Background: We compared the use of lipid lowering therapy, low density-lipoprotein cholesterol (LDL-C) levels, and proportion achieving guideline-recommended LDL-C levels in patients with private vs. public insurance coverage for their lipid lowering treatment. Materials and Methods: Guidelines Oriented Approach to Lipid lowering (GOAL) Canada enrolled 2009 patients with cardiovascular disease (CVD) or heterozygous familial hypercholesterolemia (FH) and an LDL-C above the guideline-recommended target of <2.0 mmol/L despite maximally tolerated statin therapy. During two follow-up visits physicians received online reminders of treatment recommendations. Results: Of 2009 patients enrolled (median age 63 years, 42% female), there were 1284 (64%) patients with private and 725 (36%) with public insurance for lipid lowering therapy. Patients with private insurance were younger and less likely to have a history of heart failure or to be on bile acid sequestrants. There was no difference between the groups in their lipid levels or lipid lowering therapy at baseline. During the follow up, there was no difference in the use of ezetimibe; however, the use of PCSK9i was more frequent in patients with private insurance (31.7 % vs. 21%, p<0.0001), the mean LDL-C level was slightly lower (2.11±1.17 vs. 2.31±1.17 mmol/L, p = 0.001), and the proportion of patients achieving the guideline-recommended LDL-C level was greater (54% vs. 45.5%, p = 0.001). After adjustment for other factors in a multivariable model, private insurance was not a significant predictor of achieving the guideline-recommended LDL-C level in a multivariable model. Conclusion: While PCSK9i use was higher in patients with private insurance, the majority of patients with either private or public insurance experienced similar treatment inertia. The cost of non-generic medications does not appear to be the dominant reason for the continued care gap in lipid lowering of high-risk patients.

Background: Children with congenital malformations (CM) may have congenital heart diseases (CHDs) which may be initially asymptomatic. These need to be recognised and managed early in order to reduce unnecessary morbidity in affected patients. We report the pattern of CHDs in children with congenital malformations who had echocardiography over a one year period in UDUTH, Sokoto. Materials and Methods: A cross-sectional study carried out in the Paediatric Cardiology Unit from 1st January to 31st December 2019. Children presenting with CM were recruited and had echocardiagraphic screening for CHDs. Data were analysed with SPSS 23 version. Statistical significance was taken at p < 0.05. Results: 81 children were seen with CM, comprising 42 females and 39 males (M:F=0.93:1); age range of 2 days to 13 years. Most frequent malformationswere anorectal malformations (ARM) in 28 (34.6%), Down syndrome in 17 (21.0%), multiple CM 10 (8.1%) and ocular abnormalities in 4 (4.9%). Thirty two (39.5%) of the patients with CM were diagnosed with CHD, out of which 24 (29.6%) had cardiac murmur. Most frequent CHD was atrioventricular septal defect in 9 (28.1%) followed by ventricular septal defect in 8 (25.0%) and patent arterial duct in 4 (12.5%). CHDs were found in all (100%) those with ocular abnormalities, in 76.5% of Down syndrome and in 14.3% of patients with ARM. Presence of murmur was significantly associated with CHD (?2=18.0; p=0.001; OR=8.2; 95% C.1=2.8 – 24.1). Conclusion: Congenital malformations, particularly Down syndrome and ocular abnormalities, are significantly associated with CHDs. Cardiac murmurs were suggestive of CHD in children with congenital malformations.

Background and Aim: We compared 22-year composites of valve-related reoperation, morbidity, and mortality following mitral mechanical and bioprostheses in young rheumatics aged <45years. Methods: Retrospective comparative analysis of valve-related reoperations and survival data were performed from 466 consecutive propensity matched patients undergoing either bioprosthetic MVR (Group I, n=233) or mechanical MVR (Group II, n=233) between 1998 and 2019. Results: The median age was 33 (IQR: 27-40) and 34 (IQR: 28-39) years for Group I and II respectively. The mean follow-up was 3278.9 patient-years in the biological arm and 3384.4 patient-years in mechanical arm. Bioprosthetic arm exhibited lesser cumulative mortality (4.5% vs 9.9%, SMD= -0.04, p=0.65). Hazard regression for mortality included (HR, 95% CI) preoperative congestive heart failure (CHF) 11.44 (8.44, 624.9), p<0.0001; renal failure 19.51 (8.04, 47.35), p<0.0001; previous operation 6.84 (2.48, 18.84), p<0.0001; atrial fibrillation (AF) 7.64 (1.02, 57.13), p=0.006; LA clot 61.94 (8.28, 463.08), p<0.0001; giant LA >65 mm 7.87 (2.62, 23.56), p<0.0001; poor left ventricular (LV) function 0.94 (0.92, 0.97), p<0.0001; and prolonged aortic clamp time 1.07 (1.04, 1.11), p<0.0001). Propensity matching did not exhibit any difference in reoperations between bioprostheses and mechanical prostheses (18.8% vs 13.3%, SMD= -0.152, p=0.1). At a median follow-up of 136 (IQR: 76-197) months, actuarial survival was 90.32%±0.02% (p=0.09) and there was no difference between the groups (p=0.09). Conclusions: Bioprostheses are an acceptable alternative to mechanical prostheses in young rheumatics aged <45 years unwilling for mechanical valve, redo surgeries, life-long anticoagulation, and those desirous of pregnancy.

Coronary artery bypass graft (CABG) has been the first option for revascularization in multiple vessel coronary artery disease. One of the most major obstacles after CABGs is atherosclerotic changes of SVGand more than 50 percent ofSVGare occluded at 10 years and 25 percent show severe stenosis at angiographic follow-up. Whether native vessel percutaneous coronary intervention (PCI) on native vessel or saphenous vein graft intervention is of benefit in these patients is still a debate. In this case report we want to clarify a common clinical scenario in a patient with prior CABG seven years ago which a proper decision in the right time could save many futile efforts. The patient underwent 7 PCI on the diseased SVG on OM with frequent occlusion due to stent thrombosis and in-stent restenosis which finally native vessel antegrade CTO PCI alleviated the problem and patient followed up 2 months after the procedure without any chest pain in his ordinary activities.

Oximetry is a technique that allows the evaluation of oxygen levels in the blood in patients who suffer from a pulmonary disorder or present a respiratory pathology. The main objective of this research is the design of a portable pulse oximeter, which corrects the problems of the oximeter previously developed by the ICID, due to the module used at defined low perfusion levels (modulation index of 0.4% and lower), It had difficulties to synchronize with the patients pulses and for severe low perfusion conditions (signals with a modulation index of 0.2% and less), the module did not operate. With respect to past designs, this project incorporates an oximetry module produced by recognized companies in this field, thus eradicating the deficiencies of the previous models. The components were updated, using, for example, an LCD screen, a DC / DC converter, optocouplers and the MSP430F2618 microcontroller which is very suitable for this design, as it contains sufficient resources in data and program memory. The design of the schematics of each circuit that makes up the oximeter is carried out. As well as the development of firmware programming, based on the graphic design of the algorithms of the main functions of the equipment.