Pharmacoeconomic evaluation of optical coherence tomography for imaging in cardiac interventions

Introduction: OCT is a noninvasive, contactless, optical method that uses infrared light to produce images of blood vessel anatomy, tissue microstructure, and stents during cardiac catheterization. Aim: This review aims to present a cost-effectiveness analysis and budget impact analysis of optical coherence tomography for imaging in patients undergoing cardiac catheterization and percutaneous coronary interventions. Methods: An incomplete economic analysis was chosen to evaluate the cost-effectiveness of OCT, in which only direct medical costs were assessed. The time horizon for estimating the costs and health benefi ts of OCT was one year. In addition, a budget impact analysis was conducted. Results: As a result of the incomplete economic analysis of the costs of OCT-guided PCI, it could be seen that the total cost per patient amounted to BGN 4,954.89. These costs include the unit cost of the device (OCT catheters) – BGN 2,000.00 including VAT, and the weighted average cost of the OCT-guided PCI procedure – BGN 2,954.89. Conclusion: The OCT-guided PCI strategy is associated with higher procedural costs but with more favorable clinical benefi ts, making it a cost-effective option for intravascular imaging in the long term

European Respiratory Society International Congress 2017:highlights from the Clinical Assembly

This article contains highlights and a selection of the scientific advances from the European Respiratory Society's Clinical Assembly (Assembly 1 and its six respective groups) that were presented at the 2017 European Respiratory Society International Congress in Milan, Italy. The most relevant topics from each of the groups will be discussed, covering a wide range of areas including clinical problems, rehabilitation and chronic care, thoracic imaging, interventional pulmonology, diffuse and parenchymal lung diseases, and general practice and primary care. In this comprehensive review, the newest research and actual data as well as award-winning abstracts and highlight sessions will be discusse

Global mortality and readmission rates following COPD exacerbation-related hospitalisation: a meta-analysis of 65 945 individual patients

\ua9 2024, European Respiratory Society. All rights reserved.Background Exacerbations of COPD (ECOPD) have a major impact on patients and healthcare systems across the world. Precise estimates of the global burden of ECOPD on mortality and hospital readmission are needed to inform policy makers and aid preventive strategies to mitigate this burden. The aims of the present study were to explore global in-hospital mortality, post-discharge mortality and hospital readmission rates after ECOPD-related hospitalisation using an individual patient data meta-analysis (IPDMA) design. Methods A systematic review was performed identifying studies that reported in-hospital mortality, postdischarge mortality and hospital readmission rates following ECOPD-related hospitalisation. Data analyses were conducted using a one-stage random-effects meta-analysis model. This study was conducted and reported in accordance with the PRISMA-IPD statement. Results Data of 65 945 individual patients with COPD were analysed. The pooled in-hospital mortality rate was 6.2%, pooled 30-, 90- and 365-day post-discharge mortality rates were 1.8%, 5.5% and 10.9%, respectively, and pooled 30-, 90- and 365-day hospital readmission rates were 7.1%, 12.6% and 32.1%, respectively, with noticeable variability between studies and countries. Strongest predictors of mortality and hospital readmission included noninvasive mechanical ventilation and a history of two or more ECOPD-related hospitalisation

Associations of statin use with motor performance and myalgia may be modified by 25-hydroxyvitamin D: findings from a British birth cohort

The objective was to examine whether: (1) statin use was associated with muscle related outcomes at age 60–64, (2) these associations were modifed by 25-hydroxyvitamin D (25(OH)D) status and explained by infammation, body-size or lifestyle in a British birth cohort. Markers of myalgia (intrusive body pain) and myopathy (self-reported and performance-based measures) were examined in 734 men and 822 women (MRC National Survey of Health and Development). Statin use was associated with intrusive body pain, difculty climbing stairs and slower chair rise speed. Some associations were modifed by 25(OH)D e.g. the association with intrusive body pain was evident in the insufcient (13–20ng/l) and defcient(20ng/l (OR=0.8,95% CI 0.5–1.4) (p=0.003 for interaction). Associations were maintained in fully adjusted models of intrusive body pain and difculty climbing stairs, but for chair rise speed they were fully accounted for by infammation, body-size and lifestyle. In a nationally representative British population in early old age, statin use was associated with lower limb muscle-related outcomes, and some were only apparent in those with 25(OH)D status below 20ng/l. Given 25(OH)D is modifable in clinical practice, future studies should consider the links between 25(OH)D status and muscle related outcomes

A Case of a Giant Epiphrenic Esophageal Diverticulum

The esophageal diverticula are divided into pharyngoesophageal, parabronchial and epiphrenic. They could also be divided into congenital and acquired, true and false, pulsion and traction. Pulsion diverticula are usually formed in motor disorders of the esophagus, above the place of hypertension and uncoordinated peristalsis. They are pseudo-diverticula caused by increased intramural pressure, leading to herniation of the mucosa and submucosa through the focal areas of the esophageal wall. We present a 65-year-old woman who underwent left-sided transthoracic diverticulectomy, modified Heller esophagocardiomyotomy, and modified Belsey-Mark IV fundoplication due to a huge epiphrenic esophageal diverticulum

Surgical Treatment of Infective Endocarditis, Complicated with Splenic Abscesses

Infectious endocarditis (IE) represents an inflammation of the heart endothelium usually as a result of bacterial colonization after trauma. Splenic abscess is a rare and dangerous extracardiac manifestation of IE. An expert multidisciplinary collaboration is necessary for the diagnosis and treatment strategy of this high-risk and challenging disease. Valvuloplasty and splenectomy are the mainstay of radical treatment and offer excellent long-term results. We present two cases with infectious endocarditis, complicated with splenic abscesses, which were successfully operated in the Department of Cardiac Surgery

Chronic Obstructive Pulmonary Disease and Hepatitis C

Chronic obstructive pulmonary disease (COPD) is a preventable, treatable disease with significant extrapulmonary manifestations that could affect negatively its course in some patients. Hepatitis C virus infection (HCV), on the other hand, is associated with a number of extrahepatic manifestations. COPD patients have increased prevalence of HCV and patients with HCV, especially older ones, have increased prevalence and faster progression of COPD. HCV infection exerts long-term effects on lung tissue and is an additional risk factor for the development of COPD. The presence of HCV is associated with an accelerated loss of lung function in COPD patients, especially in current smokers. COPD could represent extrahepatic manifestation associated with HCV infection. The aim of this article was to review the literature on prevalence of HCV in COPD and vice versa, pathogenetic link and the consequences of their mutual existence

Prevalence of COPD in Patients with Lung Cancer

Introduction: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, and healthcare costs worldwide. Lung cancer is the second most common cancer and is the leading cause of cancer mortality, accounting for almost 25% of all cancer deaths. This study aims to investigate the prevalence of COPD in patients with lung cancer (LC)

Spontaneous Perforation of a Malignified Corrosive Stricture of the Esophagus and Subsequent Perforation of a Giant Duodenal Stress ULCUS

Surgical interventions for corrosive stricture of the esophagus are extremely difficult and technically challenging. In this manuscript, we present a patient with esophagectomy due to perforation of a corrosive stricture of the esophagus that underwent malignant transformation and subsequent perforation of a giant duodenal stress ulcus, which occurred 12 days after the intervention. We performed a total esophagectomy, pharyngo- and gastrostomy, suture of the duodenal perforation but the postoperative period was challenging and despite our efforts, the patient died on the 50th postoperative day due to respiratory and renal failure