Cost-effectiveness of intervention combinations towards the elimination of vertical transmission of HIV in limited-resource settings: a mathematical modelling study.

BACKGROUND: Since 2000, there has been a substantial global reduction in the vertical transmission of HIV. Despite effective interventions, gaps still remain in progress towards elimination in many low-income and middle-income countries. We developed a mathematical model to determine the most cost-effective combinations of interventions to prevent vertical transmission. METHODS: We developed a 12-month Markov model to follow a cohort of women of childbearing age (aged 15-49 years) in Zambia (n=1 107 255) who were either pregnant, in delivery, or breastfeeding; the population included in the model reflects the estimated number of pregnant women in Zambia from the 2018 Zambia Demographic and Health Survey. The model incorporated nine interventions: infant prophylaxis; three different HIV retesting schedule options; oral pre-exposure prophylaxis; maternal peer-support groups; regimen shift; tracing of loss to follow-up; and point-of-care viral load testing. We analysed incident HIV infections among mothers and infants, intervention costs, and evaluated 190 scenarios of different combinations of inventions to calculate the incremental cost-effectiveness ratios (ICERs) over 1 year. FINDINGS: Three interventions with the greatest reduction in vertical transmission, individually, were support groups for 80% of those in need (35% reduction in infant infections), HIV retesting schedules (6·5% reduction), and infant prophylaxis (4·5% reduction). Of all 190 scenarios evaluated, eight were on the cost-effectiveness frontier (ie, were considered to be cost-effective); all eight included increasing infant prophylaxis, regimen shift, and use of support groups. Excluding the highest-cost scenarios, for a 1-22% increase in total budget, 23-43% of infant infections could be prevented, producing ICERs between US$244 and $16 242. INTERPRETATION: Using the interventions modelled, it is possible to reduce vertical transmission and to cost-effectively prevent up to 1734 infant HIV infections (43% reduction) in Zambia over a period of 1 year. To optimise their effect, these interventions must be scaled with fidelity. Future work is needed to incorporate evidence on additional innovative interventions and HIV risk factors, and to apply the model to other country contexts to support targeted implementation and resource use. FUNDING: The ELMA Foundation.

Evaluation of two different CAD-CAM inlay-onlays in a split-mouth study: 2-year clinical follow-up.

OBJECTIVE: To evaluate the clinical performance of hybrid ceramic inlay-onlay restorations over a 2-year period. CLINICAL CONSIDERATIONS: A total of 30 lithium disilicate glass ceramic (LDC; control group) and 30 hybrid ceramic (HC; test group) inlay/onlay restorations were performed in 14 patients. Clinical evaluations were performed after 1 week, 6 months, 1 year, and 2 years of cementation according to the modified United States Public Health Service (USPHS) criteria, gingival index, and plaque index. The Friedman test was used for the significant difference in time and Wilcoxon signed-rank test was used for the determination of differences. The clinical parameters, gingival and plaque indexes differences in time were analyzed with Chi-square test. No statistically significant difference (P > .05) was found between the two groups in the modified USPHS, gingival index, and plaque index evaluations, whether statistically significant differences were found within groups. The total survival rate was 100% for both groups after 2 years. CONCLUSION: Based on the 2-year data, the tested HC can be considered a reliable material for inlay/onlay restorations. CLINICAL SIGNIFICANCE: The results of this in vivo study suggest that both resin nanoceramic materials and LDC materials have been successfully incorporated in treatments of inlay and onlay restorations. Short-term results showed that resin nanoceramic materials can be counted as a good choice in inlay and onlay restorations in an effort to reduce the treatment time associated with ceramic firing processes.

Aberrant right subclavian artery (arteria lusoria) aneurysm with a Kommerell's diverticulum.

The treatment options for aberrant right subclavian artery vary depending on the presence of Kommerell's diverticulum. Because there is a tendency not to report mortalities of these rare cases in the literature, it is hard to reach a conclusion on treatments from the limited data on post-interventional results in these patients. We report our experience with a 67-year old patient with an aberrant right subclavian aneurysm with Kommerell's diverticulum, diagnosed by chance.

As opções de tratamento para artéria subclávia direita aberrante variam dependendo da presença de divertículo de Kommerell. Como há uma tendência a não relatar mortalidade nos raros casos descritos na literatura, é difícil chegar a uma conclusão sobre tratamentos tendo em vista os dados limitados sobre resultados pós-intervenção nesses pacientes. Relatamos aqui nossa experiência com um paciente de 67 anos de idade com aneurisma de artéria subclávia aberrante direita com divertículo de Kommerell diagnosticado ao acaso.

Aberrant right subclavian artery (arteria lusoria) aneurysm with a Kommerell's diverticulum / Aneurisma de artéria subclávia direita aberrante (artéria lusória) com divertículo de Kommerell

The treatment options for aberrant right subclavian artery vary depending on the presence of Kommerell's diverticulum. Because there is a tendency not to report mortalities of these rare cases in the literature, it is hard to reach a conclusion on treatments from the limited data on post-interventional results in these patients. We report our experience with a 67-year old patient with an aberrant right subclavian aneurysm with Kommerell's diverticulum, diagnosed by chance

As opções de tratamento para artéria subclávia direita aberrante variam dependendo da presença de divertículo de Kommerell. Como há uma tendência a não relatar mortalidade nos raros casos descritos na literatura, é difícil chegar a uma conclusão sobre tratamentos tendo em vista os dados limitados sobre resultados pós-intervenção nesses pacientes. Relatamos aqui nossa experiência com um paciente de 67 anos de idade com aneurisma de artéria subclávia aberrante direita com divertículo de Kommerell diagnosticado ao acaso

Epicardial anthracosis in a patient undergoing coronary artery bypass graft surgery.

Anthracosis is an occupational disease which is caused by long-term inhalation of coal and rock dust. We present a case of epicardial anthracosis in a patient who underwent coronary artery bypass graft surgery for coronary artery disease. This is the first case of anthracosis related to the heart in the literature to the best of our knowledge. This case report emphasizes the systemic dissemination of inorganic particles such as carbon in the human body.

The Influence of Comorbid Conditions on Graft Stenosis in Patients with Coronary Artery Bypass Graft Operation / A influência das condições comórbidas na estenose do enxerto em pacientes com coronariopatia Operação de enxerto de artéria

The primary goal of coronary artery bypass grafting is to achieve complete revascularization with grafts that will remain patent throughout the patient's lifetime. This study investigated the association between bypass graft patency and comorbidity burden determined by Charlson comorbidity index (CCI) among patients with previous bypass operation who underwent a control angiography. One-hundred and two patients who had undergone CABG in the past were included to the study. Critical stenosis was defined as 50% or greater coronary luminal obstruction of any coronary vessel or its lateral branch. Patients were divided into 2 groups group 1; critical graft stenosis; (54 pts; 41M, mean age 66.5 ± 7.8 years), group 2; graft patent (48 pts; 31M, mean age; 65.9 ± 8.2 years). Charlson comorbidity index (CCI) and modified CCI scores were used for detecting comorbidities. The comparison of continuous variables between the control and critical CAD groups was performed by the independent sample test. A p value less than 0.05 was considered statistically significant. The two groups were statistically similar with respect to demographic properties, time since bypass operation, cardiovascular risk factors, systolic blood pressure, heart rate, medications used, complete blood counts parameters, and lipid profiles. CCI was significantly higher in Group 1 compared to Group 2 (7.14 ± 2.02 vs4.72 ± 1.58; p < 0.001). Modified CCI scores were also higher in Group 1 than in Group 2 (6.14 ± 2.02 vs 3.73 ± 1.60; p < 0.001). Graft occlusion was more common among patients with a high comorbidity burden. CCI scoring system may be helpful for determining patients at increased risk at both the preoperative and postoperative periods

Off-pump Coronary Artery Bypass Grafting in Moyamoya Disease: a Case Report.

Moyamoya disease is a rare, idiopathic, progressive, occlusive disease of the internal carotid artery characterized by the development of collateral vasculature in the brain base. In patients with accompanying coronary artery disease, cardiopulmonary bypass posses a potential risk for perioperative cerebral ischemic complication. Herein, we report a 53-year-old male case of Moyamoya disease and coronary artery disease who was treated with off-pump coronary artery bypass grafting.

Off-pump coronary artery bypass grafting in moyamoya disease: a case report

Abstract Moyamoya disease is a rare, idiopathic, progressive, occlusive disease of the internal carotid artery characterized by the development of collateral vasculature in the brain base. In patients with accompanying coronary artery disease, cardiopulmonary bypass posses a potential risk for perioperative cerebral ischemic complication. Herein, we report a 53-year-old male case of Moyamoya disease and coronary artery disease who was treated with off-pump coronary artery bypass grafting.

Bronchopericardial fistula, an unusual complication of oxytetracycline sclerosis therapy.

Here we report a rare case of bronchopericardial fistula following intrapericardial instillation of oxytetracycline. A 63-year-old female patient was admitted for management of malignant pericardial effusion secondary to right-sided bronchogenic carcinoma. Medical therapy and recurrent percutaneous catheter drainage failed in resolving the problem, so subxiphoid pericardiostomy and drainage tube insertion was performed. There was no decrease in the drainage so we decided to perform pericardial sclerosis by intrapericardial tetracycline instillation. After the second time oxytetracycline instillation, the patient developed respiratory arrest with hemodynamic instability. A huge amount of yellow frothy secretion aspirated through the endotracheal tube. The presence of tetracycline in the bronchial secretion was proved by microbiological methods. The hemodynamic status of the patient deteriorated rapidly and despite all resuscitation measures we lost the patient within a few hours.