Comparative effectives of angiotensin-converting enzyme inhibitors and/or angiotensin II receptor blockers added to standard medical therapy for treating patients with stable ischemic heart disease and preserved left ventricular systolic function.
Comparative effectives of angiotensin-converting enzyme inhibitors and/or angiotensin II receptor blockers added to standard medical therapy for treating patients with stable ischemic heart disease and preserved left ventricular systolic function.
In this ppt, I am going to discuss the role of ICD in the patient with Non-ischemic cardiomyopathy. I am going to discuss all the major trials done in the patient with non-ischemic cardiomyopathy.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
In this ppt, I am going to discuss the role of ICD in the patient with Non-ischemic cardiomyopathy. I am going to discuss all the major trials done in the patient with non-ischemic cardiomyopathy.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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1. 여수제일병원
심장내과
이 우 석
2022.12.13 세르비에 심포지엄
Rationale for using perindopril
to hypertensive patients with
cardiovascular diseases
2. Global burden of CVD and Risk
Vaduganathan M, et al. J Am Coll Cardiol 2022;80:2361
Top 3 Modifiable #CV Targets:
1) ↑Blood pressure
2) Dietary risk
3) ↑LDL-C
4. The role of vascular endothelial injury or
dysfunction in cardiovascular disease
Dzau VJ, et al. Circulation 2006;114:2850
5. BP Begets BP!
Framingham Heart Study Original Cohort
Niiranen TJ, et al. JAMA Cardiol 2018;3:427
변곡점, 그 점
핏줄이 바뀐다
자연의 이치, 선택의 문제
“굵고 짧게 vs. 가늘고 길게“
송골매: resting SBP 200mgHg (심부전증)
펭귄: resting SBP 90mmHg
애완조 (앵무새): 심부전증으로 사망
7. Deleterious effects of chronic RAAS activation on
cardiovascular and renal system
Ruiz-Hurtado G, et al. Eur Heart J Cardioavsc Pharmacother 2015;1:126
8. Targets of the Renin-Angiotensin-Aldosterone System
Ferrari R, et al. Expert Rev Cardiovasc Ther 2013;11:705
9. ACEi와 ARB의 차이점
Changes in plasma angiotensin II concentrations in
both the perindopril and telmisartan
Changes in bradykinin plasma concentration in
patients
Lévy BI, et al. Am J Hypertens 2022;25:293
10. Are ACEi and ARBs equivalent
at reducing all-cause and CV mortality
in high-risk patients?
11. 고혈압 약제 처방 변화
Korea Hypertension Fact Sheet 2022
12. Divergent data between ACEi and ARB
Strauss MH, et al. Circulation 2017;135:2088, Strauss MH, et al. Prog Cardiovasc Dis 2016;58:473,
Bangalore S, et al. Mayo Clin Proc 2016;91:51, Savarese G, et al. J Am Coll Cardiol 2013;61:131,
Cheng J, et al. JAMA Intern Med 2014;174:773, Thomopoulos C, et al. J Hypertens 2015;33:195
13. KAMIR(Korean Acute Myocardial Infarction Registry)
ACEi vs. ARB in NSTEMI with DM
Byun JK, et al. Atherosclerosis 2018;277:130
14. ACEi reduced the incidence of revascularization and
MACE in NSTEMI with DM
Byun JK, et al. Atherosclerosis 2018;277:130
15. KAMIR NIH (National Institute Health) registry
ACEi vs. ARB in AMI (n=9,722)
Choi IS, et al. J Cardiovasc Pharmacol Ther 2018 Aug 21;1074248418795897
16. ACEi is provided better long-term survival benefits to
patients with AMI than ARB
Choi IS, et al. J Cardiovasc Pharmacol Ther 2018 Aug 21;1074248418795897
17. National Health Insurance claims data
ACEi vs. ARB in AMI (n=21,747)
Ann SH, et al. Int J Cardiol 2020;306:35
18. National Health Insurance claims data
ACEi provided long-term survival benefits to patients with AMI
Ann SH, et al. Int J Cardiol 2020;306:35
19. ARNI vs. ACEi in AMI patients
Jering KS, et al. Eur J Heart Fail 2021;23:1040, Gatto L. Eur Heart J Suppl 2021;23(Suppl E):E87
There were no significant differences between
the two groups even with regard to cardiovascular deaths
[sacubitril/valsartan 5.9% vs. ramipril 6.7%; HR 0.87 (0.71–1.08), P= 0.20]
and new hospitalizations for heart failure [sacubitril/valsartan 6.0% vs. ramipril
6.9%; HR 0.87 (0.70–1.06), P=0.17]2.
20. ACEi vs. ARB on New-onset DM
Shin J, et al. J Clin Pharm Ther 2021;47:97
Without Statin With Statin
21. Position of ACEi and ARB in guidelines of
hypertension, CAD and HF
22. Treatment Strategy for Uncomplicated Hypertension
ESC/ESH Guidelines 2018
The core algorithm is also appropriate for most patients with HMOD, cerebrovascular disease, diabetes, or PAD.
CCB = calcium channel blocker; ESC = European Society of Cardiology; ESH = European Society of Hypertension; HMOD = hypertension-mediated organ damage; MI = myocardial infarction; PAD = peripheral artery disease.
Williams B, et al. J Hypertens 2018;36:2284
23. ACEi vs. ARB in Hypertension
Van Vark LC, et al. Eur Heart J 2012;33:2088
Study selection:
- Prospective, randomized, controlled morbidity-
mortality trials that compared active treatment
(ACEi or ARB) with control, published between
Jan 2000 and Mar 2011.
- Trials including a large majority of hypertensive
patients (>66.7% of studied population, according
to the definition used in these trials).
- Selected total 20 randomized trials (n=158,998)
- 7 ACEi trials (n=76,615)
- 13 ARB trials (n=82,383)
24. Different Effect of ACEi on All-cause Mortality
Van Vark LC, et al. Eur Heart J 2012;33:2088
ACE
Inhibitor
ARB
perindopril
Mortality reduction
10%
(P=0.004)
Mortality reduction
N-S
28. ACEi is the choice of first line
McDoangh TA, et al. Eur Heart J 2021;42:3599
29. 여러 가이드라인에서 고혈압이 동반된 경우
ACE 억제제를 우선 치료제로 권고
Williams B, et al. J Hypertens 2018;36:2284, Cosentino F, et al. Eur Heart J. 2020;41:255, Knuuti J, et al. Eur
Heart J. 2020;41:407, Inabez B, et al. Eur Heart J 2018;39:119, McDonagh TA, et al. Eur Heart J 2021;42:3599
31. Perindopril
Perindopril is highly lipophilic and has strong
tissue enzyme-binding capabilities.
Lipophilic ACE inhibitor probably leads to
regression of atherosclerotic plaque thanks to
tissue ACE inhibition.
Ferrari R, et al. Am J Hypertens 2005;18:142S, Veltmar A, et al. Am J Hypertens 1991;4:263S,
Unger T, et al. J Cardiovasc Pharmacol 1986;8:276, Candido R, et al. Circulation 2002;106:246
34. Presumed differences in mechanisms of
action of ACEi & ARB
De´zsi CA, et al. Am J Cardiovasc Drugs 2016;16:399
35. 24 hrs Therapeutic Coverage with Perindopril
Flack JM, et al. Vasc Health Risk Manag 2011;7:777
Perindopril:
High Trough-to-Peak ratio
36. 24 hrs BP lowering efficacy
Nedogoda SV, et al. Clin Drug Investig 2013;33:553
37. Superior BP control of perindopril
Tsoukas G, et al. Am J Cardiovasc Drugs 2011;11:45, Telejko E. Curr Med Res Opin 2007;23:953
38. ADVANCE trial: Efficacy of perindopril on
macro/microvascular outcomes in patients with type 2 DM
Patel A, et al. Lancet 2007;370:829
39. Effect of Perindopril in Type 2 DM with Hypertension
Patel A, et al. Lancet 2007;370:829
40. Perindopril significantly reduced cardiovascular and renal
outcomes in patients with type 2 DM with hypertension
Patel A, et al. Lancet 2007;370:829
45. Perindopril significantly reduced MI risks in
revascularized patients
EUROPA연구의 하위분석
• 대 상 : 전체 CAD환자 12,218명 중, 심근경색 기왕력과는 관계 없이 혈관재생술을 받은 6,709명 환자
• 시험기간 : 평균 4.2년
• 시험약물 : 표준치료+Perindopril 8mg vs. 표준치료+Placebo
• Primary endpoint : Composite of cardiovascular mortality / non-fatal MI / Cardiac arrests
*Results from the revascularized patients without previous MI(n=3047)
52. Cough and ACEi: Practical Evidence
Cough is a very common symptom
• Can be elicited by many different conditions not directly involving the lung
Before definitely discontinuing treatment with an ACEi
• Any patient complaining of cough should undergo a challenge and rechallenge period
to verify whether the onset of cough is concurrent with the treatment schedule
Cardioprotective effect of ACEi
• Discontinuation of ACEi can have a negative impact on clinical outcomes in patients
with CVD
Borghi C, et al. Clin Pharmacol Ther 2019;105:550
53. Summary
ACE 억제제는 이론적으로 ARB에 비해 약리적으로 이득이 있는 약제이나 부작용의 우려
로 ARB에 비해 덜 사용된다.
ACE 억제제는 고혈압, high risk 동반 환자의 심혈관 사고 위험과 사망의 위험 감소를 입
증
고혈압, 심근경색, CAD, 심부전 가이드라인에서 ACE 억제제를 우선 치료제로 권고
Perindopril은 고혈압 및 당뇨병 동반 환자에서 사망의 위험 감소를 입증했으며, CAD 환
자의 심근경색, 심부전 입원 위험을 낮춤
Strauss MH, et al. Circulation 2017;135:2088, Strauss MH, et al. Prog Cardiovasc Dis 2016;58:473, Byun JK, et al.
Atherosclerosis 2018;277:130, Choi IS, et al. J Cardiovasc Pharmacol Ther 2018:074248418795897, Ann SH, et al.
Int J Cardiol 2019;306:35, Cosentino F, et al. Eur Heart J 2020;41:255, Knuuti J, et al. Eur Heart J 2020;41:407,
Inabez B, et al. Eur Heart J 2018;39:119, Roffi M et al. Eur Heart J 2016;37:267, McDonagh TA, et al. Eur Heart J
2021;42:3599, Patel A, et al; ADVANCE Collaborative Group. Lancet. 2007;370:829, Zoungas S, et al; ADVANCE-
ON Collaborative Group. N Engl J Med. 2014;;371:1392, Fox KM, et al; EUROPA Investigators. Lancet 2003;362:782