The document discusses that less obstructive plaques pose a greater risk of coronary occlusion than severely obstructed plaques due to their greater numbers. It also states that the aggregate risk of rupture from many non-significant lesions exceeds that of fewer significant lesions, so a myocardial infarction is more likely to originate from a non-significant lesion. Additionally, it explains that while electron beam tomography (EBT) cannot identify vulnerable plaques directly, it can identify vulnerable patients based on their coronary artery calcium (CAC) scores and percentile ranks, as risk increases with higher scores. EBT is also useful for estimating prognosis and tracking changes in plaque in response to treatment over time.
Response (Nov 2011) by the Neuroinflammation & Multiple Sclerosis Subcommittee of the Association of British Neurologists to NICE Interventional Procedures Programmes (IPG) 420, and reply by NICE (Mar 2012).
Response (Nov 2011) by the Neuroinflammation & Multiple Sclerosis Subcommittee of the Association of British Neurologists to NICE Interventional Procedures Programmes (IPG) 420, and reply by NICE (Mar 2012).
Presentation to Irish Federation of Voluntary Bodies Conference, Maynooth.
We have more to do than public investment can currently support. We have to find ways to do more with more. This calls for deep change.
Presentation to Irish Federation of Voluntary Bodies Conference, Maynooth.
We have more to do than public investment can currently support. We have to find ways to do more with more. This calls for deep change.
Medical imaging practice, diagnosis, symptoms and treatment for Cerebral Cavernous Malformation, written, edited and reviewed by Dr Walif Chbeir. Images can be found on WalifChbeir.net.
Definition of stroke and cerebrovascular disorders and pathophysiology of cerebral infarct and CT imaging overview of acute-subacute and chronic infarcts and penumbra.
causes of cerebral edema , Radiological signs of acute infarct and hemorrhagic infarct and comparison of MRI and CT in the diagnosis of acute infarct
Role of diffusion weighted imaging (DWI) and diffusion perfusion mismatch
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.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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1. Plaque Severity and Coronary Occlusion:Plaque Severity and Coronary Occlusion:
Or, Why Plaque Severity is More Important Than StenosisOr, Why Plaque Severity is More Important Than Stenosis
“…“…the less obstructive plaques gave risk to more occlusionsthe less obstructive plaques gave risk to more occlusions
than did the severely obstructed plaques because ofthan did the severely obstructed plaques because of
their much greater numbertheir much greater number....”....”
Falk, Shah, Fuster: Coronary Plaque DisruptionFalk, Shah, Fuster: Coronary Plaque Disruption
Circulation 1995;92:pg. 658Circulation 1995;92:pg. 658
““Because the aggregate risk of rupture associated with manyBecause the aggregate risk of rupture associated with many
nonsignificant lesions exceeds that of the fewer significantnonsignificant lesions exceeds that of the fewer significant
lesions, a myocardial infarction will more likely originatelesions, a myocardial infarction will more likely originate
from a nonsignificant lesion.”from a nonsignificant lesion.”
Kern, Meier: Evaluation of the Culprit PlaqueKern, Meier: Evaluation of the Culprit Plaque
Circulation 2001;103;3142Circulation 2001;103;3142
2. EBT and Coronary Artery CalciumEBT and Coronary Artery Calcium
No calcification – EBT/CACNo calcification – EBT/CAC
55 year old woman with chest pain55 year old woman with chest pain
? “low density” plaque?? “low density” plaque?
““low density” plaquelow density” plaque
With stenosisWith stenosis
EBAEBA
3. CAC by EBT and Atherosclerotic PlaqueCAC by EBT and Atherosclerotic Plaque
Although not all plaque is visualized by EBCTAlthough not all plaque is visualized by EBCT
and “soft” plaque is currently not measured,and “soft” plaque is currently not measured,
the greater the calcium score,the greater the calcium score,
the greater the plaque burdenthe greater the plaque burden
4. CAC by EBT:CAC by EBT:
““vulnerable” plaque vs “vulnerable” patientvulnerable” plaque vs “vulnerable” patient
““Risk” increases as an individuals CACRisk” increases as an individuals CAC
score and/or percentile rank increasesscore and/or percentile rank increases
Thus, although EBCT and CAC is not ableThus, although EBCT and CAC is not able
to identify the “vulnerable” plaque, it CANto identify the “vulnerable” plaque, it CAN
identifyidentify “the“the vulnerable patient”vulnerable patient”
5. EBT and Coronary Artery CalciumEBT and Coronary Artery Calcium
Estimate Prognosis? YESEstimate Prognosis? YES
but does so based upon estimates ofbut does so based upon estimates of
total coronary atherosclerotic plaque burdentotal coronary atherosclerotic plaque burden
and not on visualization of “hard” vs “soft” plaqueand not on visualization of “hard” vs “soft” plaque
6. EBT and CAC:EBT and CAC:
coronary remodeling and CACcoronary remodeling and CAC
CAC
LM/LAD RCA
43 y/o woman
+FHx
5.5 mm
8 mm
Is this patient
at higher risk
due to coronary
artery remodeling?
7. Annualized Rates of Progression - EBTAnnualized Rates of Progression - EBT
30.2%/year
12%/year
0 10 20 30 40 50 60
Untreated
Treated
n = 792
n = 292
Range 5%-20%
Range 22%-52%
Composite of 9 studies – weighted averageComposite of 9 studies – weighted average
8. EBT is the only non-invasive method visualizingEBT is the only non-invasive method visualizing
the coronary arteries that has been shown tothe coronary arteries that has been shown to
• Track changes in coronary “plaque” in responseTrack changes in coronary “plaque” in response
to lipid lowering medications, andto lipid lowering medications, and
• AndAnd suggest that the magnitude of serial changes cansuggest that the magnitude of serial changes can
potentially be of value to predict the development ofpotentially be of value to predict the development of
acute coronary syndromesacute coronary syndromes
The Search for the Vulnerable Patient
9. MRI
1. Plaque composition
2. ?Contrast?
Inflammatory Markers
1. hs-CRP
2. fibinogen
3. ?
??????
? historical
? other imaging
? lipoproteins
The Search for the Vulnerable Patient
Pieces of the Puzzle
EBCT
1. Calcium [percentile]
2. Calcium – serial changes
3. Remodeling
4. Contrast (soft plaque?)
10. MRI
1. Plaque composition
2. ?Contrast?
Inflammatory Markers
1. hs-CRP
2. fibinogen
3. ?
??????
? historical
? other imaging
? lipoproteins
The Search for the Vulnerable Patient
Pieces of the Puzzle
EBCT
1. Calcium [percentile]
2. Calcium – serial changes
3. Remodeling
4. Contrast (soft plaque?)