Carotid Artery Stent Continued Expansion Days After Deployment, Without Post Stent Deployment Angioplasty.

This is a carotid artery stent (CAS) case report, which avoids post-stent deployment angioplasty (Post-SDA), with duplex confirmed continued stent expansion at 1, 3 and 30-day post deployment. This report confirms that self-expanding nitinol stents in the carotid artery may not require Post-SDA. We believe CAS can be performed without Post-SDA, which helps reduce the occurrence of intraoperative hemodynamic depression

Mortality variability after endovascular versus open abdominal aortic aneurysm repair in a large tertiary vascular center using a Medicare-derived risk prediction model

ObjectivePrevious reports have documented better outcomes after open abdominal aortic aneurysm (AAA) repair in tertiary centers compared with lower-volume hospitals, but outcome variability for endovascular AAA repair (EVAR) vs open AAA repairs in a large tertiary center using a Medicare-derived mortality risk prediction model has not been previously reported. In the current study, we compared the observed vs predicted mortality after EVAR and open AAA repair in a single large tertiary vascular center.MethodsWe retrospectively analyzed all patients who underwent repair of a nonruptured infrarenal AAA in our center from 2003 to 2012. Univariable and multivariable logistic regression were used to evaluate 30-day mortality. Patients were stratified into low-risk, medium-risk, and high-risk groups, and mortality was predicted for each patient based on demographics and comorbidities according to the Medicare risk prediction model.ResultsWe analyzed 297 patients (EVAR, 72%; open AAA repair, 28%; symptomatic, 25%). Most of our patients were of high and moderate risk (48% and 28%, respectively). The observed 30-day mortality was 1.9% after EVAR vs 2.4% after open repair (odds ratio [OR], 0.77; 95% confidence interval [CI], 0.14-4.29; P = .67). There was no difference in mortality with EVAR vs open repair after adjusting for predefined patient characteristics (OR, 0.92; 95% CI, 0.16-7.43; P = .93); only preoperative renal disease was predictive of 30-day mortality after AAA repair in our cohort (OR, 8.39; 95% CI, 1.41-67.0). The observed mortality within our study was significantly lower than the Medicare-derived expected mortality for each treatment group within patients stratified as high risk or medium risk (P ≤ .0002 for all).ConclusionsDespite treating patients with high preoperative risk status, we report a 10-fold decrease in operative mortality for EVAR and open AAA repair in a tertiary vascular center compared with national Medicare-derived predictions. High-risk patients should be considered for aneurysm management in dedicated aortic centers, regardless of approach

Progress toward elimination of malaria in Nigeria: Uptake of artemisinin.based combination therapies for the treatment of malaria in households in Benin City

Background: The Roll Back Malaria (RBM) Partnership converged in Abuja in 2000. In 2005, Nigeria adopted artemisinin.based combination therapies (ACTs) as first.line therapy for uncomplicated malaria. It was determinedthat by 2010, 80% of persons with malaria would be effectively treated.Objectives: To describe household practices for malaria treatment in Benin City; to explore demographic characteristics that may influence use of ACTs.Materials and Methods: Multistage sampling technique was used to select households from each of the three local government areas in Benin City. Adult respondents were interviewed. Household reference persons (HRPs)were defined by International Labour Organization categories. Data were collected between December 2009 and February 2010 and were analyzed using Statistical Package for the Social Sciences Version 16.0, at a significance level of P < 0.05 (2.tailed).Results: Of the 240 households selected, 217 were accessible, and  respondents from 90% of these recalled the most recent episode (s) of malaria. One.third of malaria episodes had occurred in children younger than 5 years. ACTs were used in 4.9% of households;  sulfadoxine.pyrimethamine was the chief non.ACT antimalarial, followed byartemisinin monotherapies. Patent medicine stores were the most common sources of antimalarial medicines (38.2%), followed by private hospitals (20.3%) and private pharmacies (10.6%). Only 8.3% of households got their medicines from government hospitals. Having a HRP in managerial or professional categories was associated with a 6 times higher odds of using ACTs, compared to other occupational categories [odds ratio (OR) 5.8; confidence interval (CI) 1.470.20.758, P = 0.016]. Fathersf tertiary or higher education was significantly associated with ACT use, but notmothersf (OR 0.054, CI 0.006.0.510; P = 0.011 and OR 0.905, CI 0.195.4.198; P = 0.898, respectively).Conclusion: Ten years after the historic Abuja meeting, only 5% of households in Benin City used ACTs for the treatment of malaria, sourcing medicines chiefly from patent medicine stores and private hospitals. Fathersf level of education was significantly associated with ACT use. Interventions to eliminate malaria from Nigeria should mainstream the men folk and health care providers outside government hospitals, in line with the Nigerian reality.Keywords: Artemisinin.based combination therapy, Benin City, households, malari

Letter to EditorPhysician heal thyself

Click on the link to view the letter.Nigerian Journal of Clinical Practice • Oct-Dec 2013 • Vol 16 • Issue

Carotid artery stent continued expansion days after deployment, without post stent deployment angioplasty

This is a carotid artery stent (CAS) case report, which avoids post-stent deployment angioplasty (Post-SDA), with duplex confirmed continued stent expansion at 1, 3 and 30-day post deployment. This report confirms that self-expanding nitinol stents in the carotid artery may not require Post-SDA. We believe CAS can be performed without Post-SDA, which helps reduce the occurrence of intraoperative hemodynamic depression