Coronary heart disease is a major cause of mortality worldwide. Percutaneous coronary intervention (PCI), also known as coronary angioplasty, is a non-surgical procedure used to treat blockages within the coronary arteries of the heart. During PCI, a catheter is inserted into an artery and guided to the site of blockage where a balloon is inflated to open the artery. Often a stent is placed to keep the artery open. PCI has become a common revascularization treatment for acute coronary syndromes and stable angina. While generally safe, complications from PCI occur in less than 2% of patients and include adverse reactions, acute myocardial infarction, bleeding, and death in less than 0.08% of patients.
What are anti-coagulants?
What are the difference between antiplatelet, anticoagulants and thrombolytics?
Coagulation cascade
Virchows Triad
Classification of anti-coagulants?
Indications of anti-coagulants?
Mechanism and site of action of different anti-coagulants?
The intent of this presentation is to provide an update of coronary assessment and management for the adult intensivist. Discussion points will include:
1. An assessment of coronary severity, using established methods, in particular fractional flow reserve (FFR),
2. Which stent- highlight the evolution of the stent to the current generation and what is evolving,
3. How to keep the stent open with current concepts of antiplatelet therapy and how this impacts the critically ill patient
4. What to consider if the ECG is abnormal, but the coronaries are not flow limiting obstruction- an occasional dilemma in the critically ill patient and finally
5. Discussion around a contemporary study regarding cardiogenic shock and coronary ischemia.
What are anti-coagulants?
What are the difference between antiplatelet, anticoagulants and thrombolytics?
Coagulation cascade
Virchows Triad
Classification of anti-coagulants?
Indications of anti-coagulants?
Mechanism and site of action of different anti-coagulants?
The intent of this presentation is to provide an update of coronary assessment and management for the adult intensivist. Discussion points will include:
1. An assessment of coronary severity, using established methods, in particular fractional flow reserve (FFR),
2. Which stent- highlight the evolution of the stent to the current generation and what is evolving,
3. How to keep the stent open with current concepts of antiplatelet therapy and how this impacts the critically ill patient
4. What to consider if the ECG is abnormal, but the coronaries are not flow limiting obstruction- an occasional dilemma in the critically ill patient and finally
5. Discussion around a contemporary study regarding cardiogenic shock and coronary ischemia.
IMAGES OF A COMPLEX CASE OF MULTIPLE ANEURYSMAL DISEASE IN A 58 YEAR OLD MAN
IMMAGINI DI UN CASO COMPLESSO DI MALATTIA POLINEURISMATICA
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
Problem associated with drug eluting stentPRAVEEN GUPTA
This ppt will tell us about the problem which a cardiologist has to face after implantation of Drug eluting stent in a patient of coronary artery diseases. Although there are lots of problem but i am going to describe only three major problem.
Peripheral Angioplasty / Endovascular Management of PVD - PrinciplesSaurabh Joshi
This presentation covers the principles of peripheral angioplasty with and explanation of the TASC stratification and selection of appropriate management according to current guidelines. Endovascular management of peripheral vascular disease.
Principles of angioplasty -Endovascular Management of Peripheral Vascular Dis...Saurabh Joshi
This presentation covers the principles of peripheral angioplasty with and explanation of the TASC stratification and selection of appropriate management according to current guidelines. Endovascular management of peripheral vascular disease.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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
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.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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.
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
2. EPIDEMIOLOGY CORONARY HEART DISEASE (CHD)
Major causes of morbidity and mortality all over the world
In 2016, American Heart Association (AHA) reported that 15.5 million persons > 20 years of age in USA
have CHD, & prevalence increases with age
Every 42 seconds, an American suffers from MI1
CHD mortality declined over the last decades in western countries, it is expected to continue increasing
in developing countries2
Age-standardized CVD death rate is 272/ 100 000 population in India, which is higher than global
average of 235 per 100 000 population.2
Current estimates from epidemiologic studies show prevalence of CHD 7-13% in urban and 2-7% in
rural area.3
1. https://www.ncbi.nlm.nih.gov/pubmed/22929818
2. https://www.ncbi.nlm.nih.gov/pubmed/?term=cardiovascular+disease+in+India.+Current+Epidemiology+and+Future+directions
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860846
4. PERCUTANEOUS CORONARY INTERVENTIONS
Percutaneous coronary interventions (PCI) include
percutaneous transluminal coronary angioplasty
(PTCA) with or without stent insertion
First performed in human by Andreas Gruentzig in
1971
Most commonly performed interventional procedure
PTCA and stent placement within 90 min of onset of
pain is the optimal treatment of transmural ST-
segment–elevation myocardial infarction (STEMI).
Elective PCI may be appropriate for post-MI patients
who have recurrent or inducible angina before
hospital discharge and for patients who have angina
and remain symptomatic despite medical treatment.
Michael J. Shea. Percutaneous Coronary Interventions. MSDManual. Feb, 2016
5. INDICATIONS
Acute ST-elevation
myocardial infarction
(STEMI)
Non–ST-elevation
acute coronary
syndrome (NSTE-
ACS)
Unstable angina
Stable angina
Anginal equivalent (eg,
dyspnea, arrhythmia,
or dizziness or
syncope)
High risk stress test
findings
CONTRAINDICATION
S
• Coagulopathy
• Decompensated
congestive heart
failure
• Uncontrolled
Hypertension
• Pregnancy
• Inability for patient
cooperation
• Active infection
• Renal Failure
• Contrast mediumGeorge A Stouffer, at al. Percutaneous Coronary Intervention (PCI). Drug and disease,
6. TYPES OF PCI IN ACS WITH
STEMI
Primary PCI: Procedure is
performed within 12 hours
after the onset of symptoms.
Rescue PCI: Rescue PCI is
recommended if thrombolysis
failed within 45-60 min after
starting the administration
Post thrombolysis PCI:
Thrombolysis-facilitated
primary PCI
Ischaemia guided PCI:
Ischaemia-driven PCI after
thrombolysis
Ali Ghanie. Indication for Percutaneous Coronary Angioplasty. Acta Med Indones-Indones J Intern
Med. 2009; 41: 159-65
7. EQUIPMENTS
Balloon catheters for PCI have the following features:
A steerable guide wire precedes balloon into artery & permits navigation
through coronary tree
Inflation of balloon compresses & axially redistributes atheromatous plaque & stretches
vessel wall
Balloon catheter also serves as adjunctive device for many other interventional therapies
Intracoronary stents have the following features:
Stents differ with respect to composition, design, delivery system & drug delivered
Drug-eluting stents (DESs) have demonstrated significant reductions in re-stenosis &
target-lesion revascularization rates, with further reduction with second-generation DESs
In the United States, commercially available DESs are second-generation models that
elute everolimus & zotarolimus
Both stents with bio-absorbable polymer & fully bioresorbable scaffolds
Stents are conventionally placed after balloon predilation, but in selected
coronary lesions, direct stenting may lead to better outcomes
George A Stouffer, at al. Percutaneous Coronary Intervention (PCI). Drug and disease, Oct. 16.
8. PROCEDURE
PCI is done via percutaneous femoral,
radial, or brachial artery puncture.
Radial approach is technically
demanding compared to the femoral
approach but may reduce patient
discomfort, improve time to ambulation,
and reduce the incidence of some
complications (eg, bleeding,
pseudoaneurysm formation).
A guiding catheter is inserted into a
large peripheral artery and threaded to
appropriate coronary ostium.
A balloon-tipped catheter, guided by
fluoroscopy or intravascular
ultrasonography, is aligned within the
stenosis, then inflated to disrupt the
atherosclerotic plaque and dilate the
artery.
Angiography is repeated after the
procedure to document any changes.
The procedure is commonly done in 2 or
3 vessels as needed.
Michael J. Shea. Percutaneous Coronary Interventions. MSDManual. Feb,
2016
9. ANTICOAGULATION & ANCILLARY THERAPY
Antithrombotic therapy:
Aspirin (162-325 mg) F/B Unfractionated heparin (UFH), low-molecular-weight
heparin (LMWH), or bivalirudin used at the time of balloon angioplasty or PCI.
Antiplatelet therapy
Thienopyridines (clopidogrel, prasugrel, ticagrelor) and glycoprotein IIb/IIIa
inhibitors (abciximab, eptifibatide, tirofiban) are the standard of care for patients
with unstable non-ST-segment elevation myocardial infarction for at least 9 to 12
months after PCI.
Glycoprotein inhibitor therapy
Abciximab, tirofiban, and eptifibatide reduce ischemic complications in patients
undergoing balloon angioplasty and coronary stenting.
Calcium channel blockers and nitrates may also reduce risk of coronary spasm.
Michael J. Shea. Percutaneous Coronary Interventions. MSDManual. Feb, 2016
10. STENT TYPES
• Latest type of coronary stent
• Contains a drug with active healing technology(helps in
healing process of artery)
• Has coating both sides
DUAL THERAPY STENT
• Drug eluting stent with a dissolvable type of scaffold –
absorbed overtime
• Coated with drug released from polymer
• Reduces the chances of restenosis
BIORESORBABLE
VASCULAR SCAFFOLD
• Antibody coated stent
• Does not contain a polymer or drug
• Speeds up the epithelialization of the artery—promoted
natural healing
BIO-ENGINEERED
STENT
DRUG ELUTING STENT
BARE METAL STENT
https://www.orbusneich.com/en/patient/types-coronary-stents-0
• Stainless steel, without special coating
• As artery heals, tissue grows around stent holding it in place
• Overgrowth of scar tissue-↑ risk of re-blockage
• Coated with medications that help to prevent the growth of
scar tissue in the artery lining
• ↑ chances of blood clots– stent thrombosis
11. COMPICATIONS
MAJOR
• Allergic & Adverse reaction (30%)
• Acute MI requiring emergency
CABG (5-30%)
• Distal embolization (<2%)
• Nephropathy (3.3-16.5%)
• Hematoma and Retroperitoneal
Hemorrhage (2.8%)
• Pseudoaneurysm (0.5-2.0%)
• Arterio-venous Fistula (1%)
• Ventricular arrhythmia (1.3-3.5%)
MINOR
• Cerebrovascular Complications
(0.07-0.23%)
• Abrupt closure and dissections
(0.42% )
• Radiation injury
• Hypotension
• Hypoglycemia
• Death (0.08-1%)
• Infection (<1%)
Morteza Tavakol, et al. Risks and Complications of Coronary Angiography: A Comprehensive Review. Glob J Health Sci. 2012 Jan; 4(1): 65–93
Major complications from PIC occur in <2% of the population,
with mortality of <0.08%