non-professional exposures to HIV (50 male [39 %], 78 female patients [61 %]), average age 24.8 years (four–54 years). The most frequent exposures were due to rape (n = 74), condom rupture (n = 29), and occasional unprotected sex (n = 21). The average delay before consultation was 20.8 hours. The antiretroviral chemoprophylaxis included a protease inhibitor in 93 % of the cases; 80.5 % of patients completed 28 days of chemoprophylaxis, while 8.6 % interrupted the treatment, and 10.9 % were lost to follow-up. The most frequent adverse effects were gastrointestinal, reported by 79 patients (61.7 %). Only 34 patients (26.6 %) returned for clinical and biological post-exposure follow-up with HIV control at third month, without documented seroconversion.

Conclusion

Cases of sexual exposure to HIV are the main indication for post-exposure prophylaxis in Abidjan, except for occupational exposure to blood. However, post-exposure prophylaxis should be available in the units of primary care, such as emergencies departments.