There is association between uncontrolled hypertension and depression that is independent of sociodemographic factors, comorbids and history of hospitalization.
Objectives
Determine the outcomes of polytetrafluoroethylene (PTFE) covered stents for coronary artery perforation (CAP) and coronary artery aneurysm (CAA).
Background
PTFE covered stents have been used for treatment of potentially life‐threatening CAP and CAA. The short and long‐term outcomes of the PTFE covered stent for CAP and CAA have not been well studied.
Methods
We performed a retrospective study of PTFE covered stents that were placed in the patients from 2003 to 2017. Short term outcomes included in‐hospital mortality, pericardial effusion, cardiac tamponade, and length of stay. Long‐term outcomes included target lesion revascularization (TLR), in‐stent restenosis (ISR), and long‐term mortality.
Results
Fifty‐three PTFE covered stents were placed in 32 patients of which there were 24 patients with a CAP with a mean age of 75 ± 8 years. Two patients died in‐hospital, with no additional deaths at 30 days. The rate of ISR was 25%, with estimated rates of TLR of 2.6% (3 years) and 17.8% (5 years). The median survival was 55.6 months, with survival at 10 years estimated to be 30.9%. Eight patients received a PTFE covered stent for CAA with a mean age of 59 ± 15 years with no in‐hospital or 30‐day mortality. Median follow‐up of 49 months showed no evidence of TLR. The all‐cause mortality was 12% at 1 year and 38% at 3 years.
Conclusions
PTFE covered stents is an effective option in patients with CAP and CAA. The long‐term outcomes may be related to the pathology of the disease rather than the stent itself.
Community violence among the youth can lead to a number of adverse psychiatric outcomes including post-traumatic stress disorder (PTSD). However, little research has been conducted in non-Western countries to assess this problem. This study aims to fill the void by assessing the lifetime exposure to traumatic events and burden of probable PTSD among university students in Karachi, Pakistan. A cross-sectional study was conducted at four private institutions in Karachi. Self-administered questionnaires were filled out by 320 students. Lifetime exposure and symptoms of PTSD were assessed using modified Composite International Diagnostic Interview (CIDI) and Post-Traumatic Stress Disorder Checklist-Civilian Version (PCL-C) questionnaires, respectively. A PCL-C score of 44 or above was used as cutoff for probable PTSD. Pearson chi-square test was used to assess the association between PTSD and different variables at a level of significance of 5%. Ninety-three percent of the respondents reported having lifetime exposure to at least one traumatic event with sudden unexpected death of a loved one (n = 187) and assaultive violence (n = 169) being the commonest reported traumatic events. Positive association for PTSD was seen with enduring physical attacks and motor vehicle accidents. Over a quarter of the students screened positive for probable PTSD, among them almost one third were male and 17% were female. Our results indicate a high exposure to violent events and elevated rates of lifetime PTSD among urban youth. Reduction in violence and better access to mental health facilities is warranted to decrease the health burden of PTSD in Pakistan.
Background: Antiplatelet therapy with aspirin and a thienopyridine is the standard of care for prevention of thrombosis following coronary stent implantation. Recent evidence suggests a prolonged risk of stent thrombosis; therefore, clopidogrel therapy for at least 1 year is recommended following implantation of a drug-eluting stent. Premature discontinuation of clopidogrel is a well-recognized risk factor for stent thrombosis. Objective: To identify the rate of adherence to clopidogrel therapy among patients who have undergone percutaneous coronary intervention (PCI). Methods: We queried the central Veteran Affairs (VA) pharmacy database for each patient who underwent PCI with a drug-eluting stent between September 2004 and August 2005 at a single VA medical center. Based on pharmacy refill records, patients were considered adherent to clopidogrel if they filled more than 80% of the clopidogrel prescriptions. Results: We observed that 20.3% of patients were nonadherent to clopidogrel therapy for the course that they were assigned. Shorter duration of therapy was the only factor that predicted increased adherence. Race, polypharmacy, marital status, prior clopidogrel use, and age did not have a significant impact on adherence. Multivariable analysis did not demonstrate any other significant relationships. Conclusions: In this high-risk cohort of patients who have undergone PCI, we observed a 20% incidence of nonadherence to clopidogrel therapy. Shorter duration of therapy had a significant impact on improving rates of adherence in our analysis. This observation is of particular concern given the recent recommendations to prolong antiplatelet therapy to at least 1 year following PCI with a drug-eluting stent.
A 46-year-old woman underwent pericardiocentesis and pericardial window
for recurrent pericardial effusion. She presented 17 months later with
signs and symptoms consistent with constrictive pericarditis. Cardiac
magnetic resonance imaging revealed an infiltrative mass surrounding the
pericardium. A transcutaneous core needle biopsy of the pericardium
confirmed the diagnosis of pericardial mesothelioma.
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