- A 54-year-old man presented to a non-PCI hospital with chest pain and was found to have an ST-elevation myocardial infarction (STEMI) involving the inferior wall and right ventricular myocardial infarction.
- The nearest catheterization laboratory was 30 minutes away. The patient suffered a ventricular fibrillation cardiac arrest and received CPR and defibrillation.
- The patient was transferred for primary percutaneous coronary intervention (PPCI). Angiography showed 100% occlusion of the proximal right coronary artery, which was treated with balloon angioplasty, stent placement, and achieved TIMI III flow, resulting in successful reperfusion.
1) Acromegaly is caused by excess growth hormone production, usually from a pituitary tumor. The goals of treatment are to control symptoms, suppress hormone levels, decrease tumor size, and preserve normal pituitary function.
2) Surgical removal of the tumor via transsphenoidal surgery often results in remission, with higher rates for microadenomas versus macroadenomas. Pre-operative factors like tumor size and invasiveness affect outcomes.
3) Medical therapies like somatostatin analogs and GH receptor antagonists can help control hormone levels and symptoms in cases where surgery is not effective or possible. These medications provide alternatives or adjuncts to surgery in treating acromegaly.
The SPARTAN Study: A Pilot Study to Assess the Safety and Efficacy of an Investigational NRTI- and RTV-Sparing Regimen of Atazanavir (ATV) Experimental Dose of 300mg BID plus Raltegravir (RAL) 400mg BID (ATV+RAL) in Treatment-Naïve HIV-Infected Subjects.
CorMedix Inc. (AMEX:CRMD) is a pharmaceutical company that seeks to in-license, develop and commercialize therapeutic products for the treatment of cardiac and kidney (cardiorenal) disease.
This document discusses management and treatment options for basal cell carcinoma (BCC). It summarizes several studies on photodynamic therapy (PDT) using methyl aminolevulinate (MAL-PDT) and its long-term outcomes and recurrence rates for different types of BCC compared to other treatments like surgery and cryotherapy. It also discusses the use of imiquimod cream and fluorouracil for treating BCC, as well as cryotherapy and oral agents currently in development for advanced BCC cases. The document concludes that having a choice of topical therapies is beneficial but they have non-specific modes of action, while pathway inhibitors taken orally show promise but have limiting side effect profiles.
The RESOLUTE International study evaluated the Resolute stent in a large "real-world" patient population across multiple centers internationally. It found that use of the Resolute stent was associated with a low rate of major cardiac events such as death, heart attack and stent thrombosis, consistent with results from the RESOLUTE All Comers trial. The study enrolled over 2,300 patients across various countries and baseline characteristics and outcomes were similar between monitored and unmonitored patients, supporting the generalizability of prior RESOLUTE trial results.
07 state of the art of the management of advanced and recurrent ovarian cancerONCOcare
1) The document discusses platinum-based chemotherapy for ovarian cancer, which has a high response rate but most patients eventually relapse.
2) Two large randomized trials (GOG-0218 and ICON-7) found that adding bevacizumab to first-line platinum-based chemotherapy improved progression-free survival compared to chemotherapy alone in patients with advanced ovarian cancer.
3) For platinum-sensitive recurrent ovarian cancer, platinum-based chemotherapy regimens including carboplatin or cisplatin with paclitaxel are commonly used based on evidence from trials like ICON-4 that they provide a similar overall survival benefit.
1) The study examined outcomes in patients with heart failure who were at high risk, finding that at 6 months their risk was approximately 3.8 times higher.
2) Baseline characteristics were similar between the eplerenone and placebo groups, including average age of 64, 72% males, mean ejection fraction of 33%, and 32% with diabetes.
3) For the primary endpoints of total mortality and cardiovascular mortality or hospitalization, eplerenone demonstrated a 15% and 13% reduced risk respectively compared to placebo.
1) Acromegaly is caused by excess growth hormone production, usually from a pituitary tumor. The goals of treatment are to control symptoms, suppress hormone levels, decrease tumor size, and preserve normal pituitary function.
2) Surgical removal of the tumor via transsphenoidal surgery often results in remission, with higher rates for microadenomas versus macroadenomas. Pre-operative factors like tumor size and invasiveness affect outcomes.
3) Medical therapies like somatostatin analogs and GH receptor antagonists can help control hormone levels and symptoms in cases where surgery is not effective or possible. These medications provide alternatives or adjuncts to surgery in treating acromegaly.
The SPARTAN Study: A Pilot Study to Assess the Safety and Efficacy of an Investigational NRTI- and RTV-Sparing Regimen of Atazanavir (ATV) Experimental Dose of 300mg BID plus Raltegravir (RAL) 400mg BID (ATV+RAL) in Treatment-Naïve HIV-Infected Subjects.
CorMedix Inc. (AMEX:CRMD) is a pharmaceutical company that seeks to in-license, develop and commercialize therapeutic products for the treatment of cardiac and kidney (cardiorenal) disease.
This document discusses management and treatment options for basal cell carcinoma (BCC). It summarizes several studies on photodynamic therapy (PDT) using methyl aminolevulinate (MAL-PDT) and its long-term outcomes and recurrence rates for different types of BCC compared to other treatments like surgery and cryotherapy. It also discusses the use of imiquimod cream and fluorouracil for treating BCC, as well as cryotherapy and oral agents currently in development for advanced BCC cases. The document concludes that having a choice of topical therapies is beneficial but they have non-specific modes of action, while pathway inhibitors taken orally show promise but have limiting side effect profiles.
The RESOLUTE International study evaluated the Resolute stent in a large "real-world" patient population across multiple centers internationally. It found that use of the Resolute stent was associated with a low rate of major cardiac events such as death, heart attack and stent thrombosis, consistent with results from the RESOLUTE All Comers trial. The study enrolled over 2,300 patients across various countries and baseline characteristics and outcomes were similar between monitored and unmonitored patients, supporting the generalizability of prior RESOLUTE trial results.
07 state of the art of the management of advanced and recurrent ovarian cancerONCOcare
1) The document discusses platinum-based chemotherapy for ovarian cancer, which has a high response rate but most patients eventually relapse.
2) Two large randomized trials (GOG-0218 and ICON-7) found that adding bevacizumab to first-line platinum-based chemotherapy improved progression-free survival compared to chemotherapy alone in patients with advanced ovarian cancer.
3) For platinum-sensitive recurrent ovarian cancer, platinum-based chemotherapy regimens including carboplatin or cisplatin with paclitaxel are commonly used based on evidence from trials like ICON-4 that they provide a similar overall survival benefit.
1) The study examined outcomes in patients with heart failure who were at high risk, finding that at 6 months their risk was approximately 3.8 times higher.
2) Baseline characteristics were similar between the eplerenone and placebo groups, including average age of 64, 72% males, mean ejection fraction of 33%, and 32% with diabetes.
3) For the primary endpoints of total mortality and cardiovascular mortality or hospitalization, eplerenone demonstrated a 15% and 13% reduced risk respectively compared to placebo.
This document discusses acute coronary syndrome and myocardial infarction (heart attack). Key points include:
- Chest pain is a common symptom of a myocardial infarction which occurs when blood flow to the heart is blocked.
- Diagnosis involves electrocardiograms, cardiac enzyme blood tests, and imaging like echocardiograms.
- Treatments depend on whether the infarction is STEMI (with ST elevation) or NSTEMI (without ST elevation) and may include fibrinolysis, angioplasty, stenting, or bypass surgery.
- Complications can include arrhythmias, heart failure, or ventricular aneurysms if not properly treated. Ongoing risk stratification and potential revascularization is important for post-
This document discusses acute coronary syndrome, including its clinical presentations, mechanisms, etiology, occurrence, clinical features, diagnosis, and treatment. It covers stable angina, unstable angina, non-ST elevation myocardial infarction (NSTEMI), and ST elevation myocardial infarction (STEMI). The main clinical presentations are chronic stable angina, acute coronary syndromes including STEMI and NSTEMI/unstable angina. The document provides details on the mechanisms, risk factors, presentations, diagnostic tests, and management for each type.
Myocardial Infarction Pathogenesis and TreatmentPUDI CHIRANJEEVI
Myocardial infarction, or heart attack, occurs when blood flow to the heart is blocked, damaging heart muscle. There are two main types - STEMI caused by a complete blockage, and NSTEMI from a partial blockage. Risk factors include age, smoking, high cholesterol, diabetes, and family history. Diagnosis involves history, cardiac biomarkers like troponin that indicate heart damage, ECG showing elevated ST segments, and imaging tests. Treatment focuses on restoring blood flow through medications, angioplasty, or bypass surgery, along with long term preventative medications like aspirin, statins, and beta blockers.
This document defines angina pectoris as recurring chest pain or discomfort caused by decreased blood flow to the heart. It describes the general symptoms of angina and the three main types: stable angina induced by physical activity and relieved by rest, unstable angina which occurs more frequently and can lead to heart attack, and Prinzmetal's angina which occurs at rest due to coronary artery spasm. The case presented is determined to be stable angina based on the chest tightness occurring during physical activity and disappearing with rest.
This document discusses angina pectoris, or chest pain caused by reduced blood flow to the heart. It defines three main types of angina - stable, unstable, and variant (Prinzmetal's angina). Stable angina occurs with exertion and is relieved by rest, while unstable angina happens more frequently and is less responsive to treatment. Variant angina involves coronary artery spasms, often occurring at certain times. The document outlines symptoms, risk factors, initiating factors, and common drug treatments for angina, including nitrates like nitroglycerin and calcium channel blockers.
This document provides information about angina pectoris (angina), including its causes, types, diagnosis, and treatment. It begins by defining angina as a heart condition marked by chest pain due to reduced oxygen to the heart. It then discusses the different types of angina (stable, unstable, variant), symptoms, diagnostic tests, and pharmacological treatments which work to improve the oxygen demand/supply ratio to the heart through vasodilation and other mechanisms. The main drug classes used to treat angina are discussed in detail: nitrates, calcium channel blockers, beta-blockers, and antiplatelets.
This document provides a summary of angina pectoris (chest pain). It begins with an example case history and treatment. It then defines angina and describes the main types (stable and unstable). It discusses the pathophysiology and clinical presentation. It outlines the diagnostic tests and procedures used to diagnose angina. The goals and approaches to treatment are summarized, including drug therapies like nitrates, beta blockers, and calcium channel blockers. Other measures for managing coronary artery disease are mentioned like lifestyle changes and procedures.
How to Become a Thought Leader in Your NicheLeslie Samuel
Are bloggers thought leaders? Here are some tips on how you can become one. Provide great value, put awesome content out there on a regular basis, and help others.
Implications of the transfer ami trial for clinical practiceTrimed Media Group
The document discusses implications of the TRANSFER AMI trial for clinical practice based on a presentation. It summarizes that PCI centers should perform PCI in a timely manner (<90 minutes) and that short distance transfer patients should receive PCI within 120 minutes. For patients with expected delays, a pharmacoinvasive PCI strategy is an excellent option. However, the ideal regimen and timing remain unclear based on limitations of previous trials. Overall, reperfusion strategies should aim to restore flow in a timely fashion, as delays are associated with worse outcomes.
1) A clinical trial assessed whether chelation therapy improved quality of life outcomes in patients with stable coronary artery disease and a history of heart attack.
2) The trial found no consistent or sustained improvements in domains of health-related quality of life, including physical and mental functioning, with chelation therapy over 2 years of follow up.
3) A subgroup analysis found a potential benefit of chelation therapy for patients with angina symptoms at baseline, but no benefit was seen for patients with heart failure symptoms.
- Primary PCI is the preferred reperfusion strategy for STEMI when it can be performed at an experienced center within 120 minutes of first medical contact. Fibrinolysis is an alternative if PCI cannot be performed within this time window.
- Clopidogrel in combination with aspirin results in significant improvements in outcomes for STEMI patients over aspirin alone based on the CLARITY-TIMI 28 and COMMIT trials.
- Enoxaparin is superior to unfractionated heparin as an anticoagulant to support reperfusion therapy for STEMI based on the ExTRACT-TIMI 25 trial.
Pfizer at Lehman Brothers Global Health Care Conferencefinance5
Martin Mackay, president of Pfizer's Global Research and Development division, outlines Pfizer's 5-point plan to aggressively deliver their phase 2 and 3 pipelines. The plan includes prioritizing their portfolio, becoming a top biotherapeutics company, dramatically raising productivity, and pursuing external science. Pfizer has a rich pipeline of 85 new molecular entities in development across 10 therapeutic areas. Their goal is to rebuild their phase 3 portfolio with 15-20 phase 3 starts per year between 2008-2009. Pfizer expects 15-20 regulatory submissions between 2010-2012. Several investigational drugs, including axitinib and CP-690550, show promising results.
Susan O'Brien, M.D., Professor, Dept. of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center: Newest Strategies in the Treatment of CML/CLL presented at New Frontiers in the Management of Solid and Liquid Tumors hosted by the John Theurer Cancer Center at Hackensack University Medical Center.
1. Hematopoietic stem cell transplantation (HSCT) can provide long-term remission for some CML patients, but it carries risks of mortality and morbidity.
2. HSCT is best considered after failure of tyrosine kinase inhibitor (TKI) therapy or for accelerated/blast phase disease.
3. Directly after diagnosis, HSCT may be too risky due to transplant-related risks outweighing potential benefits. In blast crisis phase, HSCT may be too late due to disease progression.
The document discusses different strategies for reperfusion in ST-elevation myocardial infarction (STEMI) patients, including primary percutaneous coronary intervention (PPCI), fibrinolysis, and PCI following fibrinolysis. It summarizes the TRANSFER-AMI trial which compared a "pharmacoinvasive" strategy of early PCI within 6 hours of fibrinolysis to standard treatment of PCI only for failed reperfusion in high-risk STEMI patients initially treated with fibrinolysis. The trial found the pharmacoinvasive strategy reduced the primary composite endpoint of death, reinfarction, or ischemia at 30 days with no increase in bleeding risks compared to standard treatment.
HBOT may help reduce cognitive decline after CABG surgery and protect cells against stress. HBOT stimulates vascular tube formation, protects cells against heat shock, and regulates gene expression related to oxidative stress response. It increases expression of genes involved in cell proliferation, migration, and wound healing while decreasing expression of genes related to ER and Golgi pathways. HBOT promotes rapid recovery from injury through multiple protective and regenerative mechanisms.
Estudio presentado por el Dr. Andre Lamy en el último ACC.2013, realizado en San Francisco, Estados Unidos, los días 9, 10 y 11 de Marzo. Más presentaciones de este evento en www.solaci.org/es/coberturas.php
This document discusses septic shock and its management. It covers:
- The pathophysiology of septic shock including absolute and relative hypovolemia, distributive shock, and impaired oxygen extraction.
- The history of managing septic shock from focusing on normalizing blood pressure in the 1960s to measuring oxygen delivery and consumption in later decades.
- Guidelines for initial resuscitation of septic shock patients, including targeting a MAP ≥65 mmHg, CVP of 8-12 mmHg, and ScvO2 ≥70%.
- Use of fluid challenges to guide fluid resuscitation and options for vasopressors like norepinephrine if needed to support blood pressure.
Rol actual del cardiodesfibrilador implantable subcutáneo en la prevención de...Sergio Pinski
This document summarizes the role of subcutaneous implantable cardioverter defibrillators (S-ICD) in preventing sudden cardiac death. It discusses:
- How S-ICDs detect and treat ventricular fibrillation and tachycardia without leads in the heart.
- Studies showing S-ICDs effectively detect and terminate arrhythmias while having a lower risk of complications than transvenous ICDs.
- S-ICDs should be considered for any patient with an ICD indication who does not require cardiac pacing. Ongoing randomized trials will further establish the role of S-ICDs.
PRESENTACION TROPONINA. Analytical consideration for high sensitivitty tropon...manuelgn4
This document discusses analytical considerations for high sensitivity troponin assays. It explains that troponin is superior to other cardiac biomarkers due to its high myocardial tissue content. Next-generation troponin assays can measure levels in healthy individuals and improve risk stratification for cardiac events. Serial testing of troponin levels and determining changes based on biological variation can help distinguish cardiac injury from chronic conditions. Point-of-care troponin tests have advantages of rapid results but currently lack the sensitivity of high-sensitivity laboratory assays. Overall, heightened troponin assay sensitivity requires correlating results closely with clinical presentation to properly interpret potential cardiac injury.
Primary PCI is superior to thrombolysis for STEMI treatment, with lower mortality and reinfarction rates. Stents provide better outcomes than balloon angioplasty alone. Door-to-balloon times under 120 minutes are optimal. For facilities without PCI capabilities, rapid transfer for primary PCI within 2 hours is recommended over thrombolysis if possible. Facilitated PCI, using drugs to establish early reperfusion before angioplasty, combines benefits of early reperfusion and easier intervention. Pre-procedural TIMI flow grade is a determinant of PCI success and outcomes.
This document discusses acute coronary syndrome and myocardial infarction (heart attack). Key points include:
- Chest pain is a common symptom of a myocardial infarction which occurs when blood flow to the heart is blocked.
- Diagnosis involves electrocardiograms, cardiac enzyme blood tests, and imaging like echocardiograms.
- Treatments depend on whether the infarction is STEMI (with ST elevation) or NSTEMI (without ST elevation) and may include fibrinolysis, angioplasty, stenting, or bypass surgery.
- Complications can include arrhythmias, heart failure, or ventricular aneurysms if not properly treated. Ongoing risk stratification and potential revascularization is important for post-
This document discusses acute coronary syndrome, including its clinical presentations, mechanisms, etiology, occurrence, clinical features, diagnosis, and treatment. It covers stable angina, unstable angina, non-ST elevation myocardial infarction (NSTEMI), and ST elevation myocardial infarction (STEMI). The main clinical presentations are chronic stable angina, acute coronary syndromes including STEMI and NSTEMI/unstable angina. The document provides details on the mechanisms, risk factors, presentations, diagnostic tests, and management for each type.
Myocardial Infarction Pathogenesis and TreatmentPUDI CHIRANJEEVI
Myocardial infarction, or heart attack, occurs when blood flow to the heart is blocked, damaging heart muscle. There are two main types - STEMI caused by a complete blockage, and NSTEMI from a partial blockage. Risk factors include age, smoking, high cholesterol, diabetes, and family history. Diagnosis involves history, cardiac biomarkers like troponin that indicate heart damage, ECG showing elevated ST segments, and imaging tests. Treatment focuses on restoring blood flow through medications, angioplasty, or bypass surgery, along with long term preventative medications like aspirin, statins, and beta blockers.
This document defines angina pectoris as recurring chest pain or discomfort caused by decreased blood flow to the heart. It describes the general symptoms of angina and the three main types: stable angina induced by physical activity and relieved by rest, unstable angina which occurs more frequently and can lead to heart attack, and Prinzmetal's angina which occurs at rest due to coronary artery spasm. The case presented is determined to be stable angina based on the chest tightness occurring during physical activity and disappearing with rest.
This document discusses angina pectoris, or chest pain caused by reduced blood flow to the heart. It defines three main types of angina - stable, unstable, and variant (Prinzmetal's angina). Stable angina occurs with exertion and is relieved by rest, while unstable angina happens more frequently and is less responsive to treatment. Variant angina involves coronary artery spasms, often occurring at certain times. The document outlines symptoms, risk factors, initiating factors, and common drug treatments for angina, including nitrates like nitroglycerin and calcium channel blockers.
This document provides information about angina pectoris (angina), including its causes, types, diagnosis, and treatment. It begins by defining angina as a heart condition marked by chest pain due to reduced oxygen to the heart. It then discusses the different types of angina (stable, unstable, variant), symptoms, diagnostic tests, and pharmacological treatments which work to improve the oxygen demand/supply ratio to the heart through vasodilation and other mechanisms. The main drug classes used to treat angina are discussed in detail: nitrates, calcium channel blockers, beta-blockers, and antiplatelets.
This document provides a summary of angina pectoris (chest pain). It begins with an example case history and treatment. It then defines angina and describes the main types (stable and unstable). It discusses the pathophysiology and clinical presentation. It outlines the diagnostic tests and procedures used to diagnose angina. The goals and approaches to treatment are summarized, including drug therapies like nitrates, beta blockers, and calcium channel blockers. Other measures for managing coronary artery disease are mentioned like lifestyle changes and procedures.
How to Become a Thought Leader in Your NicheLeslie Samuel
Are bloggers thought leaders? Here are some tips on how you can become one. Provide great value, put awesome content out there on a regular basis, and help others.
Implications of the transfer ami trial for clinical practiceTrimed Media Group
The document discusses implications of the TRANSFER AMI trial for clinical practice based on a presentation. It summarizes that PCI centers should perform PCI in a timely manner (<90 minutes) and that short distance transfer patients should receive PCI within 120 minutes. For patients with expected delays, a pharmacoinvasive PCI strategy is an excellent option. However, the ideal regimen and timing remain unclear based on limitations of previous trials. Overall, reperfusion strategies should aim to restore flow in a timely fashion, as delays are associated with worse outcomes.
1) A clinical trial assessed whether chelation therapy improved quality of life outcomes in patients with stable coronary artery disease and a history of heart attack.
2) The trial found no consistent or sustained improvements in domains of health-related quality of life, including physical and mental functioning, with chelation therapy over 2 years of follow up.
3) A subgroup analysis found a potential benefit of chelation therapy for patients with angina symptoms at baseline, but no benefit was seen for patients with heart failure symptoms.
- Primary PCI is the preferred reperfusion strategy for STEMI when it can be performed at an experienced center within 120 minutes of first medical contact. Fibrinolysis is an alternative if PCI cannot be performed within this time window.
- Clopidogrel in combination with aspirin results in significant improvements in outcomes for STEMI patients over aspirin alone based on the CLARITY-TIMI 28 and COMMIT trials.
- Enoxaparin is superior to unfractionated heparin as an anticoagulant to support reperfusion therapy for STEMI based on the ExTRACT-TIMI 25 trial.
Pfizer at Lehman Brothers Global Health Care Conferencefinance5
Martin Mackay, president of Pfizer's Global Research and Development division, outlines Pfizer's 5-point plan to aggressively deliver their phase 2 and 3 pipelines. The plan includes prioritizing their portfolio, becoming a top biotherapeutics company, dramatically raising productivity, and pursuing external science. Pfizer has a rich pipeline of 85 new molecular entities in development across 10 therapeutic areas. Their goal is to rebuild their phase 3 portfolio with 15-20 phase 3 starts per year between 2008-2009. Pfizer expects 15-20 regulatory submissions between 2010-2012. Several investigational drugs, including axitinib and CP-690550, show promising results.
Susan O'Brien, M.D., Professor, Dept. of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center: Newest Strategies in the Treatment of CML/CLL presented at New Frontiers in the Management of Solid and Liquid Tumors hosted by the John Theurer Cancer Center at Hackensack University Medical Center.
1. Hematopoietic stem cell transplantation (HSCT) can provide long-term remission for some CML patients, but it carries risks of mortality and morbidity.
2. HSCT is best considered after failure of tyrosine kinase inhibitor (TKI) therapy or for accelerated/blast phase disease.
3. Directly after diagnosis, HSCT may be too risky due to transplant-related risks outweighing potential benefits. In blast crisis phase, HSCT may be too late due to disease progression.
The document discusses different strategies for reperfusion in ST-elevation myocardial infarction (STEMI) patients, including primary percutaneous coronary intervention (PPCI), fibrinolysis, and PCI following fibrinolysis. It summarizes the TRANSFER-AMI trial which compared a "pharmacoinvasive" strategy of early PCI within 6 hours of fibrinolysis to standard treatment of PCI only for failed reperfusion in high-risk STEMI patients initially treated with fibrinolysis. The trial found the pharmacoinvasive strategy reduced the primary composite endpoint of death, reinfarction, or ischemia at 30 days with no increase in bleeding risks compared to standard treatment.
HBOT may help reduce cognitive decline after CABG surgery and protect cells against stress. HBOT stimulates vascular tube formation, protects cells against heat shock, and regulates gene expression related to oxidative stress response. It increases expression of genes involved in cell proliferation, migration, and wound healing while decreasing expression of genes related to ER and Golgi pathways. HBOT promotes rapid recovery from injury through multiple protective and regenerative mechanisms.
Estudio presentado por el Dr. Andre Lamy en el último ACC.2013, realizado en San Francisco, Estados Unidos, los días 9, 10 y 11 de Marzo. Más presentaciones de este evento en www.solaci.org/es/coberturas.php
This document discusses septic shock and its management. It covers:
- The pathophysiology of septic shock including absolute and relative hypovolemia, distributive shock, and impaired oxygen extraction.
- The history of managing septic shock from focusing on normalizing blood pressure in the 1960s to measuring oxygen delivery and consumption in later decades.
- Guidelines for initial resuscitation of septic shock patients, including targeting a MAP ≥65 mmHg, CVP of 8-12 mmHg, and ScvO2 ≥70%.
- Use of fluid challenges to guide fluid resuscitation and options for vasopressors like norepinephrine if needed to support blood pressure.
Rol actual del cardiodesfibrilador implantable subcutáneo en la prevención de...Sergio Pinski
This document summarizes the role of subcutaneous implantable cardioverter defibrillators (S-ICD) in preventing sudden cardiac death. It discusses:
- How S-ICDs detect and treat ventricular fibrillation and tachycardia without leads in the heart.
- Studies showing S-ICDs effectively detect and terminate arrhythmias while having a lower risk of complications than transvenous ICDs.
- S-ICDs should be considered for any patient with an ICD indication who does not require cardiac pacing. Ongoing randomized trials will further establish the role of S-ICDs.
PRESENTACION TROPONINA. Analytical consideration for high sensitivitty tropon...manuelgn4
This document discusses analytical considerations for high sensitivity troponin assays. It explains that troponin is superior to other cardiac biomarkers due to its high myocardial tissue content. Next-generation troponin assays can measure levels in healthy individuals and improve risk stratification for cardiac events. Serial testing of troponin levels and determining changes based on biological variation can help distinguish cardiac injury from chronic conditions. Point-of-care troponin tests have advantages of rapid results but currently lack the sensitivity of high-sensitivity laboratory assays. Overall, heightened troponin assay sensitivity requires correlating results closely with clinical presentation to properly interpret potential cardiac injury.
Primary PCI is superior to thrombolysis for STEMI treatment, with lower mortality and reinfarction rates. Stents provide better outcomes than balloon angioplasty alone. Door-to-balloon times under 120 minutes are optimal. For facilities without PCI capabilities, rapid transfer for primary PCI within 2 hours is recommended over thrombolysis if possible. Facilitated PCI, using drugs to establish early reperfusion before angioplasty, combines benefits of early reperfusion and easier intervention. Pre-procedural TIMI flow grade is a determinant of PCI success and outcomes.
The RIVAL trial compared outcomes of radial versus femoral access in over 7,000 patients undergoing angiography or percutaneous coronary intervention. It found that radial access was associated with a lower risk of major vascular complications compared to femoral access, but found no differences in rates of death, myocardial infarction, stroke, or major bleeding. Radial access provided benefits regardless of operator or center volume. The study demonstrated that with experience, radial access can be performed as safely as femoral access in a variety of clinical settings.
Arterial Lactate Concentration is a major pronostic factor after elective sur...Eric Vibert, MD, PhD
This multicenter study evaluated end-of-surgery serum lactate concentration as a predictor of postoperative outcomes in patients undergoing liver resection. Using data from 519 patients, the study identified lactate concentration cut-offs that predicted high clinical risk scores, 90-day mortality, and severe morbidity. Models including lactate concentration showed improved accuracy over those without. Validation in 466 additional patients confirmed lactate concentration as an important predictor, especially for clinical risk and mortality. Pre- and intraoperative factors like diabetes, major hepatectomy, and transfusion predicted elevated lactate concentrations. The study concluded lactate is a reliable early indicator of postoperative outcomes after liver resection.
The document discusses strategies for early treatment of acute myocardial infarction. It provides evidence that pre-hospital thrombolytic therapy can significantly reduce mortality rates compared to in-hospital thrombolytic therapy by reducing treatment delays. Studies show administering thrombolysis within 30-60 minutes of symptoms onset can save 11-60 lives per 1000 patients. Combined strategies using both pre-hospital thrombolysis and immediate angioplasty have demonstrated high rates of coronary reperfusion and good long-term outcomes.
1) The document discusses a masterclass on non-small cell lung cancer (NSCLC) surgery.
2) It presents a case study of a 59-year-old female with an incidental chest X-ray finding and questions regarding her diagnosis, staging, and treatment options.
3) The document reviews NSCLC staging statistics, survival rates based on stage, and concepts in personalized and integrated therapy for NSCLC.
Volker Diehl, M.D., Professor, University of Cologne, Germany Customization: The Treatment of Hodgkin's Disease
Presented at New Frontiers in the Management of Solid and Liquid Tumors hosted by the John Theurer Cancer Center at Hackensack University Medical Center. jtcancercenter.org/CME
This document discusses several issues and controversies in primary percutaneous coronary intervention (PCI). It lists 9 topics that can make a difference between primary PCI and conventional PCI, including: primary PCI vs thrombolytic therapy; antiplatelet regimens; access site; anticoagulation; GP IIb-IIIa blockers; thrombosuction; methods to improve microvascular perfusion; tackling multivessel coronary artery disease; and drug-eluting stents vs bare-metal stents. The document then provides more details on some of these topics, such as antiplatelet regimens, access site, and the STEMI-RADIAL trial which compared radial vs femoral access for primary PCI.
This document summarizes guidelines for treatment of diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) from the American Diabetes Association (ADA) and Joint British Diabetes Societies Inpatient (JBDS IP). Key points include:
1) Bedside beta-hydroxybutyrate testing is now the best way to monitor treatment response in DKA.
2) For DKA, guidelines recommend fixed rate insulin infusion of 0.1 unit/kg/hr without a priming dose and adjustments to meet metabolic targets.
3) For HHS, the goal of initial therapy is to expand intravascular volume and restore perfusion by replacing approximately 50
This document discusses simulation in medical education. It defines simulation as presenting problems authentically to allow trainees to respond as they would in real situations while receiving feedback. Simulation provides controlled, safe practice opportunities and helps develop clinical skills. Factors driving increased simulation use include problems with clinical teaching, new medical technologies, assessing competence, improving patient safety, and enabling deliberate practice. Effective simulation provides feedback, repetitive practice of varying difficulty, integration into the curriculum, and clearly defined learning outcomes.
This document discusses the use of point-of-care ultrasound in emergency and critical care settings. It provides an overview of using ultrasound to diagnose pneumothorax, pulmonary edema, and other conditions. Examples are given of ultrasound findings for a pneumothorax including the lack of lung sliding and presence of a lung point. Signs of pulmonary edema on ultrasound include A-lines and B-lines. The document emphasizes that ultrasound is a rapid, noninvasive tool that can help clinicians diagnose and treat patients, but should be used along with medical history, exams, and clinical judgment.
ACTEP2014: Therapeutic hypothermia for ACTEP 2014taem
This document discusses therapeutic hypothermia after cardiac arrest and suggests starting it in the emergency department. It defines therapeutic hypothermia and reviews studies showing improved neurological outcomes when mild hypothermia is induced after cardiac arrest. The benefits of therapeutic hypothermia are explained. Methods for inducing hypothermia in the emergency department are presented, including cold intravenous fluids and surface cooling techniques. The document recommends inducing therapeutic hypothermia for comatose cardiac arrest patients with initial rhythms of ventricular fibrillation or pulseless ventricular tachycardia.
This document discusses sepsis markers and their clinical use. It summarizes several biomarkers that show potential for diagnosing and monitoring sepsis, including procalcitonin (PCT), C-reactive protein (CRP), and soluble CD14 subtype (sCD14-ST). sCD14-ST shows diagnostic value in distinguishing infection from SIRS and sepsis from severe sepsis. Studies found sCD14-ST levels correlated with severity of illness and organ dysfunction in sepsis patients. The document reviews several clinical trials and studies that evaluated these biomarkers for diagnosing and predicting outcomes in sepsis, abdominal infections, febrile neutropenia, and burns.
ACTEP2014: Sepsis management has anything change taem
This document discusses sepsis management and what has changed. It begins with an introduction to the pathophysiology of sepsis, severe sepsis, and septic shock. It then discusses early goal directed therapy (EGDT) and landmark studies like Rivers 2001 that promoted protocolized resuscitation to targets like central venous pressure, mean arterial pressure, ScvO2, and transfusion thresholds. However, later large trials like ProCESS 2014 found no difference in mortality between EGDT, standard therapy, and usual care. Targets like CVP are not accurate predictors of fluid responsiveness. Studies also found no difference in outcomes between higher and lower blood pressure or hemoglobin transfusion thresholds. There remains uncertainty around optimal fluid type, vas
ACTEP2014: How to maximise resuscitation in trauma 2014taem
This document discusses various strategies for optimizing resuscitation of trauma patients, including permissive hypotension, bedside monitoring, and hemostatic resuscitation. It provides details on the Bickell study which found delayed fluid resuscitation improved outcomes for patients with penetrating torso injuries. Bedside monitoring techniques like focused assessment with sonography for trauma (FAST) and limited trauma ultrasound exam (LTTE) can help guide fluid management. Hemostatic resuscitation involving balanced use of blood products aims to address coagulopathy often seen in severe trauma. Target blood pressures of 60 mmHg may optimize outcomes with hypotensive resuscitation.
1) A medic responds to an IED explosion where his convoy was attacked. The person next to him has bilateral mid-thigh amputations with heavy bleeding from one leg. 2) The medic's top priority is to return fire and take cover since they are still under attack. 3) Once there is suppressive fire from the rest of the convoy, the medic applies a tourniquet to the leg with arterial bleeding to control the life-threatening hemorrhage.
This document discusses the use of hemodynamic ultrasound in critical care. It describes how ultrasound can be used to diagnose various types of shock such as hypovolemic, distributive, cardiogenic, and obstructive shock. Specific conditions that can be identified include tamponade, pulmonary embolism, and reduced left or right ventricular function. The document provides guidance on assessing volume responsiveness and fluid management in critically ill patients.
The document discusses the roles and responsibilities of an emergency department director. It covers topics such as developing leadership and communication skills, implementing effective peer review and physician profiling, dealing with problem physicians, improving customer relations and patient satisfaction, managing physician and hospital contracts, recruiting and orienting new physicians, measuring productivity and compensation, managing staffing and scheduling, conducting meetings, and managing risk. The emergency department director must balance both leadership and management functions to effectively run the emergency department.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Hiranandani Hospital in Powai, Mumbai, is a premier healthcare institution that has been serving the community with exceptional medical care since its establishment. As a part of the renowned Hiranandani Group, the hospital is committed to delivering world-class healthcare services across a wide range of specialties, including kidney transplantation. With its state-of-the-art facilities, advanced medical technology, and a team of highly skilled healthcare professionals, Hiranandani Hospital has earned a reputation as a trusted name in the healthcare industry. The hospital's patient-centric approach, coupled with its focus on innovation and excellence, ensures that patients receive the highest standard of care in a compassionate and supportive environment.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
10. Mortality Reduction(%)
10
Potential outcomes
E
8 A-B : No benefit
A-C : Benefit
6 D C
B-C : Benefit
E-D : Harm
4
2 B A
0 Hr
1 3 6 12 24
Time to Rx is Critical Opening the artery is 1o Goal ( PCI>lysis)
Gersh BJ et al. JAMA 2005;293:979-986
11. Infarct size Myocardial Edema
Myocardial Salvage Microvascular
obstruction
Francone M, et al.JACC2009;23:2145
18. I IIa IIb III
with PCI capability should be Rx with p-
A PCI within 90 min of FMC .
Modified
without PCI capability who cannot be
B transferred and PCI within 90 min of FMC
Modified should be Rx with Lytic Rx within 30 min,
unless Lytic Rx is contraindicated.
FMC: First Medical Contact
19. STEMI within 12 h after onset of symptoms
At centre without PCI facilities with
>1 high risk features:
1. Cumulative ST-segment elevation of > 15 mm
2. New onset LBBB
3. Previous MI
4. Killip class of 2 or more or
5. LV ejection fraction of 35% or less.
Carlo Di Mario, Lancet 371 February 16, 2008
21. Pts with STEMI within 12 hrs after onset of symptoms
At centers : No PCI capability
Rx with Tenecteplase (TNK)
ST-segment elevation of ≥ 2 mm in two anterior leads or
ST-segment elevation of ≥ 1 mm in two inferior leads and
One high-risk characteristics:
1. Systolic BP < 100 mm Hg,
2. HR > 100 bpm,
3. Killip class II or III,
4. ST- depression of ≥ 2 mm in the anterior leads, or
5. ST- elevation of ≥ 1 mm in V4R indicative of RV
involvement.
Cantor WJ et al. N Engl J Med 2009;360:2705-2718
22. TRANSFER AMI
High Risk STEMI 12 hrs, 1059 Pts
TNK + ASA + Clopidogrel +
Community Heparin or Enoxaparin
Hospital
Randomization
Emergency
Department
Pharmacoinvasive : Standard Strategy:
Urgent PCI Centre Assess chest pain, ST resolution
at 60-90 min after randomization
PCI Centre Failed Reperfusion* Successful Reperfusion
Cath / PCI within 6 hrs Cath and Rescue Elective Cath
regardless of reperfusion PCI GP IIb/IIIa PCI
status Inhibitor > 24 hrs later
* ST segment resolution < 50% & persistent chest pain, or hemodynamic instability
Cantor WJ et al. N Engl J Med 2009;360:2705-2718
23. Kaplan-Meier Curves
Primary Endpoint* at 30 Days Re-infarction at 6 Months
Std Rx
Std Rx
Early PCI
Early PCI
*Primary endpoint was death, reinfarction, recurrent ischemia,
new or worsening heart failure, or cardiogenic shock at 30 days
Cantor WJ et al. N Engl J Med 2009;360:2705-2718
27. ER physician activate the Cath Lab
One call activate the cath lab
Cath lab team ready in 20-30 min
Prompt data feed back
Senior management commitment
Team-based approach
28. PCI-Center
ผู้ป่วยเจ็บหน้ำอก
รอบัตร รอแพทย์ตรวจ
ทำ EKG ใน 10 นำที
แพทย์เวร ER
แพทย์เวร Med
Fellow cardio
ปรึกษำ staff cardio ผ่ำน single
call operator, rtafheart@gmail.com
ตำมเจ้ำหน้ำที่ Cath Lab
Time to Lab
ส่งทำ PCI
29. Fast Track MI
EKG ด่วนแพทย์ดูใน 10 นำที
elevation ตำม staff cardio ทันที
ST
ST elevation ………………. MD.
No
39. Universal Definition of MI
Spontaneous AMI
Secondary AMI
Sudden cardiac death
Post PCI : 3x 99%URL
Post CABG : 5x 99%URL
URL: upper reference limit Thygesen et al,Circulation November 27, 2007
46. Prevalence increased RFs:
▪ Older age,
▪ Predominance of females
▪ high rate of DM
▪ Smoking and obesity
Use of preventive medications
Increasing sensitive Troponin Assay
Robert P, et al. Circulation 2009; 54: 1544
50. Everyone should be on anti-plt and anti-coag
Choose Rx Consevative vs Invasive
Choose antithrombotic regimen
The strategy selected
Bleeding risk of patients
Strategy selected Pt risk stratification
Bleeding vs Ischemic risk Equally
important
61. Assess/document bleeding risk in every pt.
Avoid crossover : UFH and LMWH
Proper dose Wt. and renal function
Use radial access in pts at high risk of
bleeding
Stop anticoag after PCI/ indication?
Selective “downstream” use of GPI