This document summarizes a randomized trial comparing radial versus femoral approaches for primary PCI in STEMI patients. The trial aims to enroll 700 STEMI patients across 4 centers. The primary endpoints are major bleeding and access site complications within 30 days. Secondary endpoints include mortality, reinfarction, procedural success, and length of stay. The trial is investigator-initiated and supported by grants, with the goal of showing radial access reduces bleeding complications compared to femoral.
A Registry-Based Randomized Trial Comparing Radial and Femoral Approaches In Women Undergoing Percutaneous Coronary Intervention: The Study of Access Enhancement of PCI for Women (SAFE-PCI for Women) Trial
Impact of access site on bleeding and ischemic events in patients with non-ST-segment elevation myocardial infarction treated with prasugrel at the time of percutaneous coronary intervention or as pretreatment at the time of diagnosis: the ACCOAST access substudy
Acute kidney injury - A european perspective. Comparison of risk of acute kidney injury following primary PCI with the transradial approach vs the transfemoral approach: The PRIPITENA Urban Registry.
A Registry-Based Randomized Trial Comparing Radial and Femoral Approaches In Women Undergoing Percutaneous Coronary Intervention: The Study of Access Enhancement of PCI for Women (SAFE-PCI for Women) Trial
Impact of access site on bleeding and ischemic events in patients with non-ST-segment elevation myocardial infarction treated with prasugrel at the time of percutaneous coronary intervention or as pretreatment at the time of diagnosis: the ACCOAST access substudy
Acute kidney injury - A european perspective. Comparison of risk of acute kidney injury following primary PCI with the transradial approach vs the transfemoral approach: The PRIPITENA Urban Registry.
Conferencia magistral "20 años de Angioplastia Primaria para el tratamiento del Infarto. Experiencia y evolución de las redes de infarto" del Dr. Petr Widimsky durante la XXV Reunión Anual de la Sección de Hemodinámica y Cardiología Intervencionista (SHCI) de 2014 en Córdoba.
Reperfusion strategy in patients with ST-Segment Elevation Myocardial Infarct...Premier Publishers
Reperfusion therapy is the cornerstone in management of STEMI. This study was designed to evaluate both In-hospital and 30 days outcome in patients with STEMI treated with primary percutaneous coronary intervention (PPCI) versus fibrinolysis. This prospective, controlled, study included 140 patients with STEMI who were eligible for reperfusion therapy. In hospital and 30 days major adverse cardiovascular events (MACE) were reported and head to head comparison was done between PPCI versus fibrinolysis. All-cause mortality was reported in 5% of patients (10% versus 0% in fibrinolysis and PPCI respectively, p=0.07), recurrence of ischemic symptoms was reported in 18% of patients (30% versus 7% in fibrinolysis and PPCI respectively, P =0.02), heart failure was evident in 22% of patients (33% versus 10% in fibrinolysis and PPCI respectively, P =0.02). PPCI is safe and effective treatment option for patients with STEMI
Lower Mortality with Transradial PCI Compared to Transfemoral PCI in 21 000 Patients with Acute Myocardial Infarction - Results from the SCAAR Database
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.
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
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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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!
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Bernat I 201111
1. A Randomized Trial of Radial vs.
Femoral Approaches for Primary PCI
Ivo Bernat, MD
Assistant-Professor of Medicine
University Hospital Pilsen, Czech Republic
2. Disclosure Statement of Financial Interest
I, Ivo Bernat DO NOT have a financial interest/arrangement or
affiliation with one or more organizations that could be
perceived as a real or apparent conflict of interest in the
context of the subject of this presentation.
3. Background
• STEMI patients are frequently aggressively anticoagulated
with high rates of femoral access site bleeding after pPCI
• Radial approach significantly lowers access site bleeding
in comparison to femoral
• Radial approach evidence in STEMI patients (before RIVAL)
only from single centers randomized trials comparing FA
and RA in STEMI and one meta-analysis
• In STEMI population from RIVAL, there was a significant
reduction in access-site complications and mortality with
neutral effect on non-CABG major bleeding (OASIS criteria).
6. Multicenter randomized trial RA vs FA in STEMI
Hypothesis:
• Radial approach will reduce the incidence of major bleeding
and entry site complications (primary endpoint) and will be
clinically not inferior to femoral approach in acute STEMI and
primary PCI (secondary endpoints)
7. HORIZONS-AMI: 30 Day Major Bleeding (non-CABG)
Heparin + GPIIb/IIIa inhibitor (n=1802)
Bivalirudin monotherapy (n=1800)
Major Bleeding (%)
Primary Endpoint
8.4%
5.0%
HR [95%CI] =
0.59 [0.45, 0.76]
P<0.0001
Time in Days
Stone G.et al, NEJM 2008;358:2218-30
8. HORIZONS-AMI bleeding definition
Major bleeding (non-CABG) :
• Intracranial bleeding
• Intraocular bleeding
• Retroperitoneal bleeding
• Access site bleed requiring intervention/surgery
• Hematoma ≥5 cm
• Hgb ≥3g/dL with an overt source
• Hgb ≥4g/dL w/o overt source
• Reoperation for bleeding
• Blood product transfusion
Stone G.et al, NEJM 2008;358:2218-30
10. STEMI - RADIAL
- ST Elevation Myocardial Infarction treated by RADIAL or femoral approach
Multicenter Randomized Trial Comparing
Radial and Femoral Approaches in Primary PCI
Investigator-Initiated-trial conducted by
Academic Cardiologists in Czech Republic :
Study is supported by grant from the Ministry of Education
of the Czech Republic (Charles University in Prague Study start date - October 2009
Research Project No. MSM 0021620817), by grant form the
Ministry of Health of the Czech Republic (FN Hradec Kralove
Research Project No. MSM 00179906), and by Regional
Hospital Liberec Research projects foundation
11. STEMI – RADIAL
Inclusion criteria: Exclusion criteria :
• age over 18 years • Killip IV class or unconsciousness
• admission for STEMI <12 hours after • patient disagreement
onset of symptoms • prior aortobifemoral bypass
• ability to sign written informed • absence of either radial or femoral artery
consent pulsation
• participation in another clinical trial
randomizing ACS patients using
antithrombotic drug.
• negative Allen's test or Barbeau test type D
• treatment with oral anticoagulants
12. Study design:
700 STEMI patients in 4 PCI centers 24/7
electronic randomization
in cathlab after written 1:1 randomization femoral or radial approach
inform consent
immediate CAG + pPCI
radial approach femoral approach
Intention to treat
48 hours
+
30 days
13.
14. Primary and secondary endpoints - at 30 days
• Primary - Major Bleeding (HORIZONS-AMI criteria)
- Access Site Complications (pseudo-aneurysm, A/V Fistula, Severe Hematoma,
Access-site complication requiring surgical or Percutaneous Intervention)
• Secondary: - MACE (Death, Re-MI, Stroke)
- Access site failure
- Procedural success
- Contrast media consumption
- Procedural and fluoroscopic times
- Duration of hospital/ICU stay
- TVR/TLR
- New hospitalization
16. Sample size
• Superiority of radial approach compared to femoral in
terms of major bleeding and access site complication
• The trial has 80% power to detect 70% relative
reduction in major bleeding and access site
complications with radial approach compared to
femoral approach with an alpha level of 0.05
assuming a reference rate of 6.5%.
17. Electronic CRF for: randomization - acute procedure - 48 h - 30 d control
(www.fnplzen.cz/radial)
19. Aknowledgements
• STEMI-RADIAL investigators - 4 centers:
Pesek J, Koza J, Smid M (Pilsen)
Dusek J, Brtko M, Polansky P, Bis J (Hradec Kralove)
Hrabos V, Sembera Z (Liberec)
Aschermann O, Kmonicek P (Prague)
• Steering committee :
Bernat I (PI), Horak D, Stasek J, Mates M, Rokyta R, Ostadal P,
Bertrand O.
20. Summary
STEMI-RADIAL Randomized Trial has the potential to show that
radial approach in comparison to femoral approach can
significantly reduce major bleeding and access site
complications in patients with STEMI treated by primary PCI.