TAVI pilot outcomes: A South African healthcare funder perspective

BACKGROUND: TAVI (Transcatheter aortic valve implantation) is used to replace the aortic valve in the treatment of aortic stenosis in high-risk, elderly patients who are unable to undergo conventional surgical replacement of the aortic valve (SAVR). However, concerns remain regarding the costs, long-term outcomes and safety of the device. A registry was developed by a healthcare funder to assess utilisation, outcomes and cost of this procedure in their patient population. METHODS: Registry data was collected for a period of 17 months. Clinical entry criteria included high-risk, elderly patients with symptomatic, severe aortic valvedisease who were unsuitable for surgical valve replacement. Clinical outcomes were mortality, readmission and pacemaker requirements post-surgery. Primary outcome measure was all-cause mortality at 30 days.RESULTS: A cohort of 78 patients was enrolled, mean age of 79.53 years. Procedures were performed in 7 centers around the country. Thirty day all-cause mortality was 9 (11.54%) with 5 deaths occurring on the day of the procedure. Eighteen (23.1%) patients were readmitted within 30 days. Average LOS was 5.71 (±4.06SD) days with an average cost of ZAR327 962 per patient. CONCLUSION: Results suggest outcomes are similar toother settings and countries. Ongoing data collection is required to better understand long-term outcomes and costs

The Cauchy problem for the 3-D Vlasov-Poisson system with point charges

In this paper we establish global existence and uniqueness of the solution to the three-dimensional Vlasov-Poisson system in presence of point charges in case of repulsive interaction. The present analysis extends an analogeous two-dimensional result by Caprino and Marchioro [On the plasma-charge model, to appear in Kinetic and Related Models (2010)].Comment: 28 page

Quality of life of patients living with psoriasis: a qualitative study

Background: Psoriasis is a multifactorial inflammatory disease prevalent in dermatology. We aimed to understand the perceptions of patients living with psoriasis in relation to their quality of life and to identify aspects to improve it. Methods: This is qualitative research carried out in a dermatology outpatient clinic of the São Paulo State University (UNESP) medical school, Botucatu, Brazil, with 81 psoriasis patients. The interviews were transcribed and analysed using the Discourse of the Collective Subject method (DCS). Results: Quality of life was linked to well-being, happiness, leisure, good food and financial stability. However, disease symptoms, social and clothing restrictions, impairment of professional activities and the absence of a cure, negatively influenced their perceptions. Suggestions for improvements included an increase of public awareness, stress reduction, disease acceptance and multidisciplinary care. Conclusion: The meanings of quality of life revealed by the participants are subjective, multidimensional, linked to moments experienced by them and to the health-disease process. Public health policies promoting reduction in social stigma and stress as well as multidisciplinary approaches towards care can contribute to improvements of QoL in psoriasi

Psychometric characteristics of DLQI-BRA and Skindex-16 to measure the impact of dermatological diseases on quality of life in Brazilian patients

OBJECTIVE: To compare the psychometric performance of the Dermatology Life Quality Index (DLQI-BRA) and Skindex-16 to assess quality of life (QoL) in Brazilian patients with dermatological diseases. METHODS: This was a cross-sectional study carried out in a dermatology outpatient clinic of the São Paulo State University, with 188 patients with dermatological diseases. QoL was evaluated using the Dermatology Life Quality Index (DLQI-BRA) and Skindex-16. Cronbach’s alpha and Intraclass Correlation for Perfect Concordance (ICC) were used to analyse the reliability and temporal stability, respectively. RESULTS: A positive correlation was found between the total Skindex-16 score and DLQI-BRA (0.75). Both instruments showed a significant (p0,7), but Skindex-16 displayed the highest Cronbach alpha (0.94; CI = 0.93–0.95). CONCLUSION: Both instruments tested showed a good psychometric performance assessing QoL in patients with skin dermatoses. The instruments displayed reliability and temporal stability as well as responsiveness

Cell block sensitivity for immunohistochemical detection of cytokeratin 5, oestrogen and progesterone receptors in canine primary mammary carcinoma

Mammary carcinomas are relatively common ailments among female canines aged around 10 years old, presentingan important morbidity with an average survival of five years. The cytoinclusion technique is frequently employed in human medicine as the investigative method of choice as it quickly provides resources for the determination of the correct therapeutic response, however, the effectiveness of the technique in canines remains understudied in veterinary medicine. This study aims at evaluating the degree of correlation with immunohistochemical marking for cytokeratin 5 (CK5), oestrogen and progesterone receptors (ER and PR) between the cytoinclusion and the histopathology technique in mammary carcinomas. Twenty-five samples of mammary carcinoma, both for the cytoinclusion and histopathological techniques were submitted for histological processing; microscope slides were created for hematoxylin-eosin (HE) staining and the immunohistochemical technique (IHC) was assessed for the ER, PR and CK5 receptors. Through the HE staining, we reached a concordance rate of 100% between the cytoinclusion and the histopathological analysis in the diagnosis of carcinomas. The immunohistochemical assay presented sensitivity of 85.71%, 95.45% and 100% and Cohen’s kappa of 0.78, 0.84 and 0.95 for ER, PR and CK5, respectively, as well as 100% specificity and P<0.01 for all three markers. Therefore, cytoinclusion represents an accessible, fast and low-cost method, offering high sensitivity for the cytomorphological and immunohistochemical diagnosis of mammary carcinoma in female canines

Cryosurgery with liquid nitrogen versus trichloroacetic acid in the treatment of human papillomavirus (HPV) penile wart: a randomized controlled trial

Background: Anogenital warts are the most prevalent sexually transmitted infection (0.5%) among dermatological consultations. Cryotherapy with liquid nitrogen (LN) and therapy with trichloroacetic acid (TCA) are remarkable among the treatment strategies. Objective: To evaluate the effectiveness of LN versus TCA in to treat penile warts in patients from a Brazilian public institution. Methods: Open, parallel, randomized clinical trial. Following randomization, the warts were counted and submitted to cryotherapy (10s) or case therapy (TCA 80%) in each visit. The primary dependent variable was the lesion count before and after four weeks of treatment. We assessed the following variables: complete clearance, age, immunosuppression, smoking, topography, and education. Results: 142 treatments were evaluated in 52 participants. There was a predominance of young adults, and the main topography affected was the penis shaft. The mean reduction rate per session was 48% for LN and 26% forTCA (p=0.11). 42 (81%) participants achieved complete clearance, with 39 (75%; 95% CI: 64-85%) reaching clearance in up to three sessions. Age was associated with a worse therapeutic response rate (β =-0.09; p<0.01). Conclusions: LN and TCA proved to be effective to treat penile warts, without difference between treatments. Age was associated with a worse therapeutic response